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Roy AJ, Leipprandt JR, Patterson JR, Stoll AC, Kemp CJ, Oula ZTD, Mola T, Batista AR, Sortwell CE, Sena-Esteves M, Neubig RR. AAV9-Mediated Intrastriatal Delivery of GNAO1 Reduces Hyperlocomotion in Gnao1 Heterozygous R209H Mutant Mice. J Pharmacol Exp Ther 2024; 390:250-259. [PMID: 38866563 DOI: 10.1124/jpet.124.002117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 04/15/2024] [Accepted: 05/15/2024] [Indexed: 06/14/2024] Open
Abstract
Mutations in the GNAO1 gene, which encodes the abundant brain G-protein Gα o, result in neurologic disorders characterized by developmental delay, epilepsy, and movement abnormalities. There are over 50 mutant alleles associated with GNAO1 disorders; the R209H mutation results in dystonia, choreoathetosis, and developmental delay without seizures. Mice heterozygous for the human mutant allele (Gnao1 +/R209H) exhibit hyperactivity in open field tests but no seizures. We developed self-complementary adeno-associated virus serotype 9 (scAAV9) vectors expressing two splice variants of human GNAO1 Gα o isoforms 1 (GoA, GNAO1.1) and 2 (GoB, GNAO1.2). Bilateral intrastriatal injections of either scAAV9-GNAO1.1 or scAAV9-GNAO1.2 significantly reversed mutation-associated hyperactivity in open field tests. GNAO1 overexpression did not increase seizure susceptibility, a potential side effect of GNAO1 vector treatment. This represents the first report of successful preclinical gene therapy for GNAO1 encephalopathy applied in vivo. Further studies are needed to uncover the molecular mechanism that results in behavior improvements after scAAV9-mediated Gα o expression and to refine the vector design. SIGNIFICANCE STATEMENT: GNAO1 mutations cause a spectrum of developmental, epilepsy, and movement disorders. Here we show that intrastriatal delivery of scAAV9-GNAO1 to express the wild-type Gα o protein reduces the hyperactivity of the Gnao1 +/R209H mouse model, which carries one of the most common movement disorder-associated mutations. This is the first report of a gene therapy for GNAO1 encephalopathy applied in vivo on a patient-allele model.
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Affiliation(s)
- Alex J Roy
- Department of Pharmacology and Toxicology (A.J.R., J.R.L., R.R.N.), Department of Microbiology and Molecular Genetics (A.J.R.), and Nicholas V. Perricone, M.D., Division of Dermatology, Department of Medicine (R.R.N.), Michigan State University, East Lansing, Michigan; Department of Translational Neuroscience (J.R.P., A.C.S., C.J.K., C.E.S.), Michigan State University, Grand Rapids, Michigan; Hauenstein Neuroscience Center, Mercy Health Saint Mary's, Grand Rapids, Michigan (C.E.S.); and Horae Gene Therapy Center and The Li Weibo Institute for Rare Diseases Research (Z.-T.D.O., T.M., A.R.B., M.S.-E.) and Department of Neurology (Z.-T.D.O., T.M., A.R.B., M.S.-E.), UMass Chan Medical School, Worcester, Massachusetts
| | - Jeffrey R Leipprandt
- Department of Pharmacology and Toxicology (A.J.R., J.R.L., R.R.N.), Department of Microbiology and Molecular Genetics (A.J.R.), and Nicholas V. Perricone, M.D., Division of Dermatology, Department of Medicine (R.R.N.), Michigan State University, East Lansing, Michigan; Department of Translational Neuroscience (J.R.P., A.C.S., C.J.K., C.E.S.), Michigan State University, Grand Rapids, Michigan; Hauenstein Neuroscience Center, Mercy Health Saint Mary's, Grand Rapids, Michigan (C.E.S.); and Horae Gene Therapy Center and The Li Weibo Institute for Rare Diseases Research (Z.-T.D.O., T.M., A.R.B., M.S.-E.) and Department of Neurology (Z.-T.D.O., T.M., A.R.B., M.S.-E.), UMass Chan Medical School, Worcester, Massachusetts
| | - Joseph R Patterson
- Department of Pharmacology and Toxicology (A.J.R., J.R.L., R.R.N.), Department of Microbiology and Molecular Genetics (A.J.R.), and Nicholas V. Perricone, M.D., Division of Dermatology, Department of Medicine (R.R.N.), Michigan State University, East Lansing, Michigan; Department of Translational Neuroscience (J.R.P., A.C.S., C.J.K., C.E.S.), Michigan State University, Grand Rapids, Michigan; Hauenstein Neuroscience Center, Mercy Health Saint Mary's, Grand Rapids, Michigan (C.E.S.); and Horae Gene Therapy Center and The Li Weibo Institute for Rare Diseases Research (Z.-T.D.O., T.M., A.R.B., M.S.-E.) and Department of Neurology (Z.-T.D.O., T.M., A.R.B., M.S.-E.), UMass Chan Medical School, Worcester, Massachusetts
| | - Anna C Stoll
- Department of Pharmacology and Toxicology (A.J.R., J.R.L., R.R.N.), Department of Microbiology and Molecular Genetics (A.J.R.), and Nicholas V. Perricone, M.D., Division of Dermatology, Department of Medicine (R.R.N.), Michigan State University, East Lansing, Michigan; Department of Translational Neuroscience (J.R.P., A.C.S., C.J.K., C.E.S.), Michigan State University, Grand Rapids, Michigan; Hauenstein Neuroscience Center, Mercy Health Saint Mary's, Grand Rapids, Michigan (C.E.S.); and Horae Gene Therapy Center and The Li Weibo Institute for Rare Diseases Research (Z.-T.D.O., T.M., A.R.B., M.S.-E.) and Department of Neurology (Z.-T.D.O., T.M., A.R.B., M.S.-E.), UMass Chan Medical School, Worcester, Massachusetts
| | - Christopher J Kemp
- Department of Pharmacology and Toxicology (A.J.R., J.R.L., R.R.N.), Department of Microbiology and Molecular Genetics (A.J.R.), and Nicholas V. Perricone, M.D., Division of Dermatology, Department of Medicine (R.R.N.), Michigan State University, East Lansing, Michigan; Department of Translational Neuroscience (J.R.P., A.C.S., C.J.K., C.E.S.), Michigan State University, Grand Rapids, Michigan; Hauenstein Neuroscience Center, Mercy Health Saint Mary's, Grand Rapids, Michigan (C.E.S.); and Horae Gene Therapy Center and The Li Weibo Institute for Rare Diseases Research (Z.-T.D.O., T.M., A.R.B., M.S.-E.) and Department of Neurology (Z.-T.D.O., T.M., A.R.B., M.S.-E.), UMass Chan Medical School, Worcester, Massachusetts
| | - Zaipo-Tcheisian D Oula
- Department of Pharmacology and Toxicology (A.J.R., J.R.L., R.R.N.), Department of Microbiology and Molecular Genetics (A.J.R.), and Nicholas V. Perricone, M.D., Division of Dermatology, Department of Medicine (R.R.N.), Michigan State University, East Lansing, Michigan; Department of Translational Neuroscience (J.R.P., A.C.S., C.J.K., C.E.S.), Michigan State University, Grand Rapids, Michigan; Hauenstein Neuroscience Center, Mercy Health Saint Mary's, Grand Rapids, Michigan (C.E.S.); and Horae Gene Therapy Center and The Li Weibo Institute for Rare Diseases Research (Z.-T.D.O., T.M., A.R.B., M.S.-E.) and Department of Neurology (Z.-T.D.O., T.M., A.R.B., M.S.-E.), UMass Chan Medical School, Worcester, Massachusetts
| | - Tyler Mola
- Department of Pharmacology and Toxicology (A.J.R., J.R.L., R.R.N.), Department of Microbiology and Molecular Genetics (A.J.R.), and Nicholas V. Perricone, M.D., Division of Dermatology, Department of Medicine (R.R.N.), Michigan State University, East Lansing, Michigan; Department of Translational Neuroscience (J.R.P., A.C.S., C.J.K., C.E.S.), Michigan State University, Grand Rapids, Michigan; Hauenstein Neuroscience Center, Mercy Health Saint Mary's, Grand Rapids, Michigan (C.E.S.); and Horae Gene Therapy Center and The Li Weibo Institute for Rare Diseases Research (Z.-T.D.O., T.M., A.R.B., M.S.-E.) and Department of Neurology (Z.-T.D.O., T.M., A.R.B., M.S.-E.), UMass Chan Medical School, Worcester, Massachusetts
| | - Ana R Batista
- Department of Pharmacology and Toxicology (A.J.R., J.R.L., R.R.N.), Department of Microbiology and Molecular Genetics (A.J.R.), and Nicholas V. Perricone, M.D., Division of Dermatology, Department of Medicine (R.R.N.), Michigan State University, East Lansing, Michigan; Department of Translational Neuroscience (J.R.P., A.C.S., C.J.K., C.E.S.), Michigan State University, Grand Rapids, Michigan; Hauenstein Neuroscience Center, Mercy Health Saint Mary's, Grand Rapids, Michigan (C.E.S.); and Horae Gene Therapy Center and The Li Weibo Institute for Rare Diseases Research (Z.-T.D.O., T.M., A.R.B., M.S.-E.) and Department of Neurology (Z.-T.D.O., T.M., A.R.B., M.S.-E.), UMass Chan Medical School, Worcester, Massachusetts
| | - Caryl E Sortwell
- Department of Pharmacology and Toxicology (A.J.R., J.R.L., R.R.N.), Department of Microbiology and Molecular Genetics (A.J.R.), and Nicholas V. Perricone, M.D., Division of Dermatology, Department of Medicine (R.R.N.), Michigan State University, East Lansing, Michigan; Department of Translational Neuroscience (J.R.P., A.C.S., C.J.K., C.E.S.), Michigan State University, Grand Rapids, Michigan; Hauenstein Neuroscience Center, Mercy Health Saint Mary's, Grand Rapids, Michigan (C.E.S.); and Horae Gene Therapy Center and The Li Weibo Institute for Rare Diseases Research (Z.-T.D.O., T.M., A.R.B., M.S.-E.) and Department of Neurology (Z.-T.D.O., T.M., A.R.B., M.S.-E.), UMass Chan Medical School, Worcester, Massachusetts
| | - Miguel Sena-Esteves
- Department of Pharmacology and Toxicology (A.J.R., J.R.L., R.R.N.), Department of Microbiology and Molecular Genetics (A.J.R.), and Nicholas V. Perricone, M.D., Division of Dermatology, Department of Medicine (R.R.N.), Michigan State University, East Lansing, Michigan; Department of Translational Neuroscience (J.R.P., A.C.S., C.J.K., C.E.S.), Michigan State University, Grand Rapids, Michigan; Hauenstein Neuroscience Center, Mercy Health Saint Mary's, Grand Rapids, Michigan (C.E.S.); and Horae Gene Therapy Center and The Li Weibo Institute for Rare Diseases Research (Z.-T.D.O., T.M., A.R.B., M.S.-E.) and Department of Neurology (Z.-T.D.O., T.M., A.R.B., M.S.-E.), UMass Chan Medical School, Worcester, Massachusetts
| | - Richard R Neubig
- Department of Pharmacology and Toxicology (A.J.R., J.R.L., R.R.N.), Department of Microbiology and Molecular Genetics (A.J.R.), and Nicholas V. Perricone, M.D., Division of Dermatology, Department of Medicine (R.R.N.), Michigan State University, East Lansing, Michigan; Department of Translational Neuroscience (J.R.P., A.C.S., C.J.K., C.E.S.), Michigan State University, Grand Rapids, Michigan; Hauenstein Neuroscience Center, Mercy Health Saint Mary's, Grand Rapids, Michigan (C.E.S.); and Horae Gene Therapy Center and The Li Weibo Institute for Rare Diseases Research (Z.-T.D.O., T.M., A.R.B., M.S.-E.) and Department of Neurology (Z.-T.D.O., T.M., A.R.B., M.S.-E.), UMass Chan Medical School, Worcester, Massachusetts
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Lasa-Aranzasti A, Larasati YA, da Silva Cardoso J, Solis GP, Koval A, Cazurro-Gutiérrez A, Ortigoza-Escobar JD, Miranda MC, De la Casa-Fages B, Moreno-Galdó A, Tizzano EF, Gómez-Andrés D, Verdura E, Katanaev VL, Pérez-Dueñas B. Clinical and Molecular Profiling in GNAO1 Permits Phenotype-Genotype Correlation. Mov Disord 2024. [PMID: 38881224 DOI: 10.1002/mds.29881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 05/07/2024] [Accepted: 05/20/2024] [Indexed: 06/18/2024] Open
Abstract
BACKGROUND Defects in GNAO1, the gene encoding the major neuronal G-protein Gαo, are related to neurodevelopmental disorders, epilepsy, and movement disorders. Nevertheless, there is a poor understanding of how molecular mechanisms explain the different phenotypes. OBJECTIVES We aimed to analyze the clinical phenotype and the molecular characterization of GNAO1-related disorders. METHODS Patients were recruited in collaboration with the Spanish GNAO1 Association. For patient phenotyping, direct clinical evaluation, analysis of homemade-videos, and an online questionnaire completed by families were analyzed. We studied Gαo cellular expression, the interactions of the partner proteins, and binding to guanosine triphosphate (GTP) and G-protein-coupled receptors (GPCRs). RESULTS Eighteen patients with GNAO1 genetic defects had a complex neurodevelopmental disorder, epilepsy, central hypotonia, and movement disorders. Eleven patients showed neurological deterioration, recurrent hyperkinetic crisis with partial recovery, and secondary complications leading to death in three cases. Deep brain stimulation improved hyperkinetic crisis, but had inconsistent benefits in dystonia. The molecular defects caused by pathogenic Gαo were aberrant GTP binding and hydrolysis activities, an inability to interact with cellular binding partners, and reduced coupling to GPCRs. Decreased localization of Gαo in the plasma membrane was correlated with the phenotype of "developmental and epileptic encephalopathy 17." We observed a genotype-phenotype correlation, pathogenic variants in position 203 were related to developmental and epileptic encephalopathy, whereas those in position 209 were related to neurodevelopmental disorder with involuntary movements. Milder phenotypes were associated with other molecular defects such as del.16q12.2q21 and I344del. CONCLUSION We highlight the complexity of the motor phenotype, which is characterized by fluctuations throughout the day, and hyperkinetic crisis with a distinct post-hyperkinetic crisis state. We confirm a molecular-based genotype-phenotype correlation for specific variants. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Amaia Lasa-Aranzasti
- Department of Clinical and Molecular Genetics, Vall d'Hebron University Hospital, Barcelona, Spain
- Pediatric Neurology Research Group, Vall d'Hebron Research Institute (VHIR), Autonomous University of Barcelona, Barcelona, Spain
- Medicine Genetics Group, Vall d'Hebron Research Institute (VHIR), Autonomous University of Barcelona, Barcelona, Spain
- Department of Pediatrics, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- European Reference Network on Rare Congenital Malformations and Rare Intellectual Disability ERN-ITHACA, Paris, France
| | - Yonika A Larasati
- Translational Research Centre in Oncohaematology, Department of Cell Physiology and Metabolism, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Juliana da Silva Cardoso
- Pediatric Neurology Research Group, Vall d'Hebron Research Institute (VHIR), Autonomous University of Barcelona, Barcelona, Spain
- Serviço de Pediatria do Centro Materno infantil do Norte, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Gonzalo P Solis
- Translational Research Centre in Oncohaematology, Department of Cell Physiology and Metabolism, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Alexey Koval
- Translational Research Centre in Oncohaematology, Department of Cell Physiology and Metabolism, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Ana Cazurro-Gutiérrez
- Pediatric Neurology Research Group, Vall d'Hebron Research Institute (VHIR), Autonomous University of Barcelona, Barcelona, Spain
- Department of Pediatrics, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juan Dario Ortigoza-Escobar
- Movement Disorders Unit, Department of Child Neurology, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
- U-703 Center for Biomedical Research on Rare Diseases (CIBER-ER), Instituto de Salud Carlos III, Barcelona, Spain
- European Reference Network-Rare Neurological Diseases (ERN-RND), Barcelona, Spain
| | - Maria Concepción Miranda
- European Reference Network-Rare Neurological Diseases (ERN-RND), Barcelona, Spain
- Department of Pediatrics Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Beatriz De la Casa-Fages
- European Reference Network-Rare Neurological Diseases (ERN-RND), Barcelona, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Movement Disorders Unit, Neurology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Antonio Moreno-Galdó
- Department of Pediatrics, Universitat Autónoma de Barcelona, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- CIBER of Rare diseases (CIBERER), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Eduardo F Tizzano
- Department of Clinical and Molecular Genetics, Vall d'Hebron University Hospital, Barcelona, Spain
- Medicine Genetics Group, Vall d'Hebron Research Institute (VHIR), Autonomous University of Barcelona, Barcelona, Spain
- European Reference Network on Rare Congenital Malformations and Rare Intellectual Disability ERN-ITHACA, Paris, France
| | - David Gómez-Andrés
- Pediatric Neurology Research Group, Vall d'Hebron Research Institute (VHIR), Autonomous University of Barcelona, Barcelona, Spain
- European Reference Network-Rare Neurological Diseases (ERN-RND), Barcelona, Spain
- Department of Neurology, Vall Hebron University Hospital Barcelona, Barcelona, Spain
| | - Edgard Verdura
- Pediatric Neurology Research Group, Vall d'Hebron Research Institute (VHIR), Autonomous University of Barcelona, Barcelona, Spain
| | - Vladimir L Katanaev
- Translational Research Centre in Oncohaematology, Department of Cell Physiology and Metabolism, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- School of Medicine and Life Sciences, Far Eastern Federal University, Vladivostok, Russia
| | - Belén Pérez-Dueñas
- Pediatric Neurology Research Group, Vall d'Hebron Research Institute (VHIR), Autonomous University of Barcelona, Barcelona, Spain
- Department of Pediatrics, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- European Reference Network-Rare Neurological Diseases (ERN-RND), Barcelona, Spain
- Department of Pediatrics, Universitat Autónoma de Barcelona, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- CIBER of Rare diseases (CIBERER), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
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Domínguez Carral J, Reinhard C, Ebrahimi-Fakhari D, Dorison N, Galosi S, Garone G, Malenica M, Ravelli C, Serdaroglu E, van de Pol LA, Koy A, Leuzzi V, Roubertie A, Lin JP, Doummar D, Cif L, Ortigoza-Escobar JD. Dyskinetic crisis in GNAO1-related disorders: clinical perspectives and management strategies. Front Neurol 2024; 15:1403815. [PMID: 38903163 PMCID: PMC11188927 DOI: 10.3389/fneur.2024.1403815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 04/26/2024] [Indexed: 06/22/2024] Open
Abstract
Background GNAO1-related disorders (GNAO1-RD) encompass a diverse spectrum of neurodevelopmental and movement disorders arising from variants in the GNAO1 gene. Dyskinetic crises, marked by sudden and intense exacerbations of abnormal involuntary movements, present a significant challenge in GNAO1-RD. Objectives This study aimed to establish a standardized framework for understanding dyskinetic crises, addressing crucial aspects such as definition, triggers, diagnostic criteria, complications, and management strategies. Methods A Delphi consensus process was conducted involving international experts in GNAO1-RD. The panel of thirteen experts participated in three voting rounds, discussing 90 statements generated through a literature review and clinical expertise. Results Consensus was achieved on 31 statements, defining dyskinetic crises as abrupt, paroxysmal episodes involving distinct abnormal movements in multiple body regions, triggered by emotional stress or infections. Dyskinetic crises may lead to functional impairment and complications, emphasizing the need for prompt recognition. While individualized pharmacological recommendations were not provided, benzodiazepines and clonidine were suggested for acute crisis management. Chronic treatment options included tetrabenazine, benzodiazepines, gabapentin, and clonidine. Deep brain stimulation should be considered early in the treatment of refractory or prolonged dyskinetic crisis. Conclusion This consensus provides a foundation for understanding and managing dyskinetic crises in GNAO1-RD for clinicians, caregivers, and researchers. The study emphasizes the importance of targeted parental and caregiver education, which enables early recognition and intervention, thereby potentially minimizing both short- and long-term complications. Future research should concentrate on differentiating dyskinetic crises from other neurological events and investigating potential risk factors that influence their occurrence and nature. The proposed standardized framework improves clinical management, stakeholder communication, and future GNAO1-RD research.
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Affiliation(s)
- Jana Domínguez Carral
- Member of the ERN EpiCARE, Epilepsy Unit, Department of Child Neurology, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Carola Reinhard
- Centre for Rare Diseases and Institute of Medical Genetics and Applied Genomics, University Hospital Tübingen, Tübingen, Germany
- European Reference Network for Rare Neurological Diseases (ERN-RND), Tübingen, Germany
| | - Darius Ebrahimi-Fakhari
- Movement Disorders Program, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| | - Nathalie Dorison
- Dyspa Unit, Pediatric Neurosurgery, Hôpital Fondation Rothschild, Paris, France
| | - Serena Galosi
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Giacomo Garone
- Neurology, Epilepsy and Movement Disorders Unit, IRCCS Bambino Gesù Children Hospital, Rome, Italy
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Masa Malenica
- Member of the ERN EpiCARE, Department of Pediatrics, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
| | - Claudia Ravelli
- Sorbonne Université, Service de Neuropédiatrie-Pathologie du développement, Centre de référence neurogénétique, Hôpital Trousseau AP-HP.SU, Paris, France
| | - Esra Serdaroglu
- Department of Pediatric Neurology, Gazi University Faculty of Medicine, Ankara, Türkiye
| | - Laura A. van de Pol
- Emma Children’s Hospital, Amsterdam Universitary Medical Centers, Amsterdam, Netherlands
- Department of Child Neurology, Amsterdam Universitary Medical Centers, Vrije Universiteit, Amsterdam, Netherlands
| | - Anne Koy
- Department of Pediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Vincenzo Leuzzi
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Agathe Roubertie
- CHU Montpellier, Département de Neuropédiatrie, INM, Université de Montpellier, Inserm U, Montpellier, France
| | - Jean-Pierre Lin
- Children's Neurosciences Department, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
- Women and Children's Institute, Faculty of Life Sciences and Medicine (FolSM), King's College London, London, United Kingdom
| | - Diane Doummar
- Sorbonne Université, Service de Neuropédiatrie-Pathologie du développement, Centre de référence neurogénétique, Hôpital Trousseau AP-HP.SU, Paris, France
| | - Laura Cif
- Département de Neurochirurgie, Unité des Pathologies Cérébrales Résistantes, Hôpital Gui de Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
- Service de Neurologie, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- Laboratoire de Recherche en Neurosciences Cliniques, Montferrier-sur-Lez, France
| | - Juan Darío Ortigoza-Escobar
- European Reference Network for Rare Neurological Diseases (ERN-RND), Tübingen, Germany
- Movement Disorders Unit, Department of Child Neurology, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
- U-703 Center for Biomedical Research on Rare Diseases (CIBER-ER), Instituto de Salud Carlos III, Barcelona, Spain
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Novelli M, Galosi S, Zorzi G, Martinelli S, Capuano A, Nardecchia F, Granata T, Pollini L, Di Rocco M, Marras CE, Nardocci N, Leuzzi V. GNAO1-related movement disorder: An update on phenomenology, clinical course, and response to treatments. Parkinsonism Relat Disord 2023:105405. [PMID: 37142469 DOI: 10.1016/j.parkreldis.2023.105405] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/09/2023] [Accepted: 04/16/2023] [Indexed: 05/06/2023]
Abstract
AIM To evaluate clinical phenotype and molecular findings of 157 cases with GNAO1 pathogenic or likely pathogenic variants delineating the clinical spectrum, course, and response to treatments. METHOD Clinical phenotype, genetic data, and pharmacological and surgical treatment history of 11 novel cases and 146 previously published patients were analyzed. RESULTS Complex hyperkinetic movement disorder (MD) characterizes 88% of GNAO1 patients. Severe hypotonia and prominent disturbance of postural control seem to be hallmarks in the early stages preceding the hyperkinetic MD. In a subgroup of patients, paroxysmal exacerbations became so severe as to require admission to intensive care units (ICU). Almost all patients had a good response to deep brain stimulation (DBS). Milder phenotypes with late-onset focal/segmental dystonia, mild to moderate intellectual disability, and other minor neurological signs (i.e., parkinsonism and myoclonus) are emerging. MRI, previously considered noncontributory to a diagnosis, can show recurrent findings (i.e., cerebral atrophy, myelination and/or basal ganglia abnormalities). Fifty-eight GNAO1 pathogenic variants, including missense changes and a few recurrent splice site defects, have been reported. Substitutions at residues Gly203, Arg209 and Glu246, together with the intronic c.724-8G > A change, account for more than 50% of cases. INTERPRETATION Infantile or childhood-onset complex hyperkinetic MD (chorea and/or dystonia) with or without paroxysmal exacerbations, associated hypotonia, and developmental disorders should prompt research for GNAO1 mutations. DBS effectively controls and prevents severe exacerbations and should be considered early in patients with specific GNAO1 variants and refractory MD. Prospective and natural history studies are necessary to define genotype-phenotype correlations further and clarify neurological outcomes.
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Affiliation(s)
- Maria Novelli
- Department of Human Neuroscience, Sapienza University of Rome, Italy
| | - Serena Galosi
- Department of Human Neuroscience, Sapienza University of Rome, Italy.
| | - Giovanna Zorzi
- Department of Pediatric Neuroscience, IRCCS Foundation Carlo Besta Neurological Institute, Milan, Italy
| | - Simone Martinelli
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy
| | | | | | - Tiziana Granata
- Department of Pediatric Neuroscience, IRCCS Foundation Carlo Besta Neurological Institute, Milan, Italy
| | - Luca Pollini
- Department of Human Neuroscience, Sapienza University of Rome, Italy
| | - Martina Di Rocco
- Department of Human Neuroscience, Sapienza University of Rome, Italy; Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy
| | | | - Nardo Nardocci
- Department of Pediatric Neuroscience, IRCCS Foundation Carlo Besta Neurological Institute, Milan, Italy
| | - Vincenzo Leuzzi
- Department of Human Neuroscience, Sapienza University of Rome, Italy
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Ling W, Huang D, Yang F, Yang Z, Liu M, Zhu Q, Huang J, Zhou R, Chen X. Treating GNAO1 mutation-related severe movement disorders with oxcarbazepine: a case report. Transl Pediatr 2022; 11:1577-1587. [PMID: 36247896 PMCID: PMC9561508 DOI: 10.21037/tp-22-297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/16/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND GNAO1 variants have been found to be associated with epileptic encephalopathies, developmental delays (DDs), and movement disorders (MDs). Therapies for patients with GNAO1 variants vary. However, treatments for GNAO1-related diseases are still in their infancy. Previous reports suggest that few pharmacological treatments are effective for patients with GNAO1 variant-related MDs. Deep brain stimulation (DBS) treatment appears to be effective, however surgical procedures and equipment failures pose risks to the patients. Effectiveness for oxcarbazepine (OXC) in GNAO1 variant-related MDs is first reported in our study, and it expand the effective drugs for MD treatment. CASE DESCRIPTION We report the case of a 5-year-old male patient with a MD, who suffered from hypotonia and refractory choreoathetosis. The patient was found to have a DD and an intellectual disability. A de-novo variant of the GNAO1 gene (NM_138736: exom6: c.709G>A [p. Glu237Lys]) was identified by whole exome sequencing (WES) when he was 8 months old. The patient visited our hospital at the age of 4 years and 3 months because of fever and recurrent convulsions. Electroencephalogram (EEG) results show abnormal spikes, and magnetic resonance imaging (MRI) showed the enlargement of the lateral ventricles. The administration of tiapride hydrochloride, phenobarbital, midazolam, and hormones had no effect. OXC treatment was then initiated. No MD behaviors, such as rigidity and twisting of the limbs and trunk, or chorea, were observed after 10 days OXC treatment. Eventually, incremental doses of OXC were effective, and our patient achieved good control of his MD. CONCLUSIONS We are the first to demonstrate the role of OXC in alleviating MDs associated with GNAO1 mutations. This report provides a novel possibility for the clinical treatment of this rare disease. To manage MDs associated with GNAO1 mutations, we recommend that OXC treatment be attempted before invasive surgical therapy.
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Affiliation(s)
- Weihao Ling
- Department of Neurology, Children's Hospital of Soochow University, Suzhou, China
| | - Danping Huang
- Department of Neurology, Children's Hospital of Soochow University, Suzhou, China
| | | | | | - Min Liu
- Department of Neurology, Children's Hospital of Soochow University, Suzhou, China
| | - Qiujiao Zhu
- Department of Neurology, Children's Hospital of Soochow University, Suzhou, China
| | - Jing Huang
- Department of Neurology, Children's Hospital of Soochow University, Suzhou, China
| | - Rui Zhou
- Department of Neurology, Children's Hospital of Soochow University, Suzhou, China
| | - Xuqin Chen
- Department of Neurology, Children's Hospital of Soochow University, Suzhou, China
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Al Masseri Z, AlSayed M. Gonadal mosaicism in GNAO1 causing neurodevelopmental disorder with involuntary movements; two additional variants. Mol Genet Metab Rep 2022; 31:100864. [PMID: 35782616 PMCID: PMC9248221 DOI: 10.1016/j.ymgmr.2022.100864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/19/2022] [Accepted: 03/20/2022] [Indexed: 11/25/2022] Open
Abstract
Background GNAO1 encodes an alpha subunit of the heterotrimeric guanine nucleotide-binding proteins (G proteins). Mutations in GNAO1 result in two clinical phenotypes: Early infantile epileptic encephalopathy 17 (EEIE17-OMIM #615473) and Neurodevelopmental disorder with involuntary movements (NEDIM-OMIM #617493). Both are inherited as autosomal dominant disorders and originate mainly as de novo. Only a few are reported as gonadal mosaicism. Materials and methods We recruited and retrospectively reviewed five patients from two families seen at King Faisal Specialist Hospital and Research Centre in Riyadh (KFSHRC). Results All patients presented with severe neurodevelopmental disorder, followed by progressive dystonia and hyperkinetic movements. In addition, none of the patients had seizures which was consistent with NEDIM phenotype. The specific diagnosis was not clinically entertained and was only found on whole exome sequencing (WES), which identified two variants (c.724-8G > A & c.709G > A). Both variants were previously reported as pathogenic de novo in patients with NEDIM, and one was reported as parental gonadal mosaicism. Conclusion We report these variants as additional variants in GNAO1 gene that may be inherited as parental gonadal mosaicism. Both variants resulted in NEDIM with no observed clinical differences in the severity than the reported cases. This noticeable reported association between GNAO1 gene associated disorders and gonadal mosaicism should be considered in reproductive genetic counselling of affected families. Furthermore, in view of these reports, more studies with prospective data collection to explore the association between GNAO1 and gonadal mosaicism and the underlying mechanisms will be necessary.
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Liu Y, Zhang Q, Wang J, Liu J, Yang W, Yan X, Ouyang Y, Yang H. Both subthalamic and pallidal deep brain stimulation are effective for GNAO1-associated dystonia: three case reports and a literature review. Ther Adv Neurol Disord 2022; 15:17562864221093507. [PMID: 35509770 PMCID: PMC9058460 DOI: 10.1177/17562864221093507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 03/24/2022] [Indexed: 11/16/2022] Open
Abstract
Background Mutations in the G-protein subunit alpha o1 (GNAO1) gene have recently been shown to be involved in the pathogenesis of early infantile epileptic encephalopathy and movement disorders. The clinical manifestations of GNAO1-associated movement disorders are highly heterogeneous. However, the genotype-phenotype correlations in this disease remain unclear, and the treatments for GNAO1-associated movement disorders are still limited. Objective The objective of this study was to explore diagnostic and therapeutic strategies for GNAO1-associated movement disorders. Methods This study describes the cases of three Chinese patients who had shown severe and progressive dystonia in the absence of epilepsy since early childhood. We performed genetic analyses in these patients. Patients 1 and 2 underwent globus pallidus internus (GPi) deep brain stimulation (DBS) implantation, and Patient 3 underwent subthalamic nucleus (STN) DBS implantation. In addition, on the basis of a literature review, we summarized and discussed the clinical characteristics and outcomes after DBS surgery for all reported patients with GNAO1-associated movement disorders. Results Whole-exome sequencing (WES) analysis revealed de novo variants in the GNAO1 gene for all three patients, including a splice-site variant (c.724-8G > A) in Patients 1 and 3 and a novel heterozygous missense variant (c.124G > A; p. Gly42Arg) in Patient 2. Both GPi and STN DBS were effective in improving the dystonia symptoms of all three patients. Conclusion DBS is effective in ameliorating motor symptoms in patients with GNAO1-associated movement disorders, and both STN DBS and GPi DBS should be considered promptly for patients with sustained refractory GNAO1-associated dystonia.
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Affiliation(s)
- Ye Liu
- Department of Neurology, The First Hospital of China Medical University, Shenyang, China
| | - Qingping Zhang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Jun Wang
- Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, China
| | - Jiyuan Liu
- Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, China
| | - Wuyang Yang
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Xuejing Yan
- Department of Neurology, The First Hospital of China Medical University, Shenyang, China
| | - Yi Ouyang
- Department of Neurology, The First Hospital of China Medical University, Shenyang 110001, Liaoning, China
| | - Haibo Yang
- Department of Pediatric Surgery, Peking University First Hospital, Beijing 100034, China
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Yang X, Niu X, Yang Y, Cheng M, Zhang J, Chen J, Yang Z, Zhang Y. Phenotypes of GNAO1 Variants in a Chinese Cohort. Front Neurol 2021; 12:662162. [PMID: 34122306 PMCID: PMC8193119 DOI: 10.3389/fneur.2021.662162] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 04/06/2021] [Indexed: 11/30/2022] Open
Abstract
This study aimed to analyze the genotypes and phenotypes of GNAO1 variants in a Chinese cohort. Seven male and four female patients with GNAO1 variants were enrolled, including siblings of brothers. Ten different GNAO1 variants (nine missense and one splicing site) were identified, among which six were novel. All the variants were confirmed to be de novo in peripheral blood DNA. Eight (73%, 8/11) patients had epilepsy; the seizure onset age ranged from 6 h after birth to 4 months (median age, 2.5 months). Focal seizures were observed in all eight patients, epileptic spasms occurred in six (75%, 6/8), tonic spasm in four (50%, 4/8), tonic seizures in two, atypical absence in one, and generalized tonic–clonic seizures in one. Seven patients had multiple seizure types. Eight (73%, 8/11) patients had movement disorders, seven of them having only dystonia, and one having dystonia with choreoathetosis. Varying degrees of developmental delay (DD) were present in all 11 patients. The phenotypes were diagnosed as early infantile epileptic encephalopathy (EIEE) in two (18%) patients, which were further diagnosed as West syndrome. Movement disorders (MD) with developmental delay were diagnosed in two (18%) brothers. EIEE and MD were overlapped in six (55%) patients, among which two were diagnosed with West syndrome, one with Ohtahara syndrome, and the other three with non-specific EIEE. One (9%) patient was diagnosed as DD alone. The onset age of GNAO1-related disorders was early infancy. The phenotypic spectrum of GNAO1 included EIEE, MD with DD, and DD alone.
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Affiliation(s)
- Xiaoling Yang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Xueyang Niu
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Ying Yang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Miaomiao Cheng
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Jing Zhang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Jiaoyang Chen
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Zhixian Yang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Yuehua Zhang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
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Akasaka M, Kamei A, Tanifuji S, Asami M, Ito J, Mizuma K, Oyama K, Tokutomi T, Yamamoto K, Fukushima A, Takenouchi T, Uehara T, Suzuki H, Kosaki K. GNAO1 mutation-related severe involuntary movements treated with gabapentin. Brain Dev 2021; 43:576-579. [PMID: 33358199 DOI: 10.1016/j.braindev.2020.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/28/2020] [Accepted: 12/02/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Mutations in GNAO1 typically result in neurodevelopmental disorders, including involuntary movements. They may be improved using calcium-channel modulators. CASE The patient visited our hospital at age 2 years because of moderate global developmental delay. Her intermittent, generalized involuntary movements started at age 8 years. A de novo GNAO1 mutation, NM_020988.2:c.626G > A, (p.Arg209Cys), was identified by whole exome sequencing. At age 9 years, she experienced severe, intermittent involuntary movements, which led to rhabdomyolysis. She needed intensive care with administration of midazolam, dantrolene sodium hydrate, and plasma exchange. We started treating her with gabapentin (GBP), after which she recovered completely. At age 11 years, she developed continuous, generalized involuntary movements. This prompted us to increase the GBP dose, which again resolved the involuntary movements completely. CONCLUSION In the case of movement disorders associated with GNAO1 mutations, GBP treatment may be attempted before more invasive procedures are performed.
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Affiliation(s)
- Manami Akasaka
- Department of Pediatrics, School of Medicine, Iwate Medical University, Japan.
| | - Atsushi Kamei
- Department of Pediatrics, School of Medicine, Iwate Medical University, Japan
| | - Sachiko Tanifuji
- Department of Pediatrics, School of Medicine, Iwate Medical University, Japan
| | - Maya Asami
- Department of Pediatrics, School of Medicine, Iwate Medical University, Japan
| | - Jun Ito
- Department of Pediatrics, School of Medicine, Iwate Medical University, Japan
| | - Kanako Mizuma
- Department of Pediatrics, School of Medicine, Iwate Medical University, Japan
| | - Kotaro Oyama
- Department of Pediatrics, School of Medicine, Iwate Medical University, Japan
| | - Tomoharu Tokutomi
- Department of Clinical Genetics, School of Medicine, Iwate Medical University, Japan
| | - Kayono Yamamoto
- Department of Clinical Genetics, School of Medicine, Iwate Medical University, Japan
| | - Akimune Fukushima
- Department of Clinical Genetics, School of Medicine, Iwate Medical University, Japan
| | - Toshiki Takenouchi
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Tomoko Uehara
- Department of Center for Medical Genetics, Keio University School of Medicine, Tokyo, Japan
| | - Hisato Suzuki
- Department of Center for Medical Genetics, Keio University School of Medicine, Tokyo, Japan
| | - Kenjiro Kosaki
- Department of Center for Medical Genetics, Keio University School of Medicine, Tokyo, Japan
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Chin EM, Gwynn HE, Robinson S, Hoon AH. Principles of Medical and Surgical Treatment of Cerebral Palsy. Neurol Clin 2020; 38:397-416. [PMID: 32279717 DOI: 10.1016/j.ncl.2020.01.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Cerebral palsy is the most common cause of childhood motor disability, affecting 2 to 3/1000 children worldwide. Clinical abnormalities in tone, posture, and movement are the result of brain dysgenesis or injury early in life, and impairment varies in type, distribution, and in severity. The underlying brain disorder may also lead to other associated neurologic and systemic impairments. Variability in functional impairments, which can change during development, necessitates an individualized treatment plan. Treatment options are primarily symptomatic and directed toward optimizing independence, function, and/or ease of care-while limiting side effects. New promising disease-preventing and modifying treatments are emerging.
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Affiliation(s)
- Eric M Chin
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, 707 North Broadway, Baltimore, MD 21205, USA.
| | - Hilary E Gwynn
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, 707 North Broadway, Baltimore, MD 21205, USA
| | - Shenandoah Robinson
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Phipps Building Rm 101, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Alexander H Hoon
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, 707 North Broadway, Baltimore, MD 21205, USA
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11
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Baizabal-Carvallo JF, Cardoso F. Chorea in children: etiology, diagnostic approach and management. J Neural Transm (Vienna) 2020; 127:1323-1342. [DOI: 10.1007/s00702-020-02238-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/01/2020] [Indexed: 01/07/2023]
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12
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Abstract
Chorea is a movement disorder characterized by ongoing random-appearing sequences of discrete involuntary movements or movement fragments. Chorea results from dysfunction of the complex neuronal networks that interconnect the basal ganglia, thalamus, and related frontal lobe cortical areas. The complexity of basal ganglia circuitry and vulnerability of those circuits to injury explains why chorea results from a wide variety of conditions. Because etiology-specific treatments or effective symptomatic treatments are available for causes of chorea, defining the underlying disease is important. The treatment of chorea can be considered in three main categories: (1) terminating or modifying exposure to the causative agent, (2) symptomatic treatment of chorea, and (3) treatment targeting the underlying etiology. Symptomatic treatment decision of chorea should be based on the functional impact on the child caused by chorea itself. There have been no reported randomized, placebo-controlled trials of symptomatic treatment for chorea in childhood. Thus the recommendations are based on clinical experience, case reports, expert opinions, and small comparative studies. Better knowledge of mechanisms underlying childhood chorea will provide more etiology-based treatments in the future.
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13
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Mohammad SS, Paget SP, Dale RC. Current therapies and therapeutic decision making for childhood-onset movement disorders. Mov Disord 2019; 34:637-656. [PMID: 30919519 DOI: 10.1002/mds.27661] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 02/12/2019] [Indexed: 12/13/2022] Open
Abstract
Movement disorders differ in children to adults. First, neurodevelopmental movement disorders such as tics and stereotypies are more prevalent than parkinsonism, and second, there is a genomic revolution which is now explaining many early-onset dystonic syndromes. We outline an approach to children with movement disorders starting with defining the movement phenomenology, determining the level of functional impairment due to abnormal movements, and screening for comorbid psychiatric conditions and cognitive impairments which often contribute more to disability than the movements themselves. The rapid improvement in our understanding of the etiology of movement disorders has resulted in an increasing focus on precision medicine, targeting treatable conditions and defining modifiable disease processes. We profile some of the key disease-modifying therapies in metabolic, neurotransmitter, inflammatory, and autoimmune conditions and the increasing focus on gene or cellular therapies. When no disease-modifying therapies are possible, symptomatic therapies are often all that is available. These classically target dopaminergic, cholinergic, alpha-adrenergic, or GABAergic neurochemistry. Increasing interest in neuromodulation has highlighted that some clinical syndromes respond better to DBS, and further highlights the importance of "disease-specific" therapies with a future focus on individualized therapies according to the genomic findings or disease pathways that are disrupted. We summarize some pragmatic applications of symptomatic therapies, neuromodulation techniques, and some rehabilitative interventions and provide a contemporary overview of treatment in childhood-onset movement disorders. © 2019 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Shekeeb S Mohammad
- Kids Neuroscience Centre, The Kids Research Institute at the Children's Hospital at Westmead, Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Westmead, NSW, Australia.,Movement Disorders Unit, T.Y. Nelson Department of Neurology, the Children's Hospital at Westmead and Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Simon P Paget
- Kids Rehab, the Children's Hospital at Westmead and Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Russell C Dale
- Kids Neuroscience Centre, The Kids Research Institute at the Children's Hospital at Westmead, Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Westmead, NSW, Australia.,Movement Disorders Unit, T.Y. Nelson Department of Neurology, the Children's Hospital at Westmead and Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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14
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Phenomenology and clinical course of movement disorder in GNAO1 variants: Results from an analytical review. Parkinsonism Relat Disord 2018; 61:19-25. [PMID: 30642806 DOI: 10.1016/j.parkreldis.2018.11.019] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 11/05/2018] [Accepted: 11/09/2018] [Indexed: 12/21/2022]
Abstract
GNAO1 variants were recently discovered as causes of epileptic encephalopathies and heterogeneous syndromes presenting with movement disorders (MDs), whose phenomenology and clinical course are yet undefined. We herein focused on GNAO1-related MD, providing an analytical review of existing data to outline the main MD phenomenology and management, clinical evolution and genotype-phenotype correlations. Reviewing 41 previously published patients and assessing 5 novel cases, a comprehensive cohort of 46 patients was analyzed, reassuming knowledge about genotypes, phenotypes, disease course and treatment of this condition. GNAO1-related MD consisted of a severe early-onset hyperkinetic syndrome, with prominent chorea, dystonia and orofacial dyskinesia. Symptoms are poorly responsive to medical therapy and fluctuate, with critical and life-threatening exacerbations, such as status dystonicus. The presence of a choreiform MD appears to be predictive of a higher risk of movement disorder emergency. Surgical treatments are sometimes effective, although severe disabilities persist. Differently from the early infantile epileptic encephalopathy phenotype (associated with loss of function variants), no clear correlation between genotype and MD phenotype emerged, although some variants recurred more frequently, mainly affecting exons 6 and 7.
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15
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Okumura A, Maruyama K, Shibata M, Kurahashi H, Ishii A, Numoto S, Hirose S, Kawai T, Iso M, Kataoka S, Okuno Y, Muramatsu H, Kojima S. A patient with a GNAO1 mutation with decreased spontaneous movements, hypotonia, and dystonic features. Brain Dev 2018; 40:926-930. [PMID: 29935962 DOI: 10.1016/j.braindev.2018.06.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 05/08/2018] [Accepted: 06/06/2018] [Indexed: 11/30/2022]
Abstract
We report on a 4-year-old girl with a de novo GNAO1 mutation who had neurological findings, including decreased spontaneous movements, hypotonia, and dystonic features. She was referred to our hospital because of delayed psychomotor development. She showed hypotonia and decreased spontaneous movements. Voluntary movements of the limbs were more frequent in the lower extremities than in the upper extremities. Occasional dyskinetic features, such as awkward hand/foot posturing and grimacing, were seen during the voluntary movements. Serum metabolic screening, head magnetic resonance imaging, and electroencephalography were unremarkable. Whole-exome sequencing revealed a de novo mutation in the patient's GNAO1 gene, c.709 G > A (p.E237K). We calculated the free-energy change using the FoldX Suite to evaluate the impact of the E237K mutation. The FoldX calculations showed an increased free-energy change in the active state of the GNAO1 protein, indicating that the E237K mutation destabilizes the active state complexes. No seizures, chorea, tremor, or myoclonia, which are frequently reported in patients with GNAO1 mutations, were observed as of the last follow up. Our patient will improve the understanding of early neurological features in patients with GNAO1 mutations.
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Affiliation(s)
| | - Koichi Maruyama
- Department of Pediatric Neurology, Aichi Prefectural Colony Central Hospital, Japan
| | - Mami Shibata
- Research Institute for the Molecular Pathomechanisms of Epilepsy, Fukuoka University, Japan
| | - Hirokazu Kurahashi
- Department of Pediatrics, Aichi Medical University, Japan; Department of Pediatric Neurology, Aichi Prefectural Colony Central Hospital, Japan
| | | | - Shingo Numoto
- Department of Pediatrics, Aichi Medical University, Japan
| | | | - Tomoko Kawai
- Department of Maternal-Fetal Biology, National Research Institute for Child Health and Development, Japan
| | - Manami Iso
- Department of Genome Medicine, National Center for Child Health and Development, Japan
| | - Shinsuke Kataoka
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Japan
| | - Yusuke Okuno
- Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Japan
| | - Hideki Muramatsu
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Japan
| | - Seiji Kojima
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Japan
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16
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Abela L, Kurian MA. Postsynaptic movement disorders: clinical phenotypes, genotypes, and disease mechanisms. J Inherit Metab Dis 2018; 41:1077-1091. [PMID: 29948482 PMCID: PMC6326993 DOI: 10.1007/s10545-018-0205-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/13/2018] [Accepted: 05/18/2018] [Indexed: 12/30/2022]
Abstract
Movement disorders comprise a group of heterogeneous diseases with often complex clinical phenotypes. Overlapping symptoms and a lack of diagnostic biomarkers may hamper making a definitive diagnosis. Next-generation sequencing techniques have substantially contributed to unraveling genetic etiologies underlying movement disorders and thereby improved diagnoses. Defects in dopaminergic signaling in postsynaptic striatal medium spiny neurons are emerging as a pathogenic mechanism in a number of newly identified hyperkinetic movement disorders. Several of the causative genes encode components of the cAMP pathway, a critical postsynaptic signaling pathway in medium spiny neurons. Here, we review the clinical presentation, genetic findings, and disease mechanisms that characterize these genetic postsynaptic movement disorders.
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Affiliation(s)
- Lucia Abela
- Molecular Neurosciences, Developmental Neuroscience, UCL Institute of Child Health, London, UK
| | - Manju A Kurian
- Molecular Neurosciences, Developmental Neuroscience, UCL Institute of Child Health, London, UK.
- Developmental Neurosciences Programme, UCL GOS - Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.
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17
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Koy A, Cirak S, Gonzalez V, Becker K, Roujeau T, Milesi C, Baleine J, Cambonie G, Boularan A, Greco F, Perrigault PF, Cances C, Dorison N, Doummar D, Roubertie A, Beroud C, Körber F, Stüve B, Waltz S, Mignot C, Nava C, Maarouf M, Coubes P, Cif L. Deep brain stimulation is effective in pediatric patients with GNAO1 associated severe hyperkinesia. J Neurol Sci 2018; 391:31-39. [DOI: 10.1016/j.jns.2018.05.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 05/21/2018] [Indexed: 12/27/2022]
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18
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Feng H, Khalil S, Neubig RR, Sidiropoulos C. A mechanistic review on GNAO1-associated movement disorder. Neurobiol Dis 2018; 116:131-141. [PMID: 29758257 DOI: 10.1016/j.nbd.2018.05.005] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 04/28/2018] [Accepted: 05/10/2018] [Indexed: 02/07/2023] Open
Abstract
Mutations in the GNAO1 gene cause a complex constellation of neurological disorders including epilepsy, developmental delay, and movement disorders. GNAO1 encodes Gαo, the α subunit of Go, a member of the Gi/o family of heterotrimeric G protein signal transducers. Go is the most abundant membrane protein in the mammalian central nervous system and plays major roles in synaptic neurotransmission and neurodevelopment. GNAO1 mutations were first reported in early infantile epileptic encephalopathy 17 (EIEE17) but are also associated with a more common syndrome termed neurodevelopmental disorder with involuntary movements (NEDIM). Here we review a mechanistic model in which loss-of-function (LOF) GNAO1 alleles cause epilepsy and gain-of-function (GOF) alleles are primarily associated with movement disorders. We also develop a signaling framework related to cyclic AMP (cAMP), synaptic vesicle release, and neural development and discuss gene mutations perturbing those mechanisms in a range of genetic movement disorders. Finally, we analyze clinical reports of patients carrying GNAO1 mutations with respect to their symptom onset and discuss pharmacological/surgical treatments in the context of our mechanistic model.
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Affiliation(s)
- Huijie Feng
- Department of Pharmacology & Toxicology, Michigan State University, East Lansing, MI 48824, USA
| | - Suad Khalil
- Department of Neurology & Ophthalmology, Michigan State University, East Lansing, MI 48824, USA
| | - Richard R Neubig
- Department of Pharmacology & Toxicology, Michigan State University, East Lansing, MI 48824, USA.
| | - Christos Sidiropoulos
- Department of Neurology & Ophthalmology, Michigan State University, East Lansing, MI 48824, USA.
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Waak M, Mohammad SS, Coman D, Sinclair K, Copeland L, Silburn P, Coyne T, McGill J, O'Regan M, Selway R, Symonds J, Grattan-Smith P, Lin JP, Dale RC, Malone S. GNAO1-related movement disorder with life-threatening exacerbations: movement phenomenology and response to DBS. J Neurol Neurosurg Psychiatry 2018; 89:221-222. [PMID: 28668776 DOI: 10.1136/jnnp-2017-315653] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 04/26/2017] [Accepted: 05/14/2017] [Indexed: 11/03/2022]
Affiliation(s)
- Michaela Waak
- Department of Neuroscience, Rehabilitation and Metabolic Medicine, Lady Cilento Children's Hospital, South Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Shekeeb S Mohammad
- Department of Neurology, Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Institute for Neuroscience and Muscle Research, Children's Hospital at Westmead, University of Sydney, Sydney, New South Wales, Australia.,School of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - David Coman
- Department of Neuroscience, Rehabilitation and Metabolic Medicine, Lady Cilento Children's Hospital, South Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia.,School of Medicine, Griffith University, Brisbane, Queensland, Australia
| | - Kate Sinclair
- Department of Neuroscience, Rehabilitation and Metabolic Medicine, Lady Cilento Children's Hospital, South Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Lisa Copeland
- Department of Neuroscience, Rehabilitation and Metabolic Medicine, Lady Cilento Children's Hospital, South Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Peter Silburn
- Asia-Pacific Centre for Neuromodulation, Queensland Brain Institute, Brisbane, Queensland, Australia
| | - Terry Coyne
- Asia-Pacific Centre for Neuromodulation, Queensland Brain Institute, Brisbane, Queensland, Australia
| | - Jim McGill
- Department of Neuroscience, Rehabilitation and Metabolic Medicine, Lady Cilento Children's Hospital, South Brisbane, Queensland, Australia
| | - Mary O'Regan
- Paediatric Neurosciences Research Group, Fraser of Allander Neurosciences Unit, Royal Hospital for Children, Glasgow, UK.,University of Glasgow, Glasgow, UK
| | - Richard Selway
- Complex Motor Disorders Service, Children's Neurosciences, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, King's Health Partners, London, UK.,Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Joseph Symonds
- Paediatric Neurosciences Research Group, Fraser of Allander Neurosciences Unit, Royal Hospital for Children, Glasgow, UK.,University of Glasgow, Glasgow, UK
| | - Padraic Grattan-Smith
- Department of Neurology, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Jean-Pierre Lin
- Complex Motor Disorders Service, Children's Neurosciences, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, King's Health Partners, London, UK.,Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Russell C Dale
- Institute for Neuroscience and Muscle Research, Children's Hospital at Westmead, University of Sydney, Sydney, New South Wales, Australia
| | - Stephen Malone
- Department of Neuroscience, Rehabilitation and Metabolic Medicine, Lady Cilento Children's Hospital, South Brisbane, Queensland, Australia
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Abstract
INTRODUCTION Chorea is defined as jerk-like movements that move randomly from one body part to another. It is due to a variety of disorders and although current symptomatic therapy is quite effective there are few etiology- or pathogenesis-targeted therapies. The aim of this review is to summarize our own experience and published evidence in the treatment of chorea. Areas covered: After evaluating current guidelines and clinical practices for chorea of all etiologies, PubMed was searched for the most recent clinical trials and reviews using the term 'chorea' cross referenced with specific drug names. Expert commentary: Inhibitors of presynaptic vesicular monoamine transporter type 2 (VMAT2) that cause striatal dopamine depletion, such as tetrabenazine, deutetrabenazine, and valbenazine, are considered the treatment of choice in patients with chorea. Some clinicians also use dopamine receptor blockers (e.g. antipsychotics) and other drugs, including anti-epileptics and anti-glutamatargics. 'Dopamine stabilizers' such as pridopidine and other experimental drugs are currently being investigated in the treatment of chorea. Deep brain stimulation is usually reserved for patients with disabling chorea despite optimal medical therapy.
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Affiliation(s)
- H Bashir
- a Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology , Baylor College of Medicine , Houston , TX , USA
| | - J Jankovic
- a Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology , Baylor College of Medicine , Houston , TX , USA
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Abstract
Purpose of Review Hyperkinetic movement disorders can manifest alone or as part of complex phenotypes. In the era of next-generation sequencing (NGS), the list of monogenic complex movement disorders is rapidly growing. This review will explore the main features of these newly identified conditions. Recent Findings Mutations in ADCY5 and PDE10A have been identified as important causes of childhood-onset dyskinesias and KMT2B mutations as one of the most frequent causes of complex dystonia in children. The delineation of the phenotypic spectrum associated with mutations in ATP1A3, FOXG1, GNAO1, GRIN1, FRRS1L, and TBC1D24 is revealing an expanding genetic overlap between epileptic encephalopathies, developmental delay/intellectual disability, and hyperkinetic movement disorders,. Summary Thanks to NGS, the etiology of several complex hyperkinetic movement disorders has been elucidated. Importantly, NGS is changing the way clinicians diagnose these complex conditions. Shared molecular pathways, involved in early stages of brain development and normal synaptic transmission, underlie basal ganglia dysfunction, epilepsy, and other neurodevelopmental disorders.
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Affiliation(s)
- Miryam Carecchio
- Molecular Neurogenetics Unit, IRCCS Foundation Carlo Besta Neurological Institute, Via L. Temolo 4, 20126, Milan, Italy.,Department of Pediatric Neurology, IRCCS Foundation Carlo Besta Neurological Institute, Via Celoria 11, 20131, Milan, Italy.,Department of Medicine and Surgery, PhD Programme in Molecular and Translational Medicine, Milan Bicocca University, Via Cadore 48, 20900, Monza, Italy
| | - Niccolò E Mencacci
- Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, IL, 60611, USA. .,Department of Molecular Neuroscience, UCL Institute of Neurology, London, WC1N 3BG, UK.
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