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Ding Y, Cen Z, Zheng Y, Qiu X, Ye Y, Chen X, Hu L, Wang B, Wang Z, Yin H, Shen C, Ming W, Ge Y, Xie F, Yang D, Ouyang Z, Wang H, Wu S, Ding M, Wang S, Luo W. Seizures and electrophysiological features in familial cortical myoclonic tremor with epilepsy 1. Ann Clin Transl Neurol 2024; 11:414-423. [PMID: 38059543 PMCID: PMC10863925 DOI: 10.1002/acn3.51961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/09/2023] [Accepted: 11/11/2023] [Indexed: 12/08/2023] Open
Abstract
OBJECTIVES To investigate and characterize epileptic seizures and electrophysiological features of familial cortical myoclonic tremor with epilepsy (FCMTE) type 1 patients in a large Chinese cohort. METHODS We systematically evaluated 125 FCMTEtype 1 patients carrying the pentanucleotide (TTTCA) repeat expansion in the SAMD12 gene in China. RESULTS Among the 28 probands, epileptic seizures (96.4%, 27/28) were the most common reason for an initial clinic visit. Ninety-seven (77.6%, 97/125) patients had experienced seizures. The seizures onset age was 36.5 ± 9.0 years, which was 6.9 years later than cortical tremors. The seizures were largely rare (<1/year, 58.8%) and occasional (1-6/year, 37.1%). Prolonged prodromes were reported in 57.7% (56/97). Thirty-one patients (24.8%, 31/125) reported photosensitivity history, and 79.5% (31/39) had a photoparoxysmal response. Interictal epileptiform discharges (IEDs) were recorded in 69.1% (56/81) of patients. Thirty-three patients showed generalized IEDs and 72.7% (24/33) were occipitally dominant, while 23 patients presented with focal IEDs with 65.2% (15/23) taking place over the occipital lobe. Overnight EEG of FCMTE patients displayed paradoxical sleep-wake fluctuation, with a higher average IED index of 0.82 ± 0.88/min during wakefulness and a lower IED index of 0.04 ± 0.06/min during non-rapid eye movement sleep stages I-II. INTERPRETATION FCMTE type 1 has a benign course of epilepsy and distinct clinical and electrophysiological features. In addition to a positive family history and cortical myoclonus tremor, the seizure prodromes, specific seizure triggers, photosensitivity, distribution of IEDs, and unique fluctuations during sleep-wake cycle are cues for proper genetic testing and an early diagnosis of FCMTE.
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Affiliation(s)
- Yao Ding
- Department of NeurologySecond Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhouZhejiangChina
- Epilepsy CenterSecond Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhouZhejiangChina
| | - Zhidong Cen
- Department of NeurologySecond Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhouZhejiangChina
| | - Yang Zheng
- Department of NeurologyZhejiang Chinese Medical University First Affiliated HospitalHangzhouZhejiangChina
| | - Xia Qiu
- Department of NeurologySecond Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhouZhejiangChina
| | - Yumao Ye
- Department of NeurologySecond Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhouZhejiangChina
- Department of NeurologyQingyuan County People's HospitalLishuiZhejiangChina
| | - Xinhui Chen
- Department of NeurologySecond Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhouZhejiangChina
| | - Lingli Hu
- Department of NeurologySecond Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhouZhejiangChina
- Epilepsy CenterSecond Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhouZhejiangChina
| | - Bo Wang
- Department of NeurologySecond Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhouZhejiangChina
| | - Zhongjin Wang
- Epilepsy CenterSecond Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhouZhejiangChina
| | - Houmin Yin
- Department of NeurologySecond Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhouZhejiangChina
| | - Chunhong Shen
- Department of NeurologySecond Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhouZhejiangChina
| | - Wenjie Ming
- Epilepsy CenterSecond Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhouZhejiangChina
| | - Yi Ge
- Department of NeurologySecond Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhouZhejiangChina
| | - Fei Xie
- Department of NeurologySir Run Run Shaw Hospital, School of Medicine, Zhejiang UniversityHangzhouZhejiangChina
| | - Dehao Yang
- Department of NeurologySecond Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhouZhejiangChina
| | - Zhiyuan Ouyang
- Department of NeurologySecond Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhouZhejiangChina
| | - Haotian Wang
- Department of NeurologySecond Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhouZhejiangChina
| | - Sheng Wu
- Department of NeurologySecond Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhouZhejiangChina
| | - Meiping Ding
- Department of NeurologySecond Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhouZhejiangChina
- Epilepsy CenterSecond Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhouZhejiangChina
| | - Shuang Wang
- Department of NeurologySecond Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhouZhejiangChina
- Epilepsy CenterSecond Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhouZhejiangChina
| | - Wei Luo
- Department of NeurologySecond Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhouZhejiangChina
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Cuccurullo C, Striano P, Coppola A. Familial Adult Myoclonus Epilepsy: A Non-Coding Repeat Expansion Disorder of Cerebellar-Thalamic-Cortical Loop. Cells 2023; 12:1617. [PMID: 37371086 DOI: 10.3390/cells12121617] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/07/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
Familial adult myoclonus Epilepsy (FAME) is a non-coding repeat expansion disorder that has been reported under different acronyms and initially linked to four main loci: FAME1 (8q23.3-q24.1), FAME 2 (2p11.1-q12.1), FAME3 (5p15.31-p15.1), and FAME4 (3q26.32-3q28). To date, it is known that the genetic mechanism underlying FAME consists of the expansion of similar non-coding pentanucleotide repeats, TTTCA and TTTTA, in different genes. FAME is characterized by cortical tremor and myoclonus usually manifesting within the second decade of life, and infrequent seizures by the third or fourth decade. Cortical tremor is the core feature of FAME and is considered part of a spectrum of cortical myoclonus. Neurophysiological investigations as jerk-locked back averaging (JLBA) and corticomuscular coherence analysis, giant somatosensory evoked potentials (SEPs), and the presence of long-latency reflex I (or C reflex) at rest support cortical tremor as the result of the sensorimotor cortex hyperexcitability. Furthermore, the application of transcranial magnetic stimulation (TMS) protocols in FAME patients has recently shown that inhibitory circuits are also altered within the primary somatosensory cortex and the concomitant involvement of subcortical networks. Moreover, neuroimaging studies and postmortem autoptic studies indicate cerebellar alterations and abnormal functional connectivity between the cerebellum and cerebrum in FAME. Accordingly, the pathophysiological mechanism underlying FAME has been hypothesized to reside in decreased sensorimotor cortical inhibition through dysfunction of the cerebellar-thalamic-cortical loop, secondary to primary cerebellar pathology. In this context, the non-coding pentameric expansions have been proposed to cause cerebellar damage through an RNA-mediated toxicity mechanism. The elucidation of the underlying pathological mechanisms of FAME paves the way to novel therapeutic possibilities, such as RNA-targeting treatments, possibly applicable to other neurodegenerative non-coding disorders.
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Affiliation(s)
- Claudia Cuccurullo
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, Federico II University of Naples, 80131 Naples, Italy
| | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, 16126 Genova, Italy
| | - Antonietta Coppola
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, Federico II University of Naples, 80131 Naples, Italy
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Dubbioso R, Suppa A, Tijssen MAJ, Ikeda A. Familial adult myoclonus epilepsy: Neurophysiological investigations. Epilepsia 2023. [PMID: 36806000 DOI: 10.1111/epi.17553] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 02/14/2023] [Accepted: 02/16/2023] [Indexed: 02/20/2023]
Abstract
Familial adult myoclonus epilepsy (FAME) also described as benign adult familial myoclonus epilepsy (BAFME) is a high-penetrant autosomal dominant condition featuring cortical myoclonus of varying frequency and occasional/rare convulsive seizures. In this update we provide a detailed overview of the main neurophysiological findings so far reported in patients with FAME/BAFME. After reviewing the diagnostic contribution of each neurophysiological technique, we discuss the possible mechanisms underlying cortical hyperexcitability and suggest the involvement of more complex circuits engaging cortical and subcortical structures, such as the cerebellum. We, thus, propose that FAME/BAFME clinical features should arise from an "abnormal neuronal network activity," where the cerebellum represents a possible common denominator. In the last part of the article, we suggest that future neurophysiological studies using more advanced transcranial magnetic stimulation (TMS) protocols could be used to evaluate the functional connectivity between the cerebellum and cortical structures. Finally, non-invasive brain stimulation techniques such as repetitive TMS or transcranial direct current stimulation could be assessed as potential therapeutic tools to ameliorate cortical excitability.
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Affiliation(s)
- Raffaele Dubbioso
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, Federico II University of Naples, Napoli, Italy
| | - Antonio Suppa
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.,IRCCS Neuromed, Pozzilli, Italy
| | - Marina A J Tijssen
- Department of Neurology, University of Groningen, University Medical Centre Groningen (UMCG), Groningen, The Netherlands.,Expertise Centre Movement Disorders Groningen, University Medical Centre Groningen (UMCG), Groningen, The Netherlands
| | - Akio Ikeda
- Department of Epilepsy, Movement Disorders and Physiology Kyoto University Graduate School of Medicine Shogoin, Kyoto, Japan
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Nakakura M, Kinoshita M, Tsuto K, Yamamoto A, Sai S, Imai K, Kozono H, Urata Y. Awake-induced increase of epileptiform discharges in a case with poststroke epilepsy. Clin Neurophysiol Pract 2021; 6:130-132. [PMID: 33997532 PMCID: PMC8091176 DOI: 10.1016/j.cnp.2021.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/12/2021] [Accepted: 02/24/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- Masayuki Nakakura
- Department of Clinical Laboratory, Japanese Red Cross Society Kyoto Daiichi Hospital, Kyoto, Japan
| | - Masako Kinoshita
- Department of Neurology, National Hospital Organization Utano National Hospital, Kyoto, Japan
| | - Kazuma Tsuto
- Department of Neurology and Stroke Treatment, Japanese Red Cross Society Kyoto Daiichi Hospital, Kyoto, Japan.,Department of Neurosurgery, Seisho Hospital, Odawara, Kanagawa, Japan
| | - Atsushi Yamamoto
- Department of Neurology and Stroke Treatment, Japanese Red Cross Society Kyoto Daiichi Hospital, Kyoto, Japan
| | - Satoshi Sai
- Department of Neurology and Stroke Treatment, Japanese Red Cross Society Kyoto Daiichi Hospital, Kyoto, Japan
| | - Keisuke Imai
- Department of Neurology and Stroke Treatment, Japanese Red Cross Society Kyoto Daiichi Hospital, Kyoto, Japan
| | - Haruhisa Kozono
- Department of Clinical Laboratory, Japanese Red Cross Society Kyoto Daiichi Hospital, Kyoto, Japan
| | - Yoji Urata
- Department of Clinical Laboratory, Japanese Red Cross Society Kyoto Daiichi Hospital, Kyoto, Japan.,Department of Clinical Pathology, Japanese Red Cross Society Kyoto Daiichi Hospital, Kyoto, Japan
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