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Giugno A, Falcone E, Fortunato F, Sammarra I, Procopio R, Gagliardi M, Bauleo A, de Stefano L, Martino I, Gambardella A. Glucose transporter-1 deficiency syndrome with extreme phenotypic variability in a five-generation family carrying a novel SLC2A1 variant. Eur J Neurol 2024; 31:e16325. [PMID: 38803061 PMCID: PMC11235872 DOI: 10.1111/ene.16325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/10/2024] [Accepted: 04/16/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND AND PURPOSE Glucose transporter-1 (GLUT1) deficiency syndrome (GLUT1-DS) is a metabolic disorder due to reduced expression of GLUT1, a glucose transporter of the central nervous system. GLUT1-DS is caused by heterozygous SLC2A1 variants that mostly arise de novo. Here, we report a large family with heterogeneous phenotypes related to a novel SLC2A1 variant. METHODS We present clinical and genetic features of a five-generation family with GLUT1-DS. RESULTS The 14 (nine living) affected members had heterogeneous phenotypes, including seizures (11/14), behavioral disturbances (5/14), mild intellectual disability (3/14), and/or gait disabilities (2/14). Brain magnetic resonance imaging revealed hippocampal sclerosis in the 8-year-old proband, who also had drug-responsive absences associated with attention-deficit/hyperactivity disorder. His 52-year-old father, who had focal epilepsy since childhood, developed paraparesis related to a reversible myelitis associated with hypoglycorrhachia. Molecular study detected a novel heterozygous missense variant (c.446C>T) in exon 4 of SLC2A1 (NM: 006516.2) that cosegregated with the illness. This variant causes an amino acid replacement (p.Pro149Leu) at the fourth transmembrane segment of GLUT1, an important domain located at its catalytic core. CONCLUSIONS Our study illustrates the extremely heterogenous phenotypes in familial GLUT1-DS, ranging from milder classic phenotypes to more subtle neurological disorder including paraparesis. This novel SLC2A1 variant (c.446C>T) provides new insight into the pathophysiology of GLUT1-DS.
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Affiliation(s)
- Alessia Giugno
- Department of Medical and Surgical Sciences, Institute of NeurologyUniversity Magna GræciaCatanzaroItaly
| | - Elena Falcone
- BIOGENET–Medical and Forensic Genetics LaboratoryCosenzaItaly
| | - Francesco Fortunato
- Department of Medical and Surgical Sciences, Institute of NeurologyUniversity Magna GræciaCatanzaroItaly
| | - Ilaria Sammarra
- Department of Medical and Surgical Sciences, Institute of NeurologyUniversity Magna GræciaCatanzaroItaly
| | - Radha Procopio
- Department of Medical and Surgical Sciences, Neuroscience Research CenterMagna Graecia UniversityCatanzaroItaly
| | - Monica Gagliardi
- Department of Medical and Surgical Sciences, Neuroscience Research CenterMagna Graecia UniversityCatanzaroItaly
| | - Alessia Bauleo
- BIOGENET–Medical and Forensic Genetics LaboratoryCosenzaItaly
| | | | - Iolanda Martino
- Department of Medical and Surgical Sciences, Institute of NeurologyUniversity Magna GræciaCatanzaroItaly
| | - Antonio Gambardella
- Department of Medical and Surgical Sciences, Institute of NeurologyUniversity Magna GræciaCatanzaroItaly
- Department of Medical and Surgical Sciences, Neuroscience Research CenterMagna Graecia UniversityCatanzaroItaly
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2
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Huang C, Huang Y, Pan L, Li L, Ling X, Wang C, Xiao Q, Zhai N, Long Y, Mo W, Lin F, Huang Y. A novel duplication mutation of SLC2A1 gene causing glucose transporter 1 deficiency syndrome. Gene 2024; 928:148762. [PMID: 39009233 DOI: 10.1016/j.gene.2024.148762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 07/05/2024] [Accepted: 07/10/2024] [Indexed: 07/17/2024]
Affiliation(s)
- Chaoyu Huang
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Key Laboratory of Clinical Laboratory Medicine of Guangxi Department of Education, Nanning 530021, Guangxi, China
| | - Yunhua Huang
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Key Laboratory of Clinical Laboratory Medicine of Guangxi Department of Education, Nanning 530021, Guangxi, China
| | - Liqiu Pan
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Key Laboratory of Clinical Laboratory Medicine of Guangxi Department of Education, Nanning 530021, Guangxi, China
| | - Linlin Li
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Key Laboratory of Clinical Laboratory Medicine of Guangxi Department of Education, Nanning 530021, Guangxi, China
| | - Xiaoting Ling
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Key Laboratory of Clinical Laboratory Medicine of Guangxi Department of Education, Nanning 530021, Guangxi, China
| | - Chenghan Wang
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Key Laboratory of Clinical Laboratory Medicine of Guangxi Department of Education, Nanning 530021, Guangxi, China
| | - Qingxing Xiao
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Key Laboratory of Clinical Laboratory Medicine of Guangxi Department of Education, Nanning 530021, Guangxi, China
| | - Ningneng Zhai
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Key Laboratory of Clinical Laboratory Medicine of Guangxi Department of Education, Nanning 530021, Guangxi, China
| | - Yan Long
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Key Laboratory of Clinical Laboratory Medicine of Guangxi Department of Education, Nanning 530021, Guangxi, China
| | - Wuning Mo
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Key Laboratory of Clinical Laboratory Medicine of Guangxi Department of Education, Nanning 530021, Guangxi, China.
| | - Faquan Lin
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Key Laboratory of Clinical Laboratory Medicine of Guangxi Department of Education, Nanning 530021, Guangxi, China.
| | - Yifang Huang
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Key Laboratory of Clinical Laboratory Medicine of Guangxi Department of Education, Nanning 530021, Guangxi, China.
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3
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Tayebi N, Leon‐Ricardo B, McCall K, Mehinovic E, Engelstad K, Huynh V, Turner TN, Weisenberg J, Thio LL, Hruz P, Williams RSB, De Vivo DC, Petit V, Haller G, Gurnett CA. Quantitative determination of SLC2A1 variant functional effects in GLUT1 deficiency syndrome. Ann Clin Transl Neurol 2023; 10:787-801. [PMID: 37000947 PMCID: PMC10187726 DOI: 10.1002/acn3.51767] [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: 11/30/2022] [Revised: 03/08/2023] [Accepted: 03/12/2023] [Indexed: 04/03/2023] Open
Abstract
OBJECTIVE The goal of this study is to demonstrate the utility of a growth assay to quantify the functional impact of single nucleotide variants (SNVs) in SLC2A1, the gene responsible for Glut1DS. METHODS The functional impact of 40 SNVs in SLC2A1 was quantitatively determined in HAP1 cells in which SLC2A1 is required for growth. Donor libraries were introduced into the endogenous SLC2A1 gene in HAP1-Lig4KO cells using CRISPR/Cas9. Cell populations were harvested and sequenced to quantify the effect of variants on growth and generate a functional score. Quantitative functional scores were compared to 3-OMG uptake, SLC2A1 cell surface expression, CADD score, and clinical data, including CSF/blood glucose ratio. RESULTS Nonsense variants (N = 3) were reduced in cell culture over time resulting in negative scores (mean score: -1.15 ± 0.17), whereas synonymous variants (N = 10) were not depleted (mean score: 0.25 ± 0.12) (P < 2e-16). Missense variants (N = 27) yielded a range of functional scores including slightly negative scores, supporting a partial function and intermediate phenotype. Several variants with normal results on either cell surface expression (p.N34S and p.W65R) or 3-OMG uptake (p.W65R) had negative functional scores. There is a moderate but significant correlation between our functional scores and CADD scores. INTERPRETATION Cell growth is useful to quantitatively determine the functional effects of SLC2A1 variants. Nonsense variants were reliably distinguished from benign variants in this in vitro functional assay. For facilitating early diagnosis and therapeutic intervention, future work is needed to determine the functional effect of every possible variant in SLC2A1.
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Affiliation(s)
- Naeimeh Tayebi
- Department of NeurologyWashington University in St LouisSt LouisMissouriUSA
| | - Brian Leon‐Ricardo
- Department of NeurologyWashington University in St LouisSt LouisMissouriUSA
| | - Kevin McCall
- Department of NeurologyWashington University in St LouisSt LouisMissouriUSA
| | - Elvisa Mehinovic
- Department of GeneticsWashington University in St LouisSt LouisMissouriUSA
| | - Kristin Engelstad
- Department of NeurologyColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Vincent Huynh
- Department of NeurologyColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Tychele N. Turner
- Department of GeneticsWashington University in St LouisSt LouisMissouriUSA
| | - Judy Weisenberg
- Department of NeurologyWashington University in St LouisSt LouisMissouriUSA
| | - Liu L. Thio
- Department of NeurologyWashington University in St LouisSt LouisMissouriUSA
| | - Paul Hruz
- Department of PediatricsWashington University in St LouisSt LouisMissouriUSA
| | - Robin S. B. Williams
- Centre for Biomedical Sciences, Department of Biological SciencesRoyal Holloway University of LondonEghamUK
| | - Darryl C. De Vivo
- Department of NeurologyColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | | | - Gabe Haller
- Department of NeurologyWashington University in St LouisSt LouisMissouriUSA
- Department of GeneticsWashington University in St LouisSt LouisMissouriUSA
- Department of Neurological SurgeryWashington University in St LouisSt LouisMissouriUSA
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Al-Ahmad AJ. Human-Induced Pluripotent Stem Cell-Based Model of the Blood-Brain at 10 Years: A Retrospective on Past and Current Disease Models. Handb Exp Pharmacol 2023; 281:141-156. [PMID: 36943490 DOI: 10.1007/164_2023_645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
The initial discovery and derivation of induced pluripotent stem cells (iPSCs) by Yamanaka and colleagues in 2006 revolutionized the field of personalized medicine, as it opened the possibility to model diseases using patient-derived stem cells. A decade of adoption of iPSCs within the community of the blood-brain barrier (BBB) significantly opened the door for modeling diseases at the BBB, a task until then considered challenging, if not impossible.In this book chapter, we provided an extensive review of the literature on the use of iPSC-based models of the human BBB to model neurological diseases including infectious diseases (COVID-19, Streptococcus, Neisseria) neurodevelopmental diseases (adrenoleukodystrophy, Allan-Herndon-Dudley Syndrome, Batten's disease, GLUT1 deficiency syndrome), and neurodegenerative diseases (Alzheimer's disease, the current findings and observations, but also the challenges and limitations inherent to the use of iPSC-based models in reproducing the human BBB during health and diseases in a Petri dish.
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Affiliation(s)
- Abraham J Al-Ahmad
- Department of Pharmaceutical Sciences, Jerry H. Hodge School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, TX, USA.
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5
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Stephen CD. The Dystonias. Continuum (Minneap Minn) 2022; 28:1435-1475. [PMID: 36222773 DOI: 10.1212/con.0000000000001159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
PURPOSE OF REVIEW This article discusses the most recent findings regarding the diagnosis, classification, and management of genetic and idiopathic dystonia. RECENT FINDINGS A new approach to classifying dystonia has been created with the aim to increase the recognition and diagnosis of dystonia. Molecular biology and genetic studies have identified several genes and biological pathways involved in dystonia. SUMMARY Dystonia is a common movement disorder involving abnormal, often twisting, postures and is a challenging condition to diagnose. The pathophysiology of dystonia involves abnormalities in brain motor networks in the context of genetic factors. Dystonia has genetic, idiopathic, and acquired forms, with a wide phenotypic spectrum, and is a common feature in complex neurologic disorders. Dystonia can be isolated or combined with another movement disorder and may be focal, segmental, multifocal, or generalized in distribution, with some forms only occurring during the performance of specific tasks (task-specific dystonia). Dystonia is classified by clinical characteristics and presumed etiology. The management of dystonia involves accurate diagnosis, followed by treatment with botulinum toxin injections, oral medications, and surgical therapies (mainly deep brain stimulation), as well as pathogenesis-directed treatments, including the prospect of disease-modifying or gene therapies.
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6
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Pervaiz I, Zahra FT, Mikelis C, Al-Ahmad AJ. An in vitro model of glucose transporter 1 deficiency syndrome at the blood-brain barrier using induced pluripotent stem cells. J Neurochem 2022; 162:483-500. [PMID: 35943296 DOI: 10.1111/jnc.15684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 07/08/2022] [Accepted: 08/03/2022] [Indexed: 11/28/2022]
Abstract
Glucose is an important source of energy for the central nervous system. Its uptake at the blood-brain barrier (BBB) is mostly mediated via glucose transporter 1 (GLUT1), a facilitated transporter encoded by the SLC2A1 gene. GLUT1 Deficiency Syndrome (GLUT1DS) is a haploinsufficiency characterized by mutations in the SLC2A1 gene, resulting in impaired glucose uptake at the BBB and clinically characterized by epileptic seizures and movement disorder. A major limitation is an absence of in vitro models of the BBB reproducing the disease. This study aimed to characterize an in vitro model of GLUT1DS using human pluripotent stem cells (iPSCs). Two GLUT1DS clones were generated (GLUT1-iPSC) from their original parental clone iPS(IMR90)-c4 by CRISPR/Cas9 and differentiated into brain microvascular endothelial cells (iBMECs). Cells were characterized in terms of SLC2A1 expression, changes in the barrier function, glucose uptake and metabolism, and angiogenesis. GLUT1DS iPSCs and iBMECs showed comparable phenotype to their parental control, with exception of reduced GLUT1 expression at the protein level. Although no major disruption in the barrier function was reported in the two clones, a significant reduction in glucose uptake accompanied by an increase in glycolysis and mitochondrial respiration was reported in both GLUT1DS-iBMECs. Finally, impaired angiogenic features were reported in such clones compared to the parental clone. Our study provides the first documented characterization of GLUT1DS-iBMECs generated by CRISPR-Cas9, suggesting that GLUT1 truncation appears detrimental to brain angiogenesis and brain endothelial bioenergetics, but maybe not be detrimental to iBMECs differentiation and barriergenesis. Our future direction is to further characterize the functional outcome of such truncated product, as well as its impact on other cells of the neurovascular unit.
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Affiliation(s)
- Iqra Pervaiz
- Texas Tech University Health Sciences Center, Jerry H. Hodge School of Pharmacy, Department of Pharmaceutical Sciences, Amarillo, Texas, United States of America
| | - Fatema Tuz Zahra
- Texas Tech University Health Sciences Center, Jerry H. Hodge School of Pharmacy, Department of Pharmaceutical Sciences, Amarillo, Texas, United States of America
| | - Constantinos Mikelis
- Texas Tech University Health Sciences Center, Jerry H. Hodge School of Pharmacy, Department of Pharmaceutical Sciences, Amarillo, Texas, United States of America
| | - Abraham Jacob Al-Ahmad
- Texas Tech University Health Sciences Center, Jerry H. Hodge School of Pharmacy, Department of Pharmaceutical Sciences, Amarillo, Texas, United States of America
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7
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van Gemert LA, Leen WG, Draaisma JM, Roeleveld N, Willemsen MA. Head circumference in glucose transporter 1 deficiency syndrome: Normal for individuals, abnormal as a group. Eur J Paediatr Neurol 2022; 38:73-76. [PMID: 35500464 DOI: 10.1016/j.ejpn.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 04/15/2022] [Accepted: 04/19/2022] [Indexed: 10/18/2022]
Abstract
In the literature, microcephaly is considered as part of the classical phenotype of glucose transporter 1 deficiency syndrome (GLUT1DS), and previous cohort studies reported a prevalence of microcephaly of around 50%. In our clinical experience, however, only very few patients with GLUT1DS appear to have microcephaly. Therefore, we conducted an observational study among a large cohort of Dutch patients with GLUT1DS to investigate the prevalence of microcephaly, defined as < 2 standard deviations (SD) below the mean. We analysed the head circumference of 54 patients and found a prevalence of microcephaly at last known measurement of 6.5%. Notably, none of the patients had a head circumference < -3 SD. However, we learned that 75.9% of the patients had a head circumference below 0 SD. This study shows that microcephaly occurs less often than previously thought in patients with GLUT1DS, and that primary or secondary microcephaly does not seem to be a sign for clinicians to suspect GLUT1DS. As a group, however, patients with GLUT1DS seem to have decreased head circumference compared to healthy individuals and as such, our study suggests that early brain development and brain growth may be compromised in GLUT1DS.
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Affiliation(s)
- Loes A van Gemert
- Department of Pediatric Neurology, Amalia Children's Hospital, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, the Netherlands.
| | - Wilhelmina G Leen
- Department of Neurology, Canisius Wilhelmina Hospital, Weg Door Jonkerbos 100, 6532, SZ, Nijmegen, the Netherlands.
| | - Jos M Draaisma
- Department of General Pediatrics, Amalia Children's Hospital, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, the Netherlands.
| | - Nel Roeleveld
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, the Netherlands.
| | - Michèl A Willemsen
- Department of Pediatric Neurology, Amalia Children's Hospital, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, the Netherlands; Donders Institute for Brain, Cognition and Behaviour, Montessorilaan 3, 6525, HR, Nijmegen, the Netherlands.
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8
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Striano P, Auvin S, Collins A, Horvath R, Scheffer IE, Tzadok M, Miller I, Koenig MK, Lacy A, Davis R, Garcia-Cazorla A, Saneto RP, Brandabur M, Blair S, Koutsoukos T, De Vivo D. A randomized, double-blind trial of triheptanoin for drug-resistant epilepsy in glucose transporter I deficiency syndrome (Glut1DS). Epilepsia 2022; 63:1748-1760. [PMID: 35441706 PMCID: PMC9546029 DOI: 10.1111/epi.17263] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 04/15/2022] [Accepted: 04/18/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Evaluate efficacy and long-term safety of triheptanoin in patients >1 year old, not on a ketogenic diet, with drug-resistant seizures associated with Glucose Transporter Type 1 Deficiency Syndrome (Glut1DS). METHODS UX007G-CL201 was a randomized, double-blind, placebo-controlled trial. Following a 6-week baseline period, eligible patients were randomized 3:1 to triheptanoin or placebo. Dosing was titrated to 35% total daily calories over 2 weeks. After an 8-week placebo-controlled period, all patients received open-label triheptanoin through Week 52. RESULTS The study included 36 patients (15 children; 13 adolescents; 8 adults). A median 12.6% reduction in overall seizure frequency was observed in the triheptanoin arm relative to baseline and a 13.5% difference was observed relative to placebo (p = .58). In patients with absence seizures only (n = 9), a median 62.2% reduction in seizure frequency was observed in the triheptanoin arm relative to baseline. Only one patient with absence seizures only was present in the control group, preventing comparison. No statistically significant differences in seizure frequency were observed. Common treatment-emergent adverse events (TEAEs) included diarrhea, vomiting, abdominal pain, and nausea, most mild or moderate in severity. No serious AEs were considered treatment related. One patient discontinued due to status epilepticus. SIGNIFICANCE Triheptanoin did not significantly reduce seizure frequency in patients with Glut1DS not on the ketogenic diet. Treatment was associated with mild to moderate GI treatment-related events; most resolved following dose reduction or interruption and/or medication for treatment. Triheptanoin was not associated with any long-term safety concerns when administered at dose levels up to 35% total daily caloric intake for up to one year.
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Affiliation(s)
- Pasquale Striano
- IRCCS Istituto 'G. Gaslini', Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Stéphane Auvin
- Robert-Debré University Hospital and Université de Paris, Paris, France.,Institut Universitaire de France (IUF), Paris, France
| | | | - Rita Horvath
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Ingrid E Scheffer
- Austin and Royal Children's Hospital, Florey and Murdoch Institutes, University of Melbourne, Melbourne, Vic., Australia
| | - Michal Tzadok
- Pediatric Neurology Units, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Ramat Gan, Israel
| | - Ian Miller
- Miami Children's Research Institute, Miami, Florida, USA
| | | | - Adrian Lacy
- Cook Children's Medical Center, Fort Worth, Texas, USA
| | - Ronald Davis
- Neurology & Epilepsy Research Center, DBO Pediatric Neurology, P.A., Orlando, Florida, USA
| | | | - Russell P Saneto
- Department of Neurology, Division of Pediatric Neurology, University of Washington/ Seattle Children's Hospital, Seattle, Washington, USA
| | | | - Susan Blair
- Ultragenyx Pharmaceutical Inc., Novato, California, USA
| | | | - Darryl De Vivo
- Columbia University Irving Medical Center, New York, New York, USA
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Stafford CF, Sanchez-Lara PA. Impact of Genetic and Genomic Testing on the Clinical Management of Patients with Autism Spectrum Disorder. Genes (Basel) 2022; 13:genes13040585. [PMID: 35456390 PMCID: PMC9030515 DOI: 10.3390/genes13040585] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 03/21/2022] [Indexed: 02/06/2023] Open
Abstract
Research has shown that genetics play a key role in the development of autism spectrum disorder (ASD). ASD has been linked to many genes and is a prominent feature in numerous genetic disorders. A genetic evaluation should be offered to any patient who receives a diagnosis of ASD, including deep phenotyping and genetic testing when clinically indicated. When insurance does not cover genetic testing for ASD patients, the lack of medical utility is often cited as a reason for prior authorization request denial. However, ample evidence exists that genetic testing has the power to change clinical management in many of these patients. Genetic testing that results in a diagnosis guides clinicians to screen for associated medical conditions and can direct targeted medical interventions. Given the potential for clinically actionable results, it is important that genetic testing be available and accessible to all patients with ASD.
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Affiliation(s)
| | - Pedro A. Sanchez-Lara
- Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
- Correspondence:
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Diagnostic and Clinical Manifestation Differences of Glucose Transporter Type 1 Deficiency Syndrome in a Family with SLC2A1 Gene Mutation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063279. [PMID: 35328965 PMCID: PMC8950241 DOI: 10.3390/ijerph19063279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/05/2022] [Accepted: 03/07/2022] [Indexed: 01/27/2023]
Abstract
Glucose transporter type 1 deficiency syndrome is a rare genetic disease that manifests neurological symptoms such as mental impairment or movement disorders, mostly seen in pediatric patients. Here, we highlight the main symptoms, diagnostic difficulties, and genetic correlations of this disease based on different clinical presentations between the members of a family carrying the same mutation. In this report, we studied siblings—a 5-year-old girl and a 6-year-old boy—who were admitted to a pediatric ward with various neurological symptoms. Different diagnostic procedures such as lumbar puncture, electroencephalography, and MRI of the brain were performed on these patients. Whole genome sequencing identified mutations in the SLC2A1 and GLUT1-DS genes, following which a ketogenic diet was implemented. This diet modification resulted in a good clinical response. Our case report reveals patients with the same genetic mutations having distinctive clinical manifestations.
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Angeli M, Vergadi E, Niotakis G, Raissaki M, Galanakis E. Abnormal gait and hypoglycorrhachia in a toddler with seizures. Pediatr Investig 2022; 6:47-49. [PMID: 35382425 PMCID: PMC8960915 DOI: 10.1002/ped4.12311] [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: 11/07/2021] [Accepted: 01/04/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Glucose transporter type 1 (Glut1) deficiency syndrome is a treatable neurometabolic disorder characterized by seizures, developmental delay, and hypoglycorrhachia. Due to the rareness and non‐specific clinical manifestations, it is usually mis‐ or underdiagnosed. Case presentation We report the case of a toddler who presented with afebrile epileptic seizures and abnormal gait. Brain imaging and electroencephalogram were normal. Further investigation of the cerebrospinal fluid revealed hypoglycorrhachia that was the clue to the diagnosis of Glut1 deficiency syndrome and the initiation of treatment with ketogenic diet. Conclusion Our case highlights the importance of lumbar puncture while investigating a child with epileptic seizures and abnormal gait or developmental delay, in order not to miss treatable neurometabolic conditions, such as Glut1 deficiency syndrome.
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Affiliation(s)
- Maria Angeli
- Department of Paediatrics University General Hospital of Heraklion, School of Medicine, University of Crete Heraklion Greece
| | - Eleni Vergadi
- Department of Paediatrics University General Hospital of Heraklion, School of Medicine, University of Crete Heraklion Greece
| | - Georgios Niotakis
- Paediatric Neurology Clinic Venizeleion General Hospital Heraklion Greece
| | - Maria Raissaki
- Department of Radiology University General Hospital of Heraklion, School of Medicine, University of Crete Heraklion Greece
| | - Emmanouil Galanakis
- Department of Paediatrics University General Hospital of Heraklion, School of Medicine, University of Crete Heraklion Greece
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GLUT1 Deficiency Syndrome-Early Treatment Maintains Cognitive Development? (Literature Review and Case Report). Genes (Basel) 2021; 12:genes12091379. [PMID: 34573360 PMCID: PMC8472230 DOI: 10.3390/genes12091379] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/22/2021] [Accepted: 08/30/2021] [Indexed: 01/13/2023] Open
Abstract
Glucose transporter type 1 (GLUT1) is the most important energy carrier of the brain across the blood-brain barrier, and a genetic defect of GLUT1 is known as GLUT1 deficiency syndrome (GLUT1DS). It is characterized by early infantile seizures, developmental delay, microcephaly, ataxia, and various paroxysmal neurological phenomena. In most cases, GLUT1DS is caused by heterozygous single-nucleotide variants (SNVs) in the SLC2A1 gene that provoke complete or severe impairment of the functionality and/or expression of GLUT1 in the brain. Despite the rarity of these diseases, GLUT1DS is of high clinical interest since a very effective therapy, the ketogenic diet, can improve or reverse symptoms, especially if it is started as early as possible. We present a clinical phenotype, biochemical analysis, electroencephalographic and neuropsychological features of an 11-month-old boy with myoclonic seizures, hypogammaglobulinemia, and mildly impaired gross motor development. Using sequence analysis and deletion/duplication testing, deletion of an entire coding sequence in the SLC2A1 gene was detected. Early introduction of a modified Atkins diet maintained a seizure-free period without antiseizure medications and normal cognitive development in the follow-up period. Our report summarizes the clinical features of GLUT1 syndromes and discusses the importance of early identification and molecular confirmation of GLUT1DS as a treatable metabolic disorder.
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Arrieta Blanco F, Bélanger Quintana A, Bengoa Rojano N, Stanescu S, Martinez Pardo M. GLUT1 and COVID-19 deficiency syndrome. ENDOCRINOL DIAB NUTR 2021; 68:514-515. [PMID: 34863417 DOI: 10.1016/j.endien.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/17/2020] [Indexed: 06/13/2023]
Affiliation(s)
- Francisco Arrieta Blanco
- Servicio de Endocrinología y Nutrición, Unidad de Enfermedades Metabólicas congénitas, Centros, Servicios y Unidades de Referencia del Sistema Nacional de Salud (CSUR), Centro de Investigación Biomédica en Red (CIBERER), Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain.
| | - Amaya Bélanger Quintana
- Servicio de Pediatría, Unidad Enfermedades Metabólicas Congénitas, Centros, Servicios y Unidades de Referencia del Sistema Nacional de Salud (CSUR), Centro de Investigación Biomédica en Red (CIBERER), Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Nuria Bengoa Rojano
- Servicio de Endocrinología y Nutrición, Unidad Enfermedades Metabólicas Congénitas, Centros, Servicios y Unidades de Referencia del Sistema Nacional de Salud (CSUR), Madrid, Spain
| | - Sinziana Stanescu
- Servicio de Pediatría, Unidad Enfermedades Metabólicas Congénitas, Centros, Servicios y Unidades de Referencia del Sistema Nacional de Salud (CSUR), Madrid, Spain
| | - Mercedes Martinez Pardo
- Unidad Enfermedades Metabólicas congénitas, Centros, Servicios y Unidades de Referencia del Sistema Nacional de Salud (CSUR), Centro de Investigación Biomédica en Red (CIBERER), Madrid, Spain
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Arrieta Blanco F, Bélanger Quintana A, Bengoa Rojano N, Stanescu S, MartinezPardo M. Síndrome de deficiencia de GLUT1 y COVID-19. ENDOCRINOL DIAB NUTR 2021; 68:514-515. [PMID: 34632289 PMCID: PMC7462458 DOI: 10.1016/j.endinu.2020.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Francisco Arrieta Blanco
- Servicio de Endocrinología y Nutrición, Unidad de Enfermedades Metabólicas congénitas, Centros, Servicios y Unidades de Referencia del Sistema Nacional de Salud (CSUR), Centro de Investigación Biomédica en Red (CIBERER), Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, España
| | - Amaya Bélanger Quintana
- Servicio de Pediatría, Unidad Enfermedades Metabólicas Congénitas, Centros, Servicios y Unidades de Referencia del Sistema Nacional de Salud (CSUR), Centro de Investigación Biomédica en Red (CIBERER), Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, España
| | - Nuria Bengoa Rojano
- Servicio de Endocrinología y Nutrición, Unidad Enfermedades Metabólicas Congénitas, Centros, Servicios y Unidades de Referencia del Sistema Nacional de Salud (CSUR), Madrid, España
| | - Sinziana Stanescu
- Servicio de Pediatría, Unidad Enfermedades Metabólicas Congénitas, Centros, Servicios y Unidades de Referencia del Sistema Nacional de Salud (CSUR), Madrid, España
| | - Mercedes MartinezPardo
- Unidad Enfermedades Metabólicas congénitas, Centros, Servicios y Unidades de Referencia del Sistema Nacional de Salud (CSUR), Centro de Investigación Biomédica en Red (CIBERER), Madrid, España
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15
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Bozkurt T, Alanay Y, Isik U, Sezerman U. Re-analysis of whole-exome sequencing data reveals a novel splicing variant in the SLC2A1 in a patient with GLUT1 Deficiency Syndrome 1 accompanied by hemangioma: a case report. BMC Med Genomics 2021; 14:197. [PMID: 34332575 PMCID: PMC8325841 DOI: 10.1186/s12920-021-01045-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 07/22/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND GLUT1 Deficiency Syndrome 1 (GLUT1DS1) is a neurological disorder caused by either heterozygous or homozygous mutations in the Solute Carrier Family 2, Member 1 (SLC2A1) gene. SLC2A1 encodes Glucose transporter type 1 (GLUT1) protein, which is the primary glucose transporter at the blood-brain barrier. A ketogenic diet (KD) provides an alternative fuel for brain metabolism to treat impaired glucose transport. By reanalyzing exome data, we identified a de novo heterozygous SLC2A1 variant in a girl with epilepsy. After reversed phenotyping with neurometabolic tests, she was diagnosed with GLUT1DS1 and started on a KD. The patient's symptoms responded to the diet. Here, we report a patient with GLUT1DS1 with a novel SLC2A1 mutation. She also has a hemangioma which has not been reported in association with this syndrome before. CASE PRESENTATION A 5-year 8-month girl with global developmental delay, spasticity, intellectual disability, dysarthric speech, abnormal eye movements, and hemangioma. The electroencephalography (EEG) result revealed that she had epilepsy. Magnetic resonance imaging (MRI) showed that non-specific white matter abnormalities. Whole Exome Sequencing (WES) was previously performed, but the case remained unsolved. The re-analysis of WES data revealed a heterozygous splicing variant in the SLC2A1 gene. Segregation analysis with parental DNA samples indicated that the variant occurred de novo. Lumbar puncture (LP) confirmed the diagnosis, and the patient started on a KD. Her seizures responded to the KD. She has been seizure-free since shortly after the initiation of the diet. She also had decreased involuntary movements, her speech became more understandable, and her vocabulary increased after the diet. CONCLUSIONS We identified a novel de novo variant in the SLC2A1 gene in a patient who previously had a negative WES result. The patient has been diagnosed with GLUT1DS1. The syndrome is a treatable condition, but the differential diagnosis is not an easy process due to showing a wide range of phenotypic spectrum and the overlapping symptoms with other neurological diseases. The diagnosis necessitates a genomic testing approach. Our findings also highlight the importance of re-analysis to undiagnosed cases after initial WES to reveal disease-causing variants.
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Affiliation(s)
- Tugce Bozkurt
- Biostatistics and Bioinformatics Program, Graduate School of Health Sciences, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Yasemin Alanay
- Division of Pediatric Genetics, Department of Pediatrics, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Ugur Isik
- Division of Pediatric Neurology, Department of Pediatrics, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Ugur Sezerman
- Biostatistics and Bioinformatics Program, Graduate School of Health Sciences, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey.
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Tajima D, Nakamura T, Ichinose F, Okamoto N, Tomonoh Y, Uda K, Furukawa R, Tashiro K, Matsuo M. Transient hypoglycorrhachia with paroxysmal abnormal eye movement in early infancy. Brain Dev 2021; 43:482-485. [PMID: 33248857 DOI: 10.1016/j.braindev.2020.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 10/30/2020] [Accepted: 11/08/2020] [Indexed: 11/17/2022]
Abstract
Paroxysmal abnormal eye movement in early infancy is one of the initial symptoms of glucose transporter 1 deficiency syndrome (GLUT1DS). We describe four early infants with transient hypoglycorrhachia presenting with abnormal eye movements. Their symptoms disappeared after the introduction of a ketogenic diet (KD), and their development was normal. Since no variants in SLC2A1 were detected, the CSF-to-blood glucose ratios (C/B) were re-examined, and within normal range. None of the four patients displayed recurrent symptoms after withdrawal from the KD. Because long-term KD has potential adverse effects and could affect the quality of life of patients and their families, re-examination of CSF glucose during late infancy should be considered in the case of absence of the SLC2A1 pathogenic variant.
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Affiliation(s)
- Daisuke Tajima
- Department of Pediatrics, Faculty of Medicine, Saga University, Japan; Department of Pediatrics, Karatsu Red Cross Hospital, Japan.
| | - Takuji Nakamura
- Department of Pediatrics, Faculty of Medicine, Saga University, Japan
| | - Fumio Ichinose
- Department of Pediatrics, Faculty of Medicine, Saga University, Japan
| | - Nobuhiko Okamoto
- Department of Medical Genetics, Osaka Women's and Children's Hospital, Japan
| | - Yuko Tomonoh
- Department of Pediatrics, Faculty of Medicine, Fukuoka University, Japan
| | - Keiko Uda
- Department of Pediatrics, Faculty of Medicine, Saga University, Japan
| | - Rie Furukawa
- Department of Pediatrics, Faculty of Medicine, Saga University, Japan; Department of Pediatrics, Karatsu Red Cross Hospital, Japan
| | - Katsuya Tashiro
- Department of Pediatrics, Faculty of Medicine, Saga University, Japan; Department of Pediatrics, Karatsu Red Cross Hospital, Japan
| | - Muneaki Matsuo
- Department of Pediatrics, Faculty of Medicine, Saga University, Japan
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17
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Frucht L, Perez DL, Callahan J, MacLean J, Song PC, Sharma N, Stephen CD. Functional Dystonia: Differentiation From Primary Dystonia and Multidisciplinary Treatments. Front Neurol 2021; 11:605262. [PMID: 33613415 PMCID: PMC7894256 DOI: 10.3389/fneur.2020.605262] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/31/2020] [Indexed: 12/12/2022] Open
Abstract
Dystonia is a common movement disorder, involving sustained muscle contractions, often resulting in twisting and repetitive movements and abnormal postures. Dystonia may be primary, as the sole feature (isolated) or in combination with other movement disorders (combined dystonia), or as one feature of another neurological process (secondary dystonia). The current hypothesis is that dystonia is a disorder of distributed brain networks, including the basal ganglia, cerebellum, thalamus and the cortex resulting in abnormal neural motor programs. In comparison, functional dystonia (FD) may resemble other forms of dystonia (OD) but has a different pathophysiology, as a subtype of functional movement disorders (FMD). FD is the second most common FMD and amongst the most diagnostically challenging FMD subtypes. Therefore, distinguishing between FD and OD is important, as the management of these disorders is distinct. There are also different pathophysiological underpinnings in FD, with for example evidence of involvement of the right temporoparietal junction in functional movement disorders that is believed to serve as a general comparator of internal predictions/motor intentions with actual motor events resulting in disturbances in self-agency. In this article, we present a comprehensive review across the spectrum of FD, including oromandibular and vocal forms and discuss the history, clinical clues, evidence for adjunctive "laboratory-based" testing, pathophysiological research and prognosis data. We also provide the approach used at the Massachusetts General Hospital Dystonia Center toward the diagnosis, management and treatment of FD. A multidisciplinary approach, including neurology, psychiatry, physical, occupational therapy and speech therapy, and cognitive behavioral psychotherapy approaches are frequently required; pharmacological approaches, including possible targeted use of botulinum toxin injections and inpatient programs are considerations in some patients. Early diagnosis and treatment may help prevent unnecessary investigations and procedures, while facilitating the appropriate management of these highly complex patients, which may help to mitigate frequently poor clinical outcomes.
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Affiliation(s)
- Lucy Frucht
- Faculty of Arts and Sciences, Harvard University, Boston, MA, United States
| | - David L. Perez
- Cognitive Behavioral Neurology Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Functional Neurological Disorder Research Program, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Neuropsychiatry Division, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Janet Callahan
- MGH Institute of Healthcare Professionals, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Julie MacLean
- Occupational Therapy Department, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Phillip C. Song
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, United States
| | - Nutan Sharma
- Functional Neurological Disorder Research Program, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Dystonia Center and Movement Disorders Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Christopher D. Stephen
- Functional Neurological Disorder Research Program, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Dystonia Center and Movement Disorders Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
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18
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Farfán-Albarracín JD, Ramírez-Sierra CL, Espitia Segura OM, Pérez SH, Téllez Prada HA, Rueda Rodríguez MC, Lemus Espitia I, Bedoya AM. Diagnostic yield of capillary compared to venous glucose in the diagnosis of hypoglycorrhachia in children: A prospective, observational study. Brain Dev 2021; 43:63-68. [PMID: 32741582 DOI: 10.1016/j.braindev.2020.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/16/2020] [Accepted: 07/21/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The ratio of cerebrospinal fluid (CSF) glucose and blood glucose is of major relevance, conducting to the diagnosis of hypoglycorrhachia, which is a sign of neuroinfection, as well as a number of neurological diseases of genetic or neoplastic etiology. Glucose in capillary sample (glucometry) is a low cost, readily available technique, as compared to venous glucose. This study aims to compare glucometry to venous glucose in the diagnosis of hypoglycorrhachia in pediatric population. METHODS Prospective cross-sectional study based on data obtained from lumbar punctures in the period from February 2017 to January 2019 in a specialized pediatric institution in Colombia. RESULTS 97 patients were analyzed, aged 1 month to 17 years old, mean 7.67 years, 52 (53.61%) were female. 26 (26.8%) were diagnosed with hypoglycorrhachia. Pearson correlation coefficient for absolute venous and capillary glucose was 0.54, and 0.55 for the ratios of CSF glucose/venous glucose and CSF glucose/glucometry, which support a linear correlation between the variables in both, absolute values and ratios. Intraclass correlation coefficient was calculated for both, the venous glucose and glucometry ratios, which was 0.52, revealing a moderate agreement among the tests. Sensitivity and specificity of CSF glucose/glucometry, as compared to gold standard are 73.1% and 60.6% respectively; whereas predictive positive value (PPV) and negative predictive value (NPV), were 40.4% and 86.0%. CONCLUSION Glucometry cannot replace the glucose in venous sample in the diagnosis of hypoglycorrhachia in children.
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Affiliation(s)
| | | | | | - Sofy Helena Pérez
- Child Neurology Department, HOMI Fundación Hospital Pediátrico la Misericordia, Colombia; Child Neurology Unit, Pediatrics Department, Faculty of Medicine, National University of Colombia, Colombia
| | - Hugo Andrés Téllez Prada
- Child Neurology Department, HOMI Fundación Hospital Pediátrico la Misericordia, Colombia; Child Neurology Unit, Pediatrics Department, Faculty of Medicine, National University of Colombia, Colombia
| | - María Camila Rueda Rodríguez
- Child Neurology Department, HOMI Fundación Hospital Pediátrico la Misericordia, Colombia; Child Neurology Unit, Pediatrics Department, Faculty of Medicine, National University of Colombia, Colombia
| | - Ingrid Lemus Espitia
- Child Neurology Department, HOMI Fundación Hospital Pediátrico la Misericordia, Colombia; Child Neurology Unit, Pediatrics Department, Faculty of Medicine, National University of Colombia, Colombia
| | - Ana Maritza Bedoya
- Child Neurology Department, HOMI Fundación Hospital Pediátrico la Misericordia, Colombia; Child Neurology Unit, Pediatrics Department, Faculty of Medicine, National University of Colombia, Colombia
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19
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Clinical characteristics and diagnostic clues to Neurometabolic causes of dystonia. J Neurol Sci 2020; 419:117167. [DOI: 10.1016/j.jns.2020.117167] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/22/2020] [Accepted: 09/29/2020] [Indexed: 12/30/2022]
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20
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Algahtani H, Shirah B, Albarakaty A, Al-Qahtani MH, Abdulkareem AA, Naseer MI. A Novel Intronic Variant in SLC2A1 Gene in a Saudi Patient with Myoclonic Epilepsy. J Epilepsy Res 2020; 10:40-43. [PMID: 32983954 PMCID: PMC7494885 DOI: 10.14581/jer.20007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/14/2020] [Accepted: 05/01/2020] [Indexed: 11/25/2022] Open
Abstract
Cerebral metabolism is primarily dependent on glucose for which a facilitated diffusion by glucose transporter protein 1 (GLUT1) across the blood-brain barrier is crucial. This GLUT1 is encoded by the SLC2A1 gene. Mutations in SLC2A1 will lead to a variety of symptoms known as GLUT1 deficiency syndrome. In this article, we report a novel heterozygous intronic variant c.1278+12delC in the SLC2A1 gene in a Saudi patient with myoclonic epilepsy. We also report a new clinical phenotype where the patient has pure myoclonic epilepsy with no focal, absence, or atonic seizures and normal developmental and cognitive functions that started in childhood rather than infancy. Our study enriches the mutation-spectrum of the SLC2A1 gene and stresses on the importance of whole-exome sequencing in the diagnosis of genetic epilepsies. Early diagnosis and initiation of a ketogenic diet are important goals for the successful management of patients with GLUT1 deficiency syndrome.
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Affiliation(s)
- Hussein Algahtani
- King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Bader Shirah
- King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Ahmad Albarakaty
- King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Mohammad H Al-Qahtani
- Center of Excellence in Genomic Medicine Research, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Muhammad Imran Naseer
- Center of Excellence in Genomic Medicine Research, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
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21
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Vaudano AE, Olivotto S, Ruggieri A, Gessaroli G, Talami F, Parmeggiani A, De Giorgis V, Veggiotti P, Meletti S. The effect of chronic neuroglycopenia on resting state networks in GLUT1 syndrome across the lifespan. Hum Brain Mapp 2020; 41:453-466. [PMID: 31710770 PMCID: PMC7313681 DOI: 10.1002/hbm.24815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 09/18/2019] [Accepted: 09/20/2019] [Indexed: 12/20/2022] Open
Abstract
Glucose transporter type I deficiency syndrome (GLUT1DS) is an encephalopathic disorder due to a chronic insufficient transport of glucose into the brain. PET studies in GLUT1DS documented a widespread cortico‐thalamic hypometabolism and a signal increase in the basal ganglia, regardless of age and clinical phenotype. Herein, we captured the pattern of functional connectivity of distinct striatal, cortical, and cerebellar regions in GLUT1DS (10 children, eight adults) and in healthy controls (HC, 19 children, 17 adults) during rest. Additionally, we explored for regional connectivity differences in GLUT1 children versus adults and according to the clinical presentation. Compared to HC, GLUT1DS exhibited increase connectivity within the basal ganglia circuitries and between the striatal regions with the frontal cortex and cerebellum. The excessive connectivity was predominant in patients with movement disorders and in children compared to adults, suggesting a correlation with the clinical phenotype and age at fMRI study. Our findings highlight the primary role of the striatum in the GLUT1DS pathophysiology and confirm the dependency of symptoms to the patients' chronological age. Despite the reduced chronic glucose uptake, GLUT1DS exhibit increased connectivity changes in regions highly sensible to glycopenia. Our results may portrait the effect of neuroprotective brain strategy to overcome the chronic poor energy supply during vulnerable ages.
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Affiliation(s)
- Anna Elisabetta Vaudano
- Neurology Unit, OCSAE Hospital, AOU Modena, Modena, Italy.,Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Sara Olivotto
- Pediatric Neurology Unit, V. Buzzi Hospital, University of Milan, Milan, Italy
| | - Andrea Ruggieri
- Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Francesca Talami
- Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Antonia Parmeggiani
- Child Neurology and Psychiatry Unit, Policlinico S. Orsola-Malpighi, Bologna, Italy.,Department of Medical and Surgical Sciences, University of Bologna, Italy
| | | | | | - Stefano Meletti
- Neurology Unit, OCSAE Hospital, AOU Modena, Modena, Italy.,Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
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22
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Screening of SLC2A1 in a large cohort of patients suspected for Glut1 deficiency syndrome: identification of novel variants and associated phenotypes. J Neurol 2019; 266:1439-1448. [PMID: 30895386 DOI: 10.1007/s00415-019-09280-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 03/04/2019] [Accepted: 03/13/2019] [Indexed: 10/27/2022]
Abstract
Glucose transporter type 1 deficiency syndrome (Glut1 DS) is a rare neurological disorder caused by impaired glucose delivery to the brain. The clinical spectrum of Glut1 DS mainly includes epilepsy, paroxysmal dyskinesia (PD), developmental delay and microcephaly. Glut1 DS diagnosis is based on the identification of hypoglycorrhachia and pathogenic mutations of the SLC2A1 gene. Here, we report the molecular screening of SLC2A1 in 354 patients clinically suspected for Glut1 DS. From this cohort, we selected 245 patients for whom comprehensive clinical and laboratory data were available. Among them, we identified 19 patients carrying nucleotide variants of pathological significance, 5 of which were novel. The symptoms of onset, which varied from neonatal to adult age, included epilepsy, PD or non-epileptic paroxysmal manifestations. The comparison of the clinical features between the 19 SLC2A1 mutated and the 226 non-mutated patients revealed that the onset of epilepsy within the first year of life (when associated with developmental delay or other neurological manifestations), the association of epilepsy with PD and acquired microcephaly are more common in mutated subjects. Taken together, these data confirm the variability of expression of the phenotypes associated with mutation of SLC2A1 and provide useful clinical tools for the early identification of subjects highly suspected for the disease.
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23
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Verrotti A, Di Francesco L, Striano P. GLUT1 deficiency and pediatric-onset hereditary spastic paraplegia: A new association. Eur J Paediatr Neurol 2019; 23:233-234. [PMID: 30876650 DOI: 10.1016/j.ejpn.2019.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Alberto Verrotti
- Department of Pediatrics, University of L'Aquila, L'Aquila, Italy.
| | | | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, 'G. Gaslini' Institute, University of Genoa, Genova, Italy.
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24
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Di Vito L, Licchetta L, Pippucci T, Baldassari S, Stipa C, Mostacci B, Alvisi L, Tinuper P, Bisulli F. Phenotype variability of GLUT1 deficiency syndrome: Description of a case series with novel SLC2A1 gene mutations. Epilepsy Behav 2018; 79:169-173. [PMID: 29306089 DOI: 10.1016/j.yebeh.2017.12.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 12/13/2017] [Accepted: 12/15/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Lidia Di Vito
- IRCCS Institute of Neurological Sciences, Via Altura 3, 40137 Bologna, Italy
| | - Laura Licchetta
- IRCCS Institute of Neurological Sciences, Via Altura 3, 40137 Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
| | - Tommaso Pippucci
- U.O. Medical Genetics, Sant'Orsola-Malpighi University Hospital, Bologna, Italy.
| | - Sara Baldassari
- IRCCS Institute of Neurological Sciences, Via Altura 3, 40137 Bologna, Italy.
| | - Carlotta Stipa
- IRCCS Institute of Neurological Sciences, Via Altura 3, 40137 Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Barbara Mostacci
- IRCCS Institute of Neurological Sciences, Via Altura 3, 40137 Bologna, Italy.
| | - Lara Alvisi
- IRCCS Institute of Neurological Sciences, Via Altura 3, 40137 Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
| | - Paolo Tinuper
- IRCCS Institute of Neurological Sciences, Via Altura 3, 40137 Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
| | - Francesca Bisulli
- IRCCS Institute of Neurological Sciences, Via Altura 3, 40137 Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
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26
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Gras D, Cousin C, Kappeler C, Fung CW, Auvin S, Essid N, Chung BH, Da Costa L, Hainque E, Luton MP, Petit V, Vuillaumier-Barrot S, Boespflug-Tanguy O, Roze E, Mochel F. A simple blood test expedites the diagnosis of glucose transporter type 1 deficiency syndrome. Ann Neurol 2017; 82:133-138. [PMID: 28556183 PMCID: PMC5601183 DOI: 10.1002/ana.24970] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 04/22/2017] [Accepted: 05/13/2017] [Indexed: 11/10/2022]
Abstract
Glucose transporter type 1 (GLUT1) deficiency syndrome (GLUT1‐DS) leads to a wide range of neurological symptoms. Ketogenic diets are very efficient to control epilepsy and movement disorders. We tested a novel simple and rapid blood test in 30 patients with GLUT1‐DS with predominant movement disorders, 18 patients with movement disorders attributed to other genetic defects, and 346 healthy controls. We detected significantly reduced GLUT1 expression only on red blood cells from patients with GLUT1‐DS (23 patients; 78%), including patients with inconclusive genetic analysis. This test opens perspectives for the screening of GLUT1‐DS in children and adults with cognitive impairment, movement disorder, or epilepsy. Ann Neurol 2017;82:133–138
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Affiliation(s)
- Domitille Gras
- APHP, Robert-Debré University Hospital, Department of Paediatric Neurology and Metabolic Diseases, Paris, France
| | | | - Caroline Kappeler
- Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Université Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
| | - Cheuk-Wing Fung
- Queen Mary Hospital, Department of Pediatrics and Adolescent Medicine, Hong Kong
| | - Stéphane Auvin
- APHP, Robert-Debré University Hospital, Department of Paediatric Neurology and Metabolic Diseases, Paris, France.,Inserm U 1141, Université Paris Diderot, Sorbonne Paris Cité, DHU Protect, Paris, France
| | - Nouha Essid
- APHP, Raymond-Poincaré Hospital, Department of Neuropediatrics, Paris, France
| | - Brian Hy Chung
- Queen Mary Hospital, Department of Pediatrics and Adolescent Medicine, Hong Kong
| | - Lydie Da Costa
- APHP, Robert-Debré University Hospital, Laboratory of Hematology, Paris, France.,Inserm U 1134; LABEX Gr-Ex; Université Paris Diderot, Paris, France
| | - Elodie Hainque
- Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Université Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France.,APHP, Pitié-Salpêtrière University Hospital, Department of Neurology, Paris, France
| | - Marie-Pierre Luton
- Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Université Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
| | | | | | - Odile Boespflug-Tanguy
- APHP, Robert-Debré University Hospital, Department of Paediatric Neurology and Metabolic Diseases, Paris, France
| | - Emmanuel Roze
- Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Université Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France.,APHP, Pitié-Salpêtrière University Hospital, Department of Neurology, Paris, France
| | - Fanny Mochel
- Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Université Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France.,APHP, Pitié-Salpêtrière University Hospital, Department of Genetics, Paris, France.,University Pierre and Marie Curie, Neurometabolic Research Group, Paris, France
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27
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Mochel F. Triheptanoin for the treatment of brain energy deficit: A 14-year experience. J Neurosci Res 2017; 95:2236-2243. [PMID: 28688166 DOI: 10.1002/jnr.24111] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 06/10/2017] [Accepted: 06/15/2017] [Indexed: 12/11/2022]
Abstract
Triheptanoin is an odd-chain triglyceride with anaplerotic properties-that is, replenishing the pool of metabolic intermediates in the Krebs cycle. Unlike even-chain fatty acids metabolized to acetyl-CoA only, triheptanoin can indeed provide both acetyl-CoA and propionyl-CoA, two key carbon sources for the Krebs cycle. Triheptanoin was initially used in patients with long-chain fatty acid oxidation disorders. The first demonstration of the possible benefit of triheptanoin for brain energy deficit came from a patient with pyruvate carboxylase deficiency, a severe metabolic disease that affects anaplerosis in the brain. In an open-label study, triheptanoin was then shown to decrease nonepileptic paroxysmal manifestations by 90% in patients with glucose transporter 1 deficiency syndrome, a disease that affects glucose transport into the brain. 31 P magnetic resonance spectroscopy studies also indicated that triheptanoin was able to correct bioenergetics in the brain of patients with Huntington disease, a neurodegenerative disease associated with brain energy deficit. Altogether, these studies indicate that triheptanoin can be a treatment for brain energy deficit related to altered anaplerosis and/or glucose metabolism. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Fanny Mochel
- Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France.,AP-HP, Pitié-Salpêtrière University Hospital, Department of Genetics, Paris, France.,University Pierre and Marie Curie, Neurometabolic Research Group, Paris, France
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28
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Çolak R, Alkan Özdemir S, Yangın Ergon E, Kağnıcı M, Çalkavur Ş. A Different SLC2A1 Gene Mutation in Glut 1 Deficiency Syndrome: c.734A>C. Balkan Med J 2017; 34:580-583. [PMID: 28443597 PMCID: PMC5785666 DOI: 10.4274/balkanmedj.2016.1376] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background: Glucose transporter type 1 deficiency syndrome is the result of impaired glucose transport into the brain. Patients with glucose transporter type 1 syndrome may present with infantile seizures, developmental delay, acquired microcephaly, spasticity and ataxia. Case Report: Here, we report a rare case of glucose transporter type 1 deficiency syndrome caused by a different pathogenic variant in a 10-day-old neonate who presented with intractable seizures and respiratory arrest. Conclusion: This new pathogenic variant can be seen in glucose transporter type 1 deficiency syndrome.
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Affiliation(s)
- Rüya Çolak
- Clinic of Neonatology, Dr. Behçet Uz Children's Hospital, İzmir, Turkey
| | | | - Ezgi Yangın Ergon
- Clinic of Neonatology, Dr. Behçet Uz Children's Hospital, İzmir, Turkey
| | - Mehtap Kağnıcı
- Clinic of Pediatric Metabolism, Dr. Behçet Uz Children's Hospital, İzmir, Turkey
| | - Şebnem Çalkavur
- Clinic of Neonatology, Dr. Behçet Uz Children's Hospital, İzmir, Turkey
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29
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Dai Y, Zhao Y, Tomi M, Shin BC, Thamotharan S, Mazarati A, Sankar R, Wang EA, Cepeda C, Levine MS, Zhang J, Frew A, Alger JR, Clark PM, Sondhi M, Kositamongkol S, Leibovitch L, Devaskar SU. Sex-Specific Life Course Changes in the Neuro-Metabolic Phenotype of Glut3 Null Heterozygous Mice: Ketogenic Diet Ameliorates Electroencephalographic Seizures and Improves Sociability. Endocrinology 2017; 158:936-949. [PMID: 28324109 PMCID: PMC5460805 DOI: 10.1210/en.2016-1816] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 01/18/2017] [Indexed: 01/13/2023]
Abstract
We tested the hypothesis that exposure of glut3+/- mice to a ketogenic diet ameliorates autism-like features, which include aberrant behavior and electrographic seizures. We first investigated the life course sex-specific changes in basal plasma-cerebrospinal fluid (CSF)-brain metabolic profile, brain glucose transport/uptake, glucose and monocarboxylate transporter proteins, and adenosine triphosphate (ATP) in the presence or absence of systemic insulin administration. Glut3+/- male but not female mice (5 months of age) displayed reduced CSF glucose/lactate concentrations with no change in brain Glut1, Mct2, glucose uptake or ATP. Exogenous insulin-induced hypoglycemia increased brain glucose uptake in glut3+/- males alone. Higher plasma-CSF ketones (β-hydroxybutyrate) and lower brain Glut3 in females vs males proved protective in the former while enhancing vulnerability in the latter. As a consequence, increased synaptic proteins (neuroligin4 and SAPAP1) with spontaneous excitatory postsynaptic activity subsequently reduced hippocampal glucose content and increased brain amyloid β1-40 deposition in an age-dependent manner in glut3+/- males but not females (4 to 24 months of age). We then explored the protective effect of a ketogenic diet on ultrasonic vocalization, sociability, spatial learning and memory, and electroencephalogram seizures in male mice (7 days to 6 to 8 months of age) alone. A ketogenic diet partially restored sociability without affecting perturbed vocalization, spatial learning and memory, and reduced seizure events. We conclude that (1) sex-specific and age-dependent perturbations underlie the phenotype of glut3+/- mice, and (2) a ketogenic diet ameliorates seizures caused by increased cortical excitation and improves sociability, but fails to rescue vocalization and cognitive deficits in glut3+/- male mice.
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Affiliation(s)
- Yun Dai
- Department of Pediatrics, Division of Neonatology & Developmental Biology, Neonatal Research Center at the UCLA Children’s Discovery and Innovation Institute
| | - Yuanzi Zhao
- Department of Pediatrics, Division of Neonatology & Developmental Biology, Neonatal Research Center at the UCLA Children’s Discovery and Innovation Institute
| | - Masatoshi Tomi
- Department of Pediatrics, Division of Neonatology & Developmental Biology, Neonatal Research Center at the UCLA Children’s Discovery and Innovation Institute
| | - Bo-Chul Shin
- Department of Pediatrics, Division of Neonatology & Developmental Biology, Neonatal Research Center at the UCLA Children’s Discovery and Innovation Institute
| | - Shanthie Thamotharan
- Department of Pediatrics, Division of Neonatology & Developmental Biology, Neonatal Research Center at the UCLA Children’s Discovery and Innovation Institute
| | | | - Raman Sankar
- Department of Pediatrics, Division of Neurology
- Department of Neurology
| | - Elizabeth A. Wang
- Intellectual and Developmental Disabilities Research Center and Brain Research Institute
| | - Carlos Cepeda
- Intellectual and Developmental Disabilities Research Center and Brain Research Institute
| | - Michael S. Levine
- Intellectual and Developmental Disabilities Research Center and Brain Research Institute
| | - Jingjing Zhang
- Department of Neurology
- Intellectual and Developmental Disabilities Research Center and Brain Research Institute
| | - Andrew Frew
- Department of Neurology
- Ahmanson-Lovelace Brain Mapping Center
| | - Jeffry R. Alger
- Department of Neurology
- Ahmanson-Lovelace Brain Mapping Center
| | - Peter M. Clark
- Department of Molecular and Medical Pharmacology and Crump Institute for Molecular Imaging, David Geffen School of Medicine at UCLA, Los Angeles, California 90095
| | - Monica Sondhi
- Department of Pediatrics, Division of Neonatology & Developmental Biology, Neonatal Research Center at the UCLA Children’s Discovery and Innovation Institute
| | - Sudatip Kositamongkol
- Department of Pediatrics, Division of Neonatology & Developmental Biology, Neonatal Research Center at the UCLA Children’s Discovery and Innovation Institute
| | - Leah Leibovitch
- Department of Pediatrics, Division of Neonatology & Developmental Biology, Neonatal Research Center at the UCLA Children’s Discovery and Innovation Institute
| | - Sherin U. Devaskar
- Department of Pediatrics, Division of Neonatology & Developmental Biology, Neonatal Research Center at the UCLA Children’s Discovery and Innovation Institute
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30
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Vaudano AE, Olivotto S, Ruggieri A, Gessaroli G, De Giorgis V, Parmeggiani A, Veggiotti P, Meletti S. Brain correlates of spike and wave discharges in GLUT1 deficiency syndrome. NEUROIMAGE-CLINICAL 2016; 13:446-454. [PMID: 28116237 PMCID: PMC5233795 DOI: 10.1016/j.nicl.2016.12.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 11/04/2016] [Accepted: 12/19/2016] [Indexed: 11/25/2022]
Abstract
Purpose To provide imaging biomarkers of generalized spike-and-wave discharges (GSWD) in patients with GLUT1 deficiency syndrome (GLUT1DS). Methods Eighteen GLUT1DS patients with pathogenetic mutation in SLC2A1 gene were studied by means of Video-EEG simultaneously recorded with functional MRI (VideoEEG-fMRI). A control group of sex and age-matched patients affected by Genetic Generalized Epilepsy (GGE) with GSWD were investigated with the same protocol. Within and between groups comparison was performed as appropriated. For GLUT1DS, correlations analyses between the contrast of interest and the main clinical measurements were provided. Results EEG during fMRI revealed interictal GSWD in 10 GLUT1DS patients. Group-level analysis showed BOLD signal increases at the premotor cortex and putamen. With respect to GGE, GLUT1DS patients demonstrated increased neuronal activity in the putamen, precuneus, cingulate cortex, SMA and paracentral lobule. Whole-brain correlation analyses disclosed a linear relationship between the GSWD-related BOLD changes and the levels of glycorrhachia at diagnosis over the sensory-motor cortex and superior parietal lobuli. Conclusion The BOLD dynamics related to GSWD in GLUT1DS are substantially different from typical GGE showing the former an increased activity in the premotor-striatal network and a decrease in the thalamus. The revealed hemodynamic maps might represent imaging biomarkers of GLUT1DS, being potentially useful for a precocious diagnosis of this genetic disorder. First report describing the epilepsy-related hemodynamic patterns in GLUT1DS. The revealed BOLD maps can represent GLUT1DS imaging biomarkers. The premotor-striatal network generates the GSWD in GLUT1DS. The glycorrhachia at diagnosis influences the epilepsy-related BOLD maps.
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Affiliation(s)
- Anna Elisabetta Vaudano
- Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; N.O.C.S.A.E. Hospital, AUSL Modena, 41100 Modena, Italy
| | - Sara Olivotto
- Brain and Behavior Department, University of Pavia, Pavia, Italy
| | - Andrea Ruggieri
- Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | - Antonia Parmeggiani
- Child Neurology and Psychiatry Unit, Policlinico S. Orsola-Malpighi, Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Pierangelo Veggiotti
- Brain and Behavior Department, University of Pavia, Pavia, Italy; Department of Child Neurology and Psychiatry, "C. Mondino" National Neurological Institute, Pavia, Italy
| | - Stefano Meletti
- Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; N.O.C.S.A.E. Hospital, AUSL Modena, 41100 Modena, Italy
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31
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Glucose Transporters at the Blood-Brain Barrier: Function, Regulation and Gateways for Drug Delivery. Mol Neurobiol 2016; 54:1046-1077. [PMID: 26801191 DOI: 10.1007/s12035-015-9672-6] [Citation(s) in RCA: 201] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 12/17/2015] [Indexed: 12/31/2022]
Abstract
Glucose transporters (GLUTs) at the blood-brain barrier maintain the continuous high glucose and energy demands of the brain. They also act as therapeutic targets and provide routes of entry for drug delivery to the brain and central nervous system for treatment of neurological and neurovascular conditions and brain tumours. This article first describes the distribution, function and regulation of glucose transporters at the blood-brain barrier, the major ones being the sodium-independent facilitative transporters GLUT1 and GLUT3. Other GLUTs and sodium-dependent transporters (SGLTs) have also been identified at lower levels and under various physiological conditions. It then considers the effects on glucose transporter expression and distribution of hypoglycemia and hyperglycemia associated with diabetes and oxygen/glucose deprivation associated with cerebral ischemia. A reduction in glucose transporters at the blood-brain barrier that occurs before the onset of the main pathophysiological changes and symptoms of Alzheimer's disease is a potential causative effect in the vascular hypothesis of the disease. Mutations in glucose transporters, notably those identified in GLUT1 deficiency syndrome, and some recreational drug compounds also alter the expression and/or activity of glucose transporters at the blood-brain barrier. Approaches for drug delivery across the blood-brain barrier include the pro-drug strategy whereby drug molecules are conjugated to glucose transporter substrates or encapsulated in nano-enabled delivery systems (e.g. liposomes, micelles, nanoparticles) that are functionalised to target glucose transporters. Finally, the continuous development of blood-brain barrier in vitro models is important for studying glucose transporter function, effects of disease conditions and interactions with drugs and xenobiotics.
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32
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Nationwide survey of glucose transporter-1 deficiency syndrome (GLUT-1DS) in Japan. Brain Dev 2015; 37:780-9. [PMID: 25487684 DOI: 10.1016/j.braindev.2014.11.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Revised: 10/20/2014] [Accepted: 11/20/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVES We conducted a nationwide survey of glucose transporter type-1 deficiency syndrome (GLUT-1DS) in Japan in order to clarify its incidence as well as clinical and laboratory information. SUBJECTS AND METHODS A questionnaire to survey the number of genetically and clinically confirmed cases of GLUT-1DS was sent to 1018 board-certified pediatric neurologists, which resulted in 57 patients being reported. We obtained the clinical and laboratory data of 33 patients through a secondary questionnaire. RESULTS The age of the 33 patients (male: 15, female: 18) at the time of the study ranged between 3 and 35 years (mean: 13.5 years). The age of these patients at the onset of initial neurological symptoms ranged between the neonatal period and 48 months (mean: 9.4 months). GLUT-1DS was diagnosed at a mean age of 8.4 years (range: 1 year to 33 years). The initial symptom was convulsive seizures, which occurred in 15 cases, and was followed by abnormal eye movements in 7 cases and apneic or cyanotic attacks in 4 cases. The latter two symptoms most frequently occurred early in infancy. Thirty-two patients (97%) exhibited some type of epileptic seizure. Neurological findings revealed that most patients had muscle hypotonia, cerebellar ataxia, dystonia, and spastic paralysis. Mild to severe mental retardation was detected in all 33 cases. Furthermore, paroxysmal episodes of ataxia, dystonia/dyskinesia, and motor paralysis were described in approximately 1/3 of all patients. The factors that frequently aggravated these events were hunger, exercise, fever, and fatigue, in that order. The mean CSF/blood glucose ratio was 0.36 (0.28-0.48). Pathological mutations in the SLC2A1 gene were identified in 28 out of 32 cases (87.5%). CONCLUSION The results described herein provided an insight into the early diagnosis of GLUT1-DS, including unexplained paroxysmal abnormal eye movements, apneic/cyanotic attacks, and convulsive seizures in infancy, as well as uncommon paroxysmal events (ataxia, atonia, and motor paralysis) in childhood.
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33
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LeDoux MS. Dystonia. Mov Disord 2015. [DOI: 10.1016/b978-0-12-405195-9.00024-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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34
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Posar A, Santucci M. Unusual phenotype of glucose transport protein type 1 deficiency syndrome: A case report and literature review. J Pediatr Neurosci 2014; 9:36-8. [PMID: 24891901 PMCID: PMC4040030 DOI: 10.4103/1817-1745.131481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The glucose transport protein type 1 (GLUT1) deficit causes a chronic brain energy failure. The classic phenotype of GLUT1 deficiency syndrome is characterized by: Mild to severe motor delay and mental retardation; infantile-onset epilepsy; head growth deceleration; movement disorders (ataxia, dystonia, spasticity); and non-epileptic paroxysmal events (intermittent ataxia, periodic confusion, recurrent headaches). During last years the classic phenotype of this syndrome, as originally reported, has expanded. We report the atypical phenotype of a boy with GLUT1 deficiency syndrome, characterized by mild mental retardation and drug-resistant absence seizures with onset at the age of 6 years, without movement disorders nor decrease of head circumference. A prompt diagnosis of this disorder is mandatory since the ketogenic diet might represent an effective treatment.
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Affiliation(s)
- Annio Posar
- Department of Biomedical and Neuromotor Sciences, Child Neurology and Psychiatry Unit, IRCCS Institute of Neurological Sciences of Bologna, University of Bologna, Bologna, Italy
| | - Margherita Santucci
- Department of Biomedical and Neuromotor Sciences, Child Neurology and Psychiatry Unit, IRCCS Institute of Neurological Sciences of Bologna, University of Bologna, Bologna, Italy
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35
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Ganos C, Edwards MJ, Bhatia KP. The Phenomenology of Functional (Psychogenic) Dystonia. Mov Disord Clin Pract 2014; 1:36-44. [PMID: 30363921 PMCID: PMC6183180 DOI: 10.1002/mdc3.12013] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 02/21/2014] [Accepted: 02/24/2014] [Indexed: 12/29/2022] Open
Abstract
From the very first descriptions of dystonia, there has been a lack of agreement on the differentiation of organic from functional (psychogenic) dystonia. This lack of agreement has had a significant effect on patients over the years, most particularly in the lack of access to appropriate management, whether for those with organic dystonia diagnosed as having a functional cause or vice versa. However, clinico-genetic advances have led to greater certainty about the phenomenology of organic dystonia and therefore recognition of atypical forms. The diagnosis of functional dystonia rests on recognition of its phenomenology and should not be, as far as possible, a diagnosis of exclusion. Here, we present an overview of the phenomenology of functional dystonia, concentrating on the three main phenotypic presentations: functional cranial dystonia; functional fixed dystonia; and functional paroxysmal dystonia. We hope that this review of phenomenology will aid in the positive diagnosis of functional dystonia and, through this, will lead to more rapid access to appropriate management.
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Affiliation(s)
- Christos Ganos
- Sobell Department of Motor Neuroscience and Movement DisordersUCL Institute of NeurologyUniversity College LondonLondonUnited Kingdom
- Department of NeurologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
- Department of Pediatric and Adult Movement Disorders and NeuropsychiatryInstitute of NeurogeneticsUniversity of LübeckLübeckGermany
| | - Mark J. Edwards
- Sobell Department of Motor Neuroscience and Movement DisordersUCL Institute of NeurologyUniversity College LondonLondonUnited Kingdom
| | - Kailash P. Bhatia
- Sobell Department of Motor Neuroscience and Movement DisordersUCL Institute of NeurologyUniversity College LondonLondonUnited Kingdom
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Veggiotti P, De Giorgis V. Dietary Treatments and New Therapeutic Perspective in GLUT1 Deficiency Syndrome. Curr Treat Options Neurol 2014; 16:291. [PMID: 24634059 DOI: 10.1007/s11940-014-0291-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OPINION STATEMENT GLUT1 deficiency syndrome (GLUT1DS) results from impaired glucose transport into the brain: awareness of its wide phenotypic spectrum is a prerequisite in order to ensure an early diagnosis, treating the patients is the subsequent challenge to allow prompt compensation for the brain's lack of fuel. The ketogenic diet (KD) plays a primary role in the treatment of GLUT1DS because it provides ketone bodies as an alternative source to meet the demands of energy of the brain. Therefore, we recommend early initiation of the KD based on the assumption that early diagnosis and treatment improves the long term neurological outcome: the classic KD (4:1 or 3:1) at the present time is the most proven and effective in GLUT1DS. A KD should be continued at least until adolescence, although there are reports of good tolerability even in adulthood, possibly with a less rigorous ratio; in our experience seizure and movement disorder control can be achieved by a 2:1 ketogenic ratio but the relationship between ketosis and neurodevelopmental outcome remains undetermined. Other types of KDs can, therefore, be considered. The Modified Atkins diet, for example, is also well tolerated and provides effective symptom control; furthermore, this diet has the advantage of being easy to prepare and more palatable, which are important requirements for good compliance. Nevertheless, about 20 % of these patients have compliance trouble or the same diet loses its effectiveness over time; for these reasons, new therapeutic strategies are currently under investigation but further studies on pathophysiological mechanisms and potential effects of novel "diets" or "therapies" are needed for this new pathology.
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Affiliation(s)
- Pierangelo Veggiotti
- Department of Child Neurology and Psychiatry C. Mondino National Neurological Institute, Via Mondino, 2, 27100, Pavia, Italy,
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37
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Tzadok M, Nissenkorn A, Porper K, Matot I, Marcu S, Anikster Y, Menascu S, Bercovich D, Ben Zeev B. The many faces of Glut1 deficiency syndrome. J Child Neurol 2014; 29:349-59. [PMID: 23340081 DOI: 10.1177/0883073812471718] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Glucose transporter protein type 1 deficiency syndrome is a metabolic disorder manifesting as cognitive impairment, acquired microcephaly, epilepsy, and/or movement disorder caused by mutations in the SLC2A1 gene. We describe a cohort of isolated and familial cases of glucose transporter protein type 1 deficiency syndrome, emphasizing seizure semiology, electroencephalographic (EEG) features, treatment response and mutation pathogenicity. SLC2A1 mutations were detected in 3 sporadic and 4 familial cases. In addition, mutations were identified in 9 clinically unaffected family members in 2 families. The phenotypic spectrum of glucose transporter protein type 1 deficiency is wider than previously recognized, with considerable intra-familial variation. Diagnosis requires either hypoglycorrachia followed by SLC2A1 sequencing or direct gene sequencing. A ketogenic diet should be the first line of treatment, but more flexible diets, like the Atkins modified diet, can also be followed. Carbonic anhydrase inhibitors, such as acetazolamide or zonisamide, can be effective for seizure control.
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Affiliation(s)
- Michal Tzadok
- 1Pediatric Neurology Unit, Edmond and Lily Safra Childern's Hospital, Sheba Medical Center, Tel Hashomer, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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38
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Occurrence of GLUT1 deficiency syndrome in patients treated with ketogenic diet. Epilepsy Behav 2014; 32:76-8. [PMID: 24508593 DOI: 10.1016/j.yebeh.2014.01.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 01/10/2014] [Accepted: 01/12/2014] [Indexed: 11/23/2022]
Abstract
Glucose transporter 1 deficiency syndrome (GLUT1-DS) is a treatable metabolic encephalopathy caused by a mutation in the SLC2A1 gene. This mutation causes a compromised transport of glucose across the blood-brain barrier. The treatment of choice is ketogenic diet, with which most patients become seizure-free. At the National Centre for Epilepsy, we have, since 2005, offered treatment with ketogenic diet (KD) and modified Atkins diet (MAD) to children with difficult-to-treat epilepsy. As we believe many children with GLUT1-DS are unrecognized, the aim of this study was to search for patients with GLUT1-DS among those who had been responders (>50% reduction in seizure frequency) to KD or MAD. Of the 130 children included, 58 (44%) were defined as responders. Among these, 11 were already diagnosed with GLUT1-DS. No mutations in the SLC2A1 gene were detected in the remaining patients. However, the clinical features of these patients differed considerably from the patients diagnosed with GLUT1-DS. While 9 out of 10 patients with GLUT1-DS became seizure-free with dietary treatment, only 3 out of the 33 remaining patients were seizure-free with KD or MAD treatment. We therefore conclude that a seizure reduction of >50% following dietary treatment is not a suitable criterion for identifying patients with GLUT1-DS, as these patients generally achieve complete seizure freedom shortly after diet initiation.
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39
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Bertoli S, Trentani C, Ferraris C, De Giorgis V, Veggiotti P, Tagliabue A. Long-term effects of a ketogenic diet on body composition and bone mineralization in GLUT-1 deficiency syndrome: a case series. Nutrition 2014; 30:726-8. [PMID: 24800673 DOI: 10.1016/j.nut.2014.01.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 01/03/2014] [Accepted: 01/03/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The only known treatment of glucose transporter 1 deficiency syndrome (GLUT-1 DS) is a ketogenic diet (KD), which provides the brain with an alternative fuel. Studies in children with intractable epilepsy have shown that a prolonged KD can induce a progressive loss of bone mineral content associated with poor bone health status, probably as a consequence of a chronic acidic environment. The aim of this study is to determine the long-term effects of a KD on body composition and bone mineral status of patients with GLUT-1 DS, is currently unknown. METHODS In this case series, we report the changes in body composition and bone mineral status observed in three adult patients with GLUT-1 DS who have been treated with a KD for more than 5 y. RESULTS A long-term KD did not produce appreciable changes in weight and body composition of adults with GLUT-1 DS. Moreover, we found no evidence of potential adverse effects of a KD on bone health. In summary, this case series contributes to a small but growing body of literature that investigated the potential long-term effects of a KD on bone health. CONCLUSIONS Our data suggest that maintaining a KD for more than 5 y does not pose any major negative effects on body composition, bone mineral content, and bone mineral density in adults with GLUT-1 DS, a finding that is at variance with previous reports focusing on children with intractable epilepsy. Further studies with larger sizes are needed to confirm and expand our findings.
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Affiliation(s)
- Simona Bertoli
- International Centre for the Assessment of Nutritional Status (ICANS), Department of Food Environmental and Nutritional Sciences (DeFENS), University of Milan, Milan, Italy
| | - Claudia Trentani
- Human Nutrition and Eating Disorder Research Center, Department of Public Health, Experimental and Forensic Medicine University of Pavia, Pavia, Italy
| | - Cinzia Ferraris
- Human Nutrition and Eating Disorder Research Center, Department of Public Health, Experimental and Forensic Medicine University of Pavia, Pavia, Italy
| | | | | | - Anna Tagliabue
- Human Nutrition and Eating Disorder Research Center, Department of Public Health, Experimental and Forensic Medicine University of Pavia, Pavia, Italy.
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GLUT1 deficiency syndrome 2013: Current state of the art. Seizure 2013; 22:803-11. [DOI: 10.1016/j.seizure.2013.07.003] [Citation(s) in RCA: 125] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 07/02/2013] [Accepted: 07/03/2013] [Indexed: 01/01/2023] Open
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Ganos C, Aguirregomozcorta M, Batla A, Stamelou M, Schwingenschuh P, Münchau A, Edwards MJ, Bhatia KP. Psychogenic paroxysmal movement disorders--clinical features and diagnostic clues. Parkinsonism Relat Disord 2013; 20:41-6. [PMID: 24090947 DOI: 10.1016/j.parkreldis.2013.09.012] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 08/12/2013] [Accepted: 09/09/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND The diagnosis of psychogenic paroxysmal movement disorders (PPMD) can be challenging, in particular their distinction from the primary paroxysmal dyskinesias (PxD) remains difficult. METHODS Here we present a large series of 26 PPMD cases, describe their characteristics, contrast them with primary PxD and focus on their distinguishing diagnostic features. RESULTS Mean age at onset was 38.6 years, i.e. much later than primary PxD. Women were predominantly affected (73%). Most subjects (88.4%) had long attacks, and unlike primary PxD there was a very high within-subject variability for attack phenomenology, duration and frequency. Dystonia was the most common single movement disorder presentation, but 69.2% of the patients had mixed or complex PxD. In 50% of PPMD cases attack triggers could be identified but these were unusual for primary PxD. 42.3% of patients employed unusual strategies to alleviate or stop the attacks. Response to typical medication used for primary PxD was poor. Precipitation of the disorder due to physical or emotional life events and stressors were documented in 57.6% and 65.3% of the cases respectively. Additional interictal psychogenic signs were documented in 34.6% and further medically unexplained somatic symptoms were present in 50% of the cases. 19.2% of patients had a comorbid organic movement disorder and 26.9% had pre-existing psychiatric comorbidities. CONCLUSION Although the phenotypic presentation of PPMD can be highly diverse, certain clinical characteristics help in distinguishing this condition from the primary forms of PxD. Recognition is important as multidisciplinary treatment approaches led to significant improvement in most cases.
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Affiliation(s)
- Christos Ganos
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, University College London, Queen Square, London WC1N 3BG, UK; Department of Neurology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Maria Aguirregomozcorta
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, University College London, Queen Square, London WC1N 3BG, UK
| | - Amit Batla
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, University College London, Queen Square, London WC1N 3BG, UK
| | - Maria Stamelou
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, University College London, Queen Square, London WC1N 3BG, UK; Second Department of Neurology, Attiko Hospital, University of Athens, Greece; Neurology Clinic, Philipps University, Marburg, Germany
| | - Petra Schwingenschuh
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, University College London, Queen Square, London WC1N 3BG, UK; Department of Neurology, Medical University of Graz, Graz, Austria
| | - Alexander Münchau
- Department of Paediatric and Adult Movement Disorders and Neuropsychiatry, Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Mark J Edwards
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, University College London, Queen Square, London WC1N 3BG, UK
| | - Kailash P Bhatia
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, University College London, Queen Square, London WC1N 3BG, UK.
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Characterization and Modulation of Glucose Uptake in a Human Blood–Brain Barrier Model. J Membr Biol 2013; 246:669-77. [DOI: 10.1007/s00232-013-9583-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 08/04/2013] [Indexed: 10/26/2022]
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Chambon R, Vuillaumier-Barrot S, Seta N, Wagner S, Sarret C. Partial effectiveness of acetazolamide in a mild form of GLUT1 deficiency: a pediatric observation. Mov Disord 2013; 28:1749-51. [PMID: 23649827 DOI: 10.1002/mds.25484] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Revised: 02/20/2013] [Accepted: 04/01/2013] [Indexed: 11/07/2022] Open
Affiliation(s)
- Renaud Chambon
- Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, Hôpital Estaing, Service de Pédiatrie Générale Multidisciplinaire, Clermont-Ferrand, France
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Ramm-Pettersen A, Nakken KO, Skogseid IM, Randby H, Skei EB, Bindoff LA, Selmer KK. Good outcome in patients with early dietary treatment of GLUT-1 deficiency syndrome: results from a retrospective Norwegian study. Dev Med Child Neurol 2013; 55:440-7. [PMID: 23448551 DOI: 10.1111/dmcn.12096] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/23/2012] [Indexed: 01/02/2023]
Abstract
AIM The aim of this study was to characterize patients diagnosed with glucose transporter protein-1 deficiency syndrome (GLUT-1 DS) clinically and genetically, and to evaluate the effect of treatment with the classic ketogenic or modified Atkins diet. METHOD We retrospectively studied medical records of 10 patients diagnosed with GLUT-1 DS. Four females and six males with a median age of 15 years were included. RESULTS The study illustrates the genetic and clinical heterogeneity of GLUT-1 DS. Analysis of the SLC2A1 gene disclosed a variety of mutation types. The time between onset of symptoms and diagnosis was more than 11 years on average. The outcome in those with early diagnosis and intervention was surprisingly good. All but one patient with the classic phenotype became seizure free after treatment with the classic ketogenic or modified Atkins diet. Acetazolamide was effective in one patient with paroxysmal exercise-induced dyskinesia. A point prevalence of GLUT-1 DS in Norway was estimated as 2.6 per 1,000,000 inhabitants. INTERPRETATION Although the long-term prognosis in patients with GLUT-1 DS partly depends on the underlying genetics, our study supports the assumption that early initiation of treatment with a ketogenic diet may positively affect the outcome.
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Abstract
Seizures may be the first and the major presenting feature of an inborn error of metabolism (IEM), for example in a neonate with pyridoxine-dependent epilepsy. In other IEMs, seizures may be preceded by other major symptoms: by a reduced level of consciousness in a child with an organic acidaemia or urea cycle defect; or by loss of skills, progressive weakness, ataxia, and upper motor signs in a child with a lysosomal storage disorder or peroxisomal leukodystrophy. This review concentrates on those IEMs for which specific treatment is available. The common metabolic causes of seizures vary according to the age at presentation. Features from the history, examination, imaging, and first line biochemical investigations can all provide clues to an inborn error. This review attempts to delineate these and to provide a guide to the specific tests that can be used to make the diagnosis of disorders with specific treatment.
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Affiliation(s)
- Shamima Rahman
- Clinical and Molecular Genetics and Neurosciences Units, University College London Institute of Child Health, London and Metabolic and Neurosciences Units, Great Ormond Street Hospital for Children NHS Trust, London, UK.
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Abstract
Dystonia has been defined as a syndrome of involuntary, sustained muscle contractions affecting one or more sites of the body, frequently causing twisting and repetitive movements or abnormal postures. Dystonia is also a clinical sign that can be the presenting or prominent manifestation of many neurodegenerative and neurometabolic disorders. Etiological categories include primary dystonia, secondary dystonia, heredodegenerative diseases with dystonia, and dystonia plus. Primary dystonia includes syndromes in which dystonia is the sole phenotypic manifestation with the exception that tremor can be present as well. Most primary dystonia begins in adults, and approximately 10% of probands report one or more affected family members. Many cases of childhood- and adolescent-onset dystonia are due to mutations in TOR1A and THAP1. Mutations in THAP1 and CIZ1 have been associated with sporadic and familial adult-onset dystonia. Although significant recent progress had been made in defining the genetic basis for most of the dystonia-plus and heredodegenerative diseases with dystonia, a major gap remains in understanding the genetic etiologies for most cases of adult-onset primary dystonia. Common themes in the cellular biology of dystonia include G1/S cell cycle control, monoaminergic neurotransmission, mitochondrial dysfunction, and the neuronal stress response.
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Affiliation(s)
- Mark S LeDoux
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
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