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Thamby J, Prange L, Boggs A, Subei MO, Myers C, Uchitel J, ElMallah M, Bartlett-Lee B, Riviello JJ, Mikati MA. Characteristics of non-sleep related apneas in children with alternating hemiplegia of childhood. Eur J Paediatr Neurol 2024; 48:101-108. [PMID: 38096596 DOI: 10.1016/j.ejpn.2023.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 10/17/2023] [Accepted: 12/03/2023] [Indexed: 03/23/2024]
Abstract
BACKGROUND Non-sleep related apnea (NSA) has been observed in alternating hemiplegia of childhood (AHC) but has yet to be characterized. GOALS Investigate the following hypotheses: 1) AHC patients manifest NSA that is often severe. 2) NSA is usually triggered by precipitating events. 3) NSA is more likely in patients with ATP1A3 mutations. METHODS Retrospective review of 51 consecutive AHC patients (ages 2-45 years) enrolled in our AHC registry. NSAs were classified as mild (not needing intervention), moderate (needing intervention but not perceived as life threatening), or severe (needing intervention and perceived as life threatening). RESULTS 19/51 patients (37 %) had 52 NSA events (6 mild, 11 moderate, 35 severe). Mean age of onset of NSA (± Standard Error of the Mean (SEM)): 3.8 ± 1.5 (range 0-24) years, frequency during follow up was higher at younger ages as compared to adulthood (year 1: 2.2/year, adulthood: 0.060/year). NSAs were associated with triggering factors, bradycardia and with younger age (p < 0.008 in all) but not with mutation status (p = 0.360). Triggers, observed in 17 patients, most commonly included epileptic seizures in 9 (47 %), anesthesia, AHC spells and intercurrent, stressful, conditions. Management included use of pulse oximeter at home in nine patients, home oxygen in seven, intubation/ventilatory support in seven, and basic CPR in six. An additional patient required tracheostomy. There were no deaths or permanent sequalae. CONCLUSIONS AHC patients experience NSAs that are often severe. These events are usually triggered by seizures or other stressful events and can be successfully managed with interventions tailored to the severity of the NSA.
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Affiliation(s)
- Julie Thamby
- Department of Pediatrics, Division of Neurology and Developmental Pediatrics, Duke University School of Medicine, Durham, NC, United States
| | - Lyndsey Prange
- Department of Pediatrics, Division of Neurology and Developmental Pediatrics, Duke University School of Medicine, Durham, NC, United States
| | - April Boggs
- Department of Pediatrics, Division of Neurology and Developmental Pediatrics, Duke University School of Medicine, Durham, NC, United States
| | - M Omar Subei
- Department of Neurology, Division of Epilepsy and Clinical Neurophysiology, Duke University School of Medicine, Durham, NC, United States
| | - Cory Myers
- Department of Neurology, Division of Epilepsy and Clinical Neurophysiology, Duke University School of Medicine, Durham, NC, United States
| | - Julie Uchitel
- Department of Pediatrics, Division of Neurology and Developmental Pediatrics, Duke University School of Medicine, Durham, NC, United States; Stanford University Medical School, Palo Alto, CA, United States
| | - Mai ElMallah
- Department of Pediatrics, Division of Pulmonary Medicine, Duke University School of Medicine, United States
| | | | - James J Riviello
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Mohamad A Mikati
- Department of Pediatrics, Division of Neurology and Developmental Pediatrics, Duke University School of Medicine, Durham, NC, United States.
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Patel SH, Panagiotakaki E, Papadopoulou MT, Fons C, De Grandis E, Vezyroglou A, Balestrini S, Hong H, Liu B, Prange L, Arzimanoglou A, Vavassori R, Mikati MA. Methodology of a Natural History Study of a Rare Neurodevelopmental Disorder: Alternating Hemiplegia of Childhood as a Prototype Disease. J Child Neurol 2023; 38:597-610. [PMID: 37728088 DOI: 10.1177/08830738231197861] [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] [Indexed: 09/21/2023]
Abstract
Here, we describe the process of development of the methodology for an international multicenter natural history study of alternating hemiplegia of childhood as a prototype disease for rare neurodevelopmental disorders. We describe a systematic multistep approach in which we first identified the relevant questions about alternating hemiplegia of childhood natural history and expected challenges. Then, based on our experience with alternating hemiplegia of childhood and on pragmatic literature searches, we identified solutions to determine appropriate methods to address these questions. Specifically, these solutions included development and standardization of alternating hemiplegia of childhood-specific spell video-library, spell calendars, adoption of tailored methodologies for prospective measurement of nonparoxysmal and paroxysmal manifestations, unified data collection protocols, centralized data platform, adoption of specialized analysis methods including, among others, Cohen kappa, interclass correlation coefficient, linear mixed effects models, principal component, propensity score, and ambidirectional analyses. Similar approaches can, potentially, benefit in the study of other rare pediatric neurodevelopmental disorders.
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Affiliation(s)
- Shital H Patel
- Department of Pediatrics, Division of Pediatric Neurology and Developmental Medicine, Duke University, Durham, NC, USA
| | - Eleni Panagiotakaki
- Department of Pediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, Member of the ERN EpiCARE, University Hospitals of Lyon (HCL), Lyon, France
| | - Maria T Papadopoulou
- Department of Pediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, Member of the ERN EpiCARE, University Hospitals of Lyon (HCL), Lyon, France
| | - Carmen Fons
- Department of Child Neurology, Sant Joan de Déu Children's Hospital, Member of the ERN EpiCARE, Barcelona, Spain
| | - Elisa De Grandis
- Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Aikaterini Vezyroglou
- Department of Developmental Neurosciences, UCL NIHR BRC Great Ormond Street Institute of Child Health, London, UK
| | - Simona Balestrini
- Department of Clinical and Experimental Epilepsy, University College of London (UCL), Queen Square Institute of Neurology, London, UK
| | - Hwanhee Hong
- Department of Biostatistics & Bioinformatics, Duke University, Durham, NC, USA
| | - Beiyu Liu
- Department of Biostatistics & Bioinformatics, Duke University, Durham, NC, USA
| | - Lyndsey Prange
- Department of Pediatrics, Division of Pediatric Neurology and Developmental Medicine, Duke University, Durham, NC, USA
| | - Alexis Arzimanoglou
- Department of Pediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, Member of the ERN EpiCARE, University Hospitals of Lyon (HCL), Lyon, France
| | - Rosaria Vavassori
- Euro Mediterranean Institute of Science and Technology IEMEST, Palermo, Italy
- Association AHC18+ e.V., member of the ERN EpiCARE Patient Advocacy Group (ePAG), Germany
| | - Mohamad A Mikati
- Department of Pediatrics, Division of Pediatric Neurology and Developmental Medicine, Duke University, Durham, NC, USA
- Department of Neurobiology, Duke University, Durham, NC, USA
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Lin WS. Translating Genetic Discovery into a Mechanistic Understanding of Pediatric Movement Disorders: Lessons from Genetic Dystonias and Related Disorders. ADVANCED GENETICS (HOBOKEN, N.J.) 2023; 4:2200018. [PMID: 37288166 PMCID: PMC10242408 DOI: 10.1002/ggn2.202200018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Indexed: 06/09/2023]
Abstract
The era of next-generation sequencing has increased the pace of gene discovery in the field of pediatric movement disorders. Following the identification of novel disease-causing genes, several studies have aimed to link the molecular and clinical aspects of these disorders. This perspective presents the developing stories of several childhood-onset movement disorders, including paroxysmal kinesigenic dyskinesia, myoclonus-dystonia syndrome, and other monogenic dystonias. These stories illustrate how gene discovery helps focus the research efforts of scientists trying to understand the mechanisms of disease. The genetic diagnosis of these clinical syndromes also helps clarify the associated phenotypic spectra and aids the search for additional disease-causing genes. Collectively, the findings of previous studies have led to increased recognition of the role of the cerebellum in the physiology and pathophysiology of motor control-a common theme in many pediatric movement disorders. To fully exploit the genetic information garnered in the clinical and research arenas, it is crucial that corresponding multi-omics analyses and functional studies also be performed at scale. Hopefully, these integrated efforts will provide us with a more comprehensive understanding of the genetic and neurobiological bases of movement disorders in childhood.
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Affiliation(s)
- Wei-Sheng Lin
- Department of Pediatrics Taipei Veterans General Hospital Taipei 11217 Taiwan
- School of Medicine National Yang Ming Chiao Tung University Taipei 112304 Taiwan
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4
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Parker LE, Wallace K, Thevathasan A, Funk E, Pratt M, Thamby J, Tran L, Prange L, Uchitel J, Boggs A, Minton M, Jasien J, Nagao KJ, Richards A, Cruse B, De-Lisle Dear G, Landstrom AP, Mikati MA. Characterization of sedation and anesthesia complications in patients with alternating hemiplegia of childhood. Eur J Paediatr Neurol 2022; 38:47-52. [PMID: 35390560 DOI: 10.1016/j.ejpn.2022.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 02/05/2022] [Accepted: 03/17/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND Alternating hemiplegia of childhood (AHC) pathophysiology suggests predisposition to sedation and anesthesia complications. GOALS Hypotheses: 1) AHC patients experience high rates of sedation-anesthesia complications. 2) ATP1A3 mutation genotype positivity, age, and AHC severity correlate with more severe complications. 3) Prior short QTc correlates with cardiac rhythm complications. METHODS Analysis of 34 consecutive AHC patients who underwent sedation or anesthesia. Classification of complications: mild (not requiring intervention), moderate (intervention), severe (intervention, risk for permanent injury or potential life-threatening emergency). STATISTICS Fisher Exact test, Spearman correlations. RESULTS These patients underwent 129 procedures (3.79 ± 2.75 procedures/patient). Twelve (35%) experienced complications during at least one procedure. Fourteen/129 procedures (11%) manifested one or more complications (2.3% mild, 7% moderate, 1.6% severe). Of the total 20 observed complications, six (33.3%) were severe: apneas (2), seizures (2), bradycardia (1), ventricular fibrillation that responded to resuscitation (1). Moderate complications: non-life-threatening bradycardias, apneas, AHC spells or seizures. Complications occurred during sedation or anesthesia and during procedures or recovery periods. Patients with disease-associated ATP1A3 variants were more likely to have moderate or severe complications. There was no correlation between complications and age or AHC severity. Presence of prior short QTc correlated with cardiac rhythm complications. After this series was analyzed, another patient had severe recurrent laryngeal dystonia requiring tracheostomy following anesthesia with intubation. CONCLUSIONS During sedation or anesthesia, AHC patients, particularly those with ATP1A3 variants and prior short QTc, are at risk for complications consistent with AHC pathophysiology. Increased awareness is warranted during planning, performance, and recovery from such procedures.
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Affiliation(s)
- Lauren E Parker
- Department of Pediatrics, Division of Neurology, Duke University School of Medicine, Durham, NC, United States; Department of Pediatrics, Division of Cardiology, and Department of Cell Biology, Duke University School of Medicine, Durham, NC, United States
| | - Keri Wallace
- Department of Pediatrics, Division of Neurology, Duke University School of Medicine, Durham, NC, United States
| | - Arthur Thevathasan
- Department of Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Emily Funk
- Department of Anesthesiology, Duke University School of Medicine, Durham, NC, United States
| | - Milton Pratt
- Department of Pediatrics, Division of Neurology, Duke University School of Medicine, Durham, NC, United States
| | - Julie Thamby
- Department of Pediatrics, Division of Neurology, Duke University School of Medicine, Durham, NC, United States
| | - Linh Tran
- Department of Pediatrics, Division of Neurology, Duke University School of Medicine, Durham, NC, United States
| | - Lyndsey Prange
- Department of Pediatrics, Division of Neurology, Duke University School of Medicine, Durham, NC, United States
| | - Julie Uchitel
- Department of Pediatrics, Division of Neurology, Duke University School of Medicine, Durham, NC, United States
| | - April Boggs
- Department of Pediatrics, Division of Neurology, Duke University School of Medicine, Durham, NC, United States
| | - Melissa Minton
- Department of Pediatrics, Division of Neurology, Duke University School of Medicine, Durham, NC, United States
| | - Joan Jasien
- Department of Pediatrics, Division of Neurology, Duke University School of Medicine, Durham, NC, United States
| | - Kanae Jennifer Nagao
- Department of Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Amanda Richards
- Department of Otolaryngology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Belinda Cruse
- Department of Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Department of Medicine (Royal Melbourne Hospital), Faculty of Medicine, Health and Dentistry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Guy De-Lisle Dear
- Department of Anesthesiology, Duke University School of Medicine, Durham, NC, United States
| | - Andrew P Landstrom
- Department of Pediatrics, Division of Cardiology, and Department of Cell Biology, Duke University School of Medicine, Durham, NC, United States
| | - Mohamad A Mikati
- Department of Pediatrics, Division of Neurology, Duke University School of Medicine, Durham, NC, United States.
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5
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Lax DN, Bieri P, Patel P. The diagnostic spectrum of ATP1A3-related disorders: 3 new patients. J Neurol Sci 2021; 430:120003. [PMID: 34655904 DOI: 10.1016/j.jns.2021.120003] [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: 06/15/2021] [Revised: 09/19/2021] [Accepted: 09/20/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND ATP1A3-related disorders are rare but increasingly recognized syndromes with overlapping phenotypes. CLINICAL OBSERVATIONS A male child and his mother with c.2452G>A (p.Glu818Lys) mutation and an unrelated child with c.2428A>T (p.Ile810Phe) mutation in the ATP1A3 gene are reported. RESULTS The first child presented with fever-induced flaccid unresponsiveness and the diagnosis was made after extensive negative workup except for abnormal EMG showing low amplitude motor responses with acute denervation; his symptomatic mother went undiagnosed for thirty years until his diagnosis. An unrelated male child presented with symptoms most consistent with the rapid-onset dystonia-Parkinsonism (RDP) phenotype but with intermediate features of alternating dystonia with choreoathetoid movements two years after a c.2428A>T (p.Ile810Phe) mutation was found. CONCLUSION ATP1A3-related disorders have variable manifestations and can remain undiagnosed for decades. Treatment remains mostly supportive. With the increasing use of genetic testing for broad indications, further research into effective therapies is necessary.
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Affiliation(s)
- Daniel N Lax
- Isabelle Rapin Division of Child Neurology of the Saul R Korey Department of Neurology, Department of Pediatrics, Albert Einstein College of Medicine and Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA..
| | - Phyllis Bieri
- The Saul R Korey Department of Neurology, Albert Einstein College of Medicine and Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA..
| | - Puja Patel
- Isabelle Rapin Division of Child Neurology of the Saul R Korey Department of Neurology, Department of Pediatrics, Albert Einstein College of Medicine and Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA..
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6
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Moya-Mendez ME, Ogbonna C, Ezekian JE, Rosamilia MB, Prange L, de la Uz C, Kim JJ, Howard T, Garcia J, Nussbaum R, Truty R, Callis TE, Funk E, Heyes M, Dear GDL, Carboni MP, Idriss SF, Mikati MA, Landstrom AP. ATP1A3-Encoded Sodium-Potassium ATPase Subunit Alpha 3 D801N Variant Is Associated With Shortened QT Interval and Predisposition to Ventricular Fibrillation Preceded by Bradycardia. J Am Heart Assoc 2021; 10:e019887. [PMID: 34459253 PMCID: PMC8649289 DOI: 10.1161/jaha.120.019887] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background Pathogenic variation in the ATP1A3‐encoded sodium‐potassium ATPase, ATP1A3, is responsible for alternating hemiplegia of childhood (AHC). Although these patients experience a high rate of sudden unexpected death in epilepsy, the pathophysiologic basis for this risk remains unknown. The objective was to determine the role of ATP1A3 genetic variants on cardiac outcomes as determined by QT and corrected QT (QTc) measurements. Methods and Results We analyzed 12‐lead ECG recordings from 62 patients (male subjects=31, female subjects=31) referred for AHC evaluation. Patients were grouped according to AHC presentation (typical versus atypical), ATP1A3 variant status (positive versus negative), and ATP1A3 variant (D801N versus other variants). Manual remeasurements of QT intervals and QTc calculations were performed by 2 pediatric electrophysiologists. QTc measurements were significantly shorter in patients with positive ATP1A3 variant status (P<0.001) than in patients with genotype‐negative status, and significantly shorter in patients with the ATP1A3‐D801N variant than patients with other variants (P<0.001). The mean QTc for ATP1A3‐D801N was 344.9 milliseconds, which varied little with age, and remained <370 milliseconds throughout adulthood. ATP1A3 genotype status was significantly associated with shortened QTc by multivariant regression analysis. Two patients with the ATP1A3‐D801N variant experienced ventricular fibrillation, resulting in death in 1 patient. Rare variants in ATP1A3 were identified in a large cohort of genotype‐negative patients referred for arrhythmia and sudden unexplained death. Conclusions Patients with AHC who carry the ATP1A3‐D801N variant have significantly shorter QTc intervals and an increased likelihood of experiencing bradycardia associated with life‐threatening arrhythmias. ATP1A3 variants may represent an independent cause of sudden unexplained death. Patients with AHC should be evaluated to identify risk of sudden death.
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Affiliation(s)
- Mary E Moya-Mendez
- Department of Pediatrics Division of Pediatric Cardiology Duke University School of Medicine Durham NC
| | - Chiagoziem Ogbonna
- Department of Pediatrics Division of Pediatric Cardiology Duke University School of Medicine Durham NC
| | - Jordan E Ezekian
- Department of Pediatrics Division of Pediatric Cardiology Duke University School of Medicine Durham NC
| | - Michael B Rosamilia
- Department of Pediatrics Division of Pediatric Cardiology Duke University School of Medicine Durham NC
| | - Lyndsey Prange
- Department of Pediatrics Division of Neurology Duke University School of Medicine Durham NC
| | - Caridad de la Uz
- Department of Pediatrics Division of Cardiology Johns Hopkins School of Medicine Baltimore MD
| | - Jeffrey J Kim
- Department of Pediatrics Section of Cardiology Baylor College of Medicine Houston TX
| | - Taylor Howard
- Department of Pediatrics Section of Cardiology Baylor College of Medicine Houston TX
| | | | | | | | | | - Emily Funk
- Duke University School of NursingAssistant Clinical ProfessorDuke University Durham NC
| | - Matthew Heyes
- Duke University School of NursingAssistant Clinical ProfessorDuke University Durham NC
| | - Guy de Lisle Dear
- Department of Anesthesia Duke University School of Medicine Durham NC
| | - Michael P Carboni
- Department of Pediatrics Division of Pediatric Cardiology Duke University School of Medicine Durham NC
| | - Salim F Idriss
- Department of Pediatrics Division of Pediatric Cardiology Duke University School of Medicine Durham NC
| | - Mohamad A Mikati
- Department of Pediatrics Division of Neurology Duke University School of Medicine Durham NC
| | - Andrew P Landstrom
- Department of Pediatrics Division of Pediatric Cardiology Duke University School of Medicine Durham NC.,Department of Cell Biology Duke University School of Medicine Durham NC
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7
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Duat-Rodríguez A, Prochazkova M, Sebastian IP, Extremera VC, Legido MJ, Palero SR, Ortiz Cabrera NV. ATP1A3-related disorders in the differential diagnosis of acute brainstem and cerebellar dysfunction. Eur J Paediatr Neurol 2021; 34:105-109. [PMID: 34464766 DOI: 10.1016/j.ejpn.2021.08.005] [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: 10/22/2020] [Revised: 08/18/2021] [Accepted: 08/23/2021] [Indexed: 11/16/2022]
Abstract
Alternating Hemiplegia of Childhood (AHC), Rapid-onset Dystonia-Parkinsonism (RDP), and CAPOS syndrome (Cerebellar ataxia, Areflexia, Pes cavus, Optic atrophy, and Sensorineural hearing loss) are all caused by mutations in the same gene: ATP1A3. Although initially they were considered separate disorders, recent evidence suggests a continuous clinical spectrum of ATP1A3-related disorders. At onset all these disorders can present with acute brainstem dysfunction triggered by a febrile illness. An infectious or autoimmune disorder is usually suspected. A genetic disorder is rarely considered in the first acute episode. We present three patients with ATP1A3 mutations: one patient with AHC, one patient with RDP, and one patient with CAPOS syndrome. We describe the acute onset and overlapping clinical features of these three patients with classical phenotypes. These cases highlight ATP1A3-related disorders as a possible cause of acute brainstem dysfunction with normal ancillary testing.
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Affiliation(s)
- Anna Duat-Rodríguez
- Department of Pediatric Neurology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain.
| | - Michaela Prochazkova
- Pediatric Neurology Section, Department of Pediatrics, Hospital Universitario La Moraleja, Madrid, Spain
| | - Isabel Perez Sebastian
- Pediatric Neurology Section, Department of Pediatrics, Hospital Universitario La Moraleja, Madrid, Spain
| | | | - Maria Jimenez Legido
- Department of Pediatric Neurology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Serafin Rodriguez Palero
- Department of Rehabilitation Medicine, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
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8
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Wallace K, Greene E, Moya-Mendez M, Freemark M, Prange L, Mikati MA. Hypothalamic-pituitary dysfunction in alternating hemiplegia of childhood. Eur J Paediatr Neurol 2021; 32:1-7. [PMID: 33756210 DOI: 10.1016/j.ejpn.2021.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/08/2021] [Accepted: 03/04/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Many central nervous system disorders result in hypothalamic-pituitary (HP) axis dysfunction. Alternating Hemiplegia of Childhood (AHC) is usually caused by mutations in the ATP1A3 subunit of the Na+/K+ ATPase, predominantly affecting GABAergic interneurons. GABAergic interneurons and the ATP1A3 subunit are both important for function of the hypothalamus. However, whether HP dysfunction occurs in AHC and, if so, how such dysfunction manifests remains to be investigated. METHODS We conducted a retrospective review of a cohort of 50 consecutive AHC patients for occurrence of HP related manifestations and analyzed the findings of the 6 patients, from that cohort, with such manifestations. RESULTS Six out of 50 AHC patients manifested HP dysfunction. Three of these patients were mutation positive and 3 were mutation negative. Of the 6 patients with HP dysfunction, 3 had central precocious puberty. A fourth had short stature due to growth hormone deficiency. Two other patients had recurrent episodes of fever of unknown origin (FUO) diagnosed, after workups, as being secondary to central fever. All patients were evaluated and co-managed by pediatric neurology and endocrinology or rheumatology. CONCLUSION AHC was associated with HP dysfunction in about 12% of patients. Awareness of such dysfunction is important for anticipatory guidance and management particularly in the case of FUO which often presents a diagnostic dilemma. Our findings are also consistent with current understandings of the underlying pathophysiology of AHC and of the HP axis.
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Affiliation(s)
- Keri Wallace
- Division of Pediatric Neurology and Developmental Medicine, Duke Children's Health Center, 2301 Erwin Rd, Durham, NC, 27710, USA.
| | - Elizabeth Greene
- Division of Pediatric Endocrinology, Duke Children's Health Center, 2301 Erwin Rd, Durham, NC, 27710, USA.
| | - Mary Moya-Mendez
- Division of Pediatric Neurology and Developmental Medicine, Duke Children's Health Center, 2301 Erwin Rd, Durham, NC, 27710, USA.
| | - Michael Freemark
- Division of Pediatric Endocrinology, Duke Children's Health Center, 2301 Erwin Rd, Durham, NC, 27710, USA.
| | - Lyndsey Prange
- Division of Pediatric Neurology and Developmental Medicine, Duke Children's Health Center, 2301 Erwin Rd, Durham, NC, 27710, USA.
| | - Mohamad A Mikati
- Division of Pediatric Neurology and Developmental Medicine, Duke Children's Health Center, 2301 Erwin Rd, Durham, NC, 27710, USA.
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9
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de Gusmão CM, Garcia L, Mikati MA, Su S, Silveira-Moriyama L. Paroxysmal Genetic Movement Disorders and Epilepsy. Front Neurol 2021; 12:648031. [PMID: 33833732 PMCID: PMC8021799 DOI: 10.3389/fneur.2021.648031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 02/22/2021] [Indexed: 01/08/2023] Open
Abstract
Paroxysmal movement disorders include paroxysmal kinesigenic dyskinesia, paroxysmal non-kinesigenic dyskinesia, paroxysmal exercise-induced dyskinesia, and episodic ataxias. In recent years, there has been renewed interest and recognition of these disorders and their intersection with epilepsy, at the molecular and pathophysiological levels. In this review, we discuss how these distinct phenotypes were constructed from a historical perspective and discuss how they are currently coalescing into established genetic etiologies with extensive pleiotropy, emphasizing clinical phenotyping important for diagnosis and for interpreting results from genetic testing. We discuss insights on the pathophysiology of select disorders and describe shared mechanisms that overlap treatment principles in some of these disorders. In the near future, it is likely that a growing number of genes will be described associating movement disorders and epilepsy, in parallel with improved understanding of disease mechanisms leading to more effective treatments.
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Affiliation(s)
- Claudio M. de Gusmão
- Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States
- Department of Neurology, Universidade Estadual de Campinas (UNICAMP), São Paulo, Brazil
| | - Lucas Garcia
- Department of Medicine, Universidade 9 de Julho, São Paulo, Brazil
| | - Mohamad A. Mikati
- Division of Pediatric Neurology and Developmental Medicine, Duke University Medical Center, Durham, NC, United States
| | - Samantha Su
- Division of Pediatric Neurology and Developmental Medicine, Duke University Medical Center, Durham, NC, United States
| | - Laura Silveira-Moriyama
- Department of Neurology, Universidade Estadual de Campinas (UNICAMP), São Paulo, Brazil
- Department of Medicine, Universidade 9 de Julho, São Paulo, Brazil
- Education Unit, University College London Institute of Neurology, University College London, London, United Kingdom
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10
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Hunanyan AS, Kantor B, Puranam RS, Elliott C, McCall A, Dhindsa J, Pagadala P, Wallace K, Poe J, Gunduz T, Asokan A, Koeberl DD, ElMallah MK, Mikati MA. Adeno-Associated Virus-Mediated Gene Therapy in the Mashlool, Atp1a3Mashl/+, Mouse Model of Alternating Hemiplegia of Childhood. Hum Gene Ther 2021; 32:405-419. [PMID: 33577387 DOI: 10.1089/hum.2020.191] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Alternating Hemiplegia of Childhood (AHC) is a devastating autosomal dominant disorder caused by ATP1A3 mutations, resulting in severe hemiplegia and dystonia spells, ataxia, debilitating disabilities, and premature death. Here, we determine the effects of delivering an extra copy of the normal gene in a mouse model carrying the most common mutation causing AHC in humans, the D801N mutation. We used an adeno-associated virus serotype 9 (AAV9) vector expressing the human ATP1A3 gene under the control of a human Synapsin promoter. We first demonstrated that intracerebroventricular (ICV) injection of this vector in wild-type mice on postnatal day 10 (P10) results in increases in ouabain-sensitive ATPase activity and in expression of reporter genes in targeted brain regions. We then tested this vector in mutant mice. Simultaneous intracisterna magna and bilateral ICV injections of this vector at P10 resulted, at P40, in reduction of inducible hemiplegia spells, improvement in balance beam test performance, and prolonged survival of treated mutant mice up to P70. Our study demonstrates, as a proof of concept, that gene therapy can induce favorable effects in a disease caused by a mutation of the gene of a protein that is, at the same time, an ATPase enzyme, a pump, and a signal transduction factor.
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Affiliation(s)
- Arsen S Hunanyan
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Duke University, Durham, North Carolina, USA
| | - Boris Kantor
- Viral Vector Core, Department of Neurobiology, Duke University, Durham, North Carolina, USA
| | - Ram S Puranam
- Department of Neurobiology, Duke University, Durham, North Carolina, USA
| | - Courtney Elliott
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Duke University, Durham, North Carolina, USA
| | - Angela McCall
- Division of Pediatric Pulmonary Medicine, Department of Pediatrics, Duke University, Durham, North Carolina, USA
| | - Justin Dhindsa
- Division of Pediatric Pulmonary Medicine, Department of Pediatrics, Duke University, Durham, North Carolina, USA
| | - Promila Pagadala
- Department of Clinical and Translational Science Institute, Duke University, Durham, North Carolina, USA
| | - Keri Wallace
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Duke University, Durham, North Carolina, USA
| | - Jordan Poe
- Viral Vector Core, Department of Neurobiology, Duke University, Durham, North Carolina, USA
| | - Talha Gunduz
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Duke University, Durham, North Carolina, USA
| | - Aravind Asokan
- Department of Surgery, Duke University, Durham, North Carolina, USA.,Molecular Genetics and Microbiology, Duke University, Durham, North Carolina, USA
| | - Dwight D Koeberl
- Division of Medical Genetics, Department of Pediatrics, Duke University, Durham, North Carolina, USA
| | - Mai K ElMallah
- Division of Pediatric Pulmonary Medicine, Department of Pediatrics, Duke University, Durham, North Carolina, USA
| | - Mohamad A Mikati
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Duke University, Durham, North Carolina, USA.,Department of Neurobiology, Duke University, Durham, North Carolina, USA
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11
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Wallace K, Uchitel J, Prange L, Jasien J, Bonner M, D'Alli R, Maslow G, Mikati MA. Characterization of Severe and Extreme Behavioral Problems in Patients With Alternating Hemiplegia of Childhood. Pediatr Neurol 2020; 111:5-12. [PMID: 32951661 DOI: 10.1016/j.pediatrneurol.2020.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/14/2020] [Accepted: 06/20/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Alternating hemiplegia of childhood often manifests severe or extreme behavioral problems, the nature of which remains to be fully characterized. METHODS We analyzed 39 consecutive patients with alternating hemiplegia of childhood for occurrence of behavioral problems and categorized those by severity: mild (not requiring intervention), moderate (requiring intervention but no risk), severe (minor risk to self, others, or both), and extreme (major risk). We then analyzed behavioral manifestations, concurrent morbidity, and medication responses in patients with severe or extreme symptoms. RESULTS Two patients had mild behavioral problems, five moderate, 10 severe, six extreme, and 16 none. Extreme cases exhibited disruptive behaviors escalating to assaults. Triggers, when present, included peer-provocation, low frustration tolerance, limits set by others, and sleep disruption. Reversible psychotic symptoms occurred in two patients: in one triggered by infection and trihexyphenidyl, and in another triggered by sertraline. Of the 16 patients with severe or extreme symptoms, 13 had concurrent neuropsychiatric diagnoses. Occurrence of severe or extreme symptoms did not correlate with age, puberty, severity of intellectual disability, or mutation status (P > 0.05). A multidisciplinary team including mental health professionals comanaged all patients with severe or extreme symptoms with either behavioral therapy, medications, or both. When considering medications prescribed to more than four patients, medicines that demonstrated efficacy or partial efficacy in more than 50% of patients were alpha-adrenergic agonists and selective-serotonin-reuptake-inhibitors. CONCLUSIONS Patients with alternating hemiplegia of childhood (41%) often experience severe or extreme behavioral problems and, rarely, medication-triggered psychotic symptoms. These observations are consistent with current understanding of underlying alternating hemiplegia of childhood brain pathophysiology. Increasing awareness of these behavioral problems facilitates alternating hemiplegia of childhood management and anticipatory guidance.
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Affiliation(s)
- Keri Wallace
- Division of Pediatric Neurology and Developmental Medicine, Duke Children's Health Center, Durham, North Carolina
| | - Julie Uchitel
- Division of Pediatric Neurology and Developmental Medicine, Duke Children's Health Center, Durham, North Carolina
| | - Lyndsey Prange
- Division of Pediatric Neurology and Developmental Medicine, Duke Children's Health Center, Durham, North Carolina
| | - Joan Jasien
- Division of Pediatric Neurology and Developmental Medicine, Duke Children's Health Center, Durham, North Carolina
| | - Melanie Bonner
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina
| | - Richard D'Alli
- Division of Child Development and Behavioral Health, Department of Pediatrics, Duke University, Durham, North Carolina
| | - Gary Maslow
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina; Department of Pediatrics, Duke University, Durham, North Carolina
| | - Mohamad A Mikati
- Division of Pediatric Neurology and Developmental Medicine, Duke Children's Health Center, Durham, North Carolina.
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12
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Pratt M, Uchitel J, McGreal N, Gordon K, Prange L, McLean M, Noel RJ, Rikard B, Rogers Boruta MK, Mikati MA. Alternating Hemiplegia of Childhood: gastrointestinal manifestations and correlation with neurological impairments. Orphanet J Rare Dis 2020; 15:231. [PMID: 32883312 PMCID: PMC7469407 DOI: 10.1186/s13023-020-01474-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 07/21/2020] [Indexed: 12/20/2022] Open
Abstract
Background Alternating Hemiplegia of Childhood (AHC) is caused by mutations of the ATP1A3 gene which is expressed in brain areas that include structures controling autonomic, gastrointestinal, gut motility and GABAergic functions. We aimed to investigate, in a cohort of 44 consecutive AHC patients, two hypotheses: 1) AHC patients frequently manifest gastrointestinal, particularly motility, problems. 2) These problems are often severe and their severity correlates with neurological impairments. Results 41/44 (93%) exhibited gastrointestinal symptoms requiring medical attention. For these 41 patients, symptoms included constipation (66%), swallowing problems (63%), vomiting (63%), anorexia (46%), diarrhea (44%), nausea (37%), and abdominal pain (22%). Symptoms indicative of dysmotility occurred in 33 (80%). The most common diagnoses were oropharyngeal dysphagia (63%) and gastroesophageal reflux (63%). 16 (39%) required gastrostomy and two fundoplication. Severity of gastrointestinal symptoms correlated with non-paroxysmal neurological disability index, Gross Motor Function Classification System scores, and with the presence/absence of non-gastrointestinal autonomic dysfunction (p = 0.031, 0.043, Spearman correlations and 0.0166 Cramer’s V, respectively) but not with the paroxysmal disability index (p = 0.408). Conclusions Most AHC patients have gastrointestinal problems. These are usually severe, most commonly are indicative of dysmotility, often require surgical therapies, and their severity correlates with that of non-paroxysmal CNS manifestations. Our findings should help in management-anticipatory guidance of AHC patients. Furthermore, they are consistent with current understandings of the pathophysiology of AHC and of gastrointestinal dysmotility, both of which involve autonomic and GABAergic dysfunction.
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Affiliation(s)
- Milton Pratt
- Division of Pediatric Neurology and Developmental Medicine, Duke University Health System, 2301 Erwin Rd., Durham, NC, 27710, USA
| | - Julie Uchitel
- Division of Pediatric Neurology and Developmental Medicine, Duke University Health System, 2301 Erwin Rd., Durham, NC, 27710, USA
| | - Nancy McGreal
- Divison of Gastroenterology, Department of Pediatrics, Duke University, Durham, NC, USA
| | - Kelly Gordon
- Department of Speech Pathology and Audiology, Duke University Health System, Durham, NC, USA
| | - Lyndsey Prange
- Division of Pediatric Neurology and Developmental Medicine, Duke University Health System, 2301 Erwin Rd., Durham, NC, 27710, USA
| | - Melissa McLean
- Division of Pediatric Neurology and Developmental Medicine, Duke University Health System, 2301 Erwin Rd., Durham, NC, 27710, USA
| | - Richard J Noel
- Divison of Gastroenterology, Department of Pediatrics, Duke University, Durham, NC, USA
| | - Blaire Rikard
- Division of Pediatric Neurology and Developmental Medicine, Duke University Health System, 2301 Erwin Rd., Durham, NC, 27710, USA
| | - Mary K Rogers Boruta
- Divison of Gastroenterology, Department of Pediatrics, Duke University, Durham, NC, USA
| | - Mohamad A Mikati
- Division of Pediatric Neurology and Developmental Medicine, Duke University Health System, 2301 Erwin Rd., Durham, NC, 27710, USA.
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13
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Prange L, Pratt M, Herman K, Schiffmann R, Mueller DM, McLean M, Mendez MM, Walley N, Heinzen EL, Goldstein D, Shashi V, Hunanyan A, Pagadala V, Mikati MA. D-DEMØ, a distinct phenotype caused by ATP1A3 mutations. NEUROLOGY-GENETICS 2020; 6:e466. [PMID: 32802951 PMCID: PMC7413631 DOI: 10.1212/nxg.0000000000000466] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 05/18/2020] [Indexed: 11/15/2022]
Abstract
Objective To describe a phenotype caused by ATP1A3 mutations, which manifests as dystonia, dysmorphism of the face, encephalopathy with developmental delay, brain MRI abnormalities always including cerebellar hypoplasia, no hemiplegia (Ø) (D-DEMØ), and neonatal onset. Methods Review and analysis of clinical and genetic data. Results Patients shared the above traits and had whole-exome sequencing that showed de novo variants of the ATP1A3 gene, predicted to be disease causing and occurring in regions of the protein critical for pump function. Patient 1 (c.1079C>G, p.Thr360Arg), an 8-year-old girl, presented on day 1 of life with episodic dystonia, complex partial seizures, and facial dysmorphism. MRI of the brain revealed cerebellar hypoplasia. Patient 2 (c.420G>T, p.Gln140His), an 18-year-old man, presented on day 1 of life with hypotonia, tremor, and facial dysmorphism. He later developed dystonia. MRI of the brain revealed cerebellar hypoplasia and, later, further cerebellar volume loss (atrophy). Patient 3 (c.974G>A, Gly325Asp), a 13-year-old girl, presented on day 1 of life with tremor, episodic dystonia, and facial dysmorphism. MRI of the brain showed severe cerebellar hypoplasia. Patient 4 (c.971A>G, p.Glu324Gly), a 14-year-old boy, presented on day 1 of life with tremor, hypotonia, dystonia, nystagmus, facial dysmorphism, and later seizures. MRI of the brain revealed moderate cerebellar hypoplasia. Conclusions D-DEMØ represents an ATP1A3-related phenotype, the observation of which should trigger investigation for ATP1A3 mutations. Our findings, and the presence of multiple distinct ATP1A3-related phenotypes, support the possibility that there are differences in the underlying mechanisms.
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Affiliation(s)
- Lyndsey Prange
- Duke University (L.P., M.P., M.M.M., N.W., V.S., A.H., M.A.M.), Durham, NC; UC Davis Health (K.H.), Sacramento; Baylor Scott & White Health (R.S.), Dallas, TX; Rosalind Franklin University of Medicine and Science (D.M.M.), Chicago, IL; University of North Carolina at Chapel Hill (E.L.H.); Columbia University (D.G.), New York City, NY; and Glycan Therapeutics, LLC (V.P.), Chapel Hill, NC
| | - Milton Pratt
- Duke University (L.P., M.P., M.M.M., N.W., V.S., A.H., M.A.M.), Durham, NC; UC Davis Health (K.H.), Sacramento; Baylor Scott & White Health (R.S.), Dallas, TX; Rosalind Franklin University of Medicine and Science (D.M.M.), Chicago, IL; University of North Carolina at Chapel Hill (E.L.H.); Columbia University (D.G.), New York City, NY; and Glycan Therapeutics, LLC (V.P.), Chapel Hill, NC
| | - Kristin Herman
- Duke University (L.P., M.P., M.M.M., N.W., V.S., A.H., M.A.M.), Durham, NC; UC Davis Health (K.H.), Sacramento; Baylor Scott & White Health (R.S.), Dallas, TX; Rosalind Franklin University of Medicine and Science (D.M.M.), Chicago, IL; University of North Carolina at Chapel Hill (E.L.H.); Columbia University (D.G.), New York City, NY; and Glycan Therapeutics, LLC (V.P.), Chapel Hill, NC
| | - Raphael Schiffmann
- Duke University (L.P., M.P., M.M.M., N.W., V.S., A.H., M.A.M.), Durham, NC; UC Davis Health (K.H.), Sacramento; Baylor Scott & White Health (R.S.), Dallas, TX; Rosalind Franklin University of Medicine and Science (D.M.M.), Chicago, IL; University of North Carolina at Chapel Hill (E.L.H.); Columbia University (D.G.), New York City, NY; and Glycan Therapeutics, LLC (V.P.), Chapel Hill, NC
| | - David M Mueller
- Duke University (L.P., M.P., M.M.M., N.W., V.S., A.H., M.A.M.), Durham, NC; UC Davis Health (K.H.), Sacramento; Baylor Scott & White Health (R.S.), Dallas, TX; Rosalind Franklin University of Medicine and Science (D.M.M.), Chicago, IL; University of North Carolina at Chapel Hill (E.L.H.); Columbia University (D.G.), New York City, NY; and Glycan Therapeutics, LLC (V.P.), Chapel Hill, NC
| | - Melissa McLean
- Duke University (L.P., M.P., M.M.M., N.W., V.S., A.H., M.A.M.), Durham, NC; UC Davis Health (K.H.), Sacramento; Baylor Scott & White Health (R.S.), Dallas, TX; Rosalind Franklin University of Medicine and Science (D.M.M.), Chicago, IL; University of North Carolina at Chapel Hill (E.L.H.); Columbia University (D.G.), New York City, NY; and Glycan Therapeutics, LLC (V.P.), Chapel Hill, NC
| | - Mary Moya Mendez
- Duke University (L.P., M.P., M.M.M., N.W., V.S., A.H., M.A.M.), Durham, NC; UC Davis Health (K.H.), Sacramento; Baylor Scott & White Health (R.S.), Dallas, TX; Rosalind Franklin University of Medicine and Science (D.M.M.), Chicago, IL; University of North Carolina at Chapel Hill (E.L.H.); Columbia University (D.G.), New York City, NY; and Glycan Therapeutics, LLC (V.P.), Chapel Hill, NC
| | - Nicole Walley
- Duke University (L.P., M.P., M.M.M., N.W., V.S., A.H., M.A.M.), Durham, NC; UC Davis Health (K.H.), Sacramento; Baylor Scott & White Health (R.S.), Dallas, TX; Rosalind Franklin University of Medicine and Science (D.M.M.), Chicago, IL; University of North Carolina at Chapel Hill (E.L.H.); Columbia University (D.G.), New York City, NY; and Glycan Therapeutics, LLC (V.P.), Chapel Hill, NC
| | - Erin L Heinzen
- Duke University (L.P., M.P., M.M.M., N.W., V.S., A.H., M.A.M.), Durham, NC; UC Davis Health (K.H.), Sacramento; Baylor Scott & White Health (R.S.), Dallas, TX; Rosalind Franklin University of Medicine and Science (D.M.M.), Chicago, IL; University of North Carolina at Chapel Hill (E.L.H.); Columbia University (D.G.), New York City, NY; and Glycan Therapeutics, LLC (V.P.), Chapel Hill, NC
| | - David Goldstein
- Duke University (L.P., M.P., M.M.M., N.W., V.S., A.H., M.A.M.), Durham, NC; UC Davis Health (K.H.), Sacramento; Baylor Scott & White Health (R.S.), Dallas, TX; Rosalind Franklin University of Medicine and Science (D.M.M.), Chicago, IL; University of North Carolina at Chapel Hill (E.L.H.); Columbia University (D.G.), New York City, NY; and Glycan Therapeutics, LLC (V.P.), Chapel Hill, NC
| | - Vandana Shashi
- Duke University (L.P., M.P., M.M.M., N.W., V.S., A.H., M.A.M.), Durham, NC; UC Davis Health (K.H.), Sacramento; Baylor Scott & White Health (R.S.), Dallas, TX; Rosalind Franklin University of Medicine and Science (D.M.M.), Chicago, IL; University of North Carolina at Chapel Hill (E.L.H.); Columbia University (D.G.), New York City, NY; and Glycan Therapeutics, LLC (V.P.), Chapel Hill, NC
| | - Arsen Hunanyan
- Duke University (L.P., M.P., M.M.M., N.W., V.S., A.H., M.A.M.), Durham, NC; UC Davis Health (K.H.), Sacramento; Baylor Scott & White Health (R.S.), Dallas, TX; Rosalind Franklin University of Medicine and Science (D.M.M.), Chicago, IL; University of North Carolina at Chapel Hill (E.L.H.); Columbia University (D.G.), New York City, NY; and Glycan Therapeutics, LLC (V.P.), Chapel Hill, NC
| | - Vijay Pagadala
- Duke University (L.P., M.P., M.M.M., N.W., V.S., A.H., M.A.M.), Durham, NC; UC Davis Health (K.H.), Sacramento; Baylor Scott & White Health (R.S.), Dallas, TX; Rosalind Franklin University of Medicine and Science (D.M.M.), Chicago, IL; University of North Carolina at Chapel Hill (E.L.H.); Columbia University (D.G.), New York City, NY; and Glycan Therapeutics, LLC (V.P.), Chapel Hill, NC
| | - Mohamad A Mikati
- Duke University (L.P., M.P., M.M.M., N.W., V.S., A.H., M.A.M.), Durham, NC; UC Davis Health (K.H.), Sacramento; Baylor Scott & White Health (R.S.), Dallas, TX; Rosalind Franklin University of Medicine and Science (D.M.M.), Chicago, IL; University of North Carolina at Chapel Hill (E.L.H.); Columbia University (D.G.), New York City, NY; and Glycan Therapeutics, LLC (V.P.), Chapel Hill, NC
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14
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Uchitel J, Abdelnour E, Boggs A, Prange L, Pratt M, Bonner M, Jasien J, Dawson G, Abrahamsen T, Mikati MA. Social impairments in alternating hemiplegia of childhood. Dev Med Child Neurol 2020; 62:820-826. [PMID: 32031250 DOI: 10.1111/dmcn.14473] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/18/2019] [Indexed: 12/18/2022]
Abstract
AIM To evaluate presence and severity of social impairments in alternating hemiplegia of childhood (AHC) and determine factors that are associated with social impairments. METHOD This was a retrospective analysis of 34 consecutive patients with AHC (19 females, 15 males; mean age: 9y 7mo, SD 8y 2mo, range 2y 7mo-40y), evaluated with the Social Responsiveness Scale, Second Edition (SRS-2). RESULTS SRS-2 scores, indicating level of social impairment, were higher than population means (75, SD 14 vs 50, SD 10, p<0.001). Of these, 27 out of 34 had high scores: 23 severe (>76), four moderate (66-76). All subscale domains, including social cognition, social communication, social awareness, social motivation, restricted interests, and repetitive behavior, had abnormal scores compared to population means (p<0.001). High SRS-2 scores were associated with the presence of autism spectrum disorder (ASD) and epilepsy (p=0.01, p=0.04), but not with other scales of AHC disease symptomatology. All nine patients who received formal evaluations for ASD, because they had high SRS-2 scores, were diagnosed with ASD. INTERPRETATION Most patients with AHC have impaired social skills involving multiple domains. ASD is not uncommon. High SRS-2 scores in patients with AHC support referral to ASD evaluation. Our findings are consistent with current understandings of the pathophysiology of AHC and ASD, both thought to involve GABAergic dysfunction. WHAT THIS PAPER ADDS Most patients with alternating hemiplegia of childhood (AHC) have impaired social skills involving multiple domains. These impairments are significant compared to population means. Most patients with AHC have high Social Responsiveness Scale, Second Edition (SRS-2) scores. Patients with AHC with high SRS-2 scores are likely to have autism spectrum disorder.
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Affiliation(s)
- Julie Uchitel
- Division of Pediatric Neurology and Developmental Medicine, Duke University, Durham, NC, USA
| | - Elie Abdelnour
- Division of Pediatric Neurology and Developmental Medicine, Duke University, Durham, NC, USA
| | - April Boggs
- Division of Pediatric Neurology and Developmental Medicine, Duke University, Durham, NC, USA
| | - Lyndsey Prange
- Division of Pediatric Neurology and Developmental Medicine, Duke University, Durham, NC, USA
| | - Milton Pratt
- Division of Pediatric Neurology and Developmental Medicine, Duke University, Durham, NC, USA
| | - Melanie Bonner
- Department of Psychiatry and Behavioral Sciences, Duke Pediatric Neuropsychology Program, Duke University, Durham, NC, USA
| | - Joan Jasien
- Division of Pediatric Neurology and Developmental Medicine, Duke University, Durham, NC, USA
| | - Geraldine Dawson
- Department of Psychiatry and Behavioral Sciences, Duke Center for Autism and Brain Development, Duke University, Durham, NC, USA
| | - Tavis Abrahamsen
- Department of Statistical Science, Duke University, Durham, NC, USA
| | - Mohamad A Mikati
- Division of Pediatric Neurology and Developmental Medicine, Duke University, Durham, NC, USA
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