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Amin S, Ruban-Fell B, Newell I, Evans J, Vyas K, Nortvedt C, Chin RF. Treatment guidelines for rare, early-onset conditions associated with epileptic seizures: a literature review on Rett syndrome and tuberous sclerosis complex. Orphanet J Rare Dis 2024; 19:89. [PMID: 38409029 PMCID: PMC10895812 DOI: 10.1186/s13023-023-02994-x] [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: 02/23/2022] [Accepted: 12/13/2023] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Rett syndrome (RTT) and tuberous sclerosis complex (TSC) are two rare disorders presenting with a range of different epileptic seizures. Seizure management requires careful therapy selection, thereby necessitating development of high-quality treatment guidelines. This targeted literature review (TLR) aimed to characterise country-specific and international treatment guidelines available for pharmacological management of seizures in RTT and TSC. METHODS A TLR was performed between 25-Jan and 11-Mar 2021. Manual searches of online rare disease and guideline databases, and websites of national heath technology assessment bodies were conducted for the following countries: Australia, Canada, France, Germany, Israel, Italy, Japan, Spain, Switzerland, UK, and US as defined by pre-specified eligibility criteria. Search terms were developed for each condition and translated into local languages where appropriate. Eligible publications were defined as guidelines/guidance reporting pharmacological management of seizures in patients with RTT and TSC. Guideline development methodology, geographical focus, author information and treatment recommendations were extracted from guidelines. An author map was generated using R version 3.5.1 to visualise extent of collaboration between authors. RESULTS 24 total guidelines were included, of which three and six contained only recommendations for RTT and TSC, respectively (some provided recommendations for ≥ 1 condition). Guideline development processes were poorly described (50% [12 guidelines] had unclear/absent literature review methodologies); reported methodologies were variable, including systematic literature reviews (SLRs)/TLRs and varying levels of expert consultation. Most (83% [20/24]) were country-specific, with guideline authors predominantly publishing in contained national groups; four guidelines were classified as 'International,' linking author groups in the US, UK, Italy and France. High levels of heterogeneity were observed in the availability of treatment recommendations across indications, with 13 and 67 recommendations found for RTT and TSC, respectively. For RTT, all treatment recommendations were positive and sodium valproate had the highest number of positive recommendations (Khwaja, Sahin (2011) Curr Opin Pediatr 23(6):633-9). All TSC treatments (21 medications) received either exclusively negative (National Organization for Rare Disorders (2019)) or positive (Chu-Shore et al. (2010) Epilepsia 51(7):1236-41) recommendations; vigabatrin received the highest number of positive recommendations (Kaur, Christodoulou (2019)). CONCLUSIONS This review highlights the need for the development of international high-quality and comprehensive consensus-based guidance for the management of seizures with pharmacological therapy in RTT and TSC. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- S Amin
- Bristol Royal Hospital for Children, Research and Education Centre, Upper Maudlin St, Bristol, BS2 8AE, UK.
| | | | | | - J Evans
- Costello Medical, Cambridge, UK
| | - K Vyas
- GW Pharmaceuticals, London, UK
| | | | - R F Chin
- Royal Hospital for Children and Young People, Edinburgh, UK
- Muir Maxwell Epilepsy Centre, Centre for Clinical Brain Sciences, Edinburgh, UK
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Whitaker-Fornek JR, Jenkins PM, Levitt ES. Inhibitory synaptic transmission is impaired in the Kölliker-Fuse of male, but not female, Rett syndrome mice. J Neurophysiol 2023; 130:1578-1587. [PMID: 37965930 PMCID: PMC11068392 DOI: 10.1152/jn.00327.2023] [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: 08/30/2023] [Revised: 10/31/2023] [Accepted: 11/09/2023] [Indexed: 11/16/2023] Open
Abstract
Rett syndrome (RTT) is a severe neurodevelopmental disorder that mainly affects females due to silencing mutations in the X-linked MECP2 gene. One of the most troubling symptoms of RTT is breathing irregularity, including apneas, breath-holds, and hyperventilation. Mice with silencing mutations in Mecp2 exhibit breathing abnormalities similar to human patients and serve as useful models for studying mechanisms underlying breathing problems in RTT. Previous work implicated the pontine, respiratory-controlling Kölliker-Fuse (KF) in the breathing problems in RTT. The goal of this study was to test the hypothesis that inhibitory synaptic transmission is deficient in KF neurons from symptomatic male and female RTT mice. We performed whole cell voltage-clamp recordings from KF neurons in acute brain slices to examine spontaneous and electrically evoked inhibitory post-synaptic currents (IPSCs) in RTT mice and age- and sex-matched wild-type mice. The frequency of spontaneous IPSCs was reduced in KF neurons from male RTT mice but surprisingly not in female RTT mice. In addition, electrically evoked IPSCs were less reliable in KF neurons from male, but not female, RTT mice, which was positively correlated with paired-pulse facilitation, indicating decreased probability of release. KF neurons from male RTT mice were also more excitable and exhibited shorter-duration action potentials. Increased excitability of KF neurons from male mice was not explained by changes in axon initial segment length. These findings indicate impaired inhibitory neurotransmission and increased excitability of KF neurons in male but not female RTT mice and suggest that sex-dependent mechanisms contribute to breathing problems in RTT.NEW & NOTEWORTHY Kölliker-Fuse (KF) neurons in acute brain slices from male Rett syndrome (RTT) mice receive reduced inhibitory synaptic inputs compared with wild-type littermates. In female RTT mice, inhibitory transmission was not different in KF neurons compared with controls. The results from this study show that sex-specific alterations in synaptic transmission occur in the KF of RTT mice.
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Affiliation(s)
- Jessica R Whitaker-Fornek
- Department of Pharmacology, University of Michigan Medical School, Ann Arbor, Michigan, United States
- Department of Pharmacology and Therapeutics, University of Florida, Gainesville, Florida, United States
| | - Paul M Jenkins
- Department of Pharmacology, University of Michigan Medical School, Ann Arbor, Michigan, United States
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, United States
| | - Erica S Levitt
- Department of Pharmacology, University of Michigan Medical School, Ann Arbor, Michigan, United States
- Department of Pharmacology and Therapeutics, University of Florida, Gainesville, Florida, United States
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan, United States
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Parent H, Ferranti A, Niswender C. Trofinetide: a pioneering treatment for Rett syndrome. Trends Pharmacol Sci 2023; 44:740-741. [PMID: 37460385 PMCID: PMC10529922 DOI: 10.1016/j.tips.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/23/2023] [Accepted: 06/23/2023] [Indexed: 08/09/2023]
Affiliation(s)
- Harrison Parent
- Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN, USA; Warren Center for Neuroscience Drug Discovery, Vanderbilt University, Nashville, TN, USA
| | - Anthony Ferranti
- Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN, USA; Warren Center for Neuroscience Drug Discovery, Vanderbilt University, Nashville, TN, USA
| | - Colleen Niswender
- Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN, USA; Warren Center for Neuroscience Drug Discovery, Vanderbilt University, Nashville, TN, USA; Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, TN, USA; Vanderbilt Brain Institute, Vanderbilt University School of Medicine, Nashville, TN, USA; Vanderbilt Institute of Chemical Biology, Vanderbilt University School of Medicine, Nashville, TN, USA.
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Zhang D, Lang S, Wilken B, Einspieler C, Neul JL, Bölte S, Holzinger D, Freilinger M, Poustka L, Sigafoos J, Marschik PB. Learning about neurodiversity from parents - Auditory gestalt perception of prelinguistic vocalisations. RESEARCH IN DEVELOPMENTAL DISABILITIES 2023; 138:104515. [PMID: 37104989 DOI: 10.1016/j.ridd.2023.104515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/11/2023] [Accepted: 04/17/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND Infants with Rett syndrome (RTT) may have subtle anomalies in their prelinguistic vocalisations but the detection of these is difficult, since their conspicuous vocalisations are often interspersed with inconspicuous ones. AIMS AND METHODS Extending a previous study with predominantly non-parents, the present study sampled parents of children with RTT and aimed to examine their gestalt perception of prelinguistic vocalisations. METHODS AND PROCEDURE Parents (n = 76) of female children with RTT listened to vocalisation recordings from RTT and typically developing (TD) infants, including an inconspicuous vocalisation from a RTT girl. For each recording, parents indicated if the vocalisation was produced by a RTT or a TD child. RESULTS Overall correct to incorrect identification rate was 2:1, which was comparable to that of the previous study. Intriguingly, parents of RTT children seemed to be sensitive to features characterising the vocalisations of RTT infants, which has especially influenced their perception of the inconspicuous vocalisation from a RTT girl. CONCLUSIONS AND IMPLICATIONS These results invite further research on the potential characterising differences between vocalisations from TD infants and infants with divergent neurodevelopment.
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Affiliation(s)
- Dajie Zhang
- Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen, 37075 Göttingen, Germany; iDN-Interdisciplinary Developmental Neuroscience, Division of Phoniatrics, Medical University of Graz, 8036 Graz, Austria; Leibniz Science Campus Primate Cognition, 37077 Göttingen, Germany.
| | - Sigrun Lang
- Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen, 37075 Göttingen, Germany
| | - Bernd Wilken
- Social Pediatric Center, Clinic in Kassel, 34125 Kassel, Germany
| | - Christa Einspieler
- iDN-Interdisciplinary Developmental Neuroscience, Division of Phoniatrics, Medical University of Graz, 8036 Graz, Austria
| | - Jeffrey L Neul
- Pediatrics, Pharmacology, and Special Education, Vanderbilt University Medical Center, Nashville, TN 37203, USA
| | - Sven Bölte
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Child and Adolescent Psychiatry, Region Stockholm, Karolinska Institutet & Stockholm Health Care Services, 17176 Stockholm, Sweden; Curtin Autism Research Group, Curtin School of Allied Health, Curtin University, Perth, WA 6845, Australia
| | - Daniel Holzinger
- Institut für Sinnes- und Sprachneurologie, Konventhospital Barmherzige Brüder Linz, 4020 Linz, Austria; Research Institute for Developmental Medicine, Johannes Kepler University Linz, 4040 Linz, Austria
| | - Michael Freilinger
- Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Luise Poustka
- Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen, 37075 Göttingen, Germany
| | - Jeff Sigafoos
- School of Education, Victoria University of Wellington, Wellington 6140, New Zealand
| | - Peter B Marschik
- Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen, 37075 Göttingen, Germany; iDN-Interdisciplinary Developmental Neuroscience, Division of Phoniatrics, Medical University of Graz, 8036 Graz, Austria; Leibniz Science Campus Primate Cognition, 37077 Göttingen, Germany; Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Child and Adolescent Psychiatry, Region Stockholm, Karolinska Institutet & Stockholm Health Care Services, 17176 Stockholm, Sweden
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Sardina F, Conte A, Paladino S, Pierantoni GM, Rinaldo C. HIPK2 in the physiology of nervous system and its implications in neurological disorders. BIOCHIMICA ET BIOPHYSICA ACTA. MOLECULAR CELL RESEARCH 2023; 1870:119465. [PMID: 36935052 DOI: 10.1016/j.bbamcr.2023.119465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/09/2023] [Accepted: 03/13/2023] [Indexed: 03/21/2023]
Abstract
HIPK2 is an evolutionary conserved serine/threonine kinase with multifunctional roles in stress response, embryonic development and pathological conditions, such as cancer and fibrosis. The heterogeneity of its interactors and targets makes HIPK2 activity strongly dependent on the cellular context, and allows it to modulate multiple signaling pathways, ultimately regulating cell fate and proliferation. HIPK2 is highly expressed in the central and peripheral nervous systems, and its genetic ablation causes neurological defects in mice. Moreover, HIPK2 is involved in processes, such as endoplasmic reticulum stress response and protein aggregate accumulation, and pathways, including TGF-β and BMP signaling, that are crucial in the pathogenesis of neurological disorders. Here, we review the data about the role of HIPK2 in neuronal development, survival, and homeostasis, highlighting the implications in the pathogenesis of neurological disorders, and pointing out HIPK2 potentiality as therapeutic target and diagnostic or prognostic marker.
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Affiliation(s)
- F Sardina
- Institute of Molecular Biology and Pathology (IBPM), Consiglio Nazionale delle Ricerche (CNR), c/o Sapienza University, Rome, Italy
| | - A Conte
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, 80131 Naples, Italy
| | - S Paladino
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, 80131 Naples, Italy
| | - G M Pierantoni
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, 80131 Naples, Italy.
| | - C Rinaldo
- Institute of Molecular Biology and Pathology (IBPM), Consiglio Nazionale delle Ricerche (CNR), c/o Sapienza University, Rome, Italy.
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May DM, Neul JL, Satija A, Cheng WY, Lema N, Boca A, Lefebvre P, Piña-Garza JE. Real-world clinical management of individuals with Rett syndrome: a physician survey. J Med Econ 2023; 26:1570-1580. [PMID: 37991281 DOI: 10.1080/13696998.2023.2286778] [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: 03/03/2023] [Accepted: 11/20/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Rett syndrome (RTT) is a severe neurodevelopmental disorder. Management strategies are heterogeneous with no clear definition of success. This study describes physician decision-making regarding diagnosis, therapeutic goals, and management strategies to better understand RTT clinical management in the US. METHODS This study was conducted among practicing physicians, specifically neurologists and pediatricians in the US with experience treating ≥2 individuals with RTT, including ≥1 individuals within the past two years. In-depth interviews with five physicians informed survey development. A cross-sectional survey was then conducted among 100 physicians. RESULTS Neurologists had treated more individuals with RTT (median: 12 vs. 5, p < 0.001) than pediatricians throughout their career and were more likely to report being "very comfortable" managing RTT (31 vs. 4%, p < 0.001). Among physicians with experience diagnosing RTT (93%), most evaluated symptoms (91%) or used genetic testing (86%) for RTT diagnoses; neurologists used the 2010 consensus diagnostic criteria more than pediatricians (54 vs. 29%; p = 0.012). Improving the quality of life (QOL) of individuals with RTT was the most important therapeutic goal among physicians, followed by improving caregivers' QOL. Most physicians used clinical practice guidelines to monitor the progress of individuals with RTT, although neurologists relied more on clinical scales than pediatricians. Among all physicians, the most commonly treated symptoms included behavioral issues, epilepsy/seizures, and feeding issues. Management strategies varied by symptom, with referral to appropriate specialists being common across symptoms. A large proportion of physicians (37%) identified the lack of novel therapies and reliance on symptom-specific management as an unmet need. CONCLUSION Although most physicians had experience and were comfortable diagnosing and treating individuals with RTT, better education and support among pediatricians is warranted. Additionally, novel treatments that target multiple symptoms associated with RTT could reduce the burden and improve the QOL of individuals with RTT and their caregivers.
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Affiliation(s)
| | - Jeffrey L Neul
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | - Neema Lema
- Analysis Group, Inc., Menlo Park, CA, USA
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Gelfo F, Petrosini L. Environmental Enrichment Enhances Cerebellar Compensation and Develops Cerebellar Reserve. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095697. [PMID: 35565093 PMCID: PMC9099498 DOI: 10.3390/ijerph19095697] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/02/2022] [Accepted: 05/05/2022] [Indexed: 12/24/2022]
Abstract
The brain is able to change its structure and function in response to environmental stimulations. Several human and animal studies have documented that enhanced stimulations provide individuals with strengthened brain structure and function that allow them to better cope with damage. In this framework, studies based on the exposure of animals to environmental enrichment (EE) have provided indications of the mechanisms involved in such a beneficial action. The cerebellum is a very plastic brain region that responds to every experience with deep structural and functional rearrangement. The present review specifically aims to collect and synthesize the evidence provided by animal models on EE exposure effects on cerebellar structure and function by considering the studies on healthy subjects and on animals exposed to EE both before and after damage involving cerebellar functionality. On the whole, the evidence supports the role of EE in enhancing cerebellar compensation and developing cerebellar reserve. However, since studies addressing this issue are still scarce, large areas of inconsistency and lack of clarity remain. Further studies are required to provide suggestions on possible mechanisms of enhancement of compensatory responses in human patients following cerebellar damage.
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Affiliation(s)
- Francesca Gelfo
- Department of Human Sciences, Guglielmo Marconi University, Via Plinio 44, 00193 Rome, Italy
- IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy;
- Correspondence:
| | - Laura Petrosini
- IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy;
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