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Ohyama-Tamagake A, Kaneko K, Itami R, Nakano M, Namioka Y, Izumi R, Sato H, Suzuki H, Takeda A, Okazaki Y, Yatsuka Y, Abe T, Murayama K, Sugeno N, Misu T, Aoki M. Adult-onset Leigh Syndrome with a m.9176T>C Mutation Manifested As Reversible Cerebral Vasoconstriction Syndrome. Intern Med 2023; 62:1995-1998. [PMID: 36543208 PMCID: PMC10372267 DOI: 10.2169/internalmedicine.0773-22] [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: 08/05/2022] [Accepted: 11/13/2022] [Indexed: 12/24/2022] Open
Abstract
A 26-year-old woman developed a sudden headache, ptosis, and diplopia. Magnetic resonance imaging and angiography demonstrated a symmetrical lesion from the midbrain to the brainstem, involving the solitary nucleus and multifocal cerebral artery narrowing. Reversible cerebral vasoconstriction syndrome (RCVS) was suspected, and the patient improved after vasodilatation. Leigh syndrome was suspected due to the elevated serum pyruvate level, so mitochondrial DNA was analyzed, and an m.9176T>C mutation was detected. The final diagnosis was adult-onset Leigh syndrome manifesting as RCVS. An uncontrolled baroreflex due to a solitary nuclear lesion or endothelial dysfunction may have contributed to her unique presentation.
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Affiliation(s)
| | | | - Ryo Itami
- Department of Neurology, Tokyo General Hospital, Japan
| | | | | | - Rumiko Izumi
- Department of Neurology, Tohoku University Hospital, Japan
| | - Haruka Sato
- Department of Cardiology, Tohoku University Hospital, Japan
| | - Hideaki Suzuki
- Department of Cardiology, Tohoku University Hospital, Japan
| | - Atsuhito Takeda
- Department of Pediatrics, Hokkaido University Hospital, Japan
| | - Yasushi Okazaki
- Diagnostics and Therapeutic of Intractable Diseases, Intractable Disease Research Center, Graduate School of Medicine, Juntendo University, Japan
- Laboratory for Comprehensive Genomic Analysis, RIKEN Center for Integrative Medical Sciences, Japan
| | - Yukiko Yatsuka
- Diagnostics and Therapeutic of Intractable Diseases, Intractable Disease Research Center, Graduate School of Medicine, Juntendo University, Japan
| | - Takaaki Abe
- Department of Clinical Biology and Hormonal Regulation, Graduate School of Medicine, Tohoku University, Japan
| | - Kei Murayama
- Department of Metabolism, Chiba Children's Hospital, Japan
| | - Naoto Sugeno
- Department of Neurology, Tohoku University Hospital, Japan
| | - Tatsuro Misu
- Department of Neurology, Tohoku University Hospital, Japan
| | - Masashi Aoki
- Department of Neurology, Tohoku University Hospital, Japan
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2
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Chen J, Wang J, Gan J, Luo R, Yang Z, Liang M, Chen X. Anti-AQP4-IgG-positive Leigh syndrome: A case report and review of the literature. Front Pediatr 2023; 11:1046731. [PMID: 36814591 PMCID: PMC9939766 DOI: 10.3389/fped.2023.1046731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 01/09/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Leigh syndrome (LS; OMIM: 256000) is a progressive neurodegenerative disease caused by genetic mutations resulting in mitochondrial oxidative phosphorylation defects. The prognosis is poor, with most children dying before the age of 2 years. MT-ATP6 variants are the most common mitochondrial DNA mutations in LS. MT-ATP6 variant-induced LS may trigger autoimmunity, and immunotherapy might be effective. Here, we present the first pediatric case of anti-aquaporin 4 (AQP4)-IgG-positive LS caused by an MT-ATP6 variant. CASE A 1-year-old boy was hospitalized due to recurrent fever, cough, and developmental regression. Two months previously, he had developed reduced responses to stimulation and psychomotor retardation. After admission, his condition deteriorated and respiratory failure ensued. Magnetic resonance imaging of the brain showed symmetrical small patchy abnormal signals around the third ventricle, pons, and dorsal periaqueductal gray matter in the dorsal medulla. Laboratory tests revealed anti-AQP4-IgG antibodies. Anti-infection, immunoglobulin, and glucocorticoid therapy were administered for symptomatic treatment. Genetic testing revealed a de novo homogeneous pathogenic variant of MT-ATP6 (m.9176T > C, mutation ratio: 99.97%). The patient was diagnosed with anti-AQP4-IgG-positive LS, treated with "cocktail therapy" (vitamins B1, B2, C, and E, l-carnitine, and coenzyme Q10), and discharged after his condition improved. A literature review revealed that LS-induced mitochondrial defects can impact the immune system; hence, immunotherapy and early mitochondrial cocktail therapy may improve outcomes. CONCLUSION Anti-AQP4-IgG-positive LS is very rare. Patients with LS with the m.9176T > C variant of MT-ATP6 may be susceptible to autoimmune damage of the central nervous system. Early cocktail therapy combined with immunotherapy may improve their prognosis.
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Affiliation(s)
- Jun Chen
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.,Department of Pediatrics, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of the Ministry of Education, Sichuan University, Chengdu, China.,Department of Pediatrics, Key Laboratory of Development and Maternal and Child Diseases of Sichuan Province, Sichuan University, Chengdu, China
| | - Jianjun Wang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.,Department of Pediatrics, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of the Ministry of Education, Sichuan University, Chengdu, China.,Department of Pediatrics, Key Laboratory of Development and Maternal and Child Diseases of Sichuan Province, Sichuan University, Chengdu, China
| | - Jing Gan
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.,Department of Pediatrics, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of the Ministry of Education, Sichuan University, Chengdu, China.,Department of Pediatrics, Key Laboratory of Development and Maternal and Child Diseases of Sichuan Province, Sichuan University, Chengdu, China
| | - Rong Luo
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.,Department of Pediatrics, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of the Ministry of Education, Sichuan University, Chengdu, China.,Department of Pediatrics, Key Laboratory of Development and Maternal and Child Diseases of Sichuan Province, Sichuan University, Chengdu, China
| | - Zuozhen Yang
- Medical Department, Cipher Gene LLC, Beijing, China
| | | | - Xiaolu Chen
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.,Department of Pediatrics, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of the Ministry of Education, Sichuan University, Chengdu, China.,Department of Pediatrics, Key Laboratory of Development and Maternal and Child Diseases of Sichuan Province, Sichuan University, Chengdu, China
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3
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Bharathidasan K, Evans A, Fernandez FMAO, Motes AT, Nugent K. Mitochondrial Myopathy in a 21-Year-Old Man Presenting With Bilateral Lower Extremity Weakness and Swelling. J Prim Care Community Health 2023; 14:21501319231172697. [PMID: 37162197 PMCID: PMC10184240 DOI: 10.1177/21501319231172697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
Bilateral lower extremity weakness and swelling can have several causes. Although often underdiagnosed, mitochondrial myopathy is more prevalent in the general population than more commonly suspected diseases, such as Guillain-Barre syndrome. The clinical manifestations of mitochondrial disease can be broadly classified into 3 categories: chronic progressive external ophthalmoplegia, skeletal muscle-central nervous system syndromes, or pure myopathy. Cardiac abnormalities occur in 30% to 32% of cases, mostly in the form of hypertrophic cardiomyopathy, dilated cardiomyopathy, or conduction abnormalities. We report a case of a 21-year-old student who developed bilateral lower limb weakness, pain, and swelling diagnosed with mitochondrial myopathy on muscle biopsy. Initial laboratory tests revealed elevated creatinine kinase, brain natriuretic peptide, troponin, myoglobin, and lactic acid and reduced serum bicarbonate. Cardiac workup revealed systolic heart failure with a reduced ejection fraction. Endomyocardial biopsy revealed punctate foci of lymphocytic myocarditis. However, cardiac magnetic resonance imaging did not reveal either myocarditis or an infiltrative cardiac disease. An extensive autoimmune and infection work-up was negative. A muscle biopsy from the patient's rectus femoris revealed scattered ragged-blue fibers (stained with NADH dehydrogenase), scattered ragged-red fibers on modified Gomori trichrome stain, and cytochrome-c oxidase negative fibers with increased perimysial and endomysial connective tissue, consistent with active and chronic primary mitochondrial myopathy. The patient was treated successfully with furosemide, metoprolol, and methylprednisolone. Adult-onset mitochondrial myopathy is a rare clinical disorder, and our experience stresses the importance of using an inter-disciplinary team approach to diagnose uncommon clinical disorders with widely variable multisystem involvement.
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Affiliation(s)
| | - Abbie Evans
- Texas Tech University Health Science Center, Lubbock, TX, USA
| | | | | | - Kenneth Nugent
- Texas Tech University Health Science Center, Lubbock, TX, USA
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Hanaford A, Johnson SC. The immune system as a driver of mitochondrial disease pathogenesis: a review of evidence. Orphanet J Rare Dis 2022; 17:335. [PMID: 36056365 PMCID: PMC9438277 DOI: 10.1186/s13023-022-02495-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 08/15/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Genetic mitochondrial diseases represent a significant challenge to human health. These diseases are extraordinarily heterogeneous in clinical presentation and genetic origin, and often involve multi-system disease with severe progressive symptoms. Mitochondrial diseases represent the most common cause of inherited metabolic disorders and one of the most common causes of inherited neurologic diseases, yet no proven therapeutic strategies yet exist. The basic cell and molecular mechanisms underlying the pathogenesis of mitochondrial diseases have not been resolved, hampering efforts to develop therapeutic agents. MAIN BODY In recent pre-clinical work, we have shown that pharmacologic agents targeting the immune system can prevent disease in the Ndufs4(KO) model of Leigh syndrome, indicating that the immune system plays a causal role in the pathogenesis of at least this form of mitochondrial disease. Intriguingly, a number of case reports have indicated that immune-targeting therapeutics may be beneficial in the setting of genetic mitochondrial disease. Here, we summarize clinical and pre-clinical evidence suggesting a key role for the immune system in mediating the pathogenesis of at least some forms of genetic mitochondrial disease. CONCLUSIONS Significant clinical and pre-clinical evidence indicates a key role for the immune system as a significant in the pathogenesis of at least some forms of genetic mitochondrial disease.
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Affiliation(s)
- Allison Hanaford
- Center for Integrative Brain Research, Seattle Children's Research Institute, 1900 9th Ave., JMB-925, Seattle, WA, 98101, USA
| | - Simon C Johnson
- Center for Integrative Brain Research, Seattle Children's Research Institute, 1900 9th Ave., JMB-925, Seattle, WA, 98101, USA.
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA.
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA.
- Department of Neurology, University of Washington, Seattle, WA, USA.
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5
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Ichikawa K, Tsuyusaki Y, Shimbo H, Goto T. Late-onset Leigh syndrome with m.9176T>C mutation in the mitochondrial ATPase 6 gene. Pediatr Int 2019; 61:1055-1056. [PMID: 31625254 DOI: 10.1111/ped.13991] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 02/28/2019] [Accepted: 06/12/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Kazushi Ichikawa
- Division of Neurology, Kanagawa Children's Medical Center, Yokohama, Kanagawa, Japan
| | - Yu Tsuyusaki
- Division of Neurology, Kanagawa Children's Medical Center, Yokohama, Kanagawa, Japan
| | - Hiroko Shimbo
- Division of Neurology, Clinical Research Institute, Kanagawa Children's Medical Center, Yokohama, Kanagawa, Japan
| | - Tomohide Goto
- Division of Neurology, Kanagawa Children's Medical Center, Yokohama, Kanagawa, Japan
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6
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Bolea I, Gella A, Sanz E, Prada-Dacasa P, Menardy F, Bard AM, Machuca-Márquez P, Eraso-Pichot A, Mòdol-Caballero G, Navarro X, Kalume F, Quintana A. Defined neuronal populations drive fatal phenotype in a mouse model of Leigh syndrome. eLife 2019; 8:e47163. [PMID: 31403401 PMCID: PMC6731060 DOI: 10.7554/elife.47163] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 08/11/2019] [Indexed: 12/12/2022] Open
Abstract
Mitochondrial deficits in energy production cause untreatable and fatal pathologies known as mitochondrial disease (MD). Central nervous system affectation is critical in Leigh Syndrome (LS), a common MD presentation, leading to motor and respiratory deficits, seizures and premature death. However, only specific neuronal populations are affected. Furthermore, their molecular identity and their contribution to the disease remains unknown. Here, using a mouse model of LS lacking the mitochondrial complex I subunit Ndufs4, we dissect the critical role of genetically-defined neuronal populations in LS progression. Ndufs4 inactivation in Vglut2-expressing glutamatergic neurons leads to decreased neuronal firing, brainstem inflammation, motor and respiratory deficits, and early death. In contrast, Ndufs4 deletion in GABAergic neurons causes basal ganglia inflammation without motor or respiratory involvement, but accompanied by hypothermia and severe epileptic seizures preceding death. These results provide novel insight in the cell type-specific contribution to the pathology, dissecting the underlying cellular mechanisms of MD.
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Affiliation(s)
- Irene Bolea
- Center for Developmental Therapeutics, Seattle Children’s Research InstituteSeattleUnited States
- Institut de Neurociències, Universitat Autònoma de BarcelonaBellaterraSpain
| | - Alejandro Gella
- Institut de Neurociències, Universitat Autònoma de BarcelonaBellaterraSpain
- Department of Biochemistry and Molecular BiologyUniversitat Autònoma de BarcelonaBellaterraSpain
| | - Elisenda Sanz
- Institut de Neurociències, Universitat Autònoma de BarcelonaBellaterraSpain
- Center for Integrative Brain Research, Seattle Children’s Research InstituteSeattleUnited States
- Department of Cell Biology, Physiology and ImmunologyUniversitat Autònoma de BarcelonaBellaterraSpain
| | - Patricia Prada-Dacasa
- Institut de Neurociències, Universitat Autònoma de BarcelonaBellaterraSpain
- Department of Cell Biology, Physiology and ImmunologyUniversitat Autònoma de BarcelonaBellaterraSpain
| | - Fabien Menardy
- Institut de Neurociències, Universitat Autònoma de BarcelonaBellaterraSpain
| | - Angela M Bard
- Center for Integrative Brain Research, Seattle Children’s Research InstituteSeattleUnited States
| | | | - Abel Eraso-Pichot
- Institut de Neurociències, Universitat Autònoma de BarcelonaBellaterraSpain
| | - Guillem Mòdol-Caballero
- Institut de Neurociències, Universitat Autònoma de BarcelonaBellaterraSpain
- Department of Cell Biology, Physiology and ImmunologyUniversitat Autònoma de BarcelonaBellaterraSpain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED)BellaterraSpain
| | - Xavier Navarro
- Institut de Neurociències, Universitat Autònoma de BarcelonaBellaterraSpain
- Department of Cell Biology, Physiology and ImmunologyUniversitat Autònoma de BarcelonaBellaterraSpain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED)BellaterraSpain
| | - Franck Kalume
- Center for Integrative Brain Research, Seattle Children’s Research InstituteSeattleUnited States
- Department of Neurological SurgeryUniversity of WashingtonSeattleUnited States
- Department of PharmacologyUniversity of WashingtonSeattleUnited States
| | - Albert Quintana
- Center for Developmental Therapeutics, Seattle Children’s Research InstituteSeattleUnited States
- Institut de Neurociències, Universitat Autònoma de BarcelonaBellaterraSpain
- Center for Integrative Brain Research, Seattle Children’s Research InstituteSeattleUnited States
- Department of Cell Biology, Physiology and ImmunologyUniversitat Autònoma de BarcelonaBellaterraSpain
- Department of PediatricsUniversity of WashingtonSeattleUnited States
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7
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Cruz ACP, Ferrasa A, Muotri AR, Herai RH. Frequency and association of mitochondrial genetic variants with neurological disorders. Mitochondrion 2018; 46:345-360. [PMID: 30218715 DOI: 10.1016/j.mito.2018.09.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 08/24/2018] [Accepted: 09/11/2018] [Indexed: 12/17/2022]
Abstract
Mitochondria are small cytosolic organelles and the main source of energy production for the cells, especially in the brain. This organelle has its own genome, the mitochondrial DNA (mtDNA), and genetic variants in this molecule can alter the normal energy metabolism in the brain, contributing to the development of a wide assortment of Neurological Disorders (ND), including neurodevelopmental syndromes, neurodegenerative diseases and neuropsychiatric disorders. These ND are comprised by a heterogeneous group of syndromes and diseases that encompass different cognitive phenotypes and behavioral disorders, such as autism, Asperger's syndrome, pervasive developmental disorder, attention deficit hyperactivity disorder, Huntington disease, Leigh Syndrome and bipolar disorder. In this work we carried out a Systematic Literature Review (SLR) to identify and describe the mitochondrial genetic variants associated with the occurrence of ND. Most of genetic variants found in mtDNA were associated with Single Nucleotide Polimorphisms (SNPs), ~79%, with ~15% corresponding to deletions, ~3% to Copy Number Variations (CNVs), ~2% to insertions and another 1% included mtDNA replication problems and genetic rearrangements. We also found that most of the variants were associated with coding regions of mitochondrial proteins but were also found in regulatory transcripts (tRNA and rRNA) and in the D-Loop replication region of the mtDNA. After analysis of mtDNA deletions and CNV, none of them occur in the D-Loop region. This SLR shows that all transcribed mtDNA molecules have mutations correlated with ND. Finally, we describe that all mtDNA variants found were associated with deterioration of cognitive (dementia) and intellectual functions, learning disabilities, developmental delays, and personality and behavior problems.
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Affiliation(s)
- Ana Carolina P Cruz
- Experimental Multiuser Laboratory (LEM), Graduate Program in Health Sciences (PPGCS), School of Medicine (PPGCS), Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Paraná 80215-901, Brazil
| | - Adriano Ferrasa
- Experimental Multiuser Laboratory (LEM), Graduate Program in Health Sciences (PPGCS), School of Medicine (PPGCS), Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Paraná 80215-901, Brazil; Department of Informatics (DEINFO), Universidade Estadual de Ponta Grossa (UEPG), Ponta Grossa, Paraná 84030-900, Brazil
| | - Alysson R Muotri
- University of California San Diego, School of Medicine, Department of Pediatrics/Rady Children's Hospital San Diego, Department of Cellular & Molecular Medicine, Stem Cell Program, La Jolla, CA 92037-0695, USA
| | - Roberto H Herai
- Experimental Multiuser Laboratory (LEM), Graduate Program in Health Sciences (PPGCS), School of Medicine (PPGCS), Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Paraná 80215-901, Brazil; Lico Kaesemodel Institute (ILK), Curitiba, Paraná 80240-000, Brazil.
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8
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Wei Y, Wang L. Adult-onset Leigh syndrome with central fever and peripheral neuropathy due to mitochondrial 9176T>C mutation. Neurol Sci 2018; 39:2225-2228. [DOI: 10.1007/s10072-018-3541-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 08/17/2018] [Indexed: 11/29/2022]
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9
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Chen L, Cui Y, Jiang D, Ma C, Tse HF, Hwu WL, Lian Q. Management of Leigh syndrome: Current status and new insights. Clin Genet 2018; 93:1131-1140. [DOI: 10.1111/cge.13139] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 08/19/2017] [Accepted: 09/09/2017] [Indexed: 01/11/2023]
Affiliation(s)
- L. Chen
- Department of Medicine; The University of Hong Kong; Hong Kong SAR P. R. China
- Shenzhen Institutes of Research and Innovation; The University of Hong Kong; P. R. China
| | - Y. Cui
- Department of Medicine; The University of Hong Kong; Hong Kong SAR P. R. China
- Shenzhen Institutes of Research and Innovation; The University of Hong Kong; P. R. China
| | - D. Jiang
- Department of Medicine; The University of Hong Kong; Hong Kong SAR P. R. China
- Shenzhen Institutes of Research and Innovation; The University of Hong Kong; P. R. China
| | - C.Y. Ma
- Department of Medicine; The University of Hong Kong; Hong Kong SAR P. R. China
- Shenzhen Institutes of Research and Innovation; The University of Hong Kong; P. R. China
| | - H.-F. Tse
- Department of Medicine; The University of Hong Kong; Hong Kong SAR P. R. China
- Shenzhen Institutes of Research and Innovation; The University of Hong Kong; P. R. China
| | - W.-L. Hwu
- Department of Pediatrics and Medical Genetics; National Taiwan University Hospital; Taipei City Taiwan
| | - Q. Lian
- Department of Medicine; The University of Hong Kong; Hong Kong SAR P. R. China
- Shenzhen Institutes of Research and Innovation; The University of Hong Kong; P. R. China
- School of Biomedical Sciences; The University of Hong Kong; Hong Kong SAR P. R. China
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10
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Abstract
ABSTRACTThis review aims at summarizing and discussing previous and recent findings concerning the cerebral manifestations of mitochondrial disorders (MIDs). MIDs frequently present as mitochondrial multiorgan disorder syndrome (MIMODS) either already at onset or later in the course. After the muscle, the brain is the organ second most frequently affected in MIMODS. Cerebral manifestations of MIDs are variable and may present with or without a lesion on imaging or functional studies, but there can be imaging/functional lesions without clinical manifestations. The most well-known cerebral manifestations of MIDs include stroke-like episodes, epilepsy, headache, ataxia, movement disorders, hypopituitarism, muscle weakness, psychiatric abnormalities, nystagmus, white and gray matter lesions, atrophy, basal ganglia calcification, and hypometabolism on 2-deoxy-2-[fluorine-18]fluoro-D-glucose positron-emission tomography. For most MIDs, only symptomatic therapy is currently available. Symptomatic treatment should be supplemented by vitamins, cofactors, and antioxidants. In conclusion, cerebral manifestations of MIDs need to be recognized and appropriately managed because they strongly determine the outcome of MID patients.
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11
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Chuquilin M, Govindarajan R, Peck D, Font Montgomery E. Response to letter to the editor: Why does Leigh syndrome responds to immunotherapy? Mol Genet Metab Rep 2016; 8:85-6. [PMID: 27547733 PMCID: PMC4982918 DOI: 10.1016/j.ymgmr.2016.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 08/02/2016] [Accepted: 08/02/2016] [Indexed: 11/28/2022] Open
Affiliation(s)
- Miguel Chuquilin
- Department of Neurology, University of Florida, HSC Box 100236, Gainesville, FL 32610
| | - Raghav Govindarajan
- Department of Neurology, University of Missouri in Columbia, Five Hospital Drive CE 514, Columbia, MO 65212, USA
| | - Dawn Peck
- Department of Genetics, University of Missouri in Columbia, 404 N Keene St, Suite 101, Columbia, MO 65201, USA
| | - Esperanza Font Montgomery
- Department of Genetics, University of Missouri in Columbia, 404 N Keene St, Suite 101, Columbia, MO 65201, USA
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