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Wang S, Liu QZ, Zhao R, Zhai X, Zhang K, Cai L, Li S, Yang Z, Shan Y, Ma K, Li Y, Hu J, Sui L, Cheng H, Li X, Su J, Zhao M, Wang X, Zhou J, Wang M, Li T, Zhang J, Liang S, Luan G, Guan Y. Seizure, Motor, and Cognitive Outcomes After Epilepsy Surgery for Patients With Sturge-Weber Syndrome: Results From a Multicenter Study. Neurology 2024; 103:e209525. [PMID: 38875518 PMCID: PMC11244739 DOI: 10.1212/wnl.0000000000209525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 04/03/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Surgery is widely performed for refractory epilepsy in patients with Sturge-Weber syndrome (SWS), but reports on its effectiveness are limited. This study aimed to analyze seizure, motor, and cognitive outcomes of surgery in these patients and to identify factors associated with the outcomes. METHODS This was a multicenter retrospective observational study using data from patients with SWS and refractory epilepsy who underwent epilepsy surgery between 2000 and 2020 at 16 centers throughout China. Longitudinal postoperative seizures were classified by Engel class, and Engel class I was regarded as seizure-free outcome. Functional (motor and cognitive) outcomes were evaluated using the SWS neurologic score, and improved or unchanged scores between baseline and follow-up were considered to have stable outcomes. Outcomes were analyzed using Kaplan-Meier analyses. Multivariate Cox regression was used to identify factors associated with outcomes. RESULTS A total of 214 patients with a median age of 2.0 (interquartile range 1.2-4.6) years underwent surgery (focal resection, FR [n = 87]; hemisphere surgery, HS [n = 127]) and completed a median of 3.5 (1.7-5.0) years of follow-up. The overall estimated probability for being seizure-free postoperatively at 1, 2, and 5 years was 86.9% (95% CI 82.5-91.6), 81.4% (95% CI 76.1-87.1), and 70.7% (95% CI 63.3-79.0), respectively. The overall estimated probability of being motor stable at the same time post operatively was 65.4% (95% CI 58.4-71.2), 80.2% (95% CI 73.8-85.0), and 85.7% (95% CI 79.5-90.1), respectively. The overall probability for being cognition stable at 1, 2, and 5 years was 80.8% (95% CI 74.8-85.5), 85.1% (95% CI 79.3-89.2), and 89.5% (95% CI 83.8-93.2), respectively. Both FR and HS were effective at ensuring seizure control. For different HS techniques, modified hemispherotomy had comparable outcomes but improved safety compared with anatomical hemispherectomy. Regarding FR, partial resection (adjusted hazard ratio [aHR] 11.50, 95% CI 4.44-29.76), acute postoperative seizure (APOS, within 30 days of surgery; aHR 10.33, 95% CI 3.94-27.12), and generalized seizure (aHR 3.09, 95% CI 1.37-6.94) were associated with seizure persistence. For HS, seizure persistence was associated with APOS (aHR 27.61, 9.92-76.89), generalized seizure (aHR 7.95, 2.74-23.05), seizure frequency ≥30 times/month (aHR 4.76, 1.27-17.87), and surgical age ≥2 years (aHR 3.78, 1.51-9.47); motor stability was associated with severe motor defects (aHR 5.23, 2.27-12.05) and postoperative seizure-free status (aHR 3.09, 1.49-6.45); and cognition stability was associated with postoperative seizure-free status (aHR 2.84, 1.39-5.78) and surgical age <2 years (aHR 1.76, 1.13-2.75). DISCUSSION FR is a valid option for refractory epilepsy in patients with SWS and has similar outcomes to those of HS, with less morbidity associated with refractory epilepsy. Early surgical treatment (under the age of 2 years) leads to better outcomes after HS, but there is insufficient evidence that surgical age affects FR outcomes. These findings warrant future prospective multicenter cohorts with international cooperation and prolonged follow-up in better exploring more precise outcomes and developing prognostic predictive models. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that in children with SWS and refractory seizures, surgical resection-focal, hemispherectomy, or modified hemispherotomy-leads to improved outcomes.
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Affiliation(s)
- Shu Wang
- From the Department of Neurosurgery (S.W., X.W., J. Zhou, G.L., Y.G.), SanBo Brain Hospital, Capital Medical University; Department of Neurosurgery (S.W., K.Z., J. Zhang), Beijing Tiantan Hospital, Capital Medical University; Pediatric Epilepsy Center (Q.-Z.L., L.C.), Peking University First Hospital, Beijing; Department of Neurosurgery (R.Z.), Children's Hospital of Fudan University, Shanghai; Department of Neurosurgery (X.Z.), Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders; Epilepsy Center (S. Li), Guangdong Sanjiu Brain Hospital, Guangzhou; Department of Neurosurgery (Z.Y.), Xiangya Hospital, Central South University, Changsha, Hunan; Department of Neurosurgery (Y.S.), Xuanwu Hospital, Capital Medical University; Department of Neurosurgery (K.M., Y.L.), Capital Institute of Pediatrics, Beijing; Department of Neurosurgery (J.H.), Huashan Hospital, Fudan University, Shanghai; Department of Epilepsy Center (L.S.), The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong; Department of Neurosurgery (H.C.), The First Affiliated Hospital of Anhui Medical University, Hefei; Department of Neurology (X.L.), Affiliated ZhongDa Hospital, Southeast University, Nanjing, Jiangsu; Department of Neurology (J.S.), Affiliated Children's Hospital of Xi'an Jiaotong University, Shaanxi; Department of Neurosurgery (M.Z.), Henan Sanbo Brain Hospital, Zhengzhou; Department of Neurology (M.W., T.L.), SanBo Brain Hospital; and Department of Functional Neurosurgery (J. Zhang), Beijing Neurosurgical Institute, Capital Medical University; Beijing Key Laboratory of Neurostimulation (J. Zhang); Functional Neurosurgery Department (S. Liang), Beijing Children's Hospital, Capital Medical University, National Center for Children's Health; Beijing Key Laboratory of Epilepsy (G.L., Y.G.); and Center of Epilepsy (G.L., Y.G.), Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, China
| | - Qing-Zhu Liu
- From the Department of Neurosurgery (S.W., X.W., J. Zhou, G.L., Y.G.), SanBo Brain Hospital, Capital Medical University; Department of Neurosurgery (S.W., K.Z., J. Zhang), Beijing Tiantan Hospital, Capital Medical University; Pediatric Epilepsy Center (Q.-Z.L., L.C.), Peking University First Hospital, Beijing; Department of Neurosurgery (R.Z.), Children's Hospital of Fudan University, Shanghai; Department of Neurosurgery (X.Z.), Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders; Epilepsy Center (S. Li), Guangdong Sanjiu Brain Hospital, Guangzhou; Department of Neurosurgery (Z.Y.), Xiangya Hospital, Central South University, Changsha, Hunan; Department of Neurosurgery (Y.S.), Xuanwu Hospital, Capital Medical University; Department of Neurosurgery (K.M., Y.L.), Capital Institute of Pediatrics, Beijing; Department of Neurosurgery (J.H.), Huashan Hospital, Fudan University, Shanghai; Department of Epilepsy Center (L.S.), The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong; Department of Neurosurgery (H.C.), The First Affiliated Hospital of Anhui Medical University, Hefei; Department of Neurology (X.L.), Affiliated ZhongDa Hospital, Southeast University, Nanjing, Jiangsu; Department of Neurology (J.S.), Affiliated Children's Hospital of Xi'an Jiaotong University, Shaanxi; Department of Neurosurgery (M.Z.), Henan Sanbo Brain Hospital, Zhengzhou; Department of Neurology (M.W., T.L.), SanBo Brain Hospital; and Department of Functional Neurosurgery (J. Zhang), Beijing Neurosurgical Institute, Capital Medical University; Beijing Key Laboratory of Neurostimulation (J. Zhang); Functional Neurosurgery Department (S. Liang), Beijing Children's Hospital, Capital Medical University, National Center for Children's Health; Beijing Key Laboratory of Epilepsy (G.L., Y.G.); and Center of Epilepsy (G.L., Y.G.), Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, China
| | - Rui Zhao
- From the Department of Neurosurgery (S.W., X.W., J. Zhou, G.L., Y.G.), SanBo Brain Hospital, Capital Medical University; Department of Neurosurgery (S.W., K.Z., J. Zhang), Beijing Tiantan Hospital, Capital Medical University; Pediatric Epilepsy Center (Q.-Z.L., L.C.), Peking University First Hospital, Beijing; Department of Neurosurgery (R.Z.), Children's Hospital of Fudan University, Shanghai; Department of Neurosurgery (X.Z.), Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders; Epilepsy Center (S. Li), Guangdong Sanjiu Brain Hospital, Guangzhou; Department of Neurosurgery (Z.Y.), Xiangya Hospital, Central South University, Changsha, Hunan; Department of Neurosurgery (Y.S.), Xuanwu Hospital, Capital Medical University; Department of Neurosurgery (K.M., Y.L.), Capital Institute of Pediatrics, Beijing; Department of Neurosurgery (J.H.), Huashan Hospital, Fudan University, Shanghai; Department of Epilepsy Center (L.S.), The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong; Department of Neurosurgery (H.C.), The First Affiliated Hospital of Anhui Medical University, Hefei; Department of Neurology (X.L.), Affiliated ZhongDa Hospital, Southeast University, Nanjing, Jiangsu; Department of Neurology (J.S.), Affiliated Children's Hospital of Xi'an Jiaotong University, Shaanxi; Department of Neurosurgery (M.Z.), Henan Sanbo Brain Hospital, Zhengzhou; Department of Neurology (M.W., T.L.), SanBo Brain Hospital; and Department of Functional Neurosurgery (J. Zhang), Beijing Neurosurgical Institute, Capital Medical University; Beijing Key Laboratory of Neurostimulation (J. Zhang); Functional Neurosurgery Department (S. Liang), Beijing Children's Hospital, Capital Medical University, National Center for Children's Health; Beijing Key Laboratory of Epilepsy (G.L., Y.G.); and Center of Epilepsy (G.L., Y.G.), Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, China
| | - Xuan Zhai
- From the Department of Neurosurgery (S.W., X.W., J. Zhou, G.L., Y.G.), SanBo Brain Hospital, Capital Medical University; Department of Neurosurgery (S.W., K.Z., J. Zhang), Beijing Tiantan Hospital, Capital Medical University; Pediatric Epilepsy Center (Q.-Z.L., L.C.), Peking University First Hospital, Beijing; Department of Neurosurgery (R.Z.), Children's Hospital of Fudan University, Shanghai; Department of Neurosurgery (X.Z.), Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders; Epilepsy Center (S. Li), Guangdong Sanjiu Brain Hospital, Guangzhou; Department of Neurosurgery (Z.Y.), Xiangya Hospital, Central South University, Changsha, Hunan; Department of Neurosurgery (Y.S.), Xuanwu Hospital, Capital Medical University; Department of Neurosurgery (K.M., Y.L.), Capital Institute of Pediatrics, Beijing; Department of Neurosurgery (J.H.), Huashan Hospital, Fudan University, Shanghai; Department of Epilepsy Center (L.S.), The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong; Department of Neurosurgery (H.C.), The First Affiliated Hospital of Anhui Medical University, Hefei; Department of Neurology (X.L.), Affiliated ZhongDa Hospital, Southeast University, Nanjing, Jiangsu; Department of Neurology (J.S.), Affiliated Children's Hospital of Xi'an Jiaotong University, Shaanxi; Department of Neurosurgery (M.Z.), Henan Sanbo Brain Hospital, Zhengzhou; Department of Neurology (M.W., T.L.), SanBo Brain Hospital; and Department of Functional Neurosurgery (J. Zhang), Beijing Neurosurgical Institute, Capital Medical University; Beijing Key Laboratory of Neurostimulation (J. Zhang); Functional Neurosurgery Department (S. Liang), Beijing Children's Hospital, Capital Medical University, National Center for Children's Health; Beijing Key Laboratory of Epilepsy (G.L., Y.G.); and Center of Epilepsy (G.L., Y.G.), Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, China
| | - Kai Zhang
- From the Department of Neurosurgery (S.W., X.W., J. Zhou, G.L., Y.G.), SanBo Brain Hospital, Capital Medical University; Department of Neurosurgery (S.W., K.Z., J. Zhang), Beijing Tiantan Hospital, Capital Medical University; Pediatric Epilepsy Center (Q.-Z.L., L.C.), Peking University First Hospital, Beijing; Department of Neurosurgery (R.Z.), Children's Hospital of Fudan University, Shanghai; Department of Neurosurgery (X.Z.), Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders; Epilepsy Center (S. Li), Guangdong Sanjiu Brain Hospital, Guangzhou; Department of Neurosurgery (Z.Y.), Xiangya Hospital, Central South University, Changsha, Hunan; Department of Neurosurgery (Y.S.), Xuanwu Hospital, Capital Medical University; Department of Neurosurgery (K.M., Y.L.), Capital Institute of Pediatrics, Beijing; Department of Neurosurgery (J.H.), Huashan Hospital, Fudan University, Shanghai; Department of Epilepsy Center (L.S.), The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong; Department of Neurosurgery (H.C.), The First Affiliated Hospital of Anhui Medical University, Hefei; Department of Neurology (X.L.), Affiliated ZhongDa Hospital, Southeast University, Nanjing, Jiangsu; Department of Neurology (J.S.), Affiliated Children's Hospital of Xi'an Jiaotong University, Shaanxi; Department of Neurosurgery (M.Z.), Henan Sanbo Brain Hospital, Zhengzhou; Department of Neurology (M.W., T.L.), SanBo Brain Hospital; and Department of Functional Neurosurgery (J. Zhang), Beijing Neurosurgical Institute, Capital Medical University; Beijing Key Laboratory of Neurostimulation (J. Zhang); Functional Neurosurgery Department (S. Liang), Beijing Children's Hospital, Capital Medical University, National Center for Children's Health; Beijing Key Laboratory of Epilepsy (G.L., Y.G.); and Center of Epilepsy (G.L., Y.G.), Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, China
| | - Lixin Cai
- From the Department of Neurosurgery (S.W., X.W., J. Zhou, G.L., Y.G.), SanBo Brain Hospital, Capital Medical University; Department of Neurosurgery (S.W., K.Z., J. Zhang), Beijing Tiantan Hospital, Capital Medical University; Pediatric Epilepsy Center (Q.-Z.L., L.C.), Peking University First Hospital, Beijing; Department of Neurosurgery (R.Z.), Children's Hospital of Fudan University, Shanghai; Department of Neurosurgery (X.Z.), Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders; Epilepsy Center (S. Li), Guangdong Sanjiu Brain Hospital, Guangzhou; Department of Neurosurgery (Z.Y.), Xiangya Hospital, Central South University, Changsha, Hunan; Department of Neurosurgery (Y.S.), Xuanwu Hospital, Capital Medical University; Department of Neurosurgery (K.M., Y.L.), Capital Institute of Pediatrics, Beijing; Department of Neurosurgery (J.H.), Huashan Hospital, Fudan University, Shanghai; Department of Epilepsy Center (L.S.), The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong; Department of Neurosurgery (H.C.), The First Affiliated Hospital of Anhui Medical University, Hefei; Department of Neurology (X.L.), Affiliated ZhongDa Hospital, Southeast University, Nanjing, Jiangsu; Department of Neurology (J.S.), Affiliated Children's Hospital of Xi'an Jiaotong University, Shaanxi; Department of Neurosurgery (M.Z.), Henan Sanbo Brain Hospital, Zhengzhou; Department of Neurology (M.W., T.L.), SanBo Brain Hospital; and Department of Functional Neurosurgery (J. Zhang), Beijing Neurosurgical Institute, Capital Medical University; Beijing Key Laboratory of Neurostimulation (J. Zhang); Functional Neurosurgery Department (S. Liang), Beijing Children's Hospital, Capital Medical University, National Center for Children's Health; Beijing Key Laboratory of Epilepsy (G.L., Y.G.); and Center of Epilepsy (G.L., Y.G.), Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, China
| | - Shaochun Li
- From the Department of Neurosurgery (S.W., X.W., J. Zhou, G.L., Y.G.), SanBo Brain Hospital, Capital Medical University; Department of Neurosurgery (S.W., K.Z., J. Zhang), Beijing Tiantan Hospital, Capital Medical University; Pediatric Epilepsy Center (Q.-Z.L., L.C.), Peking University First Hospital, Beijing; Department of Neurosurgery (R.Z.), Children's Hospital of Fudan University, Shanghai; Department of Neurosurgery (X.Z.), Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders; Epilepsy Center (S. Li), Guangdong Sanjiu Brain Hospital, Guangzhou; Department of Neurosurgery (Z.Y.), Xiangya Hospital, Central South University, Changsha, Hunan; Department of Neurosurgery (Y.S.), Xuanwu Hospital, Capital Medical University; Department of Neurosurgery (K.M., Y.L.), Capital Institute of Pediatrics, Beijing; Department of Neurosurgery (J.H.), Huashan Hospital, Fudan University, Shanghai; Department of Epilepsy Center (L.S.), The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong; Department of Neurosurgery (H.C.), The First Affiliated Hospital of Anhui Medical University, Hefei; Department of Neurology (X.L.), Affiliated ZhongDa Hospital, Southeast University, Nanjing, Jiangsu; Department of Neurology (J.S.), Affiliated Children's Hospital of Xi'an Jiaotong University, Shaanxi; Department of Neurosurgery (M.Z.), Henan Sanbo Brain Hospital, Zhengzhou; Department of Neurology (M.W., T.L.), SanBo Brain Hospital; and Department of Functional Neurosurgery (J. Zhang), Beijing Neurosurgical Institute, Capital Medical University; Beijing Key Laboratory of Neurostimulation (J. Zhang); Functional Neurosurgery Department (S. Liang), Beijing Children's Hospital, Capital Medical University, National Center for Children's Health; Beijing Key Laboratory of Epilepsy (G.L., Y.G.); and Center of Epilepsy (G.L., Y.G.), Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, China
| | - Zhiquan Yang
- From the Department of Neurosurgery (S.W., X.W., J. Zhou, G.L., Y.G.), SanBo Brain Hospital, Capital Medical University; Department of Neurosurgery (S.W., K.Z., J. Zhang), Beijing Tiantan Hospital, Capital Medical University; Pediatric Epilepsy Center (Q.-Z.L., L.C.), Peking University First Hospital, Beijing; Department of Neurosurgery (R.Z.), Children's Hospital of Fudan University, Shanghai; Department of Neurosurgery (X.Z.), Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders; Epilepsy Center (S. Li), Guangdong Sanjiu Brain Hospital, Guangzhou; Department of Neurosurgery (Z.Y.), Xiangya Hospital, Central South University, Changsha, Hunan; Department of Neurosurgery (Y.S.), Xuanwu Hospital, Capital Medical University; Department of Neurosurgery (K.M., Y.L.), Capital Institute of Pediatrics, Beijing; Department of Neurosurgery (J.H.), Huashan Hospital, Fudan University, Shanghai; Department of Epilepsy Center (L.S.), The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong; Department of Neurosurgery (H.C.), The First Affiliated Hospital of Anhui Medical University, Hefei; Department of Neurology (X.L.), Affiliated ZhongDa Hospital, Southeast University, Nanjing, Jiangsu; Department of Neurology (J.S.), Affiliated Children's Hospital of Xi'an Jiaotong University, Shaanxi; Department of Neurosurgery (M.Z.), Henan Sanbo Brain Hospital, Zhengzhou; Department of Neurology (M.W., T.L.), SanBo Brain Hospital; and Department of Functional Neurosurgery (J. Zhang), Beijing Neurosurgical Institute, Capital Medical University; Beijing Key Laboratory of Neurostimulation (J. Zhang); Functional Neurosurgery Department (S. Liang), Beijing Children's Hospital, Capital Medical University, National Center for Children's Health; Beijing Key Laboratory of Epilepsy (G.L., Y.G.); and Center of Epilepsy (G.L., Y.G.), Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, China
| | - Yongzhi Shan
- From the Department of Neurosurgery (S.W., X.W., J. Zhou, G.L., Y.G.), SanBo Brain Hospital, Capital Medical University; Department of Neurosurgery (S.W., K.Z., J. Zhang), Beijing Tiantan Hospital, Capital Medical University; Pediatric Epilepsy Center (Q.-Z.L., L.C.), Peking University First Hospital, Beijing; Department of Neurosurgery (R.Z.), Children's Hospital of Fudan University, Shanghai; Department of Neurosurgery (X.Z.), Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders; Epilepsy Center (S. Li), Guangdong Sanjiu Brain Hospital, Guangzhou; Department of Neurosurgery (Z.Y.), Xiangya Hospital, Central South University, Changsha, Hunan; Department of Neurosurgery (Y.S.), Xuanwu Hospital, Capital Medical University; Department of Neurosurgery (K.M., Y.L.), Capital Institute of Pediatrics, Beijing; Department of Neurosurgery (J.H.), Huashan Hospital, Fudan University, Shanghai; Department of Epilepsy Center (L.S.), The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong; Department of Neurosurgery (H.C.), The First Affiliated Hospital of Anhui Medical University, Hefei; Department of Neurology (X.L.), Affiliated ZhongDa Hospital, Southeast University, Nanjing, Jiangsu; Department of Neurology (J.S.), Affiliated Children's Hospital of Xi'an Jiaotong University, Shaanxi; Department of Neurosurgery (M.Z.), Henan Sanbo Brain Hospital, Zhengzhou; Department of Neurology (M.W., T.L.), SanBo Brain Hospital; and Department of Functional Neurosurgery (J. Zhang), Beijing Neurosurgical Institute, Capital Medical University; Beijing Key Laboratory of Neurostimulation (J. Zhang); Functional Neurosurgery Department (S. Liang), Beijing Children's Hospital, Capital Medical University, National Center for Children's Health; Beijing Key Laboratory of Epilepsy (G.L., Y.G.); and Center of Epilepsy (G.L., Y.G.), Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, China
| | - Kangping Ma
- From the Department of Neurosurgery (S.W., X.W., J. Zhou, G.L., Y.G.), SanBo Brain Hospital, Capital Medical University; Department of Neurosurgery (S.W., K.Z., J. Zhang), Beijing Tiantan Hospital, Capital Medical University; Pediatric Epilepsy Center (Q.-Z.L., L.C.), Peking University First Hospital, Beijing; Department of Neurosurgery (R.Z.), Children's Hospital of Fudan University, Shanghai; Department of Neurosurgery (X.Z.), Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders; Epilepsy Center (S. Li), Guangdong Sanjiu Brain Hospital, Guangzhou; Department of Neurosurgery (Z.Y.), Xiangya Hospital, Central South University, Changsha, Hunan; Department of Neurosurgery (Y.S.), Xuanwu Hospital, Capital Medical University; Department of Neurosurgery (K.M., Y.L.), Capital Institute of Pediatrics, Beijing; Department of Neurosurgery (J.H.), Huashan Hospital, Fudan University, Shanghai; Department of Epilepsy Center (L.S.), The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong; Department of Neurosurgery (H.C.), The First Affiliated Hospital of Anhui Medical University, Hefei; Department of Neurology (X.L.), Affiliated ZhongDa Hospital, Southeast University, Nanjing, Jiangsu; Department of Neurology (J.S.), Affiliated Children's Hospital of Xi'an Jiaotong University, Shaanxi; Department of Neurosurgery (M.Z.), Henan Sanbo Brain Hospital, Zhengzhou; Department of Neurology (M.W., T.L.), SanBo Brain Hospital; and Department of Functional Neurosurgery (J. Zhang), Beijing Neurosurgical Institute, Capital Medical University; Beijing Key Laboratory of Neurostimulation (J. Zhang); Functional Neurosurgery Department (S. Liang), Beijing Children's Hospital, Capital Medical University, National Center for Children's Health; Beijing Key Laboratory of Epilepsy (G.L., Y.G.); and Center of Epilepsy (G.L., Y.G.), Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, China
| | - Yunlin Li
- From the Department of Neurosurgery (S.W., X.W., J. Zhou, G.L., Y.G.), SanBo Brain Hospital, Capital Medical University; Department of Neurosurgery (S.W., K.Z., J. Zhang), Beijing Tiantan Hospital, Capital Medical University; Pediatric Epilepsy Center (Q.-Z.L., L.C.), Peking University First Hospital, Beijing; Department of Neurosurgery (R.Z.), Children's Hospital of Fudan University, Shanghai; Department of Neurosurgery (X.Z.), Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders; Epilepsy Center (S. Li), Guangdong Sanjiu Brain Hospital, Guangzhou; Department of Neurosurgery (Z.Y.), Xiangya Hospital, Central South University, Changsha, Hunan; Department of Neurosurgery (Y.S.), Xuanwu Hospital, Capital Medical University; Department of Neurosurgery (K.M., Y.L.), Capital Institute of Pediatrics, Beijing; Department of Neurosurgery (J.H.), Huashan Hospital, Fudan University, Shanghai; Department of Epilepsy Center (L.S.), The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong; Department of Neurosurgery (H.C.), The First Affiliated Hospital of Anhui Medical University, Hefei; Department of Neurology (X.L.), Affiliated ZhongDa Hospital, Southeast University, Nanjing, Jiangsu; Department of Neurology (J.S.), Affiliated Children's Hospital of Xi'an Jiaotong University, Shaanxi; Department of Neurosurgery (M.Z.), Henan Sanbo Brain Hospital, Zhengzhou; Department of Neurology (M.W., T.L.), SanBo Brain Hospital; and Department of Functional Neurosurgery (J. Zhang), Beijing Neurosurgical Institute, Capital Medical University; Beijing Key Laboratory of Neurostimulation (J. Zhang); Functional Neurosurgery Department (S. Liang), Beijing Children's Hospital, Capital Medical University, National Center for Children's Health; Beijing Key Laboratory of Epilepsy (G.L., Y.G.); and Center of Epilepsy (G.L., Y.G.), Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, China
| | - Jie Hu
- From the Department of Neurosurgery (S.W., X.W., J. Zhou, G.L., Y.G.), SanBo Brain Hospital, Capital Medical University; Department of Neurosurgery (S.W., K.Z., J. Zhang), Beijing Tiantan Hospital, Capital Medical University; Pediatric Epilepsy Center (Q.-Z.L., L.C.), Peking University First Hospital, Beijing; Department of Neurosurgery (R.Z.), Children's Hospital of Fudan University, Shanghai; Department of Neurosurgery (X.Z.), Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders; Epilepsy Center (S. Li), Guangdong Sanjiu Brain Hospital, Guangzhou; Department of Neurosurgery (Z.Y.), Xiangya Hospital, Central South University, Changsha, Hunan; Department of Neurosurgery (Y.S.), Xuanwu Hospital, Capital Medical University; Department of Neurosurgery (K.M., Y.L.), Capital Institute of Pediatrics, Beijing; Department of Neurosurgery (J.H.), Huashan Hospital, Fudan University, Shanghai; Department of Epilepsy Center (L.S.), The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong; Department of Neurosurgery (H.C.), The First Affiliated Hospital of Anhui Medical University, Hefei; Department of Neurology (X.L.), Affiliated ZhongDa Hospital, Southeast University, Nanjing, Jiangsu; Department of Neurology (J.S.), Affiliated Children's Hospital of Xi'an Jiaotong University, Shaanxi; Department of Neurosurgery (M.Z.), Henan Sanbo Brain Hospital, Zhengzhou; Department of Neurology (M.W., T.L.), SanBo Brain Hospital; and Department of Functional Neurosurgery (J. Zhang), Beijing Neurosurgical Institute, Capital Medical University; Beijing Key Laboratory of Neurostimulation (J. Zhang); Functional Neurosurgery Department (S. Liang), Beijing Children's Hospital, Capital Medical University, National Center for Children's Health; Beijing Key Laboratory of Epilepsy (G.L., Y.G.); and Center of Epilepsy (G.L., Y.G.), Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, China
| | - Lisen Sui
- From the Department of Neurosurgery (S.W., X.W., J. Zhou, G.L., Y.G.), SanBo Brain Hospital, Capital Medical University; Department of Neurosurgery (S.W., K.Z., J. Zhang), Beijing Tiantan Hospital, Capital Medical University; Pediatric Epilepsy Center (Q.-Z.L., L.C.), Peking University First Hospital, Beijing; Department of Neurosurgery (R.Z.), Children's Hospital of Fudan University, Shanghai; Department of Neurosurgery (X.Z.), Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders; Epilepsy Center (S. Li), Guangdong Sanjiu Brain Hospital, Guangzhou; Department of Neurosurgery (Z.Y.), Xiangya Hospital, Central South University, Changsha, Hunan; Department of Neurosurgery (Y.S.), Xuanwu Hospital, Capital Medical University; Department of Neurosurgery (K.M., Y.L.), Capital Institute of Pediatrics, Beijing; Department of Neurosurgery (J.H.), Huashan Hospital, Fudan University, Shanghai; Department of Epilepsy Center (L.S.), The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong; Department of Neurosurgery (H.C.), The First Affiliated Hospital of Anhui Medical University, Hefei; Department of Neurology (X.L.), Affiliated ZhongDa Hospital, Southeast University, Nanjing, Jiangsu; Department of Neurology (J.S.), Affiliated Children's Hospital of Xi'an Jiaotong University, Shaanxi; Department of Neurosurgery (M.Z.), Henan Sanbo Brain Hospital, Zhengzhou; Department of Neurology (M.W., T.L.), SanBo Brain Hospital; and Department of Functional Neurosurgery (J. Zhang), Beijing Neurosurgical Institute, Capital Medical University; Beijing Key Laboratory of Neurostimulation (J. Zhang); Functional Neurosurgery Department (S. Liang), Beijing Children's Hospital, Capital Medical University, National Center for Children's Health; Beijing Key Laboratory of Epilepsy (G.L., Y.G.); and Center of Epilepsy (G.L., Y.G.), Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, China
| | - Hongwei Cheng
- From the Department of Neurosurgery (S.W., X.W., J. Zhou, G.L., Y.G.), SanBo Brain Hospital, Capital Medical University; Department of Neurosurgery (S.W., K.Z., J. Zhang), Beijing Tiantan Hospital, Capital Medical University; Pediatric Epilepsy Center (Q.-Z.L., L.C.), Peking University First Hospital, Beijing; Department of Neurosurgery (R.Z.), Children's Hospital of Fudan University, Shanghai; Department of Neurosurgery (X.Z.), Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders; Epilepsy Center (S. Li), Guangdong Sanjiu Brain Hospital, Guangzhou; Department of Neurosurgery (Z.Y.), Xiangya Hospital, Central South University, Changsha, Hunan; Department of Neurosurgery (Y.S.), Xuanwu Hospital, Capital Medical University; Department of Neurosurgery (K.M., Y.L.), Capital Institute of Pediatrics, Beijing; Department of Neurosurgery (J.H.), Huashan Hospital, Fudan University, Shanghai; Department of Epilepsy Center (L.S.), The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong; Department of Neurosurgery (H.C.), The First Affiliated Hospital of Anhui Medical University, Hefei; Department of Neurology (X.L.), Affiliated ZhongDa Hospital, Southeast University, Nanjing, Jiangsu; Department of Neurology (J.S.), Affiliated Children's Hospital of Xi'an Jiaotong University, Shaanxi; Department of Neurosurgery (M.Z.), Henan Sanbo Brain Hospital, Zhengzhou; Department of Neurology (M.W., T.L.), SanBo Brain Hospital; and Department of Functional Neurosurgery (J. Zhang), Beijing Neurosurgical Institute, Capital Medical University; Beijing Key Laboratory of Neurostimulation (J. Zhang); Functional Neurosurgery Department (S. Liang), Beijing Children's Hospital, Capital Medical University, National Center for Children's Health; Beijing Key Laboratory of Epilepsy (G.L., Y.G.); and Center of Epilepsy (G.L., Y.G.), Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, China
| | - Xiaoli Li
- From the Department of Neurosurgery (S.W., X.W., J. Zhou, G.L., Y.G.), SanBo Brain Hospital, Capital Medical University; Department of Neurosurgery (S.W., K.Z., J. Zhang), Beijing Tiantan Hospital, Capital Medical University; Pediatric Epilepsy Center (Q.-Z.L., L.C.), Peking University First Hospital, Beijing; Department of Neurosurgery (R.Z.), Children's Hospital of Fudan University, Shanghai; Department of Neurosurgery (X.Z.), Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders; Epilepsy Center (S. Li), Guangdong Sanjiu Brain Hospital, Guangzhou; Department of Neurosurgery (Z.Y.), Xiangya Hospital, Central South University, Changsha, Hunan; Department of Neurosurgery (Y.S.), Xuanwu Hospital, Capital Medical University; Department of Neurosurgery (K.M., Y.L.), Capital Institute of Pediatrics, Beijing; Department of Neurosurgery (J.H.), Huashan Hospital, Fudan University, Shanghai; Department of Epilepsy Center (L.S.), The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong; Department of Neurosurgery (H.C.), The First Affiliated Hospital of Anhui Medical University, Hefei; Department of Neurology (X.L.), Affiliated ZhongDa Hospital, Southeast University, Nanjing, Jiangsu; Department of Neurology (J.S.), Affiliated Children's Hospital of Xi'an Jiaotong University, Shaanxi; Department of Neurosurgery (M.Z.), Henan Sanbo Brain Hospital, Zhengzhou; Department of Neurology (M.W., T.L.), SanBo Brain Hospital; and Department of Functional Neurosurgery (J. Zhang), Beijing Neurosurgical Institute, Capital Medical University; Beijing Key Laboratory of Neurostimulation (J. Zhang); Functional Neurosurgery Department (S. Liang), Beijing Children's Hospital, Capital Medical University, National Center for Children's Health; Beijing Key Laboratory of Epilepsy (G.L., Y.G.); and Center of Epilepsy (G.L., Y.G.), Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, China
| | - Jianyun Su
- From the Department of Neurosurgery (S.W., X.W., J. Zhou, G.L., Y.G.), SanBo Brain Hospital, Capital Medical University; Department of Neurosurgery (S.W., K.Z., J. Zhang), Beijing Tiantan Hospital, Capital Medical University; Pediatric Epilepsy Center (Q.-Z.L., L.C.), Peking University First Hospital, Beijing; Department of Neurosurgery (R.Z.), Children's Hospital of Fudan University, Shanghai; Department of Neurosurgery (X.Z.), Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders; Epilepsy Center (S. Li), Guangdong Sanjiu Brain Hospital, Guangzhou; Department of Neurosurgery (Z.Y.), Xiangya Hospital, Central South University, Changsha, Hunan; Department of Neurosurgery (Y.S.), Xuanwu Hospital, Capital Medical University; Department of Neurosurgery (K.M., Y.L.), Capital Institute of Pediatrics, Beijing; Department of Neurosurgery (J.H.), Huashan Hospital, Fudan University, Shanghai; Department of Epilepsy Center (L.S.), The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong; Department of Neurosurgery (H.C.), The First Affiliated Hospital of Anhui Medical University, Hefei; Department of Neurology (X.L.), Affiliated ZhongDa Hospital, Southeast University, Nanjing, Jiangsu; Department of Neurology (J.S.), Affiliated Children's Hospital of Xi'an Jiaotong University, Shaanxi; Department of Neurosurgery (M.Z.), Henan Sanbo Brain Hospital, Zhengzhou; Department of Neurology (M.W., T.L.), SanBo Brain Hospital; and Department of Functional Neurosurgery (J. Zhang), Beijing Neurosurgical Institute, Capital Medical University; Beijing Key Laboratory of Neurostimulation (J. Zhang); Functional Neurosurgery Department (S. Liang), Beijing Children's Hospital, Capital Medical University, National Center for Children's Health; Beijing Key Laboratory of Epilepsy (G.L., Y.G.); and Center of Epilepsy (G.L., Y.G.), Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, China
| | - Meng Zhao
- From the Department of Neurosurgery (S.W., X.W., J. Zhou, G.L., Y.G.), SanBo Brain Hospital, Capital Medical University; Department of Neurosurgery (S.W., K.Z., J. Zhang), Beijing Tiantan Hospital, Capital Medical University; Pediatric Epilepsy Center (Q.-Z.L., L.C.), Peking University First Hospital, Beijing; Department of Neurosurgery (R.Z.), Children's Hospital of Fudan University, Shanghai; Department of Neurosurgery (X.Z.), Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders; Epilepsy Center (S. Li), Guangdong Sanjiu Brain Hospital, Guangzhou; Department of Neurosurgery (Z.Y.), Xiangya Hospital, Central South University, Changsha, Hunan; Department of Neurosurgery (Y.S.), Xuanwu Hospital, Capital Medical University; Department of Neurosurgery (K.M., Y.L.), Capital Institute of Pediatrics, Beijing; Department of Neurosurgery (J.H.), Huashan Hospital, Fudan University, Shanghai; Department of Epilepsy Center (L.S.), The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong; Department of Neurosurgery (H.C.), The First Affiliated Hospital of Anhui Medical University, Hefei; Department of Neurology (X.L.), Affiliated ZhongDa Hospital, Southeast University, Nanjing, Jiangsu; Department of Neurology (J.S.), Affiliated Children's Hospital of Xi'an Jiaotong University, Shaanxi; Department of Neurosurgery (M.Z.), Henan Sanbo Brain Hospital, Zhengzhou; Department of Neurology (M.W., T.L.), SanBo Brain Hospital; and Department of Functional Neurosurgery (J. Zhang), Beijing Neurosurgical Institute, Capital Medical University; Beijing Key Laboratory of Neurostimulation (J. Zhang); Functional Neurosurgery Department (S. Liang), Beijing Children's Hospital, Capital Medical University, National Center for Children's Health; Beijing Key Laboratory of Epilepsy (G.L., Y.G.); and Center of Epilepsy (G.L., Y.G.), Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, China
| | - Xiongfei Wang
- From the Department of Neurosurgery (S.W., X.W., J. Zhou, G.L., Y.G.), SanBo Brain Hospital, Capital Medical University; Department of Neurosurgery (S.W., K.Z., J. Zhang), Beijing Tiantan Hospital, Capital Medical University; Pediatric Epilepsy Center (Q.-Z.L., L.C.), Peking University First Hospital, Beijing; Department of Neurosurgery (R.Z.), Children's Hospital of Fudan University, Shanghai; Department of Neurosurgery (X.Z.), Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders; Epilepsy Center (S. Li), Guangdong Sanjiu Brain Hospital, Guangzhou; Department of Neurosurgery (Z.Y.), Xiangya Hospital, Central South University, Changsha, Hunan; Department of Neurosurgery (Y.S.), Xuanwu Hospital, Capital Medical University; Department of Neurosurgery (K.M., Y.L.), Capital Institute of Pediatrics, Beijing; Department of Neurosurgery (J.H.), Huashan Hospital, Fudan University, Shanghai; Department of Epilepsy Center (L.S.), The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong; Department of Neurosurgery (H.C.), The First Affiliated Hospital of Anhui Medical University, Hefei; Department of Neurology (X.L.), Affiliated ZhongDa Hospital, Southeast University, Nanjing, Jiangsu; Department of Neurology (J.S.), Affiliated Children's Hospital of Xi'an Jiaotong University, Shaanxi; Department of Neurosurgery (M.Z.), Henan Sanbo Brain Hospital, Zhengzhou; Department of Neurology (M.W., T.L.), SanBo Brain Hospital; and Department of Functional Neurosurgery (J. Zhang), Beijing Neurosurgical Institute, Capital Medical University; Beijing Key Laboratory of Neurostimulation (J. Zhang); Functional Neurosurgery Department (S. Liang), Beijing Children's Hospital, Capital Medical University, National Center for Children's Health; Beijing Key Laboratory of Epilepsy (G.L., Y.G.); and Center of Epilepsy (G.L., Y.G.), Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, China
| | - Jian Zhou
- From the Department of Neurosurgery (S.W., X.W., J. Zhou, G.L., Y.G.), SanBo Brain Hospital, Capital Medical University; Department of Neurosurgery (S.W., K.Z., J. Zhang), Beijing Tiantan Hospital, Capital Medical University; Pediatric Epilepsy Center (Q.-Z.L., L.C.), Peking University First Hospital, Beijing; Department of Neurosurgery (R.Z.), Children's Hospital of Fudan University, Shanghai; Department of Neurosurgery (X.Z.), Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders; Epilepsy Center (S. Li), Guangdong Sanjiu Brain Hospital, Guangzhou; Department of Neurosurgery (Z.Y.), Xiangya Hospital, Central South University, Changsha, Hunan; Department of Neurosurgery (Y.S.), Xuanwu Hospital, Capital Medical University; Department of Neurosurgery (K.M., Y.L.), Capital Institute of Pediatrics, Beijing; Department of Neurosurgery (J.H.), Huashan Hospital, Fudan University, Shanghai; Department of Epilepsy Center (L.S.), The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong; Department of Neurosurgery (H.C.), The First Affiliated Hospital of Anhui Medical University, Hefei; Department of Neurology (X.L.), Affiliated ZhongDa Hospital, Southeast University, Nanjing, Jiangsu; Department of Neurology (J.S.), Affiliated Children's Hospital of Xi'an Jiaotong University, Shaanxi; Department of Neurosurgery (M.Z.), Henan Sanbo Brain Hospital, Zhengzhou; Department of Neurology (M.W., T.L.), SanBo Brain Hospital; and Department of Functional Neurosurgery (J. Zhang), Beijing Neurosurgical Institute, Capital Medical University; Beijing Key Laboratory of Neurostimulation (J. Zhang); Functional Neurosurgery Department (S. Liang), Beijing Children's Hospital, Capital Medical University, National Center for Children's Health; Beijing Key Laboratory of Epilepsy (G.L., Y.G.); and Center of Epilepsy (G.L., Y.G.), Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, China
| | - Mengyang Wang
- From the Department of Neurosurgery (S.W., X.W., J. Zhou, G.L., Y.G.), SanBo Brain Hospital, Capital Medical University; Department of Neurosurgery (S.W., K.Z., J. Zhang), Beijing Tiantan Hospital, Capital Medical University; Pediatric Epilepsy Center (Q.-Z.L., L.C.), Peking University First Hospital, Beijing; Department of Neurosurgery (R.Z.), Children's Hospital of Fudan University, Shanghai; Department of Neurosurgery (X.Z.), Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders; Epilepsy Center (S. Li), Guangdong Sanjiu Brain Hospital, Guangzhou; Department of Neurosurgery (Z.Y.), Xiangya Hospital, Central South University, Changsha, Hunan; Department of Neurosurgery (Y.S.), Xuanwu Hospital, Capital Medical University; Department of Neurosurgery (K.M., Y.L.), Capital Institute of Pediatrics, Beijing; Department of Neurosurgery (J.H.), Huashan Hospital, Fudan University, Shanghai; Department of Epilepsy Center (L.S.), The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong; Department of Neurosurgery (H.C.), The First Affiliated Hospital of Anhui Medical University, Hefei; Department of Neurology (X.L.), Affiliated ZhongDa Hospital, Southeast University, Nanjing, Jiangsu; Department of Neurology (J.S.), Affiliated Children's Hospital of Xi'an Jiaotong University, Shaanxi; Department of Neurosurgery (M.Z.), Henan Sanbo Brain Hospital, Zhengzhou; Department of Neurology (M.W., T.L.), SanBo Brain Hospital; and Department of Functional Neurosurgery (J. Zhang), Beijing Neurosurgical Institute, Capital Medical University; Beijing Key Laboratory of Neurostimulation (J. Zhang); Functional Neurosurgery Department (S. Liang), Beijing Children's Hospital, Capital Medical University, National Center for Children's Health; Beijing Key Laboratory of Epilepsy (G.L., Y.G.); and Center of Epilepsy (G.L., Y.G.), Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, China
| | - Tianfu Li
- From the Department of Neurosurgery (S.W., X.W., J. Zhou, G.L., Y.G.), SanBo Brain Hospital, Capital Medical University; Department of Neurosurgery (S.W., K.Z., J. Zhang), Beijing Tiantan Hospital, Capital Medical University; Pediatric Epilepsy Center (Q.-Z.L., L.C.), Peking University First Hospital, Beijing; Department of Neurosurgery (R.Z.), Children's Hospital of Fudan University, Shanghai; Department of Neurosurgery (X.Z.), Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders; Epilepsy Center (S. Li), Guangdong Sanjiu Brain Hospital, Guangzhou; Department of Neurosurgery (Z.Y.), Xiangya Hospital, Central South University, Changsha, Hunan; Department of Neurosurgery (Y.S.), Xuanwu Hospital, Capital Medical University; Department of Neurosurgery (K.M., Y.L.), Capital Institute of Pediatrics, Beijing; Department of Neurosurgery (J.H.), Huashan Hospital, Fudan University, Shanghai; Department of Epilepsy Center (L.S.), The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong; Department of Neurosurgery (H.C.), The First Affiliated Hospital of Anhui Medical University, Hefei; Department of Neurology (X.L.), Affiliated ZhongDa Hospital, Southeast University, Nanjing, Jiangsu; Department of Neurology (J.S.), Affiliated Children's Hospital of Xi'an Jiaotong University, Shaanxi; Department of Neurosurgery (M.Z.), Henan Sanbo Brain Hospital, Zhengzhou; Department of Neurology (M.W., T.L.), SanBo Brain Hospital; and Department of Functional Neurosurgery (J. Zhang), Beijing Neurosurgical Institute, Capital Medical University; Beijing Key Laboratory of Neurostimulation (J. Zhang); Functional Neurosurgery Department (S. Liang), Beijing Children's Hospital, Capital Medical University, National Center for Children's Health; Beijing Key Laboratory of Epilepsy (G.L., Y.G.); and Center of Epilepsy (G.L., Y.G.), Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, China
| | - Jianguo Zhang
- From the Department of Neurosurgery (S.W., X.W., J. Zhou, G.L., Y.G.), SanBo Brain Hospital, Capital Medical University; Department of Neurosurgery (S.W., K.Z., J. Zhang), Beijing Tiantan Hospital, Capital Medical University; Pediatric Epilepsy Center (Q.-Z.L., L.C.), Peking University First Hospital, Beijing; Department of Neurosurgery (R.Z.), Children's Hospital of Fudan University, Shanghai; Department of Neurosurgery (X.Z.), Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders; Epilepsy Center (S. Li), Guangdong Sanjiu Brain Hospital, Guangzhou; Department of Neurosurgery (Z.Y.), Xiangya Hospital, Central South University, Changsha, Hunan; Department of Neurosurgery (Y.S.), Xuanwu Hospital, Capital Medical University; Department of Neurosurgery (K.M., Y.L.), Capital Institute of Pediatrics, Beijing; Department of Neurosurgery (J.H.), Huashan Hospital, Fudan University, Shanghai; Department of Epilepsy Center (L.S.), The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong; Department of Neurosurgery (H.C.), The First Affiliated Hospital of Anhui Medical University, Hefei; Department of Neurology (X.L.), Affiliated ZhongDa Hospital, Southeast University, Nanjing, Jiangsu; Department of Neurology (J.S.), Affiliated Children's Hospital of Xi'an Jiaotong University, Shaanxi; Department of Neurosurgery (M.Z.), Henan Sanbo Brain Hospital, Zhengzhou; Department of Neurology (M.W., T.L.), SanBo Brain Hospital; and Department of Functional Neurosurgery (J. Zhang), Beijing Neurosurgical Institute, Capital Medical University; Beijing Key Laboratory of Neurostimulation (J. Zhang); Functional Neurosurgery Department (S. Liang), Beijing Children's Hospital, Capital Medical University, National Center for Children's Health; Beijing Key Laboratory of Epilepsy (G.L., Y.G.); and Center of Epilepsy (G.L., Y.G.), Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, China
| | - Shuli Liang
- From the Department of Neurosurgery (S.W., X.W., J. Zhou, G.L., Y.G.), SanBo Brain Hospital, Capital Medical University; Department of Neurosurgery (S.W., K.Z., J. Zhang), Beijing Tiantan Hospital, Capital Medical University; Pediatric Epilepsy Center (Q.-Z.L., L.C.), Peking University First Hospital, Beijing; Department of Neurosurgery (R.Z.), Children's Hospital of Fudan University, Shanghai; Department of Neurosurgery (X.Z.), Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders; Epilepsy Center (S. Li), Guangdong Sanjiu Brain Hospital, Guangzhou; Department of Neurosurgery (Z.Y.), Xiangya Hospital, Central South University, Changsha, Hunan; Department of Neurosurgery (Y.S.), Xuanwu Hospital, Capital Medical University; Department of Neurosurgery (K.M., Y.L.), Capital Institute of Pediatrics, Beijing; Department of Neurosurgery (J.H.), Huashan Hospital, Fudan University, Shanghai; Department of Epilepsy Center (L.S.), The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong; Department of Neurosurgery (H.C.), The First Affiliated Hospital of Anhui Medical University, Hefei; Department of Neurology (X.L.), Affiliated ZhongDa Hospital, Southeast University, Nanjing, Jiangsu; Department of Neurology (J.S.), Affiliated Children's Hospital of Xi'an Jiaotong University, Shaanxi; Department of Neurosurgery (M.Z.), Henan Sanbo Brain Hospital, Zhengzhou; Department of Neurology (M.W., T.L.), SanBo Brain Hospital; and Department of Functional Neurosurgery (J. Zhang), Beijing Neurosurgical Institute, Capital Medical University; Beijing Key Laboratory of Neurostimulation (J. Zhang); Functional Neurosurgery Department (S. Liang), Beijing Children's Hospital, Capital Medical University, National Center for Children's Health; Beijing Key Laboratory of Epilepsy (G.L., Y.G.); and Center of Epilepsy (G.L., Y.G.), Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, China
| | - Guoming Luan
- From the Department of Neurosurgery (S.W., X.W., J. Zhou, G.L., Y.G.), SanBo Brain Hospital, Capital Medical University; Department of Neurosurgery (S.W., K.Z., J. Zhang), Beijing Tiantan Hospital, Capital Medical University; Pediatric Epilepsy Center (Q.-Z.L., L.C.), Peking University First Hospital, Beijing; Department of Neurosurgery (R.Z.), Children's Hospital of Fudan University, Shanghai; Department of Neurosurgery (X.Z.), Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders; Epilepsy Center (S. Li), Guangdong Sanjiu Brain Hospital, Guangzhou; Department of Neurosurgery (Z.Y.), Xiangya Hospital, Central South University, Changsha, Hunan; Department of Neurosurgery (Y.S.), Xuanwu Hospital, Capital Medical University; Department of Neurosurgery (K.M., Y.L.), Capital Institute of Pediatrics, Beijing; Department of Neurosurgery (J.H.), Huashan Hospital, Fudan University, Shanghai; Department of Epilepsy Center (L.S.), The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong; Department of Neurosurgery (H.C.), The First Affiliated Hospital of Anhui Medical University, Hefei; Department of Neurology (X.L.), Affiliated ZhongDa Hospital, Southeast University, Nanjing, Jiangsu; Department of Neurology (J.S.), Affiliated Children's Hospital of Xi'an Jiaotong University, Shaanxi; Department of Neurosurgery (M.Z.), Henan Sanbo Brain Hospital, Zhengzhou; Department of Neurology (M.W., T.L.), SanBo Brain Hospital; and Department of Functional Neurosurgery (J. Zhang), Beijing Neurosurgical Institute, Capital Medical University; Beijing Key Laboratory of Neurostimulation (J. Zhang); Functional Neurosurgery Department (S. Liang), Beijing Children's Hospital, Capital Medical University, National Center for Children's Health; Beijing Key Laboratory of Epilepsy (G.L., Y.G.); and Center of Epilepsy (G.L., Y.G.), Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, China
| | - Yuguang Guan
- From the Department of Neurosurgery (S.W., X.W., J. Zhou, G.L., Y.G.), SanBo Brain Hospital, Capital Medical University; Department of Neurosurgery (S.W., K.Z., J. Zhang), Beijing Tiantan Hospital, Capital Medical University; Pediatric Epilepsy Center (Q.-Z.L., L.C.), Peking University First Hospital, Beijing; Department of Neurosurgery (R.Z.), Children's Hospital of Fudan University, Shanghai; Department of Neurosurgery (X.Z.), Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders; Epilepsy Center (S. Li), Guangdong Sanjiu Brain Hospital, Guangzhou; Department of Neurosurgery (Z.Y.), Xiangya Hospital, Central South University, Changsha, Hunan; Department of Neurosurgery (Y.S.), Xuanwu Hospital, Capital Medical University; Department of Neurosurgery (K.M., Y.L.), Capital Institute of Pediatrics, Beijing; Department of Neurosurgery (J.H.), Huashan Hospital, Fudan University, Shanghai; Department of Epilepsy Center (L.S.), The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong; Department of Neurosurgery (H.C.), The First Affiliated Hospital of Anhui Medical University, Hefei; Department of Neurology (X.L.), Affiliated ZhongDa Hospital, Southeast University, Nanjing, Jiangsu; Department of Neurology (J.S.), Affiliated Children's Hospital of Xi'an Jiaotong University, Shaanxi; Department of Neurosurgery (M.Z.), Henan Sanbo Brain Hospital, Zhengzhou; Department of Neurology (M.W., T.L.), SanBo Brain Hospital; and Department of Functional Neurosurgery (J. Zhang), Beijing Neurosurgical Institute, Capital Medical University; Beijing Key Laboratory of Neurostimulation (J. Zhang); Functional Neurosurgery Department (S. Liang), Beijing Children's Hospital, Capital Medical University, National Center for Children's Health; Beijing Key Laboratory of Epilepsy (G.L., Y.G.); and Center of Epilepsy (G.L., Y.G.), Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, China
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Dingenen E, Segers D, De Maeseneer H, Van Gysel D. Sturge-Weber syndrome: an update for the pediatrician. World J Pediatr 2024; 20:435-443. [PMID: 38658498 DOI: 10.1007/s12519-024-00809-y] [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: 10/21/2023] [Accepted: 03/27/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Sturge-Weber syndrome (SWS) is a rare congenital neurocutaneous disorder characterized by the simultaneous presence of both cutaneous and extracutaneous capillary malformations. SWS usually presents as a facial port-wine birthmark, with a varying presence of leptomeningeal capillary malformations and ocular vascular abnormalities. The latter may lead to significant neurological and ocular morbidity such as epilepsy and glaucoma. SWS is most often caused by a somatic mutation involving the G protein subunit alpha Q or G protein subunit alpha 11 gene causing various alterations in downstream signaling pathways. We specifically conducted a comprehensive review focusing on the current knowledge of clinical practices, the latest pathophysiological insights, and the potential novel therapeutic avenues they provide. DATA SOURCES A narrative, non-systematic review of the literature was conducted, combining expert opinion with a balanced review of the available literature. A search of PubMed, Google Scholar and Embase was conducted, using keywords "Sturge-Weber Syndrome" OR "SWS", "Capillary malformations", "G protein subunit alpha 11" OR "G protein subunit alpha Q". RESULTS One of the hallmark features of SWS is the presence of a port-wine birthmark at birth, and forehead involvement is most indicative for SWS. The most common ocular manifestations of SWS are glaucoma and choroidal hemangioma. Glaucoma presents in either in infancy (0-3 years of age) or later in life. Neurological complications are common in SWS, occurring in about 70%-80% of patients, with seizures being the most common one. SWS significantly impacts the quality of life for patients and their families, and requires a multidisciplinary approach for diagnosis and treatment. Currently, no disease-modifying therapies exist, and treatment is mostly focused on symptoms or complications as they arise. CONCLUSIONS: SWS remains a complex and heterogeneous disorder. Further research is needed to optimize diagnostic and therapeutic strategies, and to translate insights from molecular pathogenesis to clinical practice.
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Affiliation(s)
- Emilie Dingenen
- Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium
| | - Damien Segers
- Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium
| | - Hannelore De Maeseneer
- Department of Pediatrics, O.L.Vrouw Hospital Aalst, Moorselbaan 164, 9300, Aalst, Belgium
| | - Dirk Van Gysel
- Department of Pediatrics, O.L.Vrouw Hospital Aalst, Moorselbaan 164, 9300, Aalst, Belgium.
- Interdisciplinary Unit of Pediatric Dermatology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium.
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Zhang Y, Niu J, Wang J, Cai A, Wang Y, Wei G, Wang H. Neurological function and drug-refractory epilepsy in Sturge-Weber syndrome children: a retrospective analysis. Eur J Pediatr 2024; 183:1881-1890. [PMID: 38305888 DOI: 10.1007/s00431-024-05448-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/25/2023] [Accepted: 01/21/2024] [Indexed: 02/03/2024]
Abstract
Epilepsy in Sturge-Weber syndrome (SWS) is common, but drug-refractory epilepsy (DRE) in SWS has rarely been studied in children. We investigated the characteristics of epilepsy and risk factors for DRE in children with SWS. A retrospective study was conducted to analyze the clinical characteristics of children with SWS with epilepsy in our hospital from January 2013 to October 2022. Univariate and multivariate logistic analyses were performed to investigate the factors influencing DRE in children with SWS. A total of 35 SWS children with epilepsy were included (51% male; mean age of presentation 3.6 ± 0.5 years), 71% of children with SWS had their first seizure within the first year of life, and the most common type of seizure was focal seizure (77%). Eleven (31%) patients developed DRE. The median age of onset for the first seizure was 1.0 years and all these cases were of SWS type I. Multivariate logistic analysis revealed that stroke-like episodes and seizure clusters were risk factors for DRE in SWS children. A poor neurological function group was observed in twenty-five children with SWS. Status epilepticus was a risk factor that affected the neurological function of SWS children with epilepsy. Conclusion: The study explored the epileptic features of children with SWS. The results revealed that stroke-like episodes and seizure clusters are risk factors for DRE in children with SWS. The occurrence of status epilepticus impacts the neurological function of SWS children with epilepsy. Thus, long-term follow-up is necessary to monitor outcomes. What is Known: • Sturge-Weber syndrome (SWS) is a rare neurocutaneous disorder, over 75% of children with SWS experience seizures, and 30-57% develop drug-refractory epilepsy (DRE), which leads to a poor outcome. • Drug-refractory epilepsy in SWS has been rarely studied in children, and the risk factors associated with DRE are unclear. What is New: • Clinical features of SWS children with drug-refractory epilepsy. • In SWS, stroke-like episodes and seizure clusters are risk factors of DRE, the occurrence of status epilepticus impacts the neurological function.
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Affiliation(s)
- Yu Zhang
- Department of Pediatrics, the First Affiliated Hospital of Zhengzhou University, Henan Province, Zhengzhou, 450052, China
| | - Jiechao Niu
- Department of Pediatrics, the First Affiliated Hospital of Zhengzhou University, Henan Province, Zhengzhou, 450052, China
| | - Jiandong Wang
- Department of Pediatrics, the First Affiliated Hospital of Zhengzhou University, Henan Province, Zhengzhou, 450052, China
| | - Aojie Cai
- Department of Pediatrics, the First Affiliated Hospital of Zhengzhou University, Henan Province, Zhengzhou, 450052, China
| | - Yao Wang
- Department of Pediatrics, the First Affiliated Hospital of Zhengzhou University, Henan Province, Zhengzhou, 450052, China
| | - Guangshuai Wei
- Department of Pediatrics, the First Affiliated Hospital of Zhengzhou University, Henan Province, Zhengzhou, 450052, China
| | - Huaili Wang
- Department of Pediatrics, the First Affiliated Hospital of Zhengzhou University, Henan Province, Zhengzhou, 450052, China.
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Downey C, Metry D, Garzon MC, Morales LK, Baselga E. Cutis marmorata telangiectatica congenita: Incidence of extracutaneous manifestations and a proposed clinical definition. Pediatr Dermatol 2023; 40:820-828. [PMID: 37442634 DOI: 10.1111/pde.15377] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/30/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND/OBJECTIVES Cutis marmorata telangiectatica congenita (CMTC) is a capillary malformation characterized by congenital, reticulated, well-demarcated dark blue, red-purple, or violaceous macules or plaques, with a coarse fixed livedo pattern. Nearly always, contiguous areas of skin atrophy and/or ulceration are present. CMTC is usually localized but may rarely be generalized. Such generalized cases may be a feature of Adams-Oliver syndrome (AOS). The nosologic confusion surrounding the term CMTC and uncertainty about the risk of associated abnormalities hinders the appropriate workup of patients and prognostic counseling for families. We hypothesized that the risk of associated anomalies in children with localized CMTC is very low. METHODS We performed a literature review and retrospective review of patients with CMTC to propose a more precise clinical definition and ascertain the risk of associated anomalies. RESULTS We included 78 patients determined to have a diagnosis of CMTC based on consensus. The majority of patients had localized CMTC. Most patients with generalized CMTC met the criteria for the diagnosis of AOS. The associations found in patients with localized CMTC were mostly dermatological, with atrophy, ulcerations, or erosions present in 71%. Extracutaneous findings were present in 34.4% of patients and consisted mainly of extremity asymmetry (24.5%) that improved over time. CONCLUSION Our study showed a very low frequency of extracutaneous anomalies among patients with localized CTMC, ipsilateral limb discrepancy being the most common. We did not find a strong association with any other visceral anomalies that would justify routine evaluation in patients with localized CMTC.
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Affiliation(s)
- Camila Downey
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Department of Dermatology, Hospital Luis Calvo Mackenna, Facultad de Medicina Universidad de Chile, Santiago, Chile
- Department of Dermatology, Clínica Alemana de Santiago, Santiago, Chile
| | - Denise Metry
- Department of Dermatology, Baylor College of Medicine, Houston, Texas, USA
| | - Maria C Garzon
- Departments of Dermatology and Pediatrics, Vagelos College of Physicians & Surgeons, Columbia University Medical Center, New York, New York, USA
| | - Luz Karem Morales
- Department of Dermatology, Clínica Marly JCG Chía, Cundinamarca, Colombia
| | - Eulalia Baselga
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Department of Dermatology, Hospital Sant Joan de Deu, Barcelona, Spain
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5
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Sánchez-Espino LF, Ivars M, Antoñanzas J, Baselga E. Sturge-Weber Syndrome: A Review of Pathophysiology, Genetics, Clinical Features, and Current Management Approache. Appl Clin Genet 2023; 16:63-81. [PMID: 37124240 PMCID: PMC10145477 DOI: 10.2147/tacg.s363685] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 03/10/2023] [Indexed: 05/02/2023] Open
Abstract
Sturge-Weber syndrome (SWS) is a congenital, sporadic, and rare neurocutaneous disorder, characterized by the presence of a facial port-wine birthmark (PWB), glaucoma, and neurological manifestations including leptomeningeal angiomatosis and seizures. It is caused by a postzygotic, somatic, gain-of-function variant of the GNAQ gene, and more recently, the GNA11 gene in association with distinctive clinical features. Neuroimaging can help identify and stratify patients at risk for significant complications allowing closer follow-up; although no presymptomatic treatment has been demonstrated to be effective to date, these patients could benefit from early treatment and/or supportive interventions. Choroid plexus (CP) thickness measurements in brain magnetic resonance imaging (MRI) have a high sensitivity and specificity for early and incipient changes in SWS. In contrast, the absence of pathologic findings makes it possible to rule out associated neurological involvement and leads to periodical observation, with new imaging studies only in cases of new clinical signs/symptoms. Periodic ophthalmological examination is also recommended every 3 months during the first year and yearly afterwards to monitor for glaucoma and choroidal hemangiomas. Treatment for SWS depends on the extent and areas that are affected. These include laser surgery for PWB, anticonvulsants in the case of brain involvement, with either seizures or abnormal EEG, and medical treatment or surgery for glaucoma. Sirolimus has been used in a limited number of patients and appears to be a safe and potentially effective treatment for cutaneous and extra-cutaneous features, however controlled clinical studies have not been carried out. Better knowledge of GNAQ/GNA11 molecular pathways will help to develop future targeted treatments.
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Affiliation(s)
| | - Marta Ivars
- Pediatric Dermatology Department, Barcelona Children’s Hospital Sant Joan de Dèu, Barcelona, Cataluña, Spain
| | - Javier Antoñanzas
- Dermatology Department, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - Eulalia Baselga
- Pediatric Dermatology Department, Barcelona Children’s Hospital Sant Joan de Dèu, Barcelona, Cataluña, Spain
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Mozaffari K, Krishnakumar A, Chen JS, Goel K, Wang A, Shlobin NA, Weil AG, Fallah A. Seizure outcomes in children with Sturge-Weber syndrome undergoing epilepsy surgery: An individual participant data meta-analysis. Seizure 2023; 107:43-51. [PMID: 36958063 DOI: 10.1016/j.seizure.2023.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 03/06/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND A subpopulation of patients with Sturge-Weber syndrome (SWS) develop medically intractable epilepsy. There is a paucity of literature on preoperative factors that predict postoperative seizure outcomes in these patients. An individual participant data meta-analysis (IPDMA) was performed to discern preoperative variables associated with favorable seizure outcomes in pediatric SWS patients undergoing epilepsy surgery. METHODS PubMed, Cochrane, Web of Science, and Scopus were independently queried following PRISMA guidelines. Studies that reported seizure outcomes in individual pediatric SWS patients were selected. Preoperative demographic variables and disease characteristics were recorded and evaluated in a time-to-event fashion via Cox regression and Kaplan-Meier analysis with log-rank test. RESULTS A total of 18 studies with 108 patients were included for meta-analysis. Median age at seizure onset was 4.5 months, and 85 patients (78.7%) were seizure-free at last follow-up (median: 72 months). On multivariable Cox regression, no variables were independent predictors of post-operative seizure freedom duration, including the extent of hemispheric resection. There were also no differences in time-to-seizure recurrence on Kaplan-Meier analysis when comparing those treated with hemispheric surgery and those with less than hemispheric surgery (p = 0.52). CONCLUSION This IPDMA showed that both resective and hemispheric epilepsy surgery achieve favorable and comparable seizure outcomes in pediatric SWS patients. The best available evidence using IPD suggests that resective surgery may be an appropriate alternative to hemispheric epilepsy surgery in well-selected patients. Prospective multi-institutional studies with greater follow-up are warranted to further investigate predictors of seizure outcome in pediatric SWS patients.
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Affiliation(s)
- Khashayar Mozaffari
- School of Medicine and Health Sciences, The George Washington University, Washington, DC, United States
| | - Asha Krishnakumar
- School of Medicine, Virginia Commonwealth University, Richmond, United States
| | - Jia-Shu Chen
- Warren Alpert Medical School of Brown University, Providence, United States
| | - Keshav Goel
- David Geffen School of Medicine at University of California, Los Angeles, United States
| | - Andrew Wang
- David Geffen School of Medicine at University of California, Los Angeles, United States
| | - Nathan A Shlobin
- Northwestern University Feinberg School of Medicine, Chicago, United States
| | - Alexander G Weil
- Department of Surgery, Division of Neurosurgery, Ste. Justine University Hospital, University of Montreal, Quebec, Canada; Department of Neuroscience, University of Montreal, Quebec, Canada; Division of Neurosurgery, Ste. Justine Hospital, University of Montreal, Quebec, Canada
| | - Aria Fallah
- Department of Neurosurgery and Pediatrics, Los Angeles (UCLA), University of California, 300 Stein Plaza Driveway, Suite 525, Los Angeles, CA 90095, United States.
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Ha A, Kim SH, Baek SU, Kim JS, Yoon HJ, Kim YK. Incidence of Sturge-Weber Syndrome and Risk of Secondary Glaucoma: A Nationwide Population-based Study Using a Rare Disease Registry. Am J Ophthalmol 2023; 247:121-126. [PMID: 36375589 DOI: 10.1016/j.ajo.2022.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/04/2022] [Accepted: 11/04/2022] [Indexed: 11/13/2022]
Abstract
PURPOSE To determine Sturge-Weber syndrome (SWS) incidence and secondary glaucoma risk. DESIGN Nationwide retrospective cohort study. METHODS The Korean National Health Insurance (NHI) claims database from 2002 to 2019 along with the registration-program database for rare intractable diseases (ie, the rare disease registry) were accessed to identify ophthalmologist/neurologist-confirmed SWS patients. SWS incidence was estimated in a same-birth-year population (ie, a birth cohort) from 2002 to 2009. Among the SWS patients born between 2002 and 2019, the incidence of SWS-associated glaucoma was estimated. RESULTS During the 18-year observational period, a total of 1049 patients were registered as SWS. The mean birth-cohort SWS incidence was 3.08 (95% CI 2.52-3.64) per 100 000 people per year, with an approximate female-to-male ratio of 0.97:1. Among the 217 SWS patients born between 2002 and 2019, secondary glaucoma arose in 18 (8.3%) cases, including 12 males (66.7%). Among these 18 SWS-associated glaucoma cases, 15 (83.3%) were diagnosed before 1 year of age, and the other 3 (16.7%) between age 1 and 2 years. Among the 660 SWS patients under age 40 years during the study period, SWS-associated glaucoma was identified in 79 (12.0%) cases. Neurologic manifestations such as epilepsy, hemiparesis, and mental retardation did not significantly differ between SWS patients with and those without secondary glaucoma. CONCLUSIONS This study identified birth-cohort SWS incidence and determined secondary-glaucoma risk in a population of East Asian ethnicity. These data could help to promote better understanding of the epidemiologic features of SWS patients.
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Affiliation(s)
- Ahnul Ha
- From the Department of Ophthalmology, Jeju National University Hospital (A.H.), Jeju-si; Department of Ophthalmology, Jeju National University College of Medicine (A.H.), Jeju-si
| | - Su Hwan Kim
- Biomedical Research Institute, Seoul National University Hospital (S.H.K.), Seoul
| | - Sung Uk Baek
- Department of Ophthalmology, Hallym University College of Medicine (S.U.B.), Anyang; Department of Ophthalmology, Hallym University Sacred Heart Hospital (S.U.B.), Anyang
| | - Jin-Soo Kim
- Department of Ophthalmology, Chungnam National University Sejong Hospital (J.-S.K.), Sejong
| | - Hyung-Jin Yoon
- Medical Bigdata Research Center, Seoul National University College of Medicine (H.-J.Y.), Seoul.
| | - Young Kook Kim
- Department of Ophthalmology, Seoul National University College of Medicine (Y.K.K.), Seoul; Department of Ophthalmology, Seoul National University Children's Hospital (Y.K.K.), Seoul; EyeLight Data Science Lab (Y.K.K.), Seoul, South Korea.
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8
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A review of the natural history of Sturge-Weber syndrome through adulthood. J Neurol 2022; 269:4872-4883. [PMID: 35508811 DOI: 10.1007/s00415-022-11132-9] [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: 02/19/2022] [Revised: 04/05/2022] [Accepted: 04/07/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Sturge-Weber syndrome (SWS) is a neurocutaneous disorder caused by a somatic mutation in the GNAQ gene, leading to capillary venous malformations with neurological, ocular, and cutaneous abnormalities. Descriptions of adult and elderly patients with SWS are scarce compared to those of neonates or children. METHODS We reviewed clinical, neuro-radiological and electroencephalographical findings of adult patients diagnosed with SWS, treated in our tertiary center for rare epilepsies. RESULTS Ten adult patients were identified with a median age of 48 years at inclusion. All patients had seizures, with features of temporal lobe involvement for five patients. One patient presented typical drug-resistant mesial temporal seizures with ipsilateral hippocampal sclerosis and leptomeningeal enhancement, and was treated surgically. Other patients presented typical neurological and brain imaging features found in SWS. One patient without visible leptomeningeal angioma or brain calcifications presented neurological symptoms (tonic-clonic generalized seizures) for the first time at the age of 56. Two of the oldest patients in our cohort with supratentorial leptomeningeal angioma displayed contralateral cerebellar atrophy, consistent with crossed cerebellar diaschisis. Over 70 years of follow-up data were available for one patient whose epilepsy started at the age of 6 months, offering a vast overview of the course of SWS, in particular the onset of dementia and contralateral micro-bleeds in relation to the leptomeningeal angioma. CONCLUSION The long follow-up of our cohort allows for a description of the course of SWS and a characterization of uncommon neurological features in adult and elderly patients.
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9
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Zuberi SM, Wirrell E, Yozawitz E, Wilmshurst JM, Specchio N, Riney K, Pressler R, Auvin S, Samia P, Hirsch E, Galicchio S, Triki C, Snead OC, Wiebe S, Cross JH, Tinuper P, Scheffer IE, Perucca E, Moshé SL, Nabbout R. ILAE classification and definition of epilepsy syndromes with onset in neonates and infants: Position statement by the ILAE Task Force on Nosology and Definitions. Epilepsia 2022; 63:1349-1397. [PMID: 35503712 DOI: 10.1111/epi.17239] [Citation(s) in RCA: 266] [Impact Index Per Article: 133.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 03/20/2022] [Accepted: 03/21/2022] [Indexed: 12/20/2022]
Abstract
The International League Against Epilepsy (ILAE) Task Force on Nosology and Definitions proposes a classification and definition of epilepsy syndromes in the neonate and infant with seizure onset up to 2 years of age. The incidence of epilepsy is high in this age group and epilepsy is frequently associated with significant comorbidities and mortality. The licensing of syndrome specific antiseizure medications following randomized controlled trials and the development of precision, gene-related therapies are two of the drivers defining the electroclinical phenotypes of syndromes with onset in infancy. The principal aim of this proposal, consistent with the 2017 ILAE Classification of the Epilepsies, is to support epilepsy diagnosis and emphasize the importance of classifying epilepsy in an individual both by syndrome and etiology. For each syndrome, we report epidemiology, clinical course, seizure types, electroencephalography (EEG), neuroimaging, genetics, and differential diagnosis. Syndromes are separated into self-limited syndromes, where there is likely to be spontaneous remission and developmental and epileptic encephalopathies, diseases where there is developmental impairment related to both the underlying etiology independent of epileptiform activity and the epileptic encephalopathy. The emerging class of etiology-specific epilepsy syndromes, where there is a specific etiology for the epilepsy that is associated with a clearly defined, relatively uniform, and distinct clinical phenotype in most affected individuals as well as consistent EEG, neuroimaging, and/or genetic correlates, is presented. The number of etiology-defined syndromes will continue to increase, and these newly described syndromes will in time be incorporated into this classification. The tables summarize mandatory features, cautionary alerts, and exclusionary features for the common syndromes. Guidance is given on the criteria for syndrome diagnosis in resource-limited regions where laboratory confirmation, including EEG, MRI, and genetic testing, might not be available.
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Affiliation(s)
- Sameer M Zuberi
- Paediatric Neurosciences Research Group, Royal Hospital for Children, Institute of Health & Wellbeing, Collaborating Centre of European Reference Network EpiCARE, University of Glasgow, Glasgow, UK
| | - Elaine Wirrell
- Divisions of Child and Adolescent Neurology and Epilepsy, Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Elissa Yozawitz
- Isabelle Rapin Division of Child Neurology, Saul R. Korey Department of Neurology, Montefiore Medical Center, Bronx, New York, USA
| | - Jo M Wilmshurst
- Department of Paediatric Neurology, Red Cross War Memorial Children's Hospital, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Nicola Specchio
- Rare and Complex Epilepsy Unit, Department of Neuroscience, Bambino Gesu' Children's Hospital, IRCCS, Member of European Reference Network EpiCARE, Rome, Italy
| | - Kate Riney
- Neurosciences Unit, Queensland Children's Hospital, South Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, St Lucia, Queensland, Australia
| | - Ronit Pressler
- Clinical Neuroscience, UCL- Great Ormond Street Institute of Child Health, London, UK.,Department of Clinical Neurophysiology, Great Ormond Street Hospital for Children NHS Foundation Trust, Member of European Reference Network EpiCARE, London, UK
| | - Stephane Auvin
- AP-HP, Hôpital Robert-Debré, INSERM NeuroDiderot, DMU Innov-RDB, Neurologie Pédiatrique, Member of European Reference Network EpiCARE, Université de Paris, Paris, France
| | - Pauline Samia
- Department of Paediatrics and Child Health, Aga Khan University, Nairobi, Kenya
| | - Edouard Hirsch
- Neurology Epilepsy Unit "Francis Rohmer", INSERM 1258, FMTS, Strasbourg University, Strasbourg, France
| | - Santiago Galicchio
- Child Neurology Department, Victor J Vilela Child Hospital of Rosario, Santa Fe, Argentina
| | - Chahnez Triki
- Child Neurology Department, LR19ES15 Neuropédiatrie, Sfax Medical School, University of Sfax, Sfax, Tunisia
| | - O Carter Snead
- Pediatric Neurology, Hospital for Sick Children, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Samuel Wiebe
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - J Helen Cross
- Programme of Developmental Neurosciences, UCL NIHR BRC Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, Member of European Reference Network EpiCARE, London, UK.,Young Epilepsy, Lingfield, UK
| | - Paolo Tinuper
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
| | - Ingrid E Scheffer
- Austin Health and Royal Children's Hospital, Florey Institute, Murdoch Children's Research Institute, University of Melbourne, Melbourne, Victoria, Australia
| | - Emilio Perucca
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia.,Department of Medicine, Austin Health, University of Melbourne, Heidelberg, Victoria, Australia
| | - Solomon L Moshé
- Isabelle Rapin Division of Child Neurology, Saul R. Korey Department of Neurology, Bronx, New York, USA.,Departments of Neuroscience and Pediatrics, Albert Einstein College of Medicine, Bronx, New York, USA.,Montefiore Medical Center, Bronx, New York, USA
| | - Rima Nabbout
- Reference Centre for Rare Epilepsies, Department of Pediatric Neurology, Necker-Enfants Malades University Hospital, APHP, Member of European Reference Network EpiCARE, Institut Imagine, INSERM, UMR 1163, Université Paris cité, Paris, France
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Wang S, Pan J, Zhao M, Wang X, Zhang C, Li T, Wang M, Wang J, Zhou J, Liu C, Sun Y, Zhu M, Qi X, Luan G, Guan Y. Characteristics, surgical outcomes, and influential factors of epilepsy in Sturge-Weber syndrome. Brain 2021; 145:3431-3443. [PMID: 34932802 DOI: 10.1093/brain/awab470] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 11/19/2021] [Accepted: 11/28/2021] [Indexed: 02/05/2023] Open
Abstract
Abstract
Few studies have reported the clinical presentation, surgical treatment, outcomes, and influential factors for patients with epilepsy and Sturge-Weber syndrome.
This large-scale retrospective study continuously enrolled 132 patients with Sturge-Weber syndrome and epilepsy from January 2008 to December 2018 at our hospital to analyze their characteristics. Among these patients, 90 underwent epilepsy surgery, and their postoperative 2-year follow-up seizure, cognitive, and motor functional outcomes were assessed and analyzed. Univariable and multivariable logistic analyses were conducted to explore the influential factors.
Among the Sturge-Weber syndrome patients for whom characteristics were analyzed (n = 132), 76.52% of patients had their first epileptic seizures within their first year of life. The risk factors for cognitive decline were seizure history≥2 years (adjusted odds ratio [aOR] = 3.829, 95% confidence interval [CI]: 1.810-9.021, p = 0.008), bilateral leptomeningeal angiomas (aOR = 3.173, 95% CI: 1.970-48.194, p = 0.013), age at onset < 1 year (aOR = 2.903, 95% CI: 1.230-6.514, p = 0.013), brain calcification (aOR = 2.375, 95% CI: 1.396-5.201, p = 0.021) and left leptomeningeal angiomas (aOR = 2.228, 95% CI: 1.351-32.571, p = 0.030). Of the patients who underwent epilepsy surgery (n = 90), 44 were subject to focal resection, and 46 underwent hemisphere surgery (19 anatomical hemispherectomies and 27 modified hemispherotomies). A postoperative seizure-free status, favorable cognitive outcomes, and favorable motor outcomes were achieved in 83.33%, 44.44%, and 43.33% of surgical patients, respectively. The modified hemispherotomy group had similar surgical outcomes, less intraoperative blood loss and shorter postoperative hospital stays than the anatomical hemispherectomy group. Regarding seizure outcomes, full resection (aOR = 11.115, 95% CI: 1.260-98.067, p = 0.020) and age at surgery < 2 years (aOR = 6.040, 95% CI: 1.444-73.367, p = 0.031) were positive influential factors for focal resection. Age at surgery < 2 years (aOR = 15.053, 95% CI: 1.050-215.899, p = 0.036) and infrequent seizures (aOR = 8.426, 95% CI: 1.086-87.442, p = 0.042; monthly vs. weekly) were positive influential factors for hemisphere surgery.
In conclusion, epilepsy surgery resulted in a good postoperative seizure-free rate and favorable cognitive and motor functional outcomes and showed acceptable safety for patients with epilepsy and Sturge-Weber syndrome. Modified hemispherotomy is a less invasive and safer type of hemisphere surgery than traditional anatomic hemispherectomy with similar surgical outcomes. Early surgery may be helpful to achieve better seizure outcomes and cognitive protection, while the risk of surgery for young children should also be considered.
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Affiliation(s)
- Shu Wang
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing 100093, China
| | - Junhong Pan
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing 100093, China
| | - Meng Zhao
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing 100093, China
| | - Xiongfei Wang
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing 100093, China
| | - Chunsheng Zhang
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing 100093, China
| | - Tianfu Li
- Department of Neurology, SanBo Brain Hospital, Capital Medical University, Beijing 100093, China
- Beijing Key Laboratory of Epilepsy, Beijing 100093, China
- Center of Epilepsy, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing 100093, China
| | - Mengyang Wang
- Department of Neurology, SanBo Brain Hospital, Capital Medical University, Beijing 100093, China
| | - Jing Wang
- Department of Neurology, SanBo Brain Hospital, Capital Medical University, Beijing 100093, China
| | - Jian Zhou
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing 100093, China
| | - Changqing Liu
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing 100093, China
| | - Yongxing Sun
- Department of Anesthesiology, SanBo Brain Hospital, Capital Medical University, Beijing 100093, China
| | - Mingwang Zhu
- Department of Radiology, SanBo Brain Hospital, Capital Medical University, Beijing 100093, China
- Department of Pathology, SanBo Brain Hospital, Capital Medical University, Beijing 100093, China
| | | | - Guoming Luan
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing 100093, China
- Beijing Key Laboratory of Epilepsy, Beijing 100093, China
- Center of Epilepsy, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing 100093, China
| | - Yuguang Guan
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing 100093, China
- Beijing Key Laboratory of Epilepsy, Beijing 100093, China
- Center of Epilepsy, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing 100093, China
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Powell S, Fosi T, Sloneem J, Hawkins C, Richardson H, Aylett S. Neurological presentations and cognitive outcome in Sturge-Weber syndrome. Eur J Paediatr Neurol 2021; 34:21-32. [PMID: 34293629 DOI: 10.1016/j.ejpn.2021.07.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 06/03/2021] [Accepted: 07/07/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION This study of children with Sturge-Weber syndrome (SWS) profiled neurological presentations; compared patients with (+) and without (-) port-wine stain (PWS); and determined risk factors for intellectual and language impairments. METHODS A retrospective case note review was conducted at a national centre. RESULTS This cohort (n = 140, male 72, median follow up 114 months) showed sex parity. Intellectual disability ("ID": IQ ≤ 70) affected half (66), being severe (IQ ≤ 40) in two-fifths (27) with ID. Language disorder (core score≤70) affected half (57). Neurological presentations were: status epilepticus 57% (80), hemiplegia 58% (81), headaches 36% (50) and acutely acquired neurological deficits lasting over 24 h 40% (56). One-seventh (20) were PWS(-). This group had: fewer lobes with angioma (p < 0.0001); and less frequent ID (p = 0.002) or language disorder (p = 0.013). Seizure frequency and status epilepticus prevalence did not differ from PWS(+). ID and language disorder were associated with: more lobes with angioma; earlier seizure onset; more frequent status epilepticus and seizure clusters. On multivariable analysis recurrent status epilepticus (p = 0.037) and multi-lobe involvement (p = 0.002) increased the risk of severe intellectual disability. Active epilepsy was associated with language disorder (p = 0.030). CONCLUSIONS This is the largest reported series documenting detailed developmental profiles of children with SWS, including ID and ASD. PWS(+) shows high rates of ID and language disorder. PWS(-) SWS has a more favourable outcome. Cognitive outcome is contingent on number of affected lobes and bilateral involvement. Epilepsy exerts an additional deleterious effect on language and cognition. A high percentage of children have a history of status epilepticus, with evidence that this impacts language and cognitive outcomes. Acutely acquired neurological deficits did not penalise either. Regular structured clinical and developmental assessment permit greater identification of neurological and neurodevelopmental impairments in SWS, and appropriate support.
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Affiliation(s)
- Sebastian Powell
- University College London Medical School, London, Gower Street, WC1E 6BT, United Kingdom.
| | - Tangunu Fosi
- Great Ormond Street Hospital for Children Neurodisability Department, Great Ormond Street, UCL Great Ormond Street Institute of Child Health Clinical Neurosciences, London, United Kingdom
| | - Jenny Sloneem
- Great Ormond Street Hospital for Children Neurodisability Department, Great Ormond Street, London, United Kingdom
| | - Christina Hawkins
- Great Ormond Street Hospital for Children Neurodisability Department, Great Ormond Street, London, United Kingdom
| | - Hanna Richardson
- Great Ormond Street Hospital for Children Neurodisability Department, Great Ormond Street, London, United Kingdom
| | - Sarah Aylett
- Great Ormond Street Hospital for Children Neurodisability Department, Great Ormond Street, UCL Great Ormond Street Institute of Child Health Clinical Neurosciences, London, United Kingdom
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12
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Hassanpour K, Nourinia R, Gerami E, Mahmoudi G, Esfandiari H. Ocular Manifestations of the Sturge-Weber Syndrome. J Ophthalmic Vis Res 2021; 16:415-431. [PMID: 34394871 PMCID: PMC8358762 DOI: 10.18502/jovr.v16i3.9438] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 04/08/2021] [Indexed: 11/24/2022] Open
Abstract
Sturge-Weber syndrome (SWS) or encephalotrigeminal angiomatosis is a non-inherited congenital disorder characterized by neurologic, skin, and ocular abnormalities. A somatic activating mutation (R183Q) in the GNAQ gene during early embryogenesis has been recently recognized as the etiology of vascular abnormalities in SWS. Approximately, half of the patients with SWS manifest ocular involvement including glaucoma as the most common ocular abnormality followed by choroidal hemangioma (CH). The underlying pathophysiology of glaucoma in SWS has not been completely understood yet. Early onset glaucoma comprising 60% of SWS glaucoma have lower success rates after medical and surgical treatments compared with primary congenital glaucoma. Primary angle surgery is associated with modest success in the early onset SWS glaucoma while the success rate significantly decreases in late onset glaucoma. Filtration surgery is associated with a higher risk of intraoperative and postoperative choroidal effusion and suprachoroidal hemorrhage. CH is reported in 40-50% of SWS patients. The goal of treatment in patients with CH is to induce involution of the hemangioma, with reduction of subretinal and intraretinal fluid and minimal damage to the neurosensory retina. The decision for treating diffuse CHs highly depends on the patient's visual acuity, the need for glaucoma surgery, the presence of subretinal fluid (SRF), its chronicity, and the potential for visual recovery.
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Affiliation(s)
- Kiana Hassanpour
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ramin Nourinia
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ebrahim Gerami
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ghavam Mahmoudi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamed Esfandiari
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Wanitphakdeedecha R, Ng JNC, Yan C, Manuskiatti W, Sudhipongpracha T, Jantarakolica T. Quality of Life and Psychological Effects of Port-Wine Stain: A Review of Literature. Clin Cosmet Investig Dermatol 2021; 14:681-690. [PMID: 34188511 PMCID: PMC8235992 DOI: 10.2147/ccid.s315804] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 05/12/2021] [Indexed: 12/14/2022]
Abstract
Introduction Port-wine stain (PWS) is a congenital malformation that does not resolve spontaneously and can cause a physiological or psychological burden to the patients. At present, most of the studies done on PWS are focused on the treatment rather than the quality of life and psychological effects of the disease. Material and Methods A comprehensive literature search was done in MEDLINE using PubMed database, Embase®, and Cochrane. All observational studies were included in this review. Results A total of 17 relevant articles with 2,135 PWS patients were included in this review. There were 36 measurement tools used to assess the quality of life and the psychological effects among PWS patients. The results showed that patients with facial PWS had a significant negative effect on their quality of life and had also suffered from psychological disabilities. The PWS lesion tends to worsen with age and may cause further adaptation problems towards the social environment, especially in children. Conclusion Early treatment, psychological assistance, and patient support are the key management in improving the quality of life of patients with PWS. Quality of life must be regularly assessed together with the improvement of treatment.
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Affiliation(s)
- Rungsima Wanitphakdeedecha
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.,College of Interdisciplinary Studies, Thammasat University, Bangkok, Thailand
| | - Janice Natasha C Ng
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chadakan Yan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Woraphong Manuskiatti
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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14
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Wanitphakdeedecha R, Sudhipongpracha T, Ng JNC, Yan C, Jantarakolica T. Self-stigma and psychosocial burden of patients with port-wine stain: A systematic review and meta-analysis. J Cosmet Dermatol 2021; 20:2203-2210. [PMID: 33949094 DOI: 10.1111/jocd.14199] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/26/2021] [Accepted: 04/28/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND Port-wine stain (PWS) is a congenital malformation that does not resolve spontaneously and can lead to social and self-stigma. However, little is known about how PWS affects the patients' quality of life (QoL) and psychosocial well-being. In this article, we examine the existing empirical evidence on self-stigma caused by PWS. METHODS A systematic review was done using MEDLINE, PubMed, Embase, and Cochrane databases on January 15, 2021 to retrieve all case reports, cohort studies, and clinical trials written in English. The keywords used in this literature search included port-wine stain, quality of life, self-stigma, and social stigma. RESULTS From the 74 initial records, eight articles were quantitative studies that assessed the QoL and self-stigma experienced by PWS patients. With regard to perceived stigma or the patients' understanding of how others think and act toward them, we found that the parents of children with facial PWS tend to have more perceived stigma than the children. For anticipated stigma or expectations of future stigma, young patients with PWS have less or no concern about their skin conditions. In terms of enacted stigma or experiences with discriminatory acts, there were significant differences in the QoL score between patients with facial PWS and those with non-facial PWS. CONCLUSION This study suggests that self-stigma caused by PWS affects young patients and their parents. The parents in particular tend to suffer more than their children from perceived and anticipated stigma. Psychological support and early treatment can improve the livelihoods of young patients and their parents.
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Affiliation(s)
- Rungsima Wanitphakdeedecha
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.,College of Interdisciplinary Studies, Thammasat University, Bangkok, Thailand
| | | | - Janice Natasha C Ng
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chadakan Yan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Sugano H, Iimura Y, Igarashi A, Nakazawa M, Suzuki H, Mitsuhashi T, Nakajima M, Higo T, Ueda T, Nakanishi H, Niijima S, Karagiozov K, Arai H. Extent of Leptomeningeal Capillary Malformation is Associated With Severity of Epilepsy in Sturge-Weber Syndrome. Pediatr Neurol 2021; 117:64-71. [PMID: 33677229 DOI: 10.1016/j.pediatrneurol.2020.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 12/21/2020] [Accepted: 12/24/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Individuals with Sturge-Weber syndrome (SWS) often expereince intractable epilepsy and cognitive decline. We hypothesized that the extent of the leptomeningeal capillary malformation (LCM) may correlate with the severity of neurological impairment due to SWS. We tested the hypothesis in a cross-sectional study of seizure severity and electroencephalographic (EEG) findings and a retrospective cohort study for surgical indications related to the extent of the LCM. METHODS We enrolled 112 patients and classified them according to LCM distribution: (1) bilateral, (2) hemispheric, (3) multilobar, and (4) single lobe. Age at seizure onset, seizure semiology and frequency, and EEG findings were compared. Surgical indications were evaluated for each group by Fisher exact test, and predictors for surgery were evaluated by univariate and multivariate analyses. Therapeutic efficacy was evaluated by the SWS-Neurological Score (SWS-NS). RESULTS The bilateral and hemispheric groups had early seizure onset (4.0 months old and 3.0 months old), frequent seizures (88.9% and 80.6% had more than one per month), focal-to-bilateral tonic-clonic seizures (88.9% and 74.2%), and status epilepticus (100% and 87.1%). The groups' EEG findings did not differ substantially. Surgical indications were present in 77.8% of the bilateral, 88.1% of the hemispheric, and 46.8% of the multilobar groups. Seizure more than once per month was a predictor of surgical treatment. Seizure subscore improved postoperatively in the hemispheric and multilobar groups. Even after surgical treatment, the bilateral and hemispheric groups exhibited higher SWS-NSs than members of the other groups. CONCLUSION Our study demonstrated a strong association between extensive LCM and epilepsy severity. Surgical intervention improved seizure outcome in patients with SWS with large LCMs.
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Affiliation(s)
- Hidenori Sugano
- Department of Neurosurgery, Juntendo University, Bunkyo-ku, Tokyo, Japan.
| | - Yasushi Iimura
- Department of Neurosurgery, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Ayuko Igarashi
- Department of Pediatrics, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Mika Nakazawa
- Department of Pediatrics, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Hiroharu Suzuki
- Department of Neurosurgery, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Takumi Mitsuhashi
- Department of Neurosurgery, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Madoka Nakajima
- Department of Neurosurgery, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Takuma Higo
- Department of Neurosurgery, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Tetsuya Ueda
- Department of Neurosurgery, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Hajime Nakanishi
- Department of Neurosurgery, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Shinichi Niijima
- Department of Pediatrics, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | | | - Hajime Arai
- Department of Neurosurgery, Juntendo University, Bunkyo-ku, Tokyo, Japan
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Kumagai R, Ichimiya Y. Case of Sturge-Weber syndrome type III diagnosed during dementia examination. Psychiatry Clin Neurosci 2020; 74:670-671. [PMID: 32940365 DOI: 10.1111/pcn.13153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/18/2020] [Accepted: 09/14/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Ryo Kumagai
- Department of Psychiatry, Shimofusa Hospital, Chiba, Japan
| | - Yosuke Ichimiya
- Department of Psychiatry, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan
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17
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Impact of predictive, preventive and precision medicine strategies in epilepsy. Nat Rev Neurol 2020; 16:674-688. [PMID: 33077944 DOI: 10.1038/s41582-020-0409-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2020] [Indexed: 12/15/2022]
Abstract
Over the last decade, advances in genetics, neuroimaging and EEG have enabled the aetiology of epilepsy to be identified earlier in the disease course than ever before. At the same time, progress in the study of experimental models of epilepsy has provided a better understanding of the mechanisms underlying the condition and has enabled the identification of therapies that target specific aetiologies. We are now witnessing the impact of these advances in our daily clinical practice. Thus, now is the time for a paradigm shift in epilepsy treatment from a reactive attitude, treating patients after the onset of epilepsy and the initiation of seizures, to a proactive attitude that is more broadly integrated into a 'P4 medicine' approach. This P4 approach, which is personalized, predictive, preventive and participatory, puts patients at the centre of their own care and, ultimately, aims to prevent the onset of epilepsy. This aim will be achieved by adapting epilepsy treatments not only to a given syndrome but also to a given patient and moving from the usual anti-seizure treatments to personalized treatments designed to target specific aetiologies. In this Review, we present the current state of this ongoing revolution, emphasizing the impact on clinical practice.
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Muralidharan V, Failla G, Travali M, Cavallaro TL, Politi MA. Isolated leptomeningeal angiomatosis in the sixth decade of life, an adulthood variant of Sturge Weber Syndrome (Type III): role of advanced Magnetic Resonance Imaging and Digital Subtraction Angiography in diagnosis. BMC Neurol 2020; 20:366. [PMID: 33023482 PMCID: PMC7541244 DOI: 10.1186/s12883-020-01944-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/29/2020] [Indexed: 11/13/2022] Open
Abstract
Background Sturge-Weber syndrome (SWS) is primarily diagnosed in pediatric population, but clinical presentation in late adulthood is rarely reported. Evolution of radiological findings in the adulthood variant of SWS with isolated leptomeningeal angiomatosis has never been reported to our knowledge. Case presentation We report here a case of an isolated temporo-parieto-occipital leptomeningeal angiomatosis on the right cerebral hemisphere in a sixty-two-year-old male who presented with generalized seizure, GCS score 14/15 (E4 V4 M6) with equal and reacting pupils, psychomotor slowing, left hemineglect and grade 4 power in the left upper and lower limbs. Over a period of 48 h his neurological status deteriorated, but recovered spontaneously over a week on titration with anticonvulsants. He had a prior history of treatment for focal leptomeningitis, three years ago. Cerebrospinal fluid (CSF) analysis showed glucose of 75 mg/dL, proteins of 65 mg/dL and culture grew no organisms. On follow-up, he had intermittent episodes of focal seizure for two years. Initial, computed tomography of brain showed hyperdense lesion in the parieto-occipital convexity subarachnoid space on the right cerebral hemisphere mimicking subarachnoid hemorrhage and computed tomography angiography showed no significant abnormality. Magnetic resonance imaging (MRI) of brain showed intense pial enhancement in the right temporo-parieto-occipital region with a subtle T2W hyperintense signal in the underlying subcortical white matter without edema or infarct or mass effect. Digital subtraction cerebral angiography (DSA) showed hypertrophy of the cerebral arteries, arteriolo-capillary bed and venules in the right temporo-parieto-occipital territory associated with early arterio-capillary and venous opacification. Serial MRI done after six months, one and two years showed increase in the T2W hyperintense signal in the subcortical white matter and cortical atrophy with no changes in the pial enhancement. MR perfusion imaging showed reduced cerebral blood flow (CBF) and cerebral blood volume (CBV) in the right parieto-temporo-occipital cortical and subcortical regions and increased perfusion in the leptomeninges with reduction of the NAA / Cr ratios in spectroscopy. Conclusion Conglomeration of various radiological findings in MRI, Perfusion, MRS and DSA with the clinical presentation can aid in establishing the diagnosis of this rare presentation of SWS-type 3 variant in late adulthood.
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Affiliation(s)
- Vetrivel Muralidharan
- Fellow in Advanced Training in Neuroendovascular Interventions, Department of Medical Surgical Science and Advanced Technologies "GF Ingrassia", University of Catania, Catania, Italy
| | - Gaetano Failla
- Department of Neurology, Cannizzaro Hospital, Catania, Italy
| | - Mario Travali
- Resident in Radiology, Department of Medical Surgical Science and Advanced Technologies "GF Ingrassia", University of Catania, Catania, Italy
| | - Tiziana Liliana Cavallaro
- Diagnostic & Interventional Neuroradiology, Department of Neuroradiology, Cannizzaro Hospital, Via Messina, 95126, Catania, Sicily, Italy
| | - Marco Angelo Politi
- Diagnostic & Interventional Neuroradiology, Department of Neuroradiology, Cannizzaro Hospital, Via Messina, 95126, Catania, Sicily, Italy.
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Sturge-Weber syndrome: an update on the relevant issues for neurosurgeons. Childs Nerv Syst 2020; 36:2553-2570. [PMID: 32564157 DOI: 10.1007/s00381-020-04695-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/21/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Sturge-Weber syndrome (SWS) is a neurocutaneous facomatosis characterized by facial and leptomeningeal angioma, glaucoma, seizures, and neurological disability. Therefore, a challenging multidisciplinary interaction is required for its management. The goal of this paper is to review the main aspects of SWS and to present an illustrative pediatric series. METHODS The pertinent literature has been analyzed, focused mainly on etiopathogenesis, pathology, clinical features, diagnostic tools, management, and outcome of the disease. Moreover, a series of 11 children operated on for refractory epilepsy between 2005 and 2015 (minimum follow-up 5 years, mean follow-up 9.6 years) is reported. The series consists of six boys and five girls with 6.5-month and 16.2-month mean age at seizure onset and at surgery, respectively. Seizures affected all children, followed by hemiparesis and psychomotor delay (81%), glaucoma (54%), and other neurological deficits (45%). RESULTS All children underwent hemispherectomy (anatomical in three cases, functional in two cases, hemispherotomy in six cases); one patient needed a redo hemispherotomy. Mortality was nil; disseminated intravascular coagulation and interstitial pneumonia occurred in one patient each; three children had subdural fluid collection. Eight patients (72%) are in the ILAE Class 1 (completely seizure and aura free), two in Class 2 (only auras, no seizure), and one in Class 3 (1-3 seizure days per year). AEDs discontinuation was possible in 73% of cases. The most important news from the literature concerned the pathogenesis (role of the mutation of the GNAQ gene in the abnormal SWS vasculogenesis), the clinical findings (the features and pathogenesis of the stroke-like episodes are being understood), the diagnostic tools (quantitative MRI and EEG), and both the medical (migraine, seizures) and surgical management (epilepsy). The epileptic outcome of SWS patients is very good (80% are seizure-free), if compared with other hemispheric syndromes. The quality of life is affected by the neurological and cognitive deficits. CONCLUSIONS SWS still is an etiological and clinical challenge. However, the improvements over the time are consistent. In particular, the neurosurgical treatment of refractory epilepsy provides very good results as long as the indication to treatment is correct.
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Sarker BKD, Malek MIA, Mannaf SMA, Iftekhar QS, Mahatma M, Sarkar MK, Rahman M. Outcome of trabeculectomy versus Ahmed glaucoma valve implantation in the surgical management of glaucoma in patients with Sturge-Weber syndrome. Br J Ophthalmol 2020; 105:1561-1565. [PMID: 32912851 DOI: 10.1136/bjophthalmol-2020-317098] [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: 06/02/2020] [Revised: 07/11/2020] [Accepted: 08/18/2020] [Indexed: 11/04/2022]
Abstract
AIMS To compare the surgical outcomes of trabeculectomy versus Ahmed glaucoma valve (AGV) implantation in the surgical management of glaucoma in patients with Sturge-Weber syndrome (SWS). METHODS A retrospective chart review was performed on 40 eyes of secondary glaucoma in patients with SWS separated into two groups: AGV (N=20) and trabeculectomy with mitomycin C (N=20). Demographic data, intraocular pressure (IOP), visual acuity and the number anti-glaucoma medications (AGM) needed were evaluated prior to and following surgery. Surgical success was defined as an IOP of ≤21 mm Hg, with or without the use of topical AGM. Complete success was achieved when IOP values were obtained without AGM. RESULTS Mean follow-up duration was 23.15±2.36 months and 22.95±2.87 months in the AGV and trabeculectomy groups, respectively (p=0.811). Both the AGV (34.50±4.65 mm Hg at baseline to 15.20±3.31 mm Hg at last visit) and trabeculectomy (32.10±5.86 mm Hg to 16.10±3.02 mm Hg) groups achieved a statistically significant fall in IOP following surgery (p=0.000). Kaplan-Meier survival of complete success after 24 months was 80% and 70% after AGV implant and trabeculectomy, respectively, but the difference between two groups was not statistically significant (p=0.442). CONCLUSIONS Both AGV implant and trabeculectomy appear to be safe and efficacious in controlling glaucoma secondary to SWS, although the potential for serious complications such as choroidal detachment must be anticipated when planning surgeries in patient with SWS, and the authors recommend the maintenance of a stable IOP during and following the surgery to avoid such complications.
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Affiliation(s)
- Bipul Kumer De Sarker
- Ophthalmology-Glaucoma, Ispahani Islamia Eye Institute and Hospital, Dhaka, Bangladesh
| | | | - Sheikh M A Mannaf
- Glaucoma, Ispahani Islamia Eye Institute and Hospital, Dhaka, Bangladesh
| | - Quazi Sazzad Iftekhar
- Ophthalmology-Paediatric, Paediatric, Ispahani Islamia Eye Institute and Hospital, Dhaka, Bangladesh
| | - Mallika Mahatma
- Ophthalmology-Pathology, Ispahani Islamia Eye Institute and Hospital, Dhaka, Bangladesh
| | - Mridul Kumar Sarkar
- Ophthalmology-Admin and Quality, Ispahani Islamia Eye Institute and Hospital, Dhaka, Bangladesh
| | - Mostafizur Rahman
- Ophthalmology-Retina, Ispahani Islamia Eye Institute and Hospital, Dhaka, Bangladesh
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Boos MD, Bozarth XL, Sidbury R, Cooper AB, Perez F, Chon C, Paras G, Amlie-Lefond C. Forehead location and large segmental pattern of facial port-wine stains predict risk of Sturge-Weber syndrome. J Am Acad Dermatol 2020; 83:1110-1117. [PMID: 32413446 DOI: 10.1016/j.jaad.2020.05.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 04/23/2020] [Accepted: 05/05/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Children with forehead port-wine stains (PWSs) are at risk of Sturge-Weber syndrome (SWS). However, most will not develop neurologic manifestations. OBJECTIVE To identify children at greatest risk of SWS. METHOD In this retrospective cohort study of children with a forehead PWS, PWSs were classified as "large segmental" (half or more of a contiguous area of the hemiforehead or median pattern) or "trace/small segmental" (less than half of the hemiforehead). The outcome measure was a diagnosis of SWS. RESULTS Ninety-six children had a forehead PWS. Fifty-one had a large segmental PWS, and 45 had a trace/small segmental PWS. All 21 children with SWS had large segmental forehead PWSs. Large segmental forehead PWSs had a higher specificity (0.71 vs 0.27, P < .0001) and a higher positive predictive value (0.41 vs 0.22, P < .0001) for SWS than any forehead involvement by a PWS. LIMITATIONS Retrospective study at a referral center. CONCLUSION Children with large segmental forehead PWSs are at highest risk of SWS.
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Affiliation(s)
- Markus D Boos
- Division of Dermatology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington.
| | - Xiuhua L Bozarth
- Division of Neurology, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington
| | - Robert Sidbury
- Division of Dermatology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington
| | - Andrew B Cooper
- Enterprise Analytics, Seattle Children's Hospital, Seattle, Washington
| | - Francisco Perez
- Division of Radiology, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington
| | - Connie Chon
- Departmentof Pedatrics, Seattle Children's Hospital, Seattle, Washington
| | - Gabrielle Paras
- University of Washington School of Medicine, Seattle, Washington
| | - Catherine Amlie-Lefond
- Division of Neurology, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington
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Rihani HT, Dalvin LA, Hodge DO, Pulido JS. Incidence of Sturge-Weber syndrome and associated ocular involvement in Olmsted County, Minnesota, United States. Ophthalmic Genet 2020; 41:108-124. [PMID: 32233696 PMCID: PMC8851558 DOI: 10.1080/13816810.2020.1731834] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 02/05/2020] [Accepted: 02/09/2020] [Indexed: 01/15/2023]
Abstract
Background: Sturge-Weber syndrome (SWS) is a rare sporadic syndrome characterized by nevus flammeus (port-wine stain, PWS) in the trigeminal nerve distribution, diffuse choroidal hemangioma, and brain leptomeningeal hemangioma. We are unaware of previous reports of SWS incidence in the United States. This study investigated SWS incidence and associated ocular involvement in Olmsted County, Minnesota.Materials and methods: The Rochester Epidemiology Project database was used to identify SWS cases from January 1, 2000-December 31, 2017. Incidence of SWS was calculated using the Olmsted County census population. A literature review of studies investigating SWS-associated ocular involvement was also performed.Results: There were 13 patients with SWS in Olmsted County classified as type 1 (31%) or type 2 (69%). Age and sex-adjusted incidence of SWS was 0.19/100,000/year. Race was predominantly Caucasian (85%), with sex female (69%) or male (31%). All patients had PWS, mostly with unilateral distribution in the V1 and/or V2 region (85%). Two cases (15%) had associated Klippel-Trenaunay syndrome. The most common ocular features included: dilated episcleral vessels (46%), glaucoma (46%), retinal detachment (23%), DCH (7.7%), strabismus (31%), and refractive error (38%). PWS in the V1 distribution was associated with all cases of glaucoma, DCH, and neurological involvement. Severe visual impairment (>0.6 LogMAR, Snellen equivalent ≤20/100) was found in (23%) at final follow-up, and one patient (8%) required enucleation for uncontrolled glaucoma.Conclusions: SWS affects approximately 0.19/100,000/year in Olmsted County. Early diagnosis, intervention, lifelong follow-up, and multidisciplinary approach should be used to optimize systemic and ocular outcomes.
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Affiliation(s)
- Heba T Rihani
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
| | - Lauren A Dalvin
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
| | - David O Hodge
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, Florida, USA
| | - Jose S Pulido
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Molecular Medicine, Mayo Clinic, Minnesota, USA
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Rao A, Reddy VS, Parimala MD, Tejal M, Fathima K, Preeti S, Jhawar J, Dharani V, Shruthi T. Sturge–Weber syndrome coexisting with multiple vertebral vascular malformations and hemivertebra with scoliosis and upper limb and ear hypertrophy. Indian J Dermatol Venereol Leprol 2020; 86:187-190. [DOI: 10.4103/ijdvl.ijdvl_445_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Harmon KA, Day AM, Hammill AM, Pinto AL, McCulloch CE, Comi AM. Quality of Life in Children With Sturge-Weber Syndrome. Pediatr Neurol 2019; 101:26-32. [PMID: 31526690 PMCID: PMC7288751 DOI: 10.1016/j.pediatrneurol.2019.04.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 04/03/2019] [Accepted: 04/10/2019] [Indexed: 11/17/2022]
Abstract
AIM We assessed the utilization of the National Institutes of Health Quality of Life in Neurological Disorders (Neuro-QoL) in pediatric patients with Sturge-Weber syndrome, a rare neurovascular disorder which frequently results in seizures, brain atrophy, calcification, and a range of neurological impairments. METHODS Subjects were seen clinically and consented for research. All 22 patients filled out the Pediatric Neuro-QoL. The Neuro-QoL subscores were converted to T-scores to compare with the referenced control population. Twenty-one participants also filled out the Brain Vascular Malformation Consortium Database Questionnaire containing data pertaining to Sturge-Weber syndrome-related medical history, medications, comorbidities, and family history. All data were analyzed with a significance threshold of P < 0.05. RESULTS Cognitive function quality of life was significantly lower (P < 0.001) in pediatric patients with Sturge-Weber syndrome compared with referenced control subjects. Male gender (P = 0.02) was associated with lower cognitive function Neuro-QoL. The extent of skin (R = -0.46, P = 0.04), total eyelid port-wine birthmark (R = -0.56, P = 0.007), eye (R = -0.58, P = 0.005), and total Sturge-Weber syndrome involvement (R = -0.63, P = 0.002) were negatively correlated with cognitive function Neuro-QoL. A younger age at seizure onset was associated with lower cognitive function Neuro-QoL (hazard ratio = 0.90, P = 0.004) even after controlling for extent of brain, skin, or eye involvement. Antidepressant use was associated with lower cognitive function Neuro-QoL (P = 0.005), and cognitive function Neuro-QoL was negatively correlated with depression Neuro-QoL; however, after adjusting for depression this relationship was no longer significant. CONCLUSIONS The results suggest targeting cognitive function Neuro-QoL in treatment trials and reiterate the prognostic value of early seizure onset. In addition, sex-related differences were noted, which should be further studied.
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Affiliation(s)
- Kelly A Harmon
- Department of Neurology, Kennedy Krieger Institute, Baltimore, Maryland
| | - Alyssa M Day
- Department of Neurology, Kennedy Krieger Institute, Baltimore, Maryland
| | - Adrienne M Hammill
- Division of Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Anna L Pinto
- Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Charles E McCulloch
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Anne M Comi
- Department of Neurology, Kennedy Krieger Institute, Baltimore, Maryland; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland.
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Tikkanen SA, Peterson BL, Parsloe SM. Courtesy Stigma and Social Support: An Exploration of Fathers' Buffering Strategies and Blocking Rationalizations. HEALTH COMMUNICATION 2019; 34:1543-1554. [PMID: 30067393 DOI: 10.1080/10410236.2018.1504658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This study extends scholarship on stigma management communication and social support by exploring the experiences of fathers of children living with a rare health condition, Sturge-Weber Syndrome. Findings from this interview-based interpretive study reveal that fathers assuaged the negative effects of stigma on their children-and courtesy stigma on themselves-by employing buffering strategies, including reactive and preemptive information sharing, preparatory conversations, and support blocking. Further, fathers offered three rationalizations for their blocking behaviors-reasoning that to accept support would violate social norms, as well as privacy expectations and that accepting support was not worth the effort (social exchange). These findings encourage scholars to continue to upend predominant constructions of masculinity and also call to question prevailing assumptions about the relationship between technology and privacy.
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Luat AF, Juhász C, Loeb JA, Chugani HT, Falchek SJ, Jain B, Greene-Roethke C, Amlie-Lefond C, Ball KL, Davis A, Pinto A. Neurological Complications of Sturge-Weber Syndrome: Current Status and Unmet Needs. Pediatr Neurol 2019; 98:31-38. [PMID: 31272784 DOI: 10.1016/j.pediatrneurol.2019.05.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 05/28/2019] [Accepted: 05/30/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE We aimed to identify the current status and major unmet needs in the management of neurological complications in Sturge-Weber syndrome. METHODS An expert panel consisting of neurologists convened during the Sturge-Weber Foundation Clinical Care Network conference in September 2018. Literature regarding current treatment strategies for neurological complications was reviewed. RESULTS Although strong evidence-based standards are lacking, the implementation of consensus-based standards of care and outcome measures to be shared across all Sturge-Weber Foundation Clinical Care Network Centers are needed. Each patient with Sturge-Weber syndrome should have an individualized seizure action plan. There is a need to determine the appropriate abortive and preventive treatment of migraine headaches in Sturge-Weber syndrome. Likewise, a better understanding and better diagnostic modalities and treatments are needed for stroke-like episodes. As behavioral problems are common, the appropriate screening tools for mental illnesses and the timing for screening should be established. Brain magnetic resonance imaging (MRI) preferably done after age one year is the primary imaging modality of choice to establish the diagnosis, although advances in MRI techniques can improve presymptomatic diagnosis to identify patients eligible for preventive drug trials. CONCLUSION We identified the unmet needs in the management of neurological complications in Sturge-Weber syndrome. We define a minimum standard brain MRI protocol to be used by Sturge-Weber syndrome centers. Future multicenter clinical trials on specific treatments of Sturge-Weber syndrome-associated neurological complications are needed. An improved national clinical database is critically needed to understand its natural course, and for retrospective and prospective measures of treatment efficacy.
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Affiliation(s)
- Aimee F Luat
- Department of Pediatrics, Wayne State University Children's Hospital of Michigan, Detroit, Michigan; Department of Neurology, Wayne State University Children's Hospital of Michigan, Detroit, Michigan
| | - Csaba Juhász
- Department of Pediatrics, Wayne State University Children's Hospital of Michigan, Detroit, Michigan; Department of Neurology, Wayne State University Children's Hospital of Michigan, Detroit, Michigan
| | - Jeffrey A Loeb
- Department of Neurology and Rehabilitation, University of Illinois, Chicago, Illinois
| | - Harry T Chugani
- Department of Neurology, New York University School of Medicine, New York, New York
| | - Stephen J Falchek
- Department of Neurology, Nemours duPont Hospital for Children, Wilmington, Delaware; Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Badal Jain
- Department of Neurology, Nemours duPont Hospital for Children, Wilmington, Delaware; Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Carol Greene-Roethke
- Department of Neurology, Nemours duPont Hospital for Children, Wilmington, Delaware; Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | | | - Amy Davis
- Department of Neurosciences, Cook Children's Healthcare System, Forth Worth, Texas
| | - Anna Pinto
- Department of Neurology, Harvard Medical School, Children's Hospital Boston, Boston, Massachusetts.
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Gallop F, Fosi T, Prabhakar P, Aylett SE. Flunarizine for Headache Prophylaxis in Children With Sturge-Weber Syndrome. Pediatr Neurol 2019; 93:27-33. [PMID: 30686627 DOI: 10.1016/j.pediatrneurol.2018.11.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 11/14/2018] [Accepted: 11/20/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Children with Sturge-Weber syndrome can experience severe headache with or without transient hemiparesis. Flunarizine, a calcium antagonist, has been used for migraine. The experience with flunarizine for headache in a cohort of children at a national center for Sturge-Weber syndrome is reviewed, reporting its efficacy and adverse effect in this population. METHODS We collected data from health care professionals' documentation on headache (severity, frequency, duration) before and on flunarizine in 20 children with Sturge-Weber syndrome. Adverse effects reported during flunarizine treatment were collated. The Wilcoxon signed rank test was used to determine the significance of pre- versus post-treatment effect. RESULTS Flunarizine was used for headache alone (13) or mixed migrainous episodes and vascular events (7). The median duration of treatment was 145 days (range 43 to 1864 days). Flunarizine reduced headache severity (z = -3.354, P = 0.001), monthly frequency (z = -2.585, P = 0.01), and duration (z = -2.549, P = 0.01). Flunarizine was discontinued owing to intolerable adverse effects in a minority (2). Sedation and weight gain were the most common side effects. There were no reports of behavior change or extrapyramidal features. CONCLUSIONS The most effective management for headaches in patients with Sturge-Weber syndrome has not been established. This retrospective observational study found benefit of flunarizine prophylaxis on headache severity, frequency, and duration in children with Sturge-Weber syndrome without severe side effects. Flunarizine is not licensed for use in the United Kingdom, but these data support its off-license specialist use for headache prophylaxis in Sturge-Weber syndrome.
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Affiliation(s)
- Felicity Gallop
- Neurosciences, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Tangunu Fosi
- Neurosciences, Great Ormond Street Hospital NHS Foundation Trust, London, UK; Clinical Neurosciences, UCL- Institute of Child Health, London, UK.
| | - Ponnudas Prabhakar
- Neurosciences, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Sarah Elizabeth Aylett
- Neurosciences, Great Ormond Street Hospital NHS Foundation Trust, London, UK; Clinical Neurosciences, UCL- Institute of Child Health, London, UK
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Shchederkina IO, Livshtz MI, Kuzmina EV, Seliverstova EV, Kessel AE, Petryaykina EE. [Sturge-Weber syndrome in children. Clinical features, diagnosis and approaches to therapy on the example of three clinical cases]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:55-64. [PMID: 32207732 DOI: 10.17116/jnevro201911911255] [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: 11/17/2022]
Abstract
Sturge-Weber syndrome belongs to the group of phacomotoses and is characterized by a combined lesion of the skin, eyes, nervous system and internal organs. The clinical course of Sturge-Weber syndrome is quite diverse. Of particular interest in the practice of pediatric neurology and neurosurgery is the fact that 72-90% of patients present with epilepsy. Of particular difficulty is the differential diagnosis of epileptic seizures and stroke-like episodes. The article presents clinical cases of patients with Sturge-Weber syndrome of various ages with epileptic seizures and transient ischemic attacks.
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Affiliation(s)
- I O Shchederkina
- Morozov Moscow children clinical hospital, Pediatric stroke center, Moscow, Russia
| | - M I Livshtz
- Morozov Moscow children clinical hospital, Pediatric stroke center, Moscow, Russia; Pirogov Russian National Research Medical University, Moscow, Russia
| | - E V Kuzmina
- Morozov Moscow children clinical hospital, Pediatric stroke center, Moscow, Russia
| | - E V Seliverstova
- Morozov Moscow children clinical hospital, Pediatric stroke center, Moscow, Russia
| | - A E Kessel
- Morozov Moscow children clinical hospital, Pediatric stroke center, Moscow, Russia
| | - E E Petryaykina
- Morozov Moscow children clinical hospital, Pediatric stroke center, Moscow, Russia; Russian University of Friendship, Moscow, Russia
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Gittins S, Steel D, Brunklaus A, Newsom-Davis I, Hawkins C, Aylett SE. Autism spectrum disorder, social communication difficulties, and developmental comorbidities in Sturge-Weber syndrome. Epilepsy Behav 2018; 88:1-4. [PMID: 30195931 DOI: 10.1016/j.yebeh.2018.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 08/05/2018] [Accepted: 08/06/2018] [Indexed: 11/18/2022]
Abstract
Sturge-Weber syndrome (SWS) is a neurocutaneous disorder characterized by the combination of a facial naevus flammeus and pial angioma, often associated with learning difficulties and/or epilepsy. Here, we report on the neuropsychological characteristics of a cohort of 92 children with SWS seen at a national referral center between 2002 and 2015. Almost a quarter (24%) had a diagnosis of autism spectrum disorder (ASD), with 45% overall having evidence of social communication difficulties (SCD). Autism spectrum disorder was more commonly seen in those individuals with bilateral angioma (p = 0.021). Significant behavioral difficulties were reported in 50% while 26% had difficulties with sleep. Difficulties with social communication, behavior, and sleep were closely associated with one another. They were not, however, significantly associated with markers of epilepsy severity and were noted to occur even in children without epilepsy. The prevalence of ASD/SCD, sleep difficulties, and behavioral disorders seen in SWS is high and reflects the complex needs of this group.
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Affiliation(s)
- Samuel Gittins
- Neurosciences Department, Great Ormond Street Hospital NHS Foundation Trust, London, UK; University College London Medical School, London, UK
| | - Dora Steel
- Neurosciences Department, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Andreas Brunklaus
- Neurosciences Department, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Imogen Newsom-Davis
- Neurosciences Department, Great Ormond Street Hospital NHS Foundation Trust, London, UK; Developmental Neurosciences Programme of the UCL Institute of Child Health, London, UK
| | - Christina Hawkins
- Neurosciences Department, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Sarah E Aylett
- Neurosciences Department, Great Ormond Street Hospital NHS Foundation Trust, London, UK; Developmental Neurosciences Programme of the UCL Institute of Child Health, London, UK.
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Zallmann M, Mackay MT, Leventer RJ, Ditchfield M, Bekhor PS, Su JC. Retrospective review of screening for Sturge-Weber syndrome with brain magnetic resonance imaging and electroencephalography in infants with high-risk port-wine stains. Pediatr Dermatol 2018; 35:575-581. [PMID: 30020536 DOI: 10.1111/pde.13598] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND There is a lack of consensus regarding how best to screen children with facial port-wine stains for Sturge-Weber syndrome. Many favor brain magnetic resonance imaging, and adjunctive electroencephalography is increasingly used. However, the sensitivity, specificity, and negative and positive predictive value of magnetic resonance imaging and electroencephalography and whether screening improves seizure recognition is unclear. METHODS A retrospective review of children with high-risk port-wine stains presenting consecutively to the outpatient laser clinic of a tertiary pediatric hospital between December 2015 and November 2016 was undertaken. Primary outcome measures were yield, accuracy, age of and protocols for screening magnetic resonance imaging and electroencephalography, type of and age at presenting seizure, and percentage referred to neurology. RESULTS Of 126 patients with facial port-wine stains, 25.4% (32/126) were at high risk of Sturge-Weber syndrome (hemifacial, median, and forehead PWS phenotypes); 43.7% of these (14/32) underwent screening magnetic resonance imaging. Sturge-Weber syndrome was detected in 7.1% (1/14). Magnetic resonance imaging had false-negative results in 23.1% (3/13) of those screened. Screening magnetic resonance imaging had sensitivity of 25%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 76.9% for the detection of Sturge-Weber syndrome (hemifacial, median and forehead PWS phenotypes). Only one-third of those with false-negative magnetic resonance imaging were referred to neurology. Mean age of first seizure in those with false-negative screening magnetic resonance imaging was 28 months, vs 14 months in those not screened. Abnormal electroencephalographic signs were detected in the two infants who underwent presymptomatic electroencephalography. CONCLUSIONS Findings from this small cohort of individuals with port-wine stains that put them at high risk of Sturge-Weber syndrome suggest that children with positive screening magnetic resonance imaging will almost certainly develop Sturge-Weber syndrome but that negative screening magnetic resonance imaging cannot exclude Sturge-Weber syndrome (in up to 23.1% of cases). False-negative magnetic resonance imaging may delay seizure recognition. Seizure education, monitoring, and consideration of adjunctive electroencephalography are important irrespective of magnetic resonance imaging findings.
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Affiliation(s)
- Michaela Zallmann
- Department of Dermatology, Eastern Health, Monash University, Melbourne, Vic., Australia.,Murdoch Children's Research Institute, Melbourne, Vic., Australia
| | - Mark T Mackay
- Murdoch Children's Research Institute, Melbourne, Vic., Australia.,Royal Children's Hospital, Melbourne, Vic., Australia.,Department of Pediatrics, University of Melbourne, Melbourne, Vic., Australia
| | - Richard J Leventer
- Murdoch Children's Research Institute, Melbourne, Vic., Australia.,Royal Children's Hospital, Melbourne, Vic., Australia.,Department of Pediatrics, University of Melbourne, Melbourne, Vic., Australia
| | - Michael Ditchfield
- Monash Health, Monash University, Clayton, Vic., Australia.,Monash Health, Diagnostic Imaging, Clayton, Vic., Australia
| | | | - John C Su
- Department of Dermatology, Eastern Health, Monash University, Melbourne, Vic., Australia.,Murdoch Children's Research Institute, Melbourne, Vic., Australia.,Royal Children's Hospital, Melbourne, Vic., Australia.,Department of Pediatrics, University of Melbourne, Melbourne, Vic., Australia.,Monash Health, Monash University, Clayton, Vic., Australia
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Three-dimensional Photogrammetric Analysis of Facial Soft-to-Hard Tissue Ratios After Bimaxillary Surgery in Facial Asymmetry Patients With and Without Sturge-Weber Syndrome. Ann Plast Surg 2018; 81:178-185. [DOI: 10.1097/sap.0000000000001484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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De la Torre AJ, Luat AF, Juhász C, Ho ML, Argersinger DP, Cavuoto KM, Enriquez-Algeciras M, Tikkanen S, North P, Burkhart CN, Chugani HT, Ball KL, Pinto AL, Loeb JA. A Multidisciplinary Consensus for Clinical Care and Research Needs for Sturge-Weber Syndrome. Pediatr Neurol 2018; 84:11-20. [PMID: 29803545 PMCID: PMC6317878 DOI: 10.1016/j.pediatrneurol.2018.04.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 04/11/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Sturge-Weber syndrome is a neurocutaneous disorder associated with port-wine birthmark, leptomeningeal capillary malformations, and glaucoma. It is associated with an unpredictable clinical course. Because of its rarity and complexity, many physicians are unaware of the disease and its complications. A major focus moving ahead will be to turn knowledge gaps and unmet needs into new research directions. METHODS On October 1-3, 2017, the Sturge-Weber Foundation assembled clinicians from the Clinical Care Network with patients from the Patient Engagement Network of the Sturge-Weber Foundation to identify our current state of knowledge, knowledge gaps, and unmet needs. RESULTS One clear unmet need is a need for consensus guidelines on care and surveillance. It was strongly recommended that patients be followed by multidisciplinary clinical teams with life-long follow-up for children and adults to monitor disease progression in the skin, eye, and brain. Standardized neuroimaging modalities at specified time points are needed together with a stronger clinicopathologic understanding. Uniform tissue banking and clinical data acquisition strategies are needed with cross-center, longitudinal studies that will set the stage for new clinical trials. A better understanding of the pathogenic roles of cerebral calcifications and stroke-like symptoms is a clear unmet need with potentially devastating consequences. CONCLUSIONS Biomarkers capable of predicting disease progression will be needed to advance new therapeutic strategies. Importantly, how to deal with the emotional and psychological effects of Sturge-Weber syndrome and its impact on quality of life is a clear unmet need.
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Affiliation(s)
- Alejandro J De la Torre
- Department of Neurology, Northwestern University, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Aimee F Luat
- Department of Pediatrics and Neurology, Wayne State University, Children's Hospital of Michigan, Detroit, Michigan
| | - Csaba Juhász
- Department of Pediatrics and Neurology, Wayne State University, Children's Hospital of Michigan, Detroit, Michigan
| | - Mai Lan Ho
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Davis P Argersinger
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Kara M Cavuoto
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | | | | | - Paula North
- Department of Pediatric Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Craig N Burkhart
- Department of Dermatology, University of North Carolina, Chapel Hill, North Carolina
| | - Harry T Chugani
- Department of Neurology, Nemours DuPont Hospital for Children, Wilmington, Delaware
| | | | - Anna Lecticia Pinto
- Department of Neurology, Harvard Medical School, Children's Hospital Boston, Boston, Massachusetts
| | - Jeffrey A Loeb
- Department of Neurology and Rehabilitation, University of Illinois, Chicago, Illinois.
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Mohamed TH, Salman AG, Elshinawy RF. Trabeculectomy with Ologen implant versus mitomycin C in congenital glaucoma secondary to Sturge Weber Syndrome. Int J Ophthalmol 2018; 11:251-255. [PMID: 29487815 DOI: 10.18240/ijo.2018.02.12] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 10/09/2017] [Indexed: 12/14/2022] Open
Abstract
AIM To compare the efficacy and safety of collagen matrix implant [Ologen (OLO) implant] versus mitomycin C (MMC) with subscleral trabeculectomy (SST) for the surgical treatment of congenital glaucoma (CG) in Sturge-Weber Syndrome (SWS). METHODS A prospective comparative randomized study of 20 eyes of 16 patients with CG associated with SWS was divided into two groups. The first group (MMC Group) included 10 eyes that were subjected to SST with MMC. The second group (OLO Group) included 10 eyes that were subjected to trabeculectomy with a collagen matrix implant (OLO implant). Postoperative evaluation included intraocular pressure (IOP) level, bleb evaluation, complications, and the need for further medication or surgical intervention. RESULTS The mean preoperative IOP was 29±3.16 mm Hg in MMC and 29.8±3.08 mm Hg in OLO eyes. Mean 12-month percentage reduction in IOP was significant in both groups (57.9% and 56.3%). At the end of the 12 postoperative follow-up month, in the MMC Group, 80% of eyes achieved the complete success, 20% of eyes had qualified success with no failed surgery in comparison to OLO Group which 70% of eyes achieved the complete success, 20% of eyes had qualified success with 10% failed surgery. In terms of complications, the MMC Group had a higher rate of complications than the OLO Group in the form of thin polycystic bleb in 6 eyes (60%), blebitis in only one eye (10%) treated with topical antibiotics, shallow anterior chamber in two eyes (20%). CONCLUSION This study proves that the use of a collagen matrix implant yields equally effective results as MMC when combined with trabeculectomy for the treatment of CG in SWS. Furthermore, OLO implantation is safe and has low incidences of complications.
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Zallmann M, Leventer RJ, Mackay MT, Ditchfield M, Bekhor PS, Su JC. Screening for Sturge-Weber syndrome: A state-of-the-art review. Pediatr Dermatol 2018; 35:30-42. [PMID: 29034507 DOI: 10.1111/pde.13304] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Infants with a high-risk distribution of port-wine stains are commonly screened for Sturge-Weber syndrome using brain magnetic resonance imaging. There is no consensus about which port-wine stain phenotypes to screen, optimal timing, screening sensitivity, or whether presymptomatic diagnosis improves neurodevelopmental outcomes. This state-of-the-art review examines the evidence in favor of screening for Sturge-Weber syndrome, based on its effect on neurodevelopmental outcomes, against the risks and limitations of screening magnetic resonance imaging and electroencephalography. A literature search of PubMed/MEDLINE was conducted between January 2005 and May 2017 using key search terms. Relevant articles published in English were reviewed; 34 articles meeting the search criteria were analyzed according to the following outcome measures: neurodevelopmental outcome benefit of screening, diagnostic yield, financial costs, procedural risks, and limitations of screening magnetic resonance imaging and electroencephalography. There is no evidence that a presymptomatic Sturge-Weber syndrome diagnosis with magnetic resonance imaging results in better neurodevelopmental outcomes. The utility of electroencephalographic screening is also unestablished. In Sturge-Weber syndrome, neurodevelopmental outcomes depend on prompt recognition of neurologic red flags and early seizure control. Small numbers and a lack of prospective randomized controlled trials limit these findings. For infants with port-wine stain involving skin derived from the frontonasal placode (forehead and hemifacial phenotypes), we recommend early referral to a pediatric neurologist for parental education, counselling, and monitoring for neurologic red flags and seizures and consideration of electroencephalography regardless of whether magnetic resonance imaging is performed or its findings.
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Affiliation(s)
- Michaela Zallmann
- Department of Dermatology, Eastern Health, Monash University, Box Hill, VIC, Australia.,Murdoch Childrens Research Institute, Melbourne, VIC, Australia
| | - Richard J Leventer
- Murdoch Childrens Research Institute, Melbourne, VIC, Australia.,Department of Neurology, Royal Children's Hospital, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Mark T Mackay
- Murdoch Childrens Research Institute, Melbourne, VIC, Australia.,Department of Neurology, Royal Children's Hospital, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Michael Ditchfield
- Department of Paediatrics, Monash Health, Monash University, Clayton, VIC, Australia.,Diagnostic Imaging, Monash Health, Clayton, VIC, Australia
| | - Philip S Bekhor
- Department of Dermatology, Royal Children's Hospital, Melbourne, VIC, Australia
| | - John C Su
- Department of Dermatology, Eastern Health, Monash University, Box Hill, VIC, Australia.,Murdoch Childrens Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.,Department of Dermatology, Royal Children's Hospital, Melbourne, VIC, Australia
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36
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Dymerska M, Kirkorian AY, Offermann EA, Lin DD, Comi AM, Cohen BA. Size of Facial Port-Wine Birthmark May Predict Neurologic Outcome in Sturge-Weber Syndrome. J Pediatr 2017; 188:205-209.e1. [PMID: 28711177 PMCID: PMC6924278 DOI: 10.1016/j.jpeds.2017.05.053] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 03/28/2017] [Accepted: 05/18/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine whether the size of the birthmark in patients with Sturge-Weber syndrome (SWS) who have brain involvement can help predict neurologic disability. STUDY DESIGN Fifty-one patients with SWS with facial birthmarks and brain involvement documented on magnetic resonance imaging were included in this retrospective chart review. A neuroradiologist, blinded to all clinical information, assigned a previously validated SWS neuroimaging score. A pediatric neurologist prospectively assigned previously validated neurologic severity scores, based on seizures, hemiparesis, visual field cut, and cognitive impairments. Three raters, blinded to clinical scores, independently graded the size of facial birthmark in each patient based on photographs. Their scores were averaged. Birthmark scores were compared with the imaging and neurologic severity results using nonparametric correlation analysis. RESULTS Size of facial port-wine birthmark correlates with magnetic resonance imaging scores on the left and right sides (ρ = 0.57 and 0.66 [P < .001], respectively). Size is also positively associated with the neurologic severity rating for patients age 6 years and above (1-sided Fisher exact, P = .032). CONCLUSIONS The size of facial port-wine birthmark in SWS brain involvement can be developed as a tool to predict neurologic severity of the disease.
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Affiliation(s)
| | - Anna Y Kirkorian
- Division of Pediatric Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD; Division of Dermatology, Children's National Health System, Washington, DC
| | | | - Doris D Lin
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Anne M Comi
- Division of Neurology, Kennedy Krieger Institute, Baltimore, MD; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Bernard A Cohen
- Division of Pediatric Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD
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37
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Abstract
The eyelids are composed of four layers: skin and subcutaneous tissue including its adnexa, striated muscle, tarsus with the meibomian glands, and the palpebral conjunctiva. Benign and malignant tumors can arise from each of the eyelid layers. Most eyelid tumors are of cutaneous origin, mostly epidermal, which can be divided into epithelial and melanocytic tumors. Benign epithelial lesions, cystic lesions, and benign melanocytic lesions are very common. The most common malignant eyelid tumors are basal cell carcinoma in Caucasians and sebaceous gland carcinoma in Asians. Adnexal and stromal tumors are less frequent. The present review describes the more important eyelid tumors according to the following groups: Benign and malignant epithelial tumors, benign and malignant melanocytic tumors, benign and malignant adnexal tumors, stromal eyelid tumors, lymphoproliferative and metastatic tumors, other rare eyelid tumors, and inflammatory and infections lesions that simulate neoplasms.
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Affiliation(s)
- Jacob Pe'er
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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38
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Higueros E, Roe E, Granell E, Baselga E. Sturge-Weber Syndrome: A Review. ACTAS DERMO-SIFILIOGRAFICAS 2017. [DOI: 10.1016/j.adengl.2017.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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39
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Síndrome de Sturge-Weber: revisión. ACTAS DERMO-SIFILIOGRAFICAS 2017; 108:407-417. [DOI: 10.1016/j.ad.2016.09.022] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 08/11/2016] [Accepted: 09/18/2016] [Indexed: 12/14/2022] Open
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40
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Meulepas JM, Ronckers CM, Merks J, Weijerman ME, Lubin JH, Hauptmann M. Confounding of the association between radiation exposure from CT scans and risk of leukemia and brain tumors by cancer susceptibility syndromes. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2016; 36:953-974. [PMID: 27893452 DOI: 10.1088/0952-4746/36/4/953] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Recent studies linking radiation exposure from pediatric computed tomography (CT) to increased risks of leukemia and brain tumors lacked data to control for cancer susceptibility syndromes (CSS). These syndromes might be confounders because they are associated with an increased cancer risk and may increase the likelihood of pediatric CT scans. We identify CSS predisposing to leukemia and brain tumors through a systematic literature search and summarize prevalence and risk. Since empirical evidence is lacking in published literature on patterns of CT use for most types of CSS, we estimate confounding bias of relative risks (RR) for categories of radiation exposure based on expert opinion about patterns of CT scans among CSS patients. We estimate that radiation-related RRs for leukemia are not meaningfully confounded by Down syndrome, Noonan syndrome and other CSS. Moreover, tuberous sclerosis complex, von Hippel-Lindau disease, neurofibromatosis type 1 and other CSS do not meaningfully confound RRs for brain tumors. Empirical data on the use of CT scans among CSS patients is urgently needed. Our assessment indicates that associations with radiation exposure from pediatric CT scans and leukemia or brain tumors reported in previous studies are unlikely to be substantially confounded by unmeasured CSS.
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Affiliation(s)
- Johanna M Meulepas
- Department of Epidemiology and Biostatistics, Netherlands Cancer Institute, Amsterdam, The Netherlands
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41
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Rozas-Muñoz E, Frieden IJ, Roé E, Puig L, Baselga E. Vascular Stains: Proposal for a Clinical Classification to Improve Diagnosis and Management. Pediatr Dermatol 2016; 33:570-584. [PMID: 27456075 DOI: 10.1111/pde.12939] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Vascular stains are a common reason for consultation in pediatric dermatology clinics. Although vascular stains include all vascular malformations, the term is most often used to refer to capillary malformations, but capillary malformations include a wide range of vascular stains with different clinical features, prognoses, and associated findings. The discovery of several mutations in various capillary malformations and associated syndromes has reinforced these differences, but clinical recognition of these different types of capillary vascular stains is sometimes difficult, and the multitude of classifications and confusing nomenclature often hamper the correct diagnosis and management. From our own experience and a review of the most relevant literature on this topic, we propose categorizing patients with capillary vascular stains into seven major clinical patterns: nevus simplex, port-wine stain, reticulated capillary malformation, geographic capillary malformation, capillary malformation-arteriovenous malformation (CM-AVM), cutis marmorata telangiectatica congenita, and telangiectasia. We also discuss the differential diagnosis of vascular stains as well as other conditions that can closely resemble capillary malformations and thus may potentially be misdiagnosed.
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Affiliation(s)
- Eduardo Rozas-Muñoz
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Ilona J Frieden
- Department of Dermatology, University of California, San Francisco, California.,Department of Pediatrics, University of California, San Francisco, California
| | - Esther Roé
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Luis Puig
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Eulalia Baselga
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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42
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Koenraads Y, van Egmond-Ebbeling MB, de Boer JH, Imhof SM, Braun KPJ, Porro GL. Visual outcome in Sturge-Weber syndrome: a systematic review and Dutch multicentre cohort. Acta Ophthalmol 2016; 94:638-645. [PMID: 27238857 DOI: 10.1111/aos.13074] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 03/02/2016] [Indexed: 11/28/2022]
Abstract
Visual functions in Sturge-Weber syndrome (SWS) may be impaired by glaucoma, diffuse choroidal haemangioma (DCH) or leptomeningeal angioma. The aim of this study was to gain better insight in the visual deficits of SWS patients. A systematic literature search using PubMed and Embase medical databases was performed to identify articles describing visual acuity (VA) and/or visual field (VF) findings in SWS patients. In addition, a Dutch multicentre cohort with 33 SWS patients was collected and the combined results of VA and VF findings are presented. Visual acuity results of 25 studies and VF results of 12 studies were suitable for data extraction. Description of the combination of both VA and VF findings was scarce. Homonymous hemianopia (HH) was present in 42% of SWS patients. Seventy per cent of eyes had a (near) normal vision, while VA of eyes with glaucoma or DCH was severely impaired in 28% and 67%, respectively. In the Dutch cohort, only 18% (6/33) of patients had (near) normal findings of both visual parameters. In addition, half of the patients with glaucoma suffered from a combination of a HH and VA impairment. In conclusion, although SWS patients are exposed to severe functional visual impairment due to the possible cumulative consequences of glaucoma, DCH and cerebral injury, description of the combination of both VA and VF results is scarce in the literature. Particularly, the combination of visual impairment due to glaucoma or DCH, and HH might be invalidating.
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Affiliation(s)
- Yvonne Koenraads
- Department of Ophthalmology; University Medical Center Utrecht; Utrecht the Netherlands
| | | | - Joke H. de Boer
- Department of Ophthalmology; University Medical Center Utrecht; Utrecht the Netherlands
| | - Saskia M. Imhof
- Department of Ophthalmology; University Medical Center Utrecht; Utrecht the Netherlands
| | - Kees P. J. Braun
- Department of Paediatric Neurology; Brain Center Rudolf Magnus; University Medical Center Utrecht; Utrecht the Netherlands
| | - Giorgio L. Porro
- Department of Ophthalmology; University Medical Center Utrecht; Utrecht the Netherlands
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43
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Juhász C, Hu J, Xuan Y, Chugani HT. Imaging increased glutamate in children with Sturge-Weber syndrome: Association with epilepsy severity. Epilepsy Res 2016; 122:66-72. [PMID: 26970949 DOI: 10.1016/j.eplepsyres.2016.02.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 02/25/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Sturge-Weber syndrome (SWS) is strongly associated with epilepsy. Brain tissue studies have suggested that epileptic activity in SWS is driven by glutamatergic synaptic activity. Here, we used proton magnetic resonance spectroscopic imaging (MRSI) to test if glutamate (GLU) concentrations are increased in the affected hemisphere and if such increases are associated with severity of epilepsy in children with SWS. We also studied the metabolic correlates of MRSI abnormalities, using glucose positron emission tomography (PET) imaging. METHODS 3T MRI and glucose PET were performed in 10 children (age: 7-78 months) with unilateral SWS and a history of epilepsy. MRSI data were acquired from the affected (ipsilateral) and non-affected (contralateral) hemispheres. GLU, N-acetyl-aspartate (NAA) and creatine (Cr) were quantified in multiple voxels; GLU/Cr and NAA/Cr ratios were calculated and compared to seizure frequency as well as glucose PET findings. RESULTS The highest GLU/Cr ratios were found in the affected hemisphere in all children except one with severe atrophy. The maximum ipsilateral/contralateral GLU/Cr ratios ranged between 1.0 and 2.5 (mean: 1.6). Mean ipsilateral/contralateral GLU/Cr ratios were highest in the youngest children and showed a strong positive correlation with clinical seizure frequency scores assessed at the time of the scan (r=0.88, p=0.001) and also at follow-up (up to 1 year, r=0.80, p=0.009). GLU increases in the affected hemisphere coincided with areas showing current or previous increases of glucose metabolism on PET in 5 children. NAA/Cr ratios showed no association with clinical seizure frequency. CONCLUSIONS Increased glutamate concentrations in the affected hemisphere, measured by MRSI, are common in young children with unilateral SWS and are associated with frequent seizures. The findings lend support to the role of excess glutamate in SWS-associated epilepsy.
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Affiliation(s)
- Csaba Juhász
- Department of Pediatrics, Wayne State University, 3901 Beaubien St., Detroit, MI 48201, USA; Department of Neurology, Wayne State University, 3990 John R. St., Detroit, MI 48201, USA; PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, 3901 Beaubien St., Detroit, MI 48201, USA.
| | - Jiani Hu
- Department of Radiology, Harper University Hospital, 3990 John R. St., Detroit, MI 48201, USA
| | - Yang Xuan
- Department of Radiology, Harper University Hospital, 3990 John R. St., Detroit, MI 48201, USA
| | - Harry T Chugani
- Department of Pediatrics, Wayne State University, 3901 Beaubien St., Detroit, MI 48201, USA; Department of Neurology, Wayne State University, 3990 John R. St., Detroit, MI 48201, USA; PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, 3901 Beaubien St., Detroit, MI 48201, USA
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44
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Abstract
Neurocutaneous disorders are a heterogeneous group of conditions (mainly) affecting the skin [with pigmentary/vascular abnormalities and/or cutaneous tumours] and the central and peripheral nervous system [with congenital abnormalities and/or tumours]. In a number of such disorders, the skin abnormalities can assume a mosaic patterning (usually arranged in archetypical patterns). Alternating segments of affected and unaffected skin or segmentally arranged patterns of abnormal skin often mirror similar phenomena occurring in extra-cutaneous organs/tissues [eg, eye, bone, heart/vessels, lung, kidney and gut]. In some neurocutaneous syndromes the abnormal mosaic patterning involve mainly the skin and the nervous system configuring a (true) mosaic neurocutaneous disorder; or an ordinary trait of a neurocutaneous disorder is sometimes superimposed by a pronounced linear or otherwise segmental involvement; or, lastly, a neurocutaneous disorder can occur solely in a mosaic pattern. Recently, the molecular genetic and cellular bases of an increasing number of neurocutaneous disorders have been unravelled, shedding light on the interplays between common intra- and extra-neuronal signalling pathways encompassing receptor-protein and protein-to-protein cascades (eg, RAS, MAPK, mTOR, PI3K/AKT and GNAQ pathways), which are often responsible of the mosaic distribution of cutaneous and extra-cutaneous features. In this article we will focus on the well known, and less defined mosaic neurocutaneous phenotypes and their related molecular/genetic bases, including the mosaic neurofibromatoses and their related forms (ie, spinal neurofibromatosis and schwannomatosis); Legius syndrome; segmental arrangements in tuberous sclerosis; Sturge-Weber and Klippel-Trenaunay syndromes; microcephaly/megalencephaly-capillary malformation; blue rubber bleb nevus syndrome; Wyburn-Mason syndrome; mixed vascular nevus syndrome; PHACE syndrome; Incontinentia pigmenti; pigmentary mosaicism of the Ito type; neurocutaneous melanosis; cutis tricolor; speckled lentiginous syndrome; epidermal nevus syndromes; Becker's nevus syndrome; phacomatosis pigmentovascularis and pigmentokeratotica; Proteus syndrome; and encephalocraniocutaneous lipomatosis.
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Affiliation(s)
- Martino Ruggieri
- Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy.
| | - Andrea D Praticò
- Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy; Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
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45
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Meulepas JM, Ronckers CM, Merks J, Weijerman ME, Lubin JH, Hauptmann M. Confounding of the Association between Radiation Exposure from CT Scans and Risk of Leukemia and Brain Tumors by Cancer Susceptibility Syndromes. Cancer Epidemiol Biomarkers Prev 2015; 25:114-26. [DOI: 10.1158/1055-9965.epi-15-0636] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 10/23/2015] [Indexed: 11/16/2022] Open
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46
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Tamçelik N, Atalay E, Bolukbasi S, Çapar O, Ozkok A. Demographic features of subjects with congenital glaucoma. Indian J Ophthalmol 2015; 62:565-9. [PMID: 24881602 PMCID: PMC4065506 DOI: 10.4103/0301-4738.126988] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Context: Congenital glaucoma is a potentially blinding ocular disease of the childhood. Identification of the possible associated risk factors and may be helpful for prevention or early detection of this public health problem. Aims: To demonstrate the demographic features of congenital glaucoma subjects. Setting and Design: The charts of congenital glaucoma patients referred to Tamcelik Glaucoma Center were retrospectively reviewed through the dates of 2000 and 2013. Materials and Methods: Analyzed data included diagnosis, age at first presentation, symptoms at first presentation, laterality of the disease, sex, presence of consanguinity, family history of congenital glaucoma, maturity of the fetus at delivery, and maternal age at conception. Statistical Analysis Used: Statistical Package for Social Sciences (SPSS) version 19.0 by IBM (SPSS Inc, Chicago, Illinois, USA) was used to compare the mean of continuous variables with Student's t-test and analysis of variance (ANOVA) and χ2 test was used to test differences in proportions of categorical variables. Results: The data of 600 eyes of 311 patients were analyzed. The distribution of primary and secondary congenital glaucoma among the patients were 63.3% (n = 197) and 36.7% (n = 114), respectively. Of the 311 patients, 57.2% (n = 178) were male and 42.8% (n = 133) were female. The overall frequency of bilateral disease was 92.3% (n = 287). Overall rate of consanguinity and positive family history was 45.3% (n = 141) and 21.2% (n = 66), respectively. Conclusions: Bilateral disease in this study was more common than previously reported studies. Positive family history was more frequent in primary congenital glaucoma although not statistically significant.
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Affiliation(s)
- Nevbahar Tamçelik
- Department of Ophthalmology, Istanbul University Cerrahpasa Medical Faculty; Tamcelik Glaucoma Center, Istanbul, Turkey
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47
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Abstract
Cerebrospinal vascular malformations are a group of anomalies affecting the arterial wall, the capillary arteriovenous interface, or the venous and lymphatic structures. Heritability and family studies allow identification of mutations in single genes associated with rare familial conditions causing cerebral or spinal vascular malformations, as is the case in hemorrhagic hereditary telangiectasia diseases. This article reviews the genetic and epigenetic influences increasingly reported in recent years as causal factors or triggers involved in the formation and growth of cerebromedullary vascular malformations.
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Affiliation(s)
- Hortensia Alvarez
- Interventional Neuroradiology, UNC at Chapel Hill, Chapel Hill, NC 27516, USA
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48
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Kavanaugh B, Sreenivasan A, Bachur C, Papazoglou A, Comi A, Zabel TA. [Formula: see text]Intellectual and adaptive functioning in Sturge-Weber Syndrome. Child Neuropsychol 2015; 22:635-648. [PMID: 25952468 PMCID: PMC4868126 DOI: 10.1080/09297049.2015.1028349] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The present study examined the intellectual and adaptive functioning in a sample of children and young adults with Sturge-Weber Syndrome (SWS). A total of 80 research participants from a SWS study database underwent full neurological evaluation as part of their participation or concurrent medical care. Twenty-nine of the participants received neuropsychological evaluations. Analyses indicated no significant demographic or neurological differences between those who did and did not receive neuropsychological evaluations. Overall, the neuropsychological evaluation sample displayed significantly lower functioning relative to published normative data across domains of intellectual and adaptive functioning. Thirty-two percent of the sample displayed impaired performance (standard score ≤ 75) in intellectual functioning and 58% displayed impaired performance in adaptive functioning. Hemiparesis status independently predicted overall adaptive functioning while seizure frequency independently predicted overall intellectual functioning. Younger participants displayed significantly higher (more intact) ratings in adaptive functioning compared to older participants, specifically in overall adaptive functioning, motor skills, and community living skills. A composite measure of neurological status (SWS-NRS) incorporating seizure and hemiparesis status effectively distinguished between individuals with impaired or nonimpaired adaptive and intellectual functioning and showed promise as a screening method for identifying individuals with more involved intellectual and/or adaptive needs.
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Affiliation(s)
- Brian Kavanaugh
- Department of Behavioral Psychology, Kennedy Krieger Institute
| | | | | | - Aimilia Papazoglou
- Department of Neuropsychology, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Anne Comi
- Hunter Nelson Sturge-Weber Center, Kennedy Krieger Institute
- Department of Neurology, Johns Hopkins University School of Medicine
| | - T. Andrew Zabel
- Department of Neuropsychology, Kennedy Krieger Institute
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
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49
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Surgery can get favorable outcome in atypical Sturge-Weber syndrome with intractable epilepsy. J Craniofac Surg 2015; 26:597-9. [PMID: 25723661 DOI: 10.1097/scs.0000000000001340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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50
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Shields CL, Atalay HT, Wuthisiri W, Levin AV, Lally SE, Shields JA. Sector iris hemangioma in association with diffuse choroidal hemangioma. J AAPOS 2015; 19:83-6. [PMID: 25727597 DOI: 10.1016/j.jaapos.2014.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 09/02/2014] [Accepted: 09/08/2014] [Indexed: 12/01/2022]
Abstract
Two patients referred for iris lesions were found to have sector hemangioma of the iris stroma in contiguity with diffuse choroidal hemangioma. Neither patient had other manifestations of Sturge-Weber syndrome.
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Affiliation(s)
- Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania.
| | - Hatice Tuba Atalay
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Wadakarn Wuthisiri
- Pediatric Ophthalmology and Ocular Genetics Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Alex V Levin
- Pediatric Ophthalmology and Ocular Genetics Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Sara E Lally
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jerry A Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
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