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Yagasaki A, Mochizuki K, Yagasaki T, Sakaguchi H. Relationship between strabismus associated with Angelman syndrome and orbital anomaly. Jpn J Ophthalmol 2024; 68:37-41. [PMID: 38006466 DOI: 10.1007/s10384-023-01030-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 09/19/2023] [Indexed: 11/27/2023]
Abstract
PURPOSE To investigate the relationship between the details of strabismus and orbital abnormalities determined by ocular motility tests and orbital imaging examinations in 9 cases with Angelman syndrome (AS). STUDY DESIGN A retrospective, clinical report. METHODS The 9 AS cases (mean age at initial visit: 4.6 ± 8.0 years) were confirmed by genetic diagnosis of the chromosome 15q11-13 region. In all cases, axial imaging of the orbit in the transverse plane of the horizontal extraocular muscles was obtained. The opening angle between both lateral walls of the orbit (greater wing of sphenoid) was measured as the biorbital angle, and compared with the 95% confidence interval of the orbital angle in normal children. RESULTS All cases had exotropia with means of the distance and near of angle 32.2 prism diopters (Δ) ± 9.7Δ and 32.8Δ ± 8.3Δ. The mean of the biorbital angle was 107.7° ± 7.6°, greater than the biorbital angle of 94.3° ± 5.1° previously reported in 129 normal children (P < 0.0001, t-test). Except for one biorbital angle of 93° in the 25-year-old patient, all the biorbital angles in the 8 children were larger than the upper 95% confidence interval in normal children. Astigmatic and hyperopic ametropic amblyopia were detected in 3 cases and 1 case, respectively. CONCLUSIONS The frequency of exotropia in AS is higher than previously reported, with our results strongly suggesting that the enlarged biorbital angle is related to the pathogenesis of exotropia in AS.
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Affiliation(s)
- Ayaka Yagasaki
- Department of Ophthalmology, Gifu Prefectural General Medical Center, 4-6-1 Noisshiki, Gifu City, Gifu Prefecture, 500-8717, Japan.
- Department of Ophthalmology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu City, Gifu Prefecture, 501-1194, Japan.
| | - Kiyofumi Mochizuki
- Department of Ophthalmology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu City, Gifu Prefecture, 501-1194, Japan
| | - Teiji Yagasaki
- Yagasaki Eye Clinic, 62-6 Gonaka, Kaimei, Ichinomiya city, Aichi Prefecture, 494-0001, Japan
| | - Hirokazu Sakaguchi
- Department of Ophthalmology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu City, Gifu Prefecture, 501-1194, Japan
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Lin CW, Cheng YC, Yang CH, Huang HS. Light activates Ube3a, an Angelman syndrome-associated gene, by mediating the chromatin structures during postnatal development of mouse retina. J Neurochem 2023; 167:766-777. [PMID: 37994169 DOI: 10.1111/jnc.16018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 11/03/2023] [Accepted: 11/09/2023] [Indexed: 11/24/2023]
Abstract
Angelman syndrome, a severe neurodevelopmental disorder, is primarily caused by mutations or deletions of maternally inherited ubiquitin protein ligase E3A (UBE3A). Activation of the silenced paternal copy of UBE3A can occur with pharmacological perturbation; however, an environmental approach has not been examined. Here, we found Ube3a is highly expressed in embryonic and early neonatal mouse retina and is maternally-, but not paternally-, expressed in ganglion cells, amacrine cells, and horizontal cells. Moreover, we analyzed UBE3A expression in the retina and visual cortex of postnatal day 28 mice (P28) following exposure to light emissions from white compact-fluorescent bulbs or blue light-emitting diodes from postnatal day 0 (P0) to 28 (P28), encompassing a crucial phase of visual system development. We found higher levels of Ube3a RNA and protein in the retina, but not visual cortex compared with tissues from P28 mice exposure to typical lighting (controls). Levels of both paternal- and maternal-UBE3A protein in mouse retina were higher than controls in P28 mice exposed to white or blue light. Moreover, levels of open and repressive chromatin structures, indicated by histone H3 lysine 4 trimethylation (H3K4me3) and histone H3 lysine 27 trimethylation (H3K27me3), respectively, were increased in the Ube3a promoter from mouse retina exposed to white or blue light. Our findings strongly suggest that extended exposure to white or blue light constitutes a substantial environmental factor that can effectively promote UBE3A expression within the central nervous system.
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Affiliation(s)
- Chao-Wen Lin
- Graduate Institute of Brain and Mind Sciences, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yi-Chun Cheng
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chang-Hao Yang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hsien-Sung Huang
- Graduate Institute of Brain and Mind Sciences, College of Medicine, National Taiwan University, Taipei, Taiwan
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3
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Duis J, Nespeca M, Summers J, Bird L, Bindels‐de Heus KG, Valstar MJ, de Wit MY, Navis C, ten Hooven‐Radstaake M, van Iperen‐Kolk BM, Ernst S, Dendrinos M, Katz T, Diaz‐Medina G, Katyayan A, Nangia S, Thibert R, Glaze D, Keary C, Pelc K, Simon N, Sadhwani A, Heussler H, Wheeler A, Woeber C, DeRamus M, Thomas A, Kertcher E, DeValk L, Kalemeris K, Arps K, Baym C, Harris N, Gorham JP, Bohnsack BL, Chambers RC, Harris S, Chambers HG, Okoniewski K, Jalazo ER, Berent A, Bacino CA, Williams C, Anderson A. A multidisciplinary approach and consensus statement to establish standards of care for Angelman syndrome. Mol Genet Genomic Med 2022; 10:e1843. [PMID: 35150089 PMCID: PMC8922964 DOI: 10.1002/mgg3.1843] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/13/2021] [Accepted: 10/17/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Angelman syndrome (AS) is a rare neurogenetic disorder present in approximately 1/12,000 individuals and characterized by developmental delay, cognitive impairment, motor dysfunction, seizures, gastrointestinal concerns, and abnormal electroencephalographic background. AS is caused by absent expression of the paternally imprinted gene UBE3A in the central nervous system. Disparities in the management of AS are a major problem in preparing for precision therapies and occur even in patients with access to experts and recognized clinics. AS patients receive care based on collective provider experience due to limited evidence-based literature. We present a consensus statement and comprehensive literature review that proposes a standard of care practices for the management of AS at a critical time when therapeutics to alter the natural history of the disease are on the horizon. METHODS We compiled the key recognized clinical features of AS based on consensus from a team of specialists managing patients with AS. Working groups were established to address each focus area with committees comprised of providers who manage >5 individuals. Committees developed management guidelines for their area of expertise. These were compiled into a final document to provide a framework for standardizing management. Evidence from the medical literature was also comprehensively reviewed. RESULTS Areas covered by working groups in the consensus document include genetics, developmental medicine, psychology, general health concerns, neurology (including movement disorders), sleep, psychiatry, orthopedics, ophthalmology, communication, early intervention and therapies, and caregiver health. Working groups created frameworks, including flowcharts and tables, to help with quick access for providers. Data from the literature were incorporated to ensure providers had review of experiential versus evidence-based care guidelines. CONCLUSION Standards of care in the management of AS are keys to ensure optimal care at a critical time when new disease-modifying therapies are emerging. This document is a framework for providers of all familiarity levels.
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Affiliation(s)
- Jessica Duis
- Section of Genetics & Inherited Metabolic DiseaseSection of Pediatrics, Special CareDepartment of PediatricsChildren’s Hospital ColoradoUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Mark Nespeca
- Department of NeurologyRady Children’s HospitalSan DiegoCaliforniaUSA
| | - Jane Summers
- Department of PsychiatryThe Hospital for Sick ChildrenTorontoOntarioCanada
| | - Lynne Bird
- Department of PediatricsClinical Genetics / DysmorphologyUniversity of California, San DiegoRady Children’s Hospital San DiegoSan DiegoCaliforniaUSA
| | - Karen G.C.B. Bindels‐de Heus
- Department of PediatricsErasmus MC SophiaChildren’s HospitalRotterdamNetherlands,ENCORE Expertise Center for Neurodevelopmental DisordersErasmus MC University Medical CenterRotterdamThe Netherlands
| | - M. J. Valstar
- Department of PediatricsErasmus MC SophiaChildren’s HospitalRotterdamNetherlands
| | - Marie‐Claire Y. de Wit
- Department of PediatricsErasmus MC SophiaChildren’s HospitalRotterdamNetherlands,Department of Neurology and Pediatric NeurologyErasmus MCRotterdamThe Netherlands
| | - C. Navis
- Department of PediatricsErasmus MC SophiaChildren’s HospitalRotterdamNetherlands,Department of ENT (Speech & Language Pathology)Erasmus MCRotterdamThe Netherlands
| | - Maartje ten Hooven‐Radstaake
- Department of PediatricsErasmus MC SophiaChildren’s HospitalRotterdamNetherlands,ENCORE Expertise Center for Neurodevelopmental DisordersErasmus MC University Medical CenterRotterdamThe Netherlands
| | - Bianca M. van Iperen‐Kolk
- ENCORE Expertise Center for Neurodevelopmental DisordersErasmus MC University Medical CenterRotterdamThe Netherlands,Department of Physical TherapyErasmus MCRotterdamThe Netherlands
| | - Susan Ernst
- Department of Obstetrics and GynecologyUniversity of MichiganAnn ArborMichiganUSA
| | - Melina Dendrinos
- Department of Obstetrics and GynecologyUniversity of MichiganAnn ArborMichiganUSA
| | - Terry Katz
- Developmental PediatricsDepartment of PediatricsChildren’s Hospital ColoradoUniversity of Colorado Anschutz Medical CampusAuroraCOUSA
| | - Gloria Diaz‐Medina
- Division of Neurology and Developmental PediatricsDepartment of PediatricsBaylor College of MedicineHoustonTexasUSA,NeurologyTexas Children's HospitalHoustonTexasUSA
| | - Akshat Katyayan
- Division of Neurology and Developmental PediatricsDepartment of PediatricsBaylor College of MedicineHoustonTexasUSA,NeurologyTexas Children's HospitalHoustonTexasUSA
| | - Srishti Nangia
- Department of PediatricsDivision of Child NeurologyWeill Cornell MedicineNew York‐Presbyterian HospitalNew YorkNew YorkUSA
| | - Ronald Thibert
- Angelman Syndrome ProgramLurie Center for AutismMassachusetts General Hospital for ChildrenBostonMassachusettsUSA
| | - Daniel Glaze
- Division of Neurology and Developmental PediatricsDepartment of PediatricsBaylor College of MedicineHoustonTexasUSA,NeurologyTexas Children's HospitalHoustonTexasUSA
| | - Christopher Keary
- Angelman Syndrome ProgramLurie Center for AutismMassachusetts General Hospital for ChildrenBostonMassachusettsUSA
| | - Karine Pelc
- Department of NeurologyHôpital Universitaire des Enfants Reine FabiolaUniversité Libre de Bruxelles (ULB)BrusselsBelgium
| | - Nicole Simon
- Department of PsychiatryBoston Children’s HospitalBostonMAUSA
| | - Anjali Sadhwani
- Department of PsychiatryBoston Children’s HospitalBostonMAUSA
| | - Helen Heussler
- UQ Child Health Research CentreFaculty of MedicineThe University of QueenslandBrisbaneQueenslandAustralia
| | - Anne Wheeler
- Center for Newborn ScreeningRTI InternationalResearch Triangle ParkNorth CarolinaUSA
| | - Caroline Woeber
- Audiology, Speech & Learning ServicesChildren’s Hospital ColoradoAuroraColoradoUSA
| | - Margaret DeRamus
- Department of PsychiatryCarolina Institute for Developmental DisabilitiesUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Amy Thomas
- New York League for Early Learning William O'connor SchoolNew YorkNew YorkUSA
| | | | - Lauren DeValk
- Occupational TherapyChildren’s Hospital ColoradoAuroraColoradoUSA
| | - Kristen Kalemeris
- Department of Pediatric RehabilitationMonroe Carell Jr. Children's Hospital at VanderbiltNashvilleTennesseeUSA
| | - Kara Arps
- Department of Physical TherapyChildren’s Hospital ColoradoUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Carol Baym
- Physical TherapyChildren’s Hospital ColoradoAuroraColoradoUSA
| | - Nicole Harris
- Physical TherapyChildren’s Hospital ColoradoAuroraColoradoUSA
| | - John P. Gorham
- Department of Ophthalmology and Visual SciencesUniversity of MichiganAnn ArboMichiganUSA
| | - Brenda L. Bohnsack
- Division of OphthalmologyDepartment of OphthalmologyAnn & Robert H. Lurie Children’s Hospital of ChicagoNorthwestern University Feinberg School of MedicineAnn ArboMichiganUSA
| | - Reid C. Chambers
- Department of Orthopedic Surgery Nationwide Children’s HospitalColumbusOhioUSA
| | - Sarah Harris
- Division of Neurology and Developmental PediatricsDepartment of PediatricsBaylor College of MedicineHoustonTexasUSA,NeurologyTexas Children's HospitalHoustonTexasUSA
| | - Henry G. Chambers
- Orthopedic SurgerySan Diego Department of Pediatric OrthopedicsUniversity of CaliforniaRady Children’s HospitalSan DiegoCaliforniaUSA
| | - Katherine Okoniewski
- Center for Newborn ScreeningRTI InternationalResearch Triangle ParkNorth CarolinaUSA
| | | | - Allyson Berent
- Foundation for Angelman Syndrome TherapeuticsChicagoIllinoisUSA
| | - Carlos A. Bacino
- Department of Molecular and Human GeneticsBaylor College of MedicineHoustonTexasUSA
| | - Charles Williams
- Raymond C. Philips UnitDivision of Genetics and MetabolismDepartment of PediatricsUniversity of FloridaGainesvilleFloridaUSA
| | - Anne Anderson
- Division of Neurology and Developmental PediatricsDepartment of PediatricsBaylor College of MedicineHoustonTexasUSA,NeurologyTexas Children's HospitalHoustonTexasUSA
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Michieletto P, Pensiero S, Diplotti L, Ronfani L, Giangreco M, Danieli A, Bonanni P. Strabismus surgery in Angelman syndrome: More than ocular alignment. PLoS One 2020; 15:e0242366. [PMID: 33186391 PMCID: PMC7665582 DOI: 10.1371/journal.pone.0242366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 11/01/2020] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To report and evaluate strabismus surgery in children with Angelman syndrome, in order to optimize and standardize surgical approach. Other purposes are to understand the possible relation between ocular findings and motor ability, and between improvement in ocular alignment and changes in motor skills in this population. DESIGN Observational cross-sectional study. METHODS Medical records of pediatric patients with Angelman syndrome, who underwent strabismus surgery, were investigated. Collected data included: genotype, gender, age at the time of surgery, refractive error, pre-operative strabismus, surgical procedure, surgical outcome, gross and fine motor development assessment pre- and post-operatively. RESULTS Seventeen subjects, aged 3-15 years, were investigated. Fourteen patients were exotropic, three esotropic. Most patients presented astigmatism. Considering the exaggerated response to standard amounts of surgery and the risk of consecutive strabismus on long term follow-up reported by previous studies in children with developmental delay, a reduction of the amount of strabismus surgery was applied. Post-operatively, all patients presented with a significative reduction of the baseline deviation angle, with all esotropic patients and 7 exotropic patients (59%) achieving orthotropia. The surgical outcomes were variable according to the type and the amount of baseline strabismus, but no case presented with exaggerated surgical response. At baseline, patients showed important delays in all motor abilities, and, post-operatively, presented a significant improvement in walking and fine motor tasks. Pre- and post-operative motor abilities were negatively correlated to astigmatism, anisometropia, and amount of deviation. CONCLUSIONS According to our data, the standard nomograms for strabismus surgery may be successfully applied in subjects with Angelman syndrome and exotropia. Our data suggest that the reduction of the deviation angle improves motor skills in strabismic pediatric patients with Angelman syndrome.
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Affiliation(s)
- Paola Michieletto
- Ophthalmology Service, Scientific Institute IRCCS Eugenio Medea, Conegliano-Pieve di Soligo (TV), Italy
| | - Stefano Pensiero
- Department of Ophthalmology, Institute for Maternal and Child Health—IRCCS Burlo Garofolo, Trieste, Italy
| | - Laura Diplotti
- Department of Ophthalmology, Institute for Maternal and Child Health—IRCCS Burlo Garofolo, Trieste, Italy
- * E-mail:
| | - Luca Ronfani
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health—IRCCS Burlo Garofolo, Trieste, Italy
| | - Manuela Giangreco
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health—IRCCS Burlo Garofolo, Trieste, Italy
| | - Alberto Danieli
- Epilepsy and Clinical Neurophysiology Unit, Scientific Institute IRCCS Eugenio Medea, Conegliano-Pieve di Soligo (TV), Italy
| | - Paolo Bonanni
- Epilepsy and Clinical Neurophysiology Unit, Scientific Institute IRCCS Eugenio Medea, Conegliano-Pieve di Soligo (TV), Italy
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5
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Ye H, Lan X, Liu Q, Zhang Y, Wang S, Zheng C, Di Y, Qiao T. Ocular findings and strabismus surgery outcomes in Chinese children with Angelman syndrome: Three case reports. Medicine (Baltimore) 2019; 98:e18077. [PMID: 31860958 PMCID: PMC6940155 DOI: 10.1097/md.0000000000018077] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
RATIONALE Angelman syndrome (AS) is an uncommon genetic disease characterized as serious retarded mental development and ocular abnormality. PATIENT CONCERNS This report aims to present the ophthalmological features, and identify the diagnosis and outcomes of strabismus surgery in AS patients. DIAGNOSIS Three children with exotropia were diagnosed with AS based on their typical clinical features. INTERVENTIONS All patients underwent multiplex ligation-dependent probe amplification (MLPA) analysis and accepted lateral rectus recession surgery with the assistance of intravenous combined inhalation anesthesia. OUTCOMES The maternal heritage deletion of chromosome 15q11.2-q13 was verified in all patients by MLPA. All patients with strabismus could not cooperate during the vision test, and had astigmatism. The strabismus type of AS patients was horizontal exotropia, and no vertical strabismus was found. One of these patients was combined with high myopia. The hypopigmentation on the hair and iris was ubiquitous. However, retina pigmentation was normal. After different degrees of lateral rectus recession, the exotropia was significantly relieved, and the surgical effects were stable postoperatively. LESSONS Horizontal exotropia is the major strabismus type. Severe intellectual disability, hyperactivity, and speech impairment are the common characteristics of AS children. Its examination and operation design remains challenging. Thus, repeated examinations and intelligence rehabilitation are essential.
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Affiliation(s)
| | - Xiaoping Lan
- Department of Clinical Laboratory, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | | | | | | | | | - Yue Di
- Department of Ophthalmology
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Hong MP, Guilfoyle JL, Mooney LN, Wink LK, Pedapati EV, Shaffer RC, Sweeney JA, Erickson CA. Eye gaze and pupillary response in Angelman syndrome. RESEARCH IN DEVELOPMENTAL DISABILITIES 2017; 68:88-94. [PMID: 28750207 PMCID: PMC7169996 DOI: 10.1016/j.ridd.2017.06.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 03/09/2017] [Accepted: 06/23/2017] [Indexed: 05/09/2023]
Abstract
BACKGROUND Angelman syndrome (AS) is a rare neurological disorder characterized by severe developmental disability, communication impairment, elevated seizure risk, and motor system abnormalities. AIMS The aims of this study were to determine the feasibility of social scene eye tracking and pupillometry measures in individuals with AS and to compare the performance of AS participants to individuals with idiopathic Autism Spectrum Disorder (ASD) and typically developing controls (TDC). METHODS AND PROCEDURES Individuals with AS and age- and gender- matched controls completed a social eye tracking paradigm. Neurobehavioral characterization of AS participants was completed via a battery of psychological testing and caregiver behavioral evaluations. OUTCOMES AND RESULTS Eight of seventeen recruited AS participants completed the eye tracking paradigm. Compared to TDC, AS subjects demonstrated significantly less preference for social scenes than geometric shapes. Additionally, AS subjects showed less pupil dilation, compared to TDC, when viewing social scenes versus geometric shapes. There was no statistically significant difference found between AS and ASD subjects in either social eye tracking or pupillometry. CONCLUSIONS AND IMPLICATIONS The use of eye tracking and pupillometry may represent an innovative measure for quantifying AS-associated impairments in social salience.
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Affiliation(s)
- Michael P Hong
- Cincinnati Children's Hospital Medical Center, United States
| | | | | | - Logan K Wink
- Cincinnati Children's Hospital Medical Center, United States; University of Cincinnati, College of Medicine, United States
| | - Ernest V Pedapati
- Cincinnati Children's Hospital Medical Center, United States; University of Cincinnati, College of Medicine, United States
| | | | - John A Sweeney
- University of Cincinnati, College of Medicine, United States
| | - Craig A Erickson
- Cincinnati Children's Hospital Medical Center, United States; University of Cincinnati, College of Medicine, United States; Indiana University School of Medicine, United States.
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7
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Micheletti S, Palestra F, Martelli P, Accorsi P, Galli J, Giordano L, Trebeschi V, Fazzi E. Neurodevelopmental profile in Angelman syndrome: more than low intelligence quotient. Ital J Pediatr 2016; 42:91. [PMID: 27769316 PMCID: PMC5073425 DOI: 10.1186/s13052-016-0301-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 10/12/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Angelman Syndrome (AS) is a rare neurodevelopment disorder resulting from deficient expression or function of the maternally inherited allele of UBE3A gene. The aim of the study is to attempt at providing a detailed definition of neurodevelopmental profile in AS, with particular regard to motor, cognitive, communicative, behavioural and neurovisual, features by using standardized instruments. METHOD A total of ten subjects aged from 5 to 11 years (4 males and 6 females) with molecular confirmed diagnosis of AS (7 15q11.2-q13 deletion and 3 UBE3A mutation) were enrolled in our study. All of them underwent an assessment protocol including neurological and neurovisual examination and the evaluation of motor (Gross Motor Function Measure Scale), cognitive (Griffiths Mental Development Scale and Uzgiris-Hunt Scale); adaptive (Vineland Adaptive Behavioural Scale); communication (MacArthur-Bates Communicative Development Inventory and video-recordings children's verbal expression), behavioural aspects (IPDDAG Scale) and neurovisual aspects. RESULTS All children presented motor function involvement. A severe cognitive impairment was detected with different profiles according to the test applied. In all cases, communicative disability (phonemic inventory, word/gesture comprehension and production) and symptoms of inattention disorder were revealed. Neurovisual impairment was characterized by refractive errors, fundus oculi anomalies, strabismus and/or oculomotor dysfunction. CONCLUSION AS presents a complex neurodevelopmental profile in which several aspects play a negative role in global development leading to a severe functional impairment. Intellectual disability is not the only component because neurovisual functions and behavioural disorders may worsen the global function and are needed of specific rehabilitation programs.
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Affiliation(s)
- S Micheletti
- Unit of Child Neuropsychiatry and Early Neurorehabilitation, ASST Spedali Civili, Piazzale Spedali, Civili 1, 25123, Brescia, Italy. .,Cognition Psychology Neuroscience Lab, University of Pavia, Pavia, Italy. .,Unit of Child Neurology and Psychiatry, ASST Spedali Civili, Piazzale Spedali Civili 1, 25123, Brescia, Italy.
| | - F Palestra
- Unit of Child Neuropsychiatry and Early Neurorehabilitation, ASST Spedali Civili, Piazzale Spedali, Civili 1, 25123, Brescia, Italy.,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - P Martelli
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - P Accorsi
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - J Galli
- Unit of Child Neuropsychiatry and Early Neurorehabilitation, ASST Spedali Civili, Piazzale Spedali, Civili 1, 25123, Brescia, Italy.,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Unit of Child Neurology and Psychiatry, ASST Spedali Civili, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - L Giordano
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - V Trebeschi
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - E Fazzi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Unit of Child Neurology and Psychiatry, ASST Spedali Civili, Piazzale Spedali Civili 1, 25123, Brescia, Italy
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Abstract
"Angelman syndrome" (AS) is a neurodevelopmental disorder whose main features are intellectual disability, lack of speech, seizures, and a characteristic behavioral profile. The behavioral features of AS include a happy demeanor, easily provoked laughter, short attention span, hypermotoric behavior, mouthing of objects, sleep disturbance, and an affinity for water. Microcephaly and subtle dysmorphic features, as well as ataxia and other movement disturbances, are additional features seen in most affected individuals. AS is due to deficient expression of the ubiquitin protein ligase E3A (UBE3A) gene, which displays paternal imprinting. There are four molecular classes of AS, and some genotype-phenotype correlations have emerged. Much remains to be understood regarding how insufficiency of E6-AP, the protein product of UBE3A, results in the observed neurodevelopmental deficits. Studies of mouse models of AS have implicated UBE3A in experience-dependent synaptic remodeling.
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Affiliation(s)
- Lynne M Bird
- Department of Pediatrics, University of California, Division of Genetics, Rady Children’s Hospital, San Diego, California, USA
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9
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Michieletto P, Bonanni P, Pensiero S. Ophthalmic findings in Angelman syndrome. J AAPOS 2011; 15:158-61. [PMID: 21596294 DOI: 10.1016/j.jaapos.2010.12.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Revised: 12/03/2010] [Accepted: 12/06/2010] [Indexed: 01/16/2023]
Abstract
PURPOSE To provide detailed information about opthalmological findings in a group of patients with Angelman syndrome (AS). METHODS Consecutive patients with a genetically confirmed diagnosis of AS were submitted to ophthalmic and orthoptic examinations. Strabismus, visual acuity, cycloplegic refraction, and iris and fundus pigmentation were evaluated. Parents were also examined to compare the extent of fundus pigmentation. RESULTS A total of 34 patients were identified, representing 3 genetic classes: deletion, uniparental disomy, and mutation. Ametropia >1 D was present in 97% of cases: myopia in 9%, hyperopia in 76%, and astigmatism in 94%. Myopia and anisometropia were found only in the genetic deletion group. Strabismus, most frequently exotropia, was found in 24 patients (75%). Ocular hypopigmentation was observed in 18 subjects (53%), with choroidal involvement in 3 cases and isolated iris involvement in 4. Hypopigmentation was observed in all of the 3 genetic classes. CONCLUSIONS Ophthalmic alterations in AS were observed more frequently than has been previously reported, except for ocular hypopigmentation, which was observed less frequently.
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Affiliation(s)
- Paola Michieletto
- IRCCS Eugenio Medea, polo di Conegliano e Pieve di Soligo (TV), Italy
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10
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Trivedi RH, Wilson ME. Refractive lens exchange with intraocular lens implantation in hyperopic eyes of a patient with Angelman syndrome. J Cataract Refract Surg 2010; 36:1432-4. [PMID: 20656169 PMCID: PMC2911455 DOI: 10.1016/j.jcrs.2010.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Revised: 02/11/2010] [Accepted: 02/19/2010] [Indexed: 11/19/2022]
Abstract
UNLABELLED We describe a patient with Angelman syndrome with severe developmental delay who was visually impaired by uncorrected high hyperopia and poor control of accommodation. Refractive lens exchange with intraocular lens implantation was performed in both eyes when the patient was 22 years of age. Satisfactory anatomical and functional outcomes were achieved and maintained during 3 years of follow-up. Refractive lens exchange can be useful in patients with severe neurobehavioral disorders in the presence of high refractive error and poor accommodative control. FINANCIAL DISCLOSURE Neither author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Rupal H Trivedi
- Miles Center for Pediatric Ophthalmology, Storm Eye Institute, Department of Ophthalmology, Medical University of South Carolina, Charleston, South Carolina 29425-5536, USA.
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Abstract
Angelman syndrome (AS) is a distinct neurogenetic syndrome, first described in 1965. The phenotype is well known in infancy and adulthood, but the clinical features may change with age. The main clinical characteristics include severe mental retardation, epileptic seizures and EEG abnormalilties, neurological problems and distinct facial dysmorphic features. Behavioural problems such as hyperactivity and sleeping problems are reported, although these patients present mostly a happy personality with periods of inappropriate laughter. Different underlying genetic mechanisms may cause AS, with deletion of chromosome 15 as the most frequent cause. Other genetic mechanisms such as paternal uniparental disomy, imprinting defect and mutation in the UBE3A gene are present in smaller groups of patients with AS. As the recurrence risk can be up to 50%, the clinical diagnosis of AS should be confirmed by laboratory tesing, and genetic counselling should be provided. Treatment of seizures, physical therapy or other intervention strategies are helpful to ameliorate the symptoms.
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Rufa A, Dotti MT, Orrico A, Battisti C, Carletto F, Federico A. Retinochoroidal atrophy in two adult patients with Angelman syndrome. Am J Med Genet A 2003; 122A:155-8. [PMID: 12955768 DOI: 10.1002/ajmg.a.20217] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We describe a new ocular finding, retinochoroidal atrophy (RCA), associated with optic disk paleness in two adult patients with Angelman syndrome (AS) due to maternal 15q11-13 deletion. The ocular involvement described in children with AS consists iris and choroids hypopigmentation due to loss of function of one copy of P gene involved in maternal deletion. The loss of one copy of the same gene of paternal origin leads to a similar ocular phenotype as in Prader-Willi syndrome (PWS). However to our knowledge, RCA has never been described before in PWS, suggesting that other maternally expressed genes, particularly UBE3A, could be responsible for the retinal changes observed in the adult AS phenotype. Although, further investigations would be necessary to better understand the role of the UBE3A in the retina, the findings reported here should prompt a systematic ophthalmologic evaluation adult patients with AS in order to establish the real incidence of RCA and prevent further disability in these patients.
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Affiliation(s)
- A Rufa
- Unit of Neurometabolic Disease and Research Centre for Diagnosis, Therapy and Prevention of Neurohandicap, Department of Neurological and Behavioural Science University of Siena, Italy
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Van Splunder J, Stilma JS, Evenhuis HM. Visual performance in specific syndromes associated with intellectual disability. Eur J Ophthalmol 2003; 13:566-74. [PMID: 12948316 DOI: 10.1177/112067210301300610] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE To report visual performance in adults with specific causes of intellectual disability (ID) and to compare the test results to published reports. METHODS In a large-scale multicenter epidemiologic study of sensory impairments in 1598 adults with ID, the authors performed ocular assessments in 1539 persons. They compared the test results of those with five specific genetic disorders (Angelman syndrome, Prader-Willi syndrome, fragile X syndrome, Williams-Beuren syndrome, and tuberous sclerosis). RESULTS An overrepresentation of strabismus, low vision, and refractive errors was found. Apart from fragile X syndrome and Prader-Willi syndrome (with in general mild to moderate ID), the other syndrome groups contained one or more subjects with visual impairment or blindness. A number of them had never been seen by an ophthalmologist. CONCLUSIONS The authors confirm a number of ocular features previously reported by other studies and suggest some additional ocular features. They found increased frequencies of treatable ophthalmologic conditions in the subgroups. Because reliable ocular assessment is feasible for 85% of persons with ID, the results are an incentive to address visual functioning in people with ID in order to correct ocular problems and maximize their possibilities.
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Affiliation(s)
- J Van Splunder
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands
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