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Baeza-Velasco C. Neurodevelopmental atypisms in the context of joint hypermobility, hypermobility spectrum disorders, and Ehlers-Danlos syndromes. AMERICAN JOURNAL OF MEDICAL GENETICS. PART C, SEMINARS IN MEDICAL GENETICS 2021; 187:491-499. [PMID: 34741402 DOI: 10.1002/ajmg.c.31946] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 08/28/2021] [Accepted: 10/16/2021] [Indexed: 12/13/2022]
Abstract
Joint hypermobility (JHM), defined as an increased range of joint motion, is a frequent somatic trait in the general population but also the hallmark of many of the hereditary disorders of connective tissue. Ehlers-Danlos syndromes (EDS) belong to this group of diseases and are characterized by tissue fragility, skin abnormalities, and JHM. Between JHM and EDS, there are the so-called hypermobility spectrum disorders (HSD), which is an umbrella term referring to people with symptomatic JHM who do not fulfill criteria for a syndromic connective tissue disorder such as EDS. Among the variety of clinical correlates of JHM/HSD/EDS, neurodevelopmental atypisms are common although often not screened for and identified in the clinical setting. This article reviews the pertinent literature concerning neurodevelopmental conditions for which there is some evidence of an association with JHM/HSD/EDS. These include hyperactivity and attention deficit, learning, communication, and motor problems including tic disorders such as Tourette syndrome and autism spectrum disorders. Underlying mechanism hypotheses for such interconnections are also reviewed. The coexistence of connective tissue-altered conditions and neurodevelopmental atypisms increases disability in patients from an early age. Thus, increased awareness among clinicians and researchers is necessary to promote assessment, diagnosis, and develop management strategies to meet the specific needs of those affected.
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Affiliation(s)
- Carolina Baeza-Velasco
- Université de Paris, Laboratoire de Psychopathologie et Processus de Santé, Boulogne Billancourt, France.,Department of Emergency Psychiatry and Acute Care, CHU Montpellier, Montpellier, France.,IGT, University of Montpellier, CNRS, INSERM, Montpellier, France
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Ünalp A, Gazeteci Tekin H, Karaoğlu P, Akışın Z. Benefits of ketogenic diet in a pediatric patient with Ehlers-Danlos syndrome and STXBP1-related epileptic encephalopathy. Int J Neurosci 2020; 132:950-952. [PMID: 33272087 DOI: 10.1080/00207454.2020.1858825] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE/AIM Ehlers-Danlos syndrome (EDS) is a hereditary connective tissue disease. Epilepsy is not a common neurological finding in EDS. Here we report a pediatric patient with EDS comorbid with STXBP1 related epileptic encephalopathy as 'electrical status epilepticus during slow-wave sleep (ESES)' and whose refractory epileptic seizures were controlled with ketogenic diet. CASE REPORT A 6-year-old girl who had EDS presented with refractory seizures and worsening cognitive functions. Her sleep electroencephalography (EEG) revealed electrical status epilepticus during slow-wave sleep (ESES). The epileptic encephalopathy panel revealed a de novo c.560C > T (p.pro187Leu) heterozygous mutation in the STXPB1 gene. Ketogenic diet treatment was started for her refractory seizures and seizures stopped in the third month of the 3:1 classical ketogenic diet. CONCLUSION Our case is remarkable due to the coexistence of EDS and epileptic encephalopathy as well as ESES findings in STXBP1-associated epileptic encephalopathy and is therefore presented. Ketogenic diet would be beneficial on the management of refractory seizures in STXBP1-related epileptic encephalopathy and ESES.
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Affiliation(s)
- Aycan Ünalp
- Department of Pediatric Neurology, University of Health Sciences, Dr. Behcet Uz Children's Training and Research Hospital, Izmir, Turkey
| | | | - Pakize Karaoğlu
- Department of Pediatric Neurology, University of Health Sciences, Dr. Behcet Uz Children's Training and Research Hospital, Izmir, Turkey
| | - Zeynep Akışın
- Dietician, University of Health Sciences, Dr. Behcet Uz Children's Training and Research Hospital, Izmir, Turkey
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Gupta S, Suri M, Constantinescu CS. Maintenance Intravenous Immunoglobulin Treatment for Multiple Sclerosis Coexisting with Ehlers-Danlos Syndrome and Muir-Torre Syndrome: A Case Study. Neurol Ther 2020; 9:605-610. [PMID: 32780270 PMCID: PMC7606394 DOI: 10.1007/s40120-020-00209-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Indexed: 10/28/2022] Open
Abstract
The therapeutic options for disease modification in relapsing-remitting multiple sclerosis (RRMS) have expanded remarkably in the last 15 years. Although intravenous immunoglobulins (IVIg) have shown some therapeutic effects in multiple sclerosis, reducing global supplies, restriction of treatment to essential indications and availability of effective alternative treatments for MS currently exclude IVIg from being an accepted therapy for MS, other than for some exceptional considerations. We report the case of a female patient with RRMS who was diagnosed with Ehlers-Danlos syndrome (EDS) and Muir-Torre syndrome (MTS) soon after the diagnosis of active RRMS was made. The coexisting conditions precluded the use of available disease-modifying treatments. She benefited from monthly and then bi-monthly IVIg, with a single mild relapse over 10 years. Discontinuation of IVIg due to reduced availability with a brief aborted course of subcutaneous PEGylated interferon-beta was followed by significant relapses. Five months after the first ocrelizumab infusion, she developed caecal cancer requiring colectomy. Reinstitution of IVIg is contemplated.
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Affiliation(s)
- Srishti Gupta
- Department of Neurology, Queen's Medical Centre Campus, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, UK.
| | - Mohnish Suri
- Clinical Genetics Service, City Hospital Campus, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Cris S Constantinescu
- Department of Neurology, Queen's Medical Centre Campus, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, UK.
- Division of Clinical Neuroscience, Section of Clinical Neurology, University of Nottingham, Nottingham, UK.
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Cortini F, Villa C. Ehlers-Danlos syndromes and epilepsy: An updated review. Seizure 2018; 57:1-4. [DOI: 10.1016/j.seizure.2018.02.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 02/17/2018] [Accepted: 02/23/2018] [Indexed: 01/10/2023] Open
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Edwards LJ, Constantinescu CS. A prospective study of conditions associated with multiple sclerosis in a cohort of 658 consecutive outpatients attending a multiple sclerosis clinic. Mult Scler 2016; 10:575-81. [PMID: 15471376 DOI: 10.1191/1352458504ms1087oa] [Citation(s) in RCA: 152] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The cause of multiple sclerosis (MS) remains unknown. It is largely regarded as being an inflammatory autoimmune disease and has been reported in association with other inflammatory/autoimmune diseases. We performed a prospective study in 658 consecutive patients diagnosed with MS attending our outpatient MS management clinic between June 2002 and June 2003. Prevalence of associated conditions in these patients was calculated and compared with values from population studies using chi-square tests, odds ratios and confidence intervals. The MS population had significantly increased rates of asthma, inflammatory bowel disease, type I diabetes mellitus, pernicious anaemia, autoimmune thyroid disease, uveitis, seronegative spondyloarthropathies, bipolar disorder and melanoma compared to the general population. Both T helper type 1 (Th1)-mediated and T helper type 2 (Th2)-mediated diseases were significantly increased compared to the general population. There were also interesting associations seen with polyglandular autoimmune syndrome and rare single case associations. MS is associated with several other conditions. This work does not give evidence for the hypothesis that MS and atopy, reflecting Th1 and Th2 polarization, respectively, are mutually exclusive. Further work, ideally with a matched control population, is indicated.
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Affiliation(s)
- L J Edwards
- Division of Clinical Neurology, Queen's Medical Centre, University of Nottingham, Nottingham NG7 2UH, UK
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Puledda F, Viganò A, Celletti C, Petolicchio B, Toscano M, Vicenzini E, Castori M, Laudani G, Valente D, Camerota F, Di Piero V. A study of migraine characteristics in joint hypermobility syndrome a.k.a. Ehlers–Danlos syndrome, hypermobility type. Neurol Sci 2015; 36:1417-24. [DOI: 10.1007/s10072-015-2173-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 03/13/2015] [Indexed: 12/23/2022]
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Verrotti A, Monacelli D, Castagnino M, Villa MP, Parisi P. Ehlers-Danlos syndrome: a cause of epilepsy and periventricular heterotopia. Seizure 2014; 23:819-24. [PMID: 25131162 DOI: 10.1016/j.seizure.2014.07.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 07/20/2014] [Accepted: 07/23/2014] [Indexed: 01/13/2023] Open
Abstract
PURPOSE Ehlers-Danlos syndrome (EDS) comprises a variety of inherited connective tissue disorders that have been described in association with various neurological features. Until now the neurological symptoms have not been studied in detail; therefore, the aim of this review is to analyze the possible association between EDS, epilepsy and periventricular heterotopia (PH). METHODS We have carried out a critical review of all cases of epilepsy in EDS patients with and without PH. RESULTS Epilepsy is a frequent neurological manifestation of EDS; generally, it is characterized by focal seizures with temporo-parieto-occipital auras and the most common EEG findings epileptiform discharges and slow intermittent rhythm with delta-theta waves. Epilepsy in EDS patients is usually responsive to common antiepileptic therapy; very few cases of drug resistant focal epilepsy requested surgical treatment, with favorable results in terms of outcome. Epilepsy is the most common presenting neurological manifestation associated with PH in EDS patients. Abnormal anatomic circuitries (including heterotopic nodules) could generate epilepsy in patients with PH. CONCLUSION Among the principal neurological manifestations, epilepsy and PH have a considerable importance and can influence the long-term evolution of these patients. We hypothesize that PH may determine the epileptic manifestations in patients with EDS; much remains to be learnt about the relationships between nodules and the epileptic manifestations in EDS syndrome.
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Affiliation(s)
| | | | | | - Maria Pia Villa
- Child Neurology, NESMOS Department, Chair of Pediatrics, Faculty of Medicine and Psychology, Sapienza University c/o Sant'Andrea Hospital, Via di Grottarossa, 1035-1039, 00189 Rome, Italy
| | - Pasquale Parisi
- Child Neurology, NESMOS Department, Chair of Pediatrics, Faculty of Medicine and Psychology, Sapienza University c/o Sant'Andrea Hospital, Via di Grottarossa, 1035-1039, 00189 Rome, Italy.
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Verrotti A, Spartà MV, Monacelli D, Porto R, Castagnino M, Russo Raucci A, Compagno F, Viglio S, Foiadelli T, Nicita F, Grosso S, Spalice A, Chiarelli F, Marseglia G, Savasta S. Long-term prognosis of patients with Ehlers-Danlos syndrome and epilepsy. Epilepsia 2014; 55:1213-9. [DOI: 10.1111/epi.12699] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2014] [Indexed: 12/30/2022]
Affiliation(s)
| | | | | | - Rossella Porto
- Department of Pediatrics; IRCCS San Matteo; Pavia University; Pavia Italy
| | | | | | - Francesca Compagno
- Department of Pediatrics; IRCCS San Matteo; Pavia University; Pavia Italy
| | - Simona Viglio
- Department of Molecular Medicine; Pavia University; Pavia Italy
| | - Thomas Foiadelli
- Department of Pediatrics; IRCCS San Matteo; Pavia University; Pavia Italy
| | | | | | - Alberto Spalice
- Department of Pediatrics; La Sapienza University; Rome Italy
| | | | | | - Salvatore Savasta
- Department of Pediatrics; IRCCS San Matteo; Pavia University; Pavia Italy
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Debette S, Germain DP. Neurologic manifestations of inherited disorders of connective tissue. HANDBOOK OF CLINICAL NEUROLOGY 2014; 119:565-76. [PMID: 24365320 DOI: 10.1016/b978-0-7020-4086-3.00037-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Inherited disorders of connective tissue are single gene disorders affecting structure or function of the connective tissue. Neurological manifestations are classic and potentially severe complications of many such disorders. The most common neurological manifestations are cerebrovascular. Ischemic stroke is a classic complication of vascular Ehlers-Danlos syndrome (type IV), homocystinuria, and arterial tortuosity syndrome, and may occasionally be seen in Marfan syndrome and pseudoxanthoma elasticum with distinct underlying mechanisms for each disease. Vascular Ehlers-Danlos syndrome can also lead to cervical artery dissection (with or without ischemic stroke), carotid-cavernous fistula, intracranial dissections and aneurysms potentially causing subarachnoid or intracerebral hemorrhage, and arterial rupture. Other neurological manifestations include nerve root compression and intracranial hypotension due to dural ectasia in Marfan and Loeys-Dietz syndrome, spinal cord compression in osteogenesis imperfecta, and mucopolysaccharidosis type I and VI, carpal tunnel syndrome in mucopolysaccharidosis type I, II, and VI. Impaired mental development can be observed in homocystinuria, mucopolysaccharidosis type II, and the severe form of mucopolysaccharidosis type I. For the neurologist, being aware of these complications and of the diagnostic criteria for inherited connective tissue disorders is important since neurological complications can be the first manifestation of the disease and because caution may be warranted for the management of these patients.
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Affiliation(s)
- Stéphanie Debette
- Department of Epidemiology and Public Health, Raymond Poincaré Hospital, Garches, France; INSERM Unit U708, Pitié-Salpêtrière Hospital, Paris, France; University of Versailles - St Quentin en Yvelines, Versailles, France.
| | - Dominique P Germain
- University of Versailles - St Quentin en Yvelines, Versailles, France; Division of Medical Genetics, National Referral Center for Fabry Disease and Inherited Disorders of Connective Tissue, CHU Raymond Poincaré, Garches, France
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Savasta S, Merli P, Ruggieri M, Bianchi L, Spartà MV. Ehlers-Danlos syndrome and neurological features: a review. Childs Nerv Syst 2011; 27:365-71. [PMID: 20697718 DOI: 10.1007/s00381-010-1256-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Accepted: 07/26/2010] [Indexed: 11/28/2022]
Abstract
Ehlers-Danlos Syndrome is a term that comprises a variety of inherited connective tissue disorders characterized primarily by skin hyperextensibility, joints hypermobility and excessive dislocations, easy bruisability, generalized fragility. If much is known about orthopedic or physiatric features of this syndrome, poor is known about the neurological ones. Thus neurological assessment is very important due to the possible various clinical manifestations in this syndrome.
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Affiliation(s)
- Salvatore Savasta
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, P.le Golgi, 2, 27100 Pavia, Italy.
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Selim B, Lane CR, Rubinowitz AN, Siner JM. Spontaneous hemothorax and recurrent hemoptysis in a 26-year-old man with skin lesions. Chest 2010; 137:480-3. [PMID: 20133296 DOI: 10.1378/chest.09-1030] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Bernardo Selim
- Department of Internal Medicine, Section of Pulmonary and Critical Care Medicine, Yale University School of Medicine, New Haven, CT 06520, USA
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Vilisaar J, Harikrishnan S, Suri M, Constantinescu CS. Ehlers—Danlos syndrome and multiple sclerosis: a possible association. Mult Scler 2008; 14:567-70. [DOI: 10.1177/1352458507083187] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Ehlers—Danlos syndrome (EDS) has various neurological manifestations. Here we present an association of EDS with multiple sclerosis (MS). Four MS patients from a total of 1892 followed up at our MS outpatient clinics had EDS. This frequency suggests 10—11 times increased prevalence of EDS in MS patients compared with the general population ( P = 0.02). Suggested implications include a possible causal relationship on a connective tissue level with a higher susceptibility to MS in EDS. Diagnostic and management considerations are important in coexisting MS and EDS. Our patients had relatively florid lesions on brain MRIs and typical course and features of MS. Multiple Sclerosis 2008; 14 : 567—570. http://msj.sagepub.com
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Affiliation(s)
- J. Vilisaar
- Division of Clinical Neurology, Faculty of Medicine and Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - S. Harikrishnan
- Division of Clinical Neurology, Faculty of Medicine and Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - M. Suri
- Clinical Genetics Service, City Hospital, Nottingham, UK
| | - CS Constantinescu
- Division of Clinical Neurology, Faculty of Medicine and Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK,
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Notaridis G, Ebbing K, Giannakopoulos P, Bouras C, Kövari E. Neuropathological analysis of an asymptomatic adult case with Dandy-Walker variant. Neuropathol Appl Neurobiol 2006; 32:344-50. [PMID: 16640653 DOI: 10.1111/j.1365-2990.2006.00719.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The Dandy-Walker (DW) complex is a rare posterior fossa malformation, usually observed during the prenatal period or the early infancy. Clinically, it is characterized by mental retardation, seizures, cerebellar ataxia as well as symptoms of hydrocephalus. Structural imaging reveal a hypoplasia or agenesis of the cerebellar vermis, enlargement of the fourth ventricle with a posterior fossa cyst. Additional neurodevelopmental changes such as agenesis of the corpus callosum, lissencephaly and cortical dysplasia are also present. We report the first neuropathological analysis of an adult asymptomatic DW case. Brain computerized tomography showed a massive posterior fossa cyst and hypoplasia of the cerebellum. An Ehlers-Danlos syndrome type IV characterized by repetitive intestinal perforations and a saccular aneurysm on the left posterior communicating artery was also present. Macroscopic brain examination revealed hypoplasia of both cerebellar hemispheres and posterior part of the vermis, as well as dilatation of the fourth ventricle without hydrocephalus. The posterior fossa cyst wall was formed by an external arachnoid layer, middle layer with loose connective tissue and an internal layer of ependymal cells. There were two foci of cerebellar cortical dysplasia but no ectopic neurons, neuronal loss or gliosis in both cerebellum and cerebral cortex. No vascular or significant neurodegenerative lesions were observed. In comparison with previous reports in DW infants, this adult case displayed milder brain abnormalities compatible with a diagnosis of DW variant. The preservation of the cortical cytoarchitecture as well as the paucity of additional neurodevelopmental changes may explain the absence of clinical expression.
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Affiliation(s)
- G Notaridis
- Department of Psychiatry, HUG Belle-Idée, University of Geneva School of Medicine, Geneva, Switzerland
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Abstract
OBJECTIVE Ehlers-Danlos Syndrome (EDS) is a complex hereditary connective tissue disorder with neurologic manifestations that include cerebrovascular disorders and chronic pain. The clinical data collected on 18 patients with EDS and chronic headaches is reported. PROCEDURE Clinical history, neurologic examination, computerized tomography of the head, magnetic resonance imaging (MRI) of the brain, and electroencephalogram (EEG). Headaches were classified according to the International Headache Society and the patients were followed by the author for a minimum of 2 years. FINDINGS Four patients had migraine with aura, four had migraine without aura, four had tension headaches, four had a combination of migraine and tension headaches, and two had post-traumatic headaches. Nine patients exhibited blepharoclonus but none had history of seizures and their EEGs were normal, ruling out eye closure epilepsy. Although one patient had a small right frontal angioma, a second had Arnold Chiari malformation type I, and a third had an old stroke, headaches did not clinically correlate with their central nervous system (CNS) lesions. CONCLUSION Chronic recurrent headaches may constitute the neurologic presentation of EDS in the absence of structural, congenital, or acquired CNS lesions that correlate with their symptoms. Individuals with EDS may be prone to migraine due to an inherent disorder of cerebrovascular reactivity or cortical excitability. Additional studies are needed to elucidate the pathogenesis of headaches in EDS.
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Affiliation(s)
- D E Jacome
- Franklin Medical Center, Department of Medicine, Greenfield, MA, USA.
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