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Nair LJ, Vijayaraghavan A. Unraveling Phenotypic Variability in Action Myoclonus with Renal Failure with SCARB2 Mutation in Siblings. Mov Disord Clin Pract 2024; 11:1035-1037. [PMID: 38741477 PMCID: PMC11329563 DOI: 10.1002/mdc3.14067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 04/24/2024] [Accepted: 04/27/2024] [Indexed: 05/16/2024] Open
Affiliation(s)
- Lakshmi J. Nair
- Department of NeurologySree Chitra Tirunal Institute for Medical Sciences and TechnologyThiruvananthapuramIndia
| | - Asish Vijayaraghavan
- Comprehensive Care Centre for Movement Disorders (CCCMD), Department of NeurologySree Chitra Tirunal Institute for Medical Sciences and TechnologyThiruvananthapuramIndia
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2
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G S B Lima PL, Nobrega PR, Freua F, Braga-Neto P, Paiva ARB, Guimarães TG, Kok F. Myoclonus improvement after seizures in progressive myoclonic epilepsy type 7: a case report. BMC Neurol 2024; 24:169. [PMID: 38783211 PMCID: PMC11112770 DOI: 10.1186/s12883-024-03625-z] [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: 12/26/2023] [Accepted: 04/05/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Progressive Myoclonic Epilepsy (PME) is a group of rare diseases that are difficult to differentiate from one another based on phenotypical characteristics. CASE REPORT We report a case of PME type 7 due to a pathogenic variant in KCNC1 with myoclonus improvement after epileptic seizures. DISCUSSION Myoclonus improvement after seizures may be a clue to the diagnosis of Progressive Myoclonic Epilepsy type 7.
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Affiliation(s)
| | - Paulo R Nobrega
- Division of Neurology, Federal University of Ceara, Fortaleza, Ceara, Brazil
- Centro Universitário Christus, Fortaleza, Ceara, Brazil
| | - Fernando Freua
- Neurogenetics Center, Department of Neurology, University of Sao Paulo, Sao Paulo, Brazil
| | - Pedro Braga-Neto
- Division of Neurology, Federal University of Ceara, Fortaleza, Ceara, Brazil
| | - Anderson R B Paiva
- Neurogenetics Center, Department of Neurology, University of Sao Paulo, Sao Paulo, Brazil
| | - Thiago Gonçalves Guimarães
- Movement Disorders Center, Department of Neurology, University of Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar, 255, 5th Floor, Room 5084, Cerqueira Cesar, Sao Paulo, Sao Paulo, 05403-900, Brazil.
| | - Fernando Kok
- Neurogenetics Center, Department of Neurology, University of Sao Paulo, Sao Paulo, Brazil
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3
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Kelly A, Dunne J, Orr C, Lawn N. Adult-onset Kufs disease. Pract Neurol 2024; 24:41-44. [PMID: 37802651 DOI: 10.1136/pn-2022-003652] [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] [Accepted: 09/15/2023] [Indexed: 10/08/2023]
Abstract
A young man from Pakistan had his first-ever tonic-clonic seizure while playing cricket. Since age 12 years, he had reported involuntary jerks and tremulousness, sometimes with falls, particularly with bright lights. Family history included a brother who developed seizures with myoclonus in his mid-20s and parental consanguinity. Developmental history was normal. Examination identified cognitive impairment with action myoclonus. His clinical presentation raised suspicion of a progressive myoclonus epilepsy. MR scan of the brain showed white matter changes suggesting leucodystrophy with cortical atrophy. Electroencephalogram showed generalised epileptiform abnormalities with photoparoxysmal responses, including at low frequencies (1 Hz). Cortical hyperexcitability was confirmed with giant median somatosensory evoked potentials and long loop reflexes at rest. Multichannel electromyography showed action myoclonus with variable synchronous and asynchronous agonist and antagonist muscle activation with short-burst duration of 25-75 ms, and jerk-locked back-averaging showed premyoclonic potentials consistent with cortical myoclonus. Genetic sequencing identified a homozygous missense variant in the CLN6 gene (c.768C>G p.(Asp256Glu), confirming Kufs disease type A.
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Affiliation(s)
- Albert Kelly
- Neurology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - John Dunne
- Neurology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- Internal Medicine, The University of Western Australia Faculty of Health and Medical Sciences, Perth, Western Australia, Australia
| | - Carolyn Orr
- Neurology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Nicholas Lawn
- Neurology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- Neurology, Western Australian Adult Epilepsy Service, Perth, Western Australia, Australia
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4
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Cameron JM, Ellis CA, Berkovic SF. ILAE Genetics Literacy series: Progressive myoclonus epilepsies. Epileptic Disord 2023; 25:670-680. [PMID: 37616028 PMCID: PMC10947580 DOI: 10.1002/epd2.20152] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/21/2023] [Accepted: 08/19/2023] [Indexed: 08/25/2023]
Abstract
Progressive Myoclonus Epilepsy (PME) is a rare epilepsy syndrome characterized by the development of progressively worsening myoclonus, ataxia, and seizures. A molecular diagnosis can now be established in approximately 80% of individuals with PME. Almost fifty genetic causes of PME have now been established, although some remain extremely rare. Herein, we provide a review of clinical phenotypes and genotypes of the more commonly encountered PMEs. Using an illustrative case example, we describe appropriate clinical investigation and therapeutic strategies to guide the management of this often relentlessly progressive and devastating epilepsy syndrome. This manuscript in the Genetic Literacy series maps to Learning Objective 1.2 of the ILAE Curriculum for Epileptology (Epileptic Disord. 2019;21:129).
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Affiliation(s)
- Jillian M. Cameron
- Epilepsy Research Centre, Department of MedicineUniversity of MelbourneAustin HealthMelbourneVictoriaAustralia
| | - Colin A. Ellis
- Department of NeurologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Samuel F. Berkovic
- Epilepsy Research Centre, Department of MedicineUniversity of MelbourneAustin HealthMelbourneVictoriaAustralia
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5
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Wang F, Lin L, Hu J, Zhang J, Wang K. Neurophysiolgical implications in sialidosis type 1: a case report. Int J Neurosci 2022; 132:589-592. [PMID: 32988250 DOI: 10.1080/00207454.2020.1829615] [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: 10/23/2022]
Abstract
Sialidosis is a rare autosomal recessive hereditary disease caused by NEU1 gene mutations. A 25-year-old woman developed generalized tonic-clonic seizures since teenage, followed by progressive visional decline and limb myoclonus. Her sister had similar presentations. Both patients were products of a consanguineous marriage. Electroencephalography (EEG) revealed extensive paroxysmal spiky beta brush. Somatosensory evoked potentials (SEP) after stimulation of median nerves demonstrated giant SEP and C-reflex support the cortical origin of myoclonus. Genetic tests confirmed that both sisters carried the known pathogenic homozygous mutation of c.544A > G in exon 3 of the NEU1 gene. The diagnosis of sialidosis type 1 was then made. This suggests that neurophysiological abnormalities, especially spiky beta brush on EEG, might facilitate the early diagnosis of sialidosis type 1.
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Affiliation(s)
- Fei Wang
- EEG Lab, TMC Hospital of Changxing, Changxing, China
| | - Li Lin
- EEG Lab, Jingdezhen People's Hospital, Jingdezhen, China
| | - Jing Hu
- Department of Neurology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jianfang Zhang
- Department of Neurology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Kang Wang
- Department of Neurology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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6
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Narayanan DL, Somashekar PH, Majethia P, Shukla A. KCTD7-related progressive myoclonic epilepsy: report of three Indian families and review of literature. Clin Dysmorphol 2022; 31:6-10. [PMID: 34866617 PMCID: PMC8918358 DOI: 10.1097/mcd.0000000000000394] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Epilepsy, progressive myoclonic 3, with or without intracellular inclusions (MIM# 611726) is a rare autosomal recessive condition associated with pathogenic variants in KCTD7, which encodes the BR-C,ttk and bab/pox virus and zinc finger domain-containing KCTD7 protein. We report four individuals from three Indian families presenting with an initial period of normal development, progressive myoclonic seizures followed by neuroregression and an abnormal electroencephalogram. We identified two novel missense variants, c.458G>C p.(Arg153Pro) and c.205C>G p.(Leu69Val) and one known disease-causing variant, c.280C>T p.(Arg94Trp) in KCTD7 by exome sequencing. We review the literature of 67 individuals with variants in KCTD7. Our study expands the molecular spectrum of KCTD7-related progressive myoclonic epilepsy.
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Affiliation(s)
- Dhanya Lakshmi Narayanan
- Department of Medical Genetics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
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7
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Vial F, McGurrin P, Attaripour S, d'Azzo A, Tifft CJ, Toro C, Hallett M. Myoclonus generators in sialidosis. Clin Neurophysiol Pract 2022; 7:169-173. [PMID: 35800887 PMCID: PMC9253402 DOI: 10.1016/j.cnp.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 05/19/2022] [Indexed: 11/04/2022] Open
Abstract
The cortical origin of myoclonus in sialidosis does not fully explain the phenomena. We used electrophysiology to show a possible subcortical source for the myoclonus. Correct understanding of this physiopathology may help improve treatment.
Objective Sialidosis is an inborn error of metabolism. There is evidence that the myoclonic movements observed in this disorder have a cortical origin, but this mechanism does not fully explain the bilaterally synchronous myoclonus activity frequently observed in many patients. We present evidence of a subcortical basis for synchronous myoclonic phenomena. Methods Electromyographic investigations were undertaken in two molecularly and biochemically confirmed patients with sialidosis type-1. Results The EMG recordings showed clear episodes of bilaterally synchronous myoclonic activity in contralateral homologous muscles. We also observed a high muscular-muscular coherence with near-zero time-lag between these muscles. Conclusion The absence of coherence phase lag between the right-and-left homologous muscles during synchronous events indicates that a unilateral cortical source cannot fully explain the myoclonic activity. There must exist a subcortical mechanism for bilateral synchronization accounting for this phenomenon. Significance Understanding this mechanism may illuminate cortical-subcortical relationships in myoclonus.
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8
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Martin S, Salman MS. Assessing Children with Poor Coordination Can Be Tricky - A Review on Ataxia and Ataxia Mimickers and a Study of Three Children with Severe Epilepsy. J Multidiscip Healthc 2021; 14:3331-3341. [PMID: 34876818 PMCID: PMC8643209 DOI: 10.2147/jmdh.s251860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/16/2021] [Indexed: 11/30/2022] Open
Abstract
While ataxia is a relatively common presenting feature in pediatric patients, it represents only one possible cause of uncoordinated movements. Other possible causes of uncoordinated movements include ingestion of toxic substances, musculoskeletal diseases, psychogenic disorders, extrapyramidal movement disorders, peripheral neuropathies, spasticity from any cause, and epilepsy. Therefore, primary health care providers must recognize and exclude other etiologies of uncoordinated movements before attaching the label “ataxia” to any patient presenting with poor coordination. Once the presence of ataxia is confirmed, the cause should be investigated. As ataxia may be vestibular, sensory, or cerebellar in origin, medical practitioners must evaluate the diverse symptoms and signs to effectively differentiate the various types of ataxia. Three case studies are presented to illustrate the complexity associated with the assessment of ataxia. Each case will discuss a pediatric patient who displays cerebellar ataxia as a concurrent feature of a gene-specific developmental and epileptic encephalopathy. These cases will provide an example of how ataxia may be differentiated from other causes of uncoordinated movements related to epilepsy and anti-seizure medications, namely: nonconvulsive seizures, postictal state, and medication side effects or toxicity. The assessment of poor balance can be challenging at times; however, with knowledge of the differential diagnosis of poor balance, medical practitioners will be able to confidently determine the presence of true ataxia from various ataxia mimickers, thereby allowing for timely and accurate diagnosis, and appropriate management.
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Affiliation(s)
- Sydney Martin
- Department of Family Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Michael S Salman
- Section of Pediatric Neurology, Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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9
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Haryanyan G, Ozdemir O, Tutkavul K, Dervent A, Ayta S, Ozkara C, Salman B, Yucesan E, Kesim Y, Susgun S, Ozbek U, Baykan B, Ugur Iseri SA, Bebek N. The rare rs769301934 variant in NHLRC1 is a common cause of Lafora disease in Turkey. J Hum Genet 2021; 66:1145-1151. [PMID: 34117373 DOI: 10.1038/s10038-021-00944-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 02/06/2023]
Abstract
Lafora disease (LD) is a severe form of progressive myoclonus epilepsy inherited in an autosomal recessive fashion. It is associated with biallelic pathogenic variations in EPM2A or NHLRC1, which encode laforin and malin, respectively. The disease usually starts with adolescent onset seizures followed by progressive dementia, refractory status epilepticus and eventually death within 10 years of onset. LD is generally accepted as having a homogenous clinical course with no considerable differences between EPM2A or NHLRC1 associated forms. Nevertheless, late-onset and slow progressing forms of the disease have also been reported. Herein, we have performed clinical and genetic analyses of 14 LD patients from 12 different families and identified 8 distinct biallelic variations in these patients. Five of these variations were novel and/or associated with the LD phenotype for the first time. Interestingly, almost half of the cases were homozygous for the rare rs769301934 (NM_198586.3(NHLRC1): c.436 G > A; p.(Asp146Asn)) allele in NHLRC1. A less severe phenotype with an onset at a later age may be the reason for the biased inflation of this variant, which is already present in the human gene pool and can hence arise in the homozygous form in populations with increased parental consanguinity.
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Affiliation(s)
- Garen Haryanyan
- Department of Genetics, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey.,Graduate School of Health Sciences, Istanbul University, Istanbul, Turkey
| | - Ozkan Ozdemir
- Department of Genetics, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey.,Graduate School of Health Sciences, Istanbul University, Istanbul, Turkey.,Department of Medical Genetics, Faculty of Medicine, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey.,Genome Studies Program, Institute of Health Sciences, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Kemal Tutkavul
- Department of Neurology, Istanbul Haydarpasa Numune Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Aysin Dervent
- Department of Neurology, Pediatric Neurology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Semih Ayta
- Department of Pediatrics, Child Neurology Unit, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Cigdem Ozkara
- Department of Neurology and Clinical Neurophysiology, Cerrahpasa Medical Faculty, Istanbul University Cerrahpasa, Istanbul, Turkey
| | - Baris Salman
- Department of Genetics, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey.,Graduate School of Health Sciences, Istanbul University, Istanbul, Turkey
| | - Emrah Yucesan
- Department of Medical Biology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Yesim Kesim
- Department of Genetics, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey.,Graduate School of Health Sciences, Istanbul University, Istanbul, Turkey
| | - Seda Susgun
- Department of Genetics, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey.,Graduate School of Health Sciences, Istanbul University, Istanbul, Turkey.,Department of Medical Biology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Ugur Ozbek
- Department of Genetics, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey.,Department of Medical Genetics, Faculty of Medicine, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey.,Genome Studies Program, Institute of Health Sciences, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Betul Baykan
- Department of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sibel A Ugur Iseri
- Department of Genetics, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey.
| | - Nerses Bebek
- Department of Genetics, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey.,Department of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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10
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Vidhale TA, Gupta HR, Prafulla Jaya R, Pustake M. Fulminant subacute sclerosing panencephalitis (SSPE) presented with acute hemiparesis in a 13-year-old girl with perinatally acquired HIV infection. BMJ Case Rep 2021; 14:e241205. [PMID: 34518172 PMCID: PMC8438743 DOI: 10.1136/bcr-2020-241205] [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] [Accepted: 08/22/2021] [Indexed: 11/03/2022] Open
Abstract
A 13-year-old girl with perinatally acquired HIV infection was admitted to us with acute onset, right-sided hemiparesis of 30 days duration and right-sided myoclonic jerks of 2 days duration affecting the face, upper and lower limbs. On examination, she exhibited increased tone and a pyramidal pattern of weakness in her right upper and lower limbs, along with spontaneous multifocal myoclonic jerks in the affected area. IgG levels in the serum and cerebrospinal fluid for measles were significantly elevated. Brain MRI depicted T2-weighted-hyperintensities in the subcortical white matter. The electroencephalogram demonstrated evidence of lateralised long interval periodic discharges. This patient had no past behavioural problems or poor academic performance. This case underlines the fact that, though subacute sclerosing panencephalitis (SSPE) is a chronic disease, a rare fulminant form of SSPE might develop acutely and atypically, with an increased proclivity for HIV-infected patients.
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Affiliation(s)
- Tushar Ashok Vidhale
- General Medicine, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
| | - Hemant R Gupta
- General Medicine, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
| | - Rohan Prafulla Jaya
- Department of Radiology, BGS Global Institute of Medical Sciences, Bangalore, Karnataka, India
| | - Manas Pustake
- General Medicine, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
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11
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A De Novo SEMA6B Variant in a Chinese Patient with Progressive Myoclonic Epilepsy-11 and Review of the Literature. J Mol Neurosci 2021; 71:1944-1950. [PMID: 34218423 DOI: 10.1007/s12031-021-01880-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/21/2021] [Indexed: 10/20/2022]
Abstract
Progressive myoclonic epilepsy is a group of neurodegenerative diseases with complex clinical and genetic heterogeneity, which is associated with spontaneous or action-induced myoclonus and progressive neurodegeneration. Since 2020, 4 families with progressive myoclonic epilepsy-11 [OMIM#618876] have been reported with a very limited spectrum of SEMA6B pathogenic variants. In our study, whole-exome sequencing was used in a proband from a nonconsanguineous Chinese family presenting with growth retardation and recurrent atonic seizures. A deletion mutation (c.1960_1978del, p.Leu654Argfs*25) in the last exon of SEMA6B was detected, which is a de novo variant and pathogenic. The new genetic evidence we reported here strengthened the gene-disease relationship, and the gene curation level between SEMA6B and progressive myoclonic epilepsy-11 became "strong" following the ClinGen SOP. Therefore, the results of this study broaden the mutation spectrum of SEMA6B in different ethnic groups and strengthen the gene-disease relationship between SEMA6B and progressive myoclonic epilepsy-11.
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12
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Koens LH, de Vries JJ, Vansenne F, de Koning TJ, Tijssen MAJ. How to detect late-onset inborn errors of metabolism in patients with movement disorders - A modern diagnostic approach. Parkinsonism Relat Disord 2021; 85:124-132. [PMID: 33745796 DOI: 10.1016/j.parkreldis.2021.02.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 12/15/2020] [Accepted: 02/24/2021] [Indexed: 12/30/2022]
Abstract
We propose a modern approach to assist clinicians to recognize and diagnose inborn errors of metabolism (IEMs) in adolescents and adults that present with a movement disorder. IEMs presenting in adults are still largely unexplored. These disorders receive little attention in neurological training and daily practice, and are considered complicated by many neurologists. Adult-onset presentations of IEMs differ from childhood-onset phenotypes, which may lead to considerable diagnostic delay. The identification of adult-onset phenotypes at the earliest stage of the disease is important, since early treatment may prevent or lessen further brain damage. Our approach is based on a systematic review of all papers that concerned movement disorders due to an IEM in patients of 16 years or older. Detailed clinical phenotyping is the diagnostic cornerstone of the approach. An underlying IEM should be suspected in particular in patients with more than one movement disorder, or in patients with additional neurological, psychiatric, or systemic manifestations. As IEMs are all genetic disorders, we recommend next-generation sequencing (NGS) as the first diagnostic approach to confirm an IEM. Biochemical tests remain the first choice in acute-onset or treatable IEMs that require rapid diagnosis, or to confirm the metabolic diagnosis after NGS results. With the use of careful and systematic clinical phenotyping combined with novel diagnostic approaches such as NGS, the diagnostic yield of late-onset IEMs will increase, in particular in patients with mild or unusual phenotypes.
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Affiliation(s)
- Lisette H Koens
- Department of Neurology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, the Netherlands; Expertise Center Movement Disorders Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, the Netherlands
| | - Jeroen J de Vries
- Department of Neurology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, the Netherlands; Expertise Center Movement Disorders Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, the Netherlands
| | - Fleur Vansenne
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, the Netherlands; Department of Genetics, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, the Netherlands
| | - Tom J de Koning
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, the Netherlands; Department of Genetics, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, the Netherlands; Department of Clinical Sciences and Department of Pediatrics, Lund University, Box 188, SE-221 00, Lund, Sweden
| | - Marina A J Tijssen
- Department of Neurology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, the Netherlands; Expertise Center Movement Disorders Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, the Netherlands.
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13
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Afrantou T, Lagoudaki R, Papadopoulos T, Karayannopoulou G, Galidis E, Migkos K, Stavridou E, Kimiskidis V, Ioannidis P, Grigoriadis N. Novel frameshift variant of NHLRC1 gene in compound heterozygosity in an adult Greek patient with Lafora disease. Seizure 2021; 86:49-51. [PMID: 33540374 DOI: 10.1016/j.seizure.2021.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 01/04/2021] [Accepted: 01/06/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
- Theodora Afrantou
- B' Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece.
| | - Roza Lagoudaki
- B' Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece
| | | | - Georgia Karayannopoulou
- Pathology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece
| | - Eleftherios Galidis
- Pathology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece
| | - Konstantinos Migkos
- B' Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece
| | - Eleni Stavridou
- B' Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece
| | - Vasilios Kimiskidis
- Laboratory of Clinical Neurophysiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panagotis Ioannidis
- B' Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece
| | - Nikolaos Grigoriadis
- B' Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece
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14
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Kaur R, Balaini N, Sharma S, Sharma SK. Lafora body disease: a case of progressive myoclonic epilepsy. BMJ Case Rep 2020; 13:e236971. [PMID: 33370974 PMCID: PMC7757443 DOI: 10.1136/bcr-2020-236971] [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] [Accepted: 12/02/2020] [Indexed: 12/24/2022] Open
Abstract
Progressive myoclonic epilepsy (PME) is a progressive neurological disorder. Unfortunately, until now, no definitive curative treatment exists; however, it is of utmost importance to identify patients with PME. The underlying aetiology can be pinpointed if methodological clinical evaluation is performed, followed by subsequent genetic testing. We report a case of PME that was diagnosed as Lafora body disease. This case emphasises that, suspecting and identifying PME is important so as to start appropriate treatment and reduce the probability of morbidity and prognosticate the family.
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Affiliation(s)
- Ranjot Kaur
- Medicine, Indira Gandhi Medical College, Shimla, India
| | | | - Sudhir Sharma
- Neurology, Indira Gandhi Medical College, Shimla, India
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15
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Pereira M, Durães J, Macário MDC. Two sisters with myoclonus and ataxia. Pract Neurol 2020; 20:249-252. [DOI: 10.1136/practneurol-2019-002446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2020] [Indexed: 11/03/2022]
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16
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Abstract
The progressive myoclonic epilepsies (PMEs) represent a rare but devastating group of syndromes characterized by epileptic myoclonus, typically action-induced seizures, neurological regression, medically refractory epilepsy, and a variety of other signs and symptoms depending on the specific syndrome. Most of the PMEs begin in children who are developing as expected, with the onset of the disorder heralded by myoclonic and other seizure types. The conditions are considerably heterogenous, but medical intractability to epilepsy, particularly myoclonic seizures, is a core feature. With the increasing use of molecular genetic techniques, mutations and their abnormal protein products are being delineated, providing a basis for disease-based therapy. However, genetic and enzyme replacement or substrate removal are in the nascent stage, and the primary therapy is through antiepileptic drugs. Epilepsy in children with progressive myoclonic seizures is notoriously difficult to treat. The disorder is rare, so few double-blinded, placebo-controlled trials have been conducted in PME, and drugs are chosen based on small open-label trials or extrapolation of data from drug trials of other syndromes with myoclonic seizures. This review discusses the major PME syndromes and their neurogenetic basis, pathophysiological underpinning, electroencephalographic features, and currently available treatments.
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Affiliation(s)
- Gregory L Holmes
- Department of Neurological Sciences, Larner College of Medicine, University of Vermont College of Medicine, Stafford Hall, 118C, Burlington, VT, 05405, USA.
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17
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Papandreou A, Danti FR, Spaull R, Leuzzi V, Mctague A, Kurian MA. The expanding spectrum of movement disorders in genetic epilepsies. Dev Med Child Neurol 2020; 62:178-191. [PMID: 31784983 DOI: 10.1111/dmcn.14407] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2019] [Indexed: 12/27/2022]
Abstract
An ever-increasing number of neurogenetic conditions presenting with both epilepsy and atypical movements are now recognized. These disorders within the 'genetic epilepsy-dyskinesia' spectrum are clinically and genetically heterogeneous. Increased clinical awareness is therefore necessary for a rational diagnostic approach. Furthermore, careful interpretation of genetic results is key to establishing the correct diagnosis and initiating disease-specific management strategies in a timely fashion. In this review we describe the spectrum of movement disorders associated with genetically determined epilepsies. We also propose diagnostic strategies and putative pathogenic mechanisms causing these complex syndromes associated with both seizures and atypical motor control. WHAT THIS PAPER ADDS: Implicated genes encode proteins with very diverse functions. Pathophysiological mechanisms by which epilepsy and movement disorder phenotypes manifest are often not clear. Early diagnosis of treatable disorders is essential and next generation sequencing may be required.
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Affiliation(s)
- Apostolos Papandreou
- Molecular Neurosciences, Developmental Neurosciences Programme, UCL Great Ormond Street Institute of Child Health, London, UK
- Department of Neurology, Great Ormond Street Hospital, London, UK
| | - Federica Rachele Danti
- Molecular Neurosciences, Developmental Neurosciences Programme, UCL Great Ormond Street Institute of Child Health, London, UK
- Department of Human Neuroscience, Unit of Child Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Robert Spaull
- Department of Paediatric Neurology, Bristol Royal Hospital for Children, Bristol, UK
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Vincenzo Leuzzi
- Department of Human Neuroscience, Unit of Child Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Amy Mctague
- Molecular Neurosciences, Developmental Neurosciences Programme, UCL Great Ormond Street Institute of Child Health, London, UK
- Department of Neurology, Great Ormond Street Hospital, London, UK
| | - Manju A Kurian
- Molecular Neurosciences, Developmental Neurosciences Programme, UCL Great Ormond Street Institute of Child Health, London, UK
- Department of Neurology, Great Ormond Street Hospital, London, UK
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Lambrechts RA, Polet SS, Hernandez-Pichardo A, van Ninhuys L, Gorter JA, Grzeschik NA, de Koning-Tijssen MAJ, de Koning TJ, Sibon OCM. North Sea Progressive Myoclonus Epilepsy is Exacerbated by Heat, A Phenotype Primarily Associated with Affected Glia. Neuroscience 2019; 423:1-11. [PMID: 31682953 DOI: 10.1016/j.neuroscience.2019.10.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 10/18/2019] [Accepted: 10/21/2019] [Indexed: 01/05/2023]
Abstract
Progressive myoclonic epilepsies (PMEs) comprise a group of rare disorders of different genetic aetiologies, leading to childhood-onset myoclonus, myoclonic seizures and subsequent neurological decline. One of the genetic causes for PME, a mutation in the gene coding for Golgi SNAP receptor 2 (GOSR2), gives rise to a PME-subtype prevalent in Northern Europe and hence referred to as North Sea Progressive Myoclonic Epilepsy (NS-PME). Treatment for NS-PME, as for all PME subtypes, is symptomatic; the pathophysiology of NS-PME is currently unknown, precluding targeted therapy. Here, we investigated the pathophysiology of NS-PME. By means of chart review in combination with interviews with patients (n = 14), we found heat to be an exacerbating factor for a majority of NS-PME patients (86%). To substantiate these findings, we designed a NS-PME Drosophila melanogaster model. Downregulation of the Drosophila GOSR2-orthologue Membrin leads to heat-induced seizure-like behaviour. Specific downregulation of GOSR2/Membrin in glia but not in neuronal cells resulted in a similar phenotype, which was progressive as the flies aged and was partially responsive to treatment with sodium barbital. Our data suggest a role for GOSR2 in glia in the pathophysiology of NS-PME.
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Affiliation(s)
- Roald A Lambrechts
- Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Sjoukje S Polet
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Alejandra Hernandez-Pichardo
- Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Lisa van Ninhuys
- Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Jenke A Gorter
- Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Nicola A Grzeschik
- Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Marina A J de Koning-Tijssen
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Tom J de Koning
- Department of Pediatrics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Department of Medical Genetics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Ody C M Sibon
- Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
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Freitas ME, Ruiz-Lopez M, Dalmau J, Erro R, Privitera M, Andrade D, Fasano A. Seizures and movement disorders: phenomenology, diagnostic challenges and therapeutic approaches. J Neurol Neurosurg Psychiatry 2019; 90:920-928. [PMID: 30796133 DOI: 10.1136/jnnp-2018-320039] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 02/06/2019] [Accepted: 02/07/2019] [Indexed: 02/07/2023]
Abstract
Seizures and movement disorders (MDs) are distinct neurological conditions presenting with abnormal movements. Despite sharing an overlap in phenomenology, these movements have different origins. In order to explore the overlaps and the narrow boundaries between these two conditions, we performed a review of the literature to explore the risk of seizures in MDs. We discussed the mimics and chameleons including MDs that look like seizure (eg, paroxysmal dyskinesia, status dystonicus) and seizures that look like MDs (eg, epilepsia partialis continua, nocturnal frontal lobe epilepsy). Additionally, we examined the therapeutic challenges as well as the anatomical and chemical pathways relevant in the interplay between epilepsy and MDs. Finally, we proposed an algorithm to guide clinicians towards the final diagnosis of conditions characterised by the co-occurrence of MDs and seizures.
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Affiliation(s)
- Maria Eliza Freitas
- Medicine, McMaster University Division of Neurology, Hamilton, Ontario, Canada
| | - Marta Ruiz-Lopez
- Service of Neurology, Fundación Jimenez Diaz University Hospital, Madrid, Spain
| | - Josep Dalmau
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Roberto Erro
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', University of Salerno, UCL Institute of Neurology, Baronissi, Italy
| | - Michael Privitera
- Epilepsy Center, University of Cincinnati Gardner Neuroscience Institute, Cincinnati, Ohio, USA
| | | | - Alfonso Fasano
- Neurology, Krembil Brain Institute; Movement Disorders Centre and the Edmond J Safra Program in Parkinson's Disease, Toronto, Ontario, Canada
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Algahtani H, Al-Hakami F, Al-Shehri M, Shirah B, Al-Qahtani MH, Abdulkareem AA, Naseer MI. A very rare form of autosomal dominant progressive myoclonus epilepsy caused by a novel variant in the PRICKLE1 gene. Seizure 2019; 69:133-139. [DOI: 10.1016/j.seizure.2019.04.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/17/2019] [Accepted: 04/19/2019] [Indexed: 01/13/2023] Open
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Lv Y, Zhang N, Liu C, Shi M, Sun L. Occipital epilepsy versus progressive myoclonic epilepsy in a patient with continuous occipital spikes and photosensitivity in electroencephalogram: A case report. Medicine (Baltimore) 2018; 97:e0299. [PMID: 29642155 PMCID: PMC5908557 DOI: 10.1097/md.0000000000010299] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Progressive myoclonic epilepsy (PME) is rare epilepsy syndrome. Although EEG is a useful neurophysiological technique in the evaluation of epilepsy, few EEG abnormalities have been described in PME. So, how to use EEG hints to establish the suspected diagnosis of PME as soon as possible should be addressed. CASE PRESENT We presented a case with refractory myoclonic seizures, and progressive neurological deterioration, diagnosed as PME and neuronal ceroid lipofuscinosis disease by gene testing. The patient manifested with a significant regression in her speech ability and motor balance. The mini-mental state examination showed poor scores of 15/30. The magnetic resonance imaging showed diffused atrophy. Her EEG showed slow background with continuous occipital small spikes and photosensitivity. The following genetic testing with mutation in CLN6 confirmed the diagnosis and excluded the occipital epilepsy. CONCLUSION Our case showed rare manifestations and special EEG features of PME, which may be confused with occipital epilepsy or photosensitive epilepsy. Thus, if the continuous occipital spikes and photosensitivity were presented in a patient with refractory seizures and developmental regression, PME should be considered.
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Affiliation(s)
- Yudan Lv
- Department of Neurology and Neuroscience Center, The First Hospital of JiLin University, Changchun
| | - Nan Zhang
- Department of Neurology and Neuroscience Center, The First Hospital of JiLin University, Changchun
- Department of Neurology, Yidu Central Hospital, Weifang, Shandong, China
| | - Chang Liu
- Department of Neurology and Neuroscience Center, The First Hospital of JiLin University, Changchun
| | - Mingchao Shi
- Department of Neurology and Neuroscience Center, The First Hospital of JiLin University, Changchun
| | - Li Sun
- Department of Neurology and Neuroscience Center, The First Hospital of JiLin University, Changchun
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22
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Hu SC, Hung KL, Chen HJ, Lee WT. Seizure remission and improvement of neurological function in sialidosis with perampanel therapy. EPILEPSY & BEHAVIOR CASE REPORTS 2018; 10:32-34. [PMID: 29977792 PMCID: PMC6030028 DOI: 10.1016/j.ebcr.2018.02.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Revised: 02/04/2018] [Accepted: 02/12/2018] [Indexed: 11/26/2022]
Abstract
A 15-year-old boy experienced myoclonic seizures for 3 years. He initially had occasional myoclonus, gradually progressive ataxia, tremors, and psychomotor and speech regression developed. Eventually, he exhibited nearly continuous myoclonus. He received treatment of sodium valproate, levetiracetam, clobazam, and phenobarbital, without efficacy. A ketogenic diet also proved ineffective. Adjunctive therapy with 4 mg/day of perampanel was started and was gradually titrated to 10 mg/day. The remission of myoclonic seizures was achieved within one month. The patient's neurological and cognitive functions improved to a certain degree during the following 20 months. Sialidosis was confirmed by the mutations of NEU1 gene. A case of sialidosis I with compound mutations of c.544A > G and c.619C > T in NEU1 gene presented with drug-resistant seizures. Seizures associated with sialidosis eventually resolved on adjunctive perampanel therapy titrated to 10 mg/day. Our patient with sialidosis was drug-resistant to anti-seizure medication before responding to perampanel. Perampanel might be a potentially effective treatment for sialidosis in patients with Progressive Myoclonus Epilepsy.
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Affiliation(s)
- Su-Ching Hu
- Department of Pediatrics, Cathay General Hospital, Taipei, Taiwan
| | - Kun-Long Hung
- Department of Pediatrics, Cathay General Hospital, Taipei, Taiwan.,Department of Pediatrics, Fu-Jen Catholic University Hospital, New Taipei, Taiwan
| | - Hui-Ju Chen
- Department of Pediatrics, Cathay General Hospital, Taipei, Taiwan.,Department of Pediatric Neurology, Mackay Children's Hospital Taipei, Taiwan
| | - Wang-Tso Lee
- Department of Pediatric Neurology, National Taiwan University Children's Hospital Taipei, Taiwan
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Abstract
Juvenile myoclonic epilepsy (JME) is a sleep-related epilepsy syndrome, and only a few studies have addressed the relationship between JME and sleep disorders. In this review, the sleep characteristics of patients with JME were summarized based on the features of circadian rhythm, the possible cause of the early morning seizures, the common subjective and objective sleep disorders, the alterations in sleep architecture, and the effect of sleep deprivation and sodium valproate (VPA). The aims of this study were to summarize the interaction between JME and sleep, to reveal JME sleep characteristics, to encourage clinicians to focus on JME and sleep, to heighten the positive diagnosis rate, to guide the treatment, to improve the prognosis, and to enhance the daily life quality of patients with JME. At the same time, this study aimed to present existing controversies, in order to necessitate further studies.
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25
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Eberhardt O, Topka H. Myoclonic Disorders. Brain Sci 2017; 7:E103. [PMID: 28805718 PMCID: PMC5575623 DOI: 10.3390/brainsci7080103] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 08/06/2017] [Accepted: 08/08/2017] [Indexed: 01/17/2023] Open
Abstract
Few movement disorders seem to make a straightforward approach to diagnosis and treatment more difficult and frustrating than myoclonus, due to its plethora of causes and its variable classifications. Nevertheless, in recent years, exciting advances have been made in the elucidation of the pathophysiology and genetic basis of many disorders presenting with myoclonus. Here, we provide a review of all of the important types of myoclonus encountered in pediatric and adult neurology, with an emphasis on the recent developments that have led to a deeper understanding of this intriguing phenomenon. An up-to-date list of the genetic basis of all major myoclonic disorders is presented. Randomized studies are scarce in myoclonus therapy, but helpful pragmatic approaches at diagnosis as well as treatment have been recently suggested.
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Affiliation(s)
- Olaf Eberhardt
- Klinik für Neurologie, Klinikum Bogenhausen, Städt. Klinikum München GmbH, Englschalkinger Str. 77, 81925 München, Germany.
| | - Helge Topka
- Klinik für Neurologie, Klinikum Bogenhausen, Städt. Klinikum München GmbH, Englschalkinger Str. 77, 81925 München, Germany.
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26
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Hainque E, Blancher A, Mesnage V, Rivaud-Pechoux S, Bertrand A, Dupont S, Navarro V, Roze E, Gourfinkel-An I, Apartis E. A clinical and neurophysiological motor signature of Unverricht-Lundborg disease. Rev Neurol (Paris) 2017; 174:56-65. [PMID: 28688606 DOI: 10.1016/j.neurol.2017.06.005] [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: 10/20/2016] [Revised: 04/03/2017] [Accepted: 06/01/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Unverricht-Lundborg disease (ULD) is the most common form of progressive myoclonus epilepsy. Cerebellar dysfunction may appear over time, contributing along with myoclonus to motor disability. The purpose of the present work was to clarify the motor and neurophysiological characteristics of ULD patients. METHODS Nine patients with genetically proven ULD were evaluated clinically (medical history collected from patient charts, the Scale for the Assessment and Rating of Ataxia and Unified Myoclonus Rating Scale). Neurophysiological investigations included EEG, surface polymyography, long-loop C-reflexes, somatosensory evoked potentials, EEG jerk-locked back-averaging (JLBA) and oculomotor recordings. All patients underwent brain MRI. Non-parametric Mann-Whitney tests were used to compare ULD patients' oculomotor parameters with those of a matched group of healthy volunteers (HV). RESULTS Myoclonus was activated by action but was virtually absent at rest and poorly induced by stimuli. Positive myoclonus was multifocal, often rhythmic and of brief duration, with top-down pyramidal temporospatial propagation. Cortical neurophysiology revealed a transient wave preceding myoclonus on EEG JLBA (n=8), enlarged somatosensory evoked potentials (n=7) and positive long-loop C-reflexes at rest (n=5). Compared with HV, ULD patients demonstrated decreased saccadic gain, increased gain dispersion and a higher frequency of hypermetric saccades associated with decreased peak velocity. CONCLUSION A homogeneous motor pattern was delineated that may represent a ULD clinical and neurophysiological signature. Clinical and neurophysiological findings confirmed the pure cortical origin of the permanent myoclonus. Also, oculomotor findings shed new light on ULD pathophysiology by evidencing combined midbrain and cerebellar dysfunction.
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Affiliation(s)
- E Hainque
- Unité de neurophysiologie, département DéPAS, hôpital Saint-Antoine, AP-HP, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France; Inserm U1127, CNRS UMR7225, institut du cerveau et de la moelle épinière, ICM, Paris Sorbonne universités, UPMC, université de Paris 06, UMR S1127, 47, boulevard de l'hôpital, 75651 Paris cedex 13, France
| | - A Blancher
- Unité de neurophysiologie, département DéPAS, hôpital Saint-Antoine, AP-HP, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - V Mesnage
- Service de neurologie, hôpital Saint-Antoine, AP-HP, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - S Rivaud-Pechoux
- Inserm U1127, CNRS UMR7225, institut du cerveau et de la moelle épinière, ICM, Paris Sorbonne universités, UPMC, université de Paris 06, UMR S1127, 47, boulevard de l'hôpital, 75651 Paris cedex 13, France
| | - A Bertrand
- Inserm U1127, CNRS UMR7225, institut du cerveau et de la moelle épinière, ICM, Paris Sorbonne universités, UPMC, université de Paris 06, UMR S1127, 47, boulevard de l'hôpital, 75651 Paris cedex 13, France; Service de neuroradiologie diagnostique et fonctionnelle, hôpital Pitié-Salpêtrière, AP-HP, 47, boulevard de l'hôpital, 75651 Paris cedex 13, France
| | - S Dupont
- Unité d'épileptologie, neurologie 1, hôpital Pitié-Salpêtrière, AP-HP, Paris47, boulevard de l'hôpital, 75651 Paris cedex 13, France
| | - V Navarro
- Inserm U1127, CNRS UMR7225, institut du cerveau et de la moelle épinière, ICM, Paris Sorbonne universités, UPMC, université de Paris 06, UMR S1127, 47, boulevard de l'hôpital, 75651 Paris cedex 13, France; Unité d'épileptologie, neurologie 1, hôpital Pitié-Salpêtrière, AP-HP, Paris47, boulevard de l'hôpital, 75651 Paris cedex 13, France
| | - E Roze
- Inserm U1127, CNRS UMR7225, institut du cerveau et de la moelle épinière, ICM, Paris Sorbonne universités, UPMC, université de Paris 06, UMR S1127, 47, boulevard de l'hôpital, 75651 Paris cedex 13, France; Département de neurologie, hôpital Pitié-Salpêtrière, AP-HP, 47, boulevard de l'hôpital, 75651 Paris cedex 13, France
| | - I Gourfinkel-An
- Unité d'épileptologie, neurologie 1, hôpital Pitié-Salpêtrière, AP-HP, Paris47, boulevard de l'hôpital, 75651 Paris cedex 13, France; Centre de référence épilepsie rare, hôpital Pitié-Salpêtrière, AP-HP, Paris, France
| | - E Apartis
- Unité de neurophysiologie, département DéPAS, hôpital Saint-Antoine, AP-HP, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France; Inserm U1127, CNRS UMR7225, institut du cerveau et de la moelle épinière, ICM, Paris Sorbonne universités, UPMC, université de Paris 06, UMR S1127, 47, boulevard de l'hôpital, 75651 Paris cedex 13, France.
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Casciato S, Gambardella S, Mascia A, Quarato PP, D'Aniello A, Ackurina Y, Albano V, Fornai F, Scala S, Di Gennaro G. Severe and rapidly-progressive Lafora disease associated with NHLRC1 mutation: a case report. Int J Neurosci 2017; 127:1150-1153. [DOI: 10.1080/00207454.2017.1337012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | | | | | | | | | - Yana Ackurina
- Functional Diagnostic Department, Kazakh-Russian Medical National University, Almaty, Kazakhstan
| | | | - Francesco Fornai
- IRCCS “NEUROMED”, Pozzilli (IS), Italy
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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28
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Magrinelli F, Pezzini F, Moro F, Santorelli FM, Simonati A. Diagnostic methods and emerging treatments for adult neuronal ceroid lipofuscinoses (Kufs disease). Expert Opin Orphan Drugs 2017. [DOI: 10.1080/21678707.2017.1325359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Francesca Magrinelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Francesco Pezzini
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Francesca Moro
- Molecular Medicine and Neurogenetics Unit, IRCCS Stella Maris, Pisa, Italy
| | | | - Alessandro Simonati
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Neurophysiological and BOLD signal uncoupling of giant somatosensory evoked potentials in progressive myoclonic epilepsy: a case-series study. Sci Rep 2017; 7:44664. [PMID: 28294187 PMCID: PMC5353703 DOI: 10.1038/srep44664] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 02/13/2017] [Indexed: 01/27/2023] Open
Abstract
In progressive myoclonic epilepsy (PME), a rare epileptic syndrome caused by a variety of genetic disorders, the combination of peripheral stimulation and functional magnetic resonance imaging (fMRI) can shed light on the mechanisms underlying cortical dysfunction. The aim of the study is to investigate sensorimotor network modifications in PME by assessing the relationship between neurophysiological findings and blood oxygen level dependent (BOLD) activation. Somatosensory-evoked potential (SSEP) obtained briefly before fMRI and BOLD activation during median-nerve electrical stimulation were recorded in four subjects with typical PME phenotype and compared with normative data. Giant scalp SSEPs with enlarger N20-P25 complex compared to normal data (mean amplitude of 26.2 ± 8.2 μV after right stimulation and 27.9 ± 3.7 μV after left stimulation) were detected. Statistical group analysis showed a reduced BOLD activation in response to median nerve stimulation in PMEs compared to controls over the sensorimotor (SM) areas and an increased response over subcortical regions (p < 0.01, Z > 2.3, corrected). PMEs show dissociation between neurophysiological and BOLD findings of SSEPs (giant SSEP with reduced BOLD activation over SM). A direct pathway connecting a highly restricted area of the somatosensory cortex with the thalamus can be hypothesized to support the higher excitability of these areas.
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30
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van Egmond ME, Weijenberg A, van Rijn ME, Elting JWJ, Gelauff JM, Zutt R, Sival DA, Lambrechts RA, Tijssen MAJ, Brouwer OF, de Koning TJ. The efficacy of the modified Atkins diet in North Sea Progressive Myoclonus Epilepsy: an observational prospective open-label study. Orphanet J Rare Dis 2017; 12:45. [PMID: 28264719 PMCID: PMC5340041 DOI: 10.1186/s13023-017-0595-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 02/21/2017] [Indexed: 01/01/2023] Open
Abstract
Background North Sea Progressive Myoclonus Epilepsy is a rare and severe disorder caused by mutations in the GOSR2 gene. It is clinically characterized by progressive myoclonus, seizures, early-onset ataxia and areflexia. As in other progressive myoclonus epilepsies, the efficacy of antiepileptic drugs is disappointingly limited in North Sea Progressive Myoclonus Epilepsy. The ketogenic diet and the less restrictive modified Atkins diet have been proven to be effective in other drug-resistant epilepsy syndromes, including those with myoclonic seizures. Our aim was to evaluate the efficacy of the modified Atkins diet in patients with North Sea Progressive Myoclonus Epilepsy. Results Four North Sea Progressive Myoclonus Epilepsy patients (aged 7–20 years) participated in an observational, prospective, open-label study on the efficacy of the modified Atkins diet. Several clinical parameters were assessed at baseline and again after participants had been on the diet for 3 months. The primary outcome measure was health-related quality of life, with seizure frequency and blinded rated myoclonus severity as secondary outcome measures. Ketosis was achieved within 2 weeks and all patients completed the 3 months on the modified Atkins diet. The diet was well tolerated by all four patients. Health-related quality of life improved considerably in one patient and showed sustained improvement during long-term follow-up, despite the progressive nature of the disorder. Health-related quality of life remained broadly unchanged in the other three patients and they did not continue the diet. Seizure frequency remained stable and blinded rating of their myoclonus showed improvement, albeit modest, in all patients. Conclusions This observational, prospective study shows that some North Sea Progressive Myoclonus Epilepsy patients may benefit from the modified Atkins diet with sustained health-related quality of life improvement. Not all our patients continued on the diet, but nonetheless we show that the modified Atkins diet might be considered as a possible treatment in this devastating disorder.
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Affiliation(s)
- Martje E van Egmond
- Department of Neurology, University Medical Centre Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands.,Department of Neurology, Ommelander Ziekenhuis Groningen, PO Box 30.000, 9670 RA, Winschoten, The Netherlands
| | - Amerins Weijenberg
- Department of Neurology, University Medical Centre Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Margreet E van Rijn
- Department of Paediatrics, University Medical Centre Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Jan Willem J Elting
- Department of Neurology, University Medical Centre Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Jeannette M Gelauff
- Department of Neurology, University Medical Centre Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Rodi Zutt
- Department of Neurology, University Medical Centre Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Deborah A Sival
- Department of Paediatrics, University Medical Centre Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Roald A Lambrechts
- Department of Neurology, University Medical Centre Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Marina A J Tijssen
- Department of Neurology, University Medical Centre Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Oebele F Brouwer
- Department of Neurology, University Medical Centre Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Tom J de Koning
- Department of Paediatrics, University Medical Centre Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands. .,Department of Genetics, University Medical Centre Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands.
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Moen MN, Fjær R, Hamdani EH, Laerdahl JK, Menchini RJ, Vigeland MD, Sheng Y, Undlien DE, Hassel B, Salih MA, El Khashab HY, Selmer KK, Chaudhry FA. Pathogenic variants in KCTD7 perturb neuronal K+ fluxes and glutamine transport. Brain 2016; 139:3109-3120. [PMID: 27742667 DOI: 10.1093/brain/aww244] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 06/11/2016] [Accepted: 08/17/2016] [Indexed: 12/11/2022] Open
Abstract
Progressive myoclonus epilepsy is a heterogeneous group of disorders characterized by myoclonic and tonic-clonic seizures, ataxia and cognitive decline. We here present two affected brothers. At 9 months of age the elder brother developed ataxia and myoclonic jerks. In his second year he lost the ability to walk and talk, and he developed drug-resistant progressive myoclonus epilepsy. The cerebrospinal fluid level of glutamate was decreased while glutamine was increased. His younger brother manifested similar symptoms from 6 months of age. By exome sequencing of the proband we identified a novel homozygous frameshift variant in the potassium channel tetramerization domain 7 (KCTD7) gene (NM_153033.1:c.696delT: p.F232fs), which results in a truncated protein. The identified F232fs variant is inherited in an autosomal recessive manner, and the healthy consanguineous parents carry the variant in a heterozygous state. Bioinformatic analyses and structure modelling showed that KCTD7 is a highly conserved protein, structurally similar to KCTD5 and several voltage-gated potassium channels, and that it may form homo- or heteromultimers. By heterologous expression in Xenopus laevis oocytes, we demonstrate that wild-type KCTD7 hyperpolarizes cells in a K+ dependent manner and regulates activity of the neuronal glutamine transporter SAT2 (Slc38a2), while the F232fs variant impairs K+ fluxes and obliterates SAT2-dependent glutamine transport. Characterization of four additional disease-causing variants (R94W, R184C, N273I, Y276C) bolster these results and reveal the molecular mechanisms involved in the pathophysiology of KCTD7-related progressive myoclonus epilepsy. Thus, our data demonstrate that KCTD7 has an impact on K+ fluxes, neurotransmitter synthesis and neuronal function, and that malfunction of the encoded protein may lead to progressive myoclonus epilepsy.
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Affiliation(s)
- Marivi Nabong Moen
- 1 The Institute of Basic Medical Sciences, Department of Molecular Medicine, University of Oslo, Oslo, Norway
| | - Roar Fjær
- 2 Department of Medical Genetics, Oslo University Hospital and University of Oslo, Norway
| | - El Hassan Hamdani
- 1 The Institute of Basic Medical Sciences, Department of Molecular Medicine, University of Oslo, Oslo, Norway.,3 Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - Jon K Laerdahl
- 4 Department of Microbiology, Oslo University Hospital, Oslo, Norway.,5 Bioinformatics Core Facility, Department of Informatics, University of Oslo, Oslo, Norway
| | - Robin Johansen Menchini
- 1 The Institute of Basic Medical Sciences, Department of Molecular Medicine, University of Oslo, Oslo, Norway
| | - Magnus Dehli Vigeland
- 2 Department of Medical Genetics, Oslo University Hospital and University of Oslo, Norway
| | - Ying Sheng
- 2 Department of Medical Genetics, Oslo University Hospital and University of Oslo, Norway
| | - Dag Erik Undlien
- 2 Department of Medical Genetics, Oslo University Hospital and University of Oslo, Norway
| | - Bjørnar Hassel
- 6 Department of Complex Neurology and Neurohabilitation, Oslo University Hospital, Oslo, Norway
| | - Mustafa A Salih
- 7 Division of Paediatric Neurology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Heba Y El Khashab
- 7 Division of Paediatric Neurology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,8 Department of Paediatrics, Ain Shams University, Cairo, Egypt
| | - Kaja Kristine Selmer
- 2 Department of Medical Genetics, Oslo University Hospital and University of Oslo, Norway.,9 National Centre for Rare Epilepsy-related Disorders, Oslo University Hospital, Oslo, Norway
| | - Farrukh Abbas Chaudhry
- 1 The Institute of Basic Medical Sciences, Department of Molecular Medicine, University of Oslo, Oslo, Norway .,3 Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
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32
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Anderson DG, Németh AH, Fawcett KA, Sims D, Miller J, Krause A. Deep Brain Stimulation in Three Related Cases of North Sea Progressive Myoclonic Epilepsy from South Africa. Mov Disord Clin Pract 2016; 4:249-253. [PMID: 30838261 DOI: 10.1002/mdc3.12372] [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: 12/05/2015] [Revised: 04/01/2016] [Accepted: 04/10/2016] [Indexed: 11/12/2022] Open
Abstract
We report on a white Afrikaans family from eastern South Africa with three members affected with North Sea progressive myoclonus epilepsy, resulting from a homozygous founder GOSR2 mutation (c.430G>T, p.Gly144Trp). The mutation was identified by exomic sequencing in a research study investigating childhood onset ataxias. All three subjects presented with ataxia, tremor, early gait difficulties, and myoclonic and generalized tonic clonic (GTC) epilepsy. Each patient underwent deep brain stimulation of the caudal Zona Incerta before coming to the attention of the authors. In each case there was a reduction in GTC seizures, and two patients exhibited a reduction in involuntary movements, as evaluated during long-term follow-up. In one case there was an improvement in gait and stance when assessed while the stimulation was on.
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Affiliation(s)
- David G Anderson
- Department of Neurology University of the Witwatersrand Donald Gordon Medical Centre Johannesburg South Africa.,Division of Human Genetics School of Pathology Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa
| | - Andrea H Németh
- Nuffield Department of Clinical Neurosciences University of Oxford Oxford United Kingdom
| | - Katherine A Fawcett
- CGAT Department of Physiology, Anatomy and Genetics University of Oxford Oxford United Kingdom
| | - David Sims
- CGAT Department of Physiology, Anatomy and Genetics University of Oxford Oxford United Kingdom
| | - Jack Miller
- CGAT Department of Physiology, Anatomy and Genetics University of Oxford Oxford United Kingdom
| | - Amanda Krause
- Division of Human Genetics School of Pathology Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa.,Division of Human Genetics National Health Laboratory Service Johannesburg South Africa
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Shbarou R, Mikati MA. The Expanding Clinical Spectrum of Genetic Pediatric Epileptic Encephalopathies. Semin Pediatr Neurol 2016; 23:134-42. [PMID: 27544470 DOI: 10.1016/j.spen.2016.06.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Pediatric epileptic encephalopathies represent a clinically challenging and often devastating group of disorders that affect children at different stages of infancy and childhood. With the advances in genetic testing and neuroimaging, the etiologies of these epileptic syndromes are now better defined. The various encephalopathies that are reviewed in this article include the following: early infantile epileptic encephalopathy or Ohtahara syndrome, early myoclonic encephalopathy, epilepsy of infancy with migrating focal seizures, West syndrome, severe myoclonic epilepsy in infancy (Dravet syndrome), Landau-Kleffner syndrome, Lennox-Gastaut syndrome, and epileptic encephalopathy with continuous spike-and-wave during sleep. Their clinical features, prognosis as well as underlying genetic etiologies are presented and updated.
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Affiliation(s)
- Rolla Shbarou
- Department of Pediatrics and Adolescent Medicine, American University of Beirut, Lebanon
| | - Mohamad A Mikati
- Division of Pediatric Neurology, Children's Health Center, Duke University Medical Center, Durham, NC.
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