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Judy RL, Reynolds JL, Jnah AJ. Identifying Metabolic Diseases That Precipitate Neonatal Seizures. Neonatal Netw 2024; 43:139-147. [PMID: 38816225 DOI: 10.1891/nn-2023-0048] [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] [Indexed: 06/01/2024]
Abstract
Although a rare cause of neonatal seizures, inborn errors of metabolism (IEMs) remain an essential component of a comprehensive differential diagnosis for poorly controlled neonatal epilepsy. Diagnosing neonatal-onset metabolic conditions proves a difficult task for clinicians; however, routine state newborn screening panels now include many IEMs. Three in particular-pyridoxine-dependent epilepsy, maple syrup urine disease, and Zellweger spectrum disorders-are highly associated with neonatal epilepsy and neurocognitive injury yet are often misdiagnosed. As research surrounding biomarkers for these conditions is emerging and gene sequencing technologies are advancing, clinicians are beginning to better establish early identification strategies for these diseases. In this literature review, the authors aim to present clinicians with an innovative clinical guide highlighting IEMs associated with neonatal-onset seizures, with the goal of promoting quality care and safety.
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Huisman LM, Huisman TAGM. World-Renowned "Swiss" Pediatricians, Their Syndromes, and Matching Imaging Findings: A Historical Perspective. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1668. [PMID: 37892331 PMCID: PMC10605885 DOI: 10.3390/children10101668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/03/2023] [Accepted: 10/06/2023] [Indexed: 10/29/2023]
Abstract
The goal of this manuscript is to present and summarize several rare pediatric syndromes (Zellweger syndrome, Kartagener syndrome, Prader-Willi syndrome, Schinzel-Giedion syndrome, Fanconi anemia, Joubert-Boltshauser syndrome, Poretti-Boltshauser syndrome, and Langer-Giedion syndrome) who have been named after luminary "Swiss" physicians (pediatricians, pediatric neurologists, or pediatric radiologists) who recognized, studied, and published these syndromes. In this manuscript, a brief historical summary of the physicians is combined with the key clinical symptoms at presentation and the typical imaging findings. This manuscript is not aiming to give a complete comprehensive summary of the syndromes, nor does it ignore the valuable contributions of many "Swiss" scientists who are not included here, but focuses on several rare syndromes that benefit from imaging data.
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Affiliation(s)
- Laura M. Huisman
- Edward B. Singleton Department of Radiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX 77030, USA;
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Characterization of Severity in Zellweger Spectrum Disorder by Clinical Findings: A Scoping Review, Meta-Analysis and Medical Chart Review. Cells 2022; 11:cells11121891. [PMID: 35741019 PMCID: PMC9221082 DOI: 10.3390/cells11121891] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/05/2022] [Accepted: 06/06/2022] [Indexed: 02/04/2023] Open
Abstract
Zellweger spectrum disorder (ZSD) is a rare, debilitating genetic disorder of peroxisome biogenesis that affects multiple organ systems and presents with broad clinical heterogeneity. Although severe, intermediate, and mild forms of ZSD have been described, these designations are often arbitrary, presenting difficulty in understanding individual prognosis and treatment effectiveness. The purpose of this study is to conduct a scoping review and meta-analysis of existing literature and a medical chart review to determine if characterization of clinical findings can predict severity in ZSD. Our PubMed search for articles describing severity, clinical findings, and survival in ZSD resulted in 107 studies (representing 307 patients) that were included in the review and meta-analysis. We also collected and analyzed these same parameters from medical records of 136 ZSD individuals from our natural history study. Common clinical findings that were significantly different across severity categories included seizures, hypotonia, reduced mobility, feeding difficulties, renal cysts, adrenal insufficiency, hearing and vision loss, and a shortened lifespan. Our primary data analysis also revealed significant differences across severity categories in failure to thrive, gastroesophageal reflux, bone fractures, global developmental delay, verbal communication difficulties, and cardiac abnormalities. Univariable multinomial logistic modeling analysis of clinical findings and very long chain fatty acid (VLCFA) hexacosanoic acid (C26:0) levels showed that the number of clinical findings present among seizures, abnormal EEG, renal cysts, and cardiac abnormalities, as well as plasma C26:0 fatty acid levels could differentiate severity categories. We report the largest characterization of clinical findings in relation to overall disease severity in ZSD. This information will be useful in determining appropriate outcomes for specific subjects in clinical trials for ZSD.
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Diaz J, Matsumoto L, Kucera Neville J. Prenatal diagnosis of zellweger syndrome by fetal MRI: a case report. Radiol Case Rep 2021; 16:3950-3954. [PMID: 34712375 PMCID: PMC8531463 DOI: 10.1016/j.radcr.2021.09.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 09/20/2021] [Indexed: 11/27/2022] Open
Abstract
Zellweger Syndrome (ZS) is a rare peroxisomal disorder also referred to as cerebrohepatorenal syndrome. ZS is an autosomal recessive disease often manifesting in the neonatal period with profound dysfunction of the central nervous system, liver and kidneys. Prenatal diagnosis of this syndrome is infrequent with imaging findings on fetal MRI rarely illustrated in the literature. This case highlights the pivotal role fetal MRI can play in identifying subtle features of the disease that are difficult to visualize on prenatal ultrasound. It is important for pediatric radiologists to be familiar with the most common imaging features of ZS on fetal MRI to expedite the diagnosis and help facilitate appropriate prenatal counseling.
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Affiliation(s)
- Joana Diaz
- Department of Radiology, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, Tampa, FL STC 6102, USA
| | - Larry Matsumoto
- Department of Maternal Fetal Medicine, Sarasota Memorial Hospital, Sarasota, FL, USA
| | - Jennifer Kucera Neville
- Department of Radiology, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, Tampa, FL STC 6102, USA.,Department of Radiology, Johns Hopkins All Children's Hospital, University of South Florida, St. Petersburg, FL, USA
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Kashgari A. Neonate with classic Zellweger syndrome. INTERNATIONAL JOURNAL OF PEDIATRICS AND ADOLESCENT MEDICINE 2020; 6:165-166. [PMID: 31890844 PMCID: PMC6926218 DOI: 10.1016/j.ijpam.2019.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Kerr A, Patel PA, LaConte LEW, Liang C, Chen CK, Shah V, Fox MA, Mukherjee K. Non-Cell Autonomous Roles for CASK in Optic Nerve Hypoplasia. Invest Ophthalmol Vis Sci 2019; 60:3584-3594. [PMID: 31425583 PMCID: PMC6701874 DOI: 10.1167/iovs.19-27197] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Purpose Heterozygous mutations in the essential X-linked gene CASK associate with optic nerve hypoplasia (ONH) and other retinal disorders in girls. CASK+/− heterozygous knockout mice with mosaic CASK expression exhibit ONH with a loss of retinal ganglion cells (RGCs) but no changes in retinal morphology. It remains unclear if CASK deficiency selectively affects RGCs or also affects other retinal cells. Furthermore, it is not known if CASK expression in RGCs is critical for optic nerve (ON) development and maintenance. Methods The visual behavior of CASK+/− mice was assessed and electroretinography (ERG) was performed. Using a mouse line with a floxed CASK gene that expresses approximately 40% CASK globally in all cells (hypomorph) under hemizygous and homozygous conditions, we investigated effects of CASK reduction on the retina and ON. CASK then was completely deleted from RGCs to examine its cell-autonomous role. Finally, for the first time to our knowledge, we describe a hemizygous CASK missense mutation in a boy with ONH. Results CASK+/− heterozygous mutant mice display reduced visual contrast sensitivity, but ERG is indistinguishable from wildtype. CASK hypomorph mice exhibit ONH, but deletion of CASK from RGCs in this background does not exacerbate the condition. The boy with ONH harbors a missense mutation (p.Pro673Leu) that destabilizes CASK and weakens the crucial CASK–neurexin interaction. Conclusions Our results demonstrate that mosaic or global reduction in CASK expression and/or function disproportionately affects RGCs. CASK expression in RGCs does not appear critical for cell survival, indicating a noncell autonomous role for CASK in the development of ON.
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Affiliation(s)
- Alicia Kerr
- Center for Neurobiology Research, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, Virginia, United States.,Graduate Program in Translational Biology, Medicine, and Health, Virginia Tech, Blacksburg, Virginia, United States
| | - Paras A Patel
- Center for Neurobiology Research, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, Virginia, United States.,Graduate Program in Translational Biology, Medicine, and Health, Virginia Tech, Blacksburg, Virginia, United States
| | - Leslie E W LaConte
- Center for Neurobiology Research, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, Virginia, United States.,Department of Basic Science Education, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, United States
| | - Chen Liang
- Center for Neurobiology Research, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, Virginia, United States
| | - Ching-Kang Chen
- Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, United States
| | - Veeral Shah
- Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, United States.,Texas Children's Hospital, Houston, Texas, United States
| | - Michael A Fox
- Center for Neurobiology Research, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, Virginia, United States.,Department of Biological Sciences, Virginia Tech, Blacksburg, Virginia, United States.,Department of Pediatrics, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, United States
| | - Konark Mukherjee
- Center for Neurobiology Research, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, Virginia, United States.,Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, United States
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Mankad K, Talenti G, Tan AP, Gonçalves FG, Robles C, Kan EYL, Siddiqui A. Neurometabolic Disorders of the Newborn. Top Magn Reson Imaging 2018; 27:179-196. [PMID: 30086107 DOI: 10.1097/rmr.0000000000000176] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
There is an extensive and diverse set of medical conditions affecting the neonatal brain within the spectrum of neurometabolic disorders. As such, their clinical presentations can be rather nonspecific, and can often mimic acquired entities such as hypoxic-ischemic encephalopathy and sepsis. Similarly, the radiological findings in these entities can also be frequently nonspecific, but a more detailed analysis of imaging findings (especially magnetic resonance imaging) alongside the relevant clinical details can be a rewarding experience, thus enabling a timely and targeted diagnosis. Early diagnosis of an underlying neurometabolic disorder is vital, as some of these entities are potentially treatable, and laboratory and genetic testing can be precisely targeted. Further, their detection helps with counselling families for future pregnancies. We present a review of neurometabolic disorders specific to the newborns with a focus on how neuroimaging findings match their clinical presentation patterns.
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Affiliation(s)
- Kshitij Mankad
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | | | - Ai Peng Tan
- Department of Diagnostic Imaging, National University Health System, Singapore, Singapore
| | | | - Carlos Robles
- Department of Radiology, Hospital Clinico Universidad de Chile, Región Metropolitana, Chile
| | - Elaine Y L Kan
- Department of Radiology, Hong Kong Children's Hospital, Kai Tak, Hong Kong
| | - Ata Siddiqui
- Department of Neuroradiology, King's College Hospital, London, UK
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Quintas-Neves M, Carvalho R, Soares-Fernandes JP. Brain MRI in a newborn with Zellweger syndrome: ADC quantitation in white matter disease. Childs Nerv Syst 2018; 34:1103-1104. [PMID: 29619570 DOI: 10.1007/s00381-018-3791-0] [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] [Received: 03/01/2018] [Accepted: 03/28/2018] [Indexed: 10/17/2022]
Affiliation(s)
- Miguel Quintas-Neves
- Department of Neuroradiology, Hospital de Braga, Serviço de Imagiologia, 4710-243, Braga, Portugal.
| | - Raquel Carvalho
- Department of Neuroradiology, Hospital de Braga, Serviço de Imagiologia, 4710-243, Braga, Portugal
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Smitthimedhin A, Otero HJ. Scimitar-like ossification of patellae led to diagnosis of Zellweger syndrome in newborn: a case report. Clin Imaging 2018; 49:128-130. [PMID: 29414506 DOI: 10.1016/j.clinimag.2018.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 01/04/2018] [Accepted: 01/16/2018] [Indexed: 10/18/2022]
Abstract
Zellweger syndrome is the most severe form of a group of autosomal recessive disorders with defective peroxisomes. We report a case of Zellweger syndrome in a newborn baby, which was first suspected by the presence of scimitar-like patella seen on skeletal survey. The subsequent brain MRI showed germinolytic cysts and polymicrogyria, which furthered the suspicion. Laboratory and genetic results confirmed the diagnosis. To date, there are a limited number of case reports of this rare disease. We emphasize skeletal findings that can lead to targeted genetic and laboratory testing and hence earlier diagnosis.
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Affiliation(s)
- Anilawan Smitthimedhin
- Children's National Health System, 111 Michigan avenue NW, Washington, D.C. 20010, United States.
| | - Hansel J Otero
- Children's National Health System, 111 Michigan avenue NW, Washington, D.C. 20010, United States
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