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Ghosh S, Lien IG, Martinez K, Lin T, Bleiweis MS, Philip J, Jordan LC, Pavlakis SG. Prevalence and Risk Factors for Cerebral Palsy in Children With Congenital Heart Disease Based on Risk of Surgical Mortality. Pediatr Neurol 2024; 155:133-140. [PMID: 38640862 DOI: 10.1016/j.pediatrneurol.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 12/20/2023] [Accepted: 02/26/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND Children with congenital heart disease (CHD) have a higher prevalence of motor impairment secondary to brain injury, resulting in cerebral palsy (CP). The purpose of this study is to determine the prevalence of CP in CHD in a single-center cohort, stratify risk based on surgical mortality using Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) categories and identify risk factors. METHODS Retrospective cohort study of pediatric patients registered in the University of Florida (UF) Society of Thoracic Surgeons Congenital Heart Surgery database from 2006 to 2017 with a diagnosis of CHD who continued follow-up for more than two years at UF. RESULTS A total of 701 children with CHD met inclusion criteria. Children identified to have CP were 54 (7.7%). Most common presentation was spastic hemiplegic CP with a Gross Motor Function Classification System of level 2. Analysis of surgical and intensive care factors between the two groups showed that children with CHD and CP had longer time from admission to surgery (P = 0.003), higher STAT categories 4 and 5 (P = 0.038), and higher frequency of brain injury and seizures (P < 0.001). Developmental disabilities and rehabilitation needs were significantly greater for children with CHD and CP when compared with those with CHD alone (P < 0.001). CONCLUSIONS In our cohort, 7.7% children with CHD develop CP; this is significantly higher than the 2010 US population estimate of 0.3%. Our study suggests higher STAT categories, brain injury, and seizures are associated with developing CP in children with CHD.
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Affiliation(s)
- Suman Ghosh
- State University of New York at Downstate Health Sciences University, Brooklyn, New York; Department of Neurology, New York City Health and Hospitals Corporation Kings County Hospital, Brooklyn, New York.
| | - Ing Grace Lien
- Department of Neurology, University of Florida, Gainesville, Florida
| | - Kerstin Martinez
- Herbert Wertheim College of Engineering, University of Florida, Gainesville, Florida
| | - Tracy Lin
- College of Liberal Arts and Sciences, University of Florida, Gainesville, Florida
| | - Mark S Bleiweis
- University of Florida Health Congenital Heart Center, Gainesville, Florida
| | - Joseph Philip
- University of Florida Health Congenital Heart Center, Gainesville, Florida
| | - Lori C Jordan
- Division of Pediatric Neurology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Steven G Pavlakis
- State University of New York at Downstate Health Sciences University, Brooklyn, New York; Department of Neurology, New York City Health and Hospitals Corporation Kings County Hospital, Brooklyn, New York
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Srivastava S, Koh HY, Smith L, Poduri A. Cerebral Palsy Phenotypes in Genetic Epilepsies. Pediatr Neurol 2024; 157:79-86. [PMID: 38901369 DOI: 10.1016/j.pediatrneurol.2024.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 03/03/2024] [Accepted: 05/26/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Although there are established connections between genetic epilepsies and neurodevelopmental disorders like intellectual disability, the presence of cerebral palsy (CP) in genetic epilepsies is undercharacterized. We performed a retrospective chart review evaluating the motor phenotype of patients with genetic epilepsies. METHODS Patients were ascertained through a research exome sequencing study to identify genetic causes of epilepsy. We analyzed data from the first 100 individuals with molecular diagnoses. We determined motor phenotype by reviewing medical records for muscle tone and motor function data. We characterized patients according to CP subtypes: spastic diplegic, spastic quadriplegic, spastic hemiplegic, dyskinetic, hypotonic-ataxic. RESULTS Of 100 individuals with genetic epilepsies, 14% had evidence of possible CP, including 5% characterized as hypotonic-ataxic CP, 5% spastic quadriplegic CP, 3% spastic diplegic CP, and 1% hemiplegic CP. Presence of CP did not correlate with seizure onset age (P = 0.63) or seizure control (P = 0.07). CP occurred in 11% (n = 3 of 27) with focal epilepsy, 9% (n = 5 of 54) with generalized epilepsy, and 32% (n = 6 of 19) with combined focal/generalized epilepsy (P = 0.06). CONCLUSIONS In this retrospective analysis of patients with genetic epilepsies, we identified a substantial portion with CP phenotypes, representing an under-recognized comorbidity. These findings underscore the many neurodevelopmental features associated with neurogenetic conditions, regardless of the feature for which they were ascertained for sequencing. Detailed motor phenotyping is needed to determine the prevalence of CP and its subtypes among genetic epilepsies. These motor phenotypes require clinical management and represent important targeted outcomes in trials for patients with genetic epilepsies.
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Affiliation(s)
- Siddharth Srivastava
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Neurology, Rosamund Stone Zander Translational Neuroscience Center, Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts; Cerebral Palsy and Spasticity Center, Boston Children's Hospital, Boston, Massachusetts
| | - Hyun Yong Koh
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Neurogenetics Program and Epilepsy Genetics Program, Boston Children's Hospital, Boston, Massachusetts
| | - Lacey Smith
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Neurogenetics Program and Epilepsy Genetics Program, Boston Children's Hospital, Boston, Massachusetts
| | - Annapurna Poduri
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Neurology, Rosamund Stone Zander Translational Neuroscience Center, Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts; Neurogenetics Program and Epilepsy Genetics Program, Boston Children's Hospital, Boston, Massachusetts.
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Ramírez-Barragán A, Galán-Olleros M, Egea-Gámez RM, Palazón-Quevedo A, Martínez-Caballero I. Severe rigid hip flexion-abduction contracture in cerebral palsy: a case report and review of the literature. ACTA ORTOPEDICA MEXICANA 2024; 38:197-201. [PMID: 38862151 DOI: 10.35366/115816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
INTRODUCTION severe, rigid hip abduction deformity in individuals with cerebral palsy (CP) is an exceptionally uncommon condition. This posture hinders the positioning in the wheelchair and the completion of basic activities of daily living (ADL). Addressing such severe deformities can be quite challenging. MATERIAL AND METHODS a 14-year-old male, with spastic-dystonic quadriplegic CP, developed rigid and severe flexion-abduction contractures in both hips, characterized by 90 degrees of flexion and 100 degrees of abduction. These contractures severely impeded his ability to comfortably use a wheelchair and even pass through doorways. Performing basic ADLs became a significant challenge for both the patient and his caregivers. RESULTS the treatment approach involved a two-stage surgical procedure, one for each hip, with a two-month interval between them. An extensive release of the fascia latae, gluteus maximus, external rotators, and hip flexors; in combination with a proximal femur osteotomy were performed. To maintain the corrections achieved, long-leg casts connected with two bars were employed, followed by orthotic support and physiotherapy. Following the procedure, lower limb adduction was achieved, and the patient and caregivers were highly satisfied, as ADLs and basic caregiving had been greatly facilitated. CONCLUSIONS while the available literature on the management of severe rigid abduction hip contractures in non-ambulatory CP patients is limited, and treatment options are often complex, the present case underscores the effectiveness of a comprehensive approach involving soft tissue release and bone surgery. Achieving a more favorable wheelchair positioning and facilitating basic ADLs and care represents a significant success for patients and families.
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Affiliation(s)
- A Ramírez-Barragán
- Orthopaedic Surgery and Traumatology Department. Hospital Infantil Universitario Niño Jesús. Madrid, España
| | - M Galán-Olleros
- Orthopaedic Surgery and Traumatology Department. Hospital Infantil Universitario Niño Jesús. Madrid, España
| | - R M Egea-Gámez
- Orthopaedic Surgery and Traumatology Department. Hospital Infantil Universitario Niño Jesús. Madrid, España
| | - A Palazón-Quevedo
- Orthopaedic Surgery and Traumatology Department. Hospital Infantil Universitario Niño Jesús. Madrid, España
| | - I Martínez-Caballero
- Orthopaedic Surgery and Traumatology Department. Hospital Infantil Universitario Niño Jesús. Madrid, España
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Bekteshi S. Navigating the complexity of 18 motor disorder combinations in cerebral palsy. Dev Med Child Neurol 2024; 66:274-275. [PMID: 37658665 DOI: 10.1111/dmcn.15749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 08/17/2023] [Indexed: 09/03/2023]
Abstract
This commentary is on the original article by Dar et al. on pages 317–325 of this issue.
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Affiliation(s)
- Saranda Bekteshi
- Department of Rehabilitation Sciences, KU Leuven, Bruges, Belgium
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Kahlon S, Barton CR, Abu Libdeh A, O'Malley JA, Pearson T, Waugh JL, Wu SW, Zea Vera AG, Kruer MC. Emerging Subspecialties: Pediatric Movement Disorders Neurology. Neurology 2024; 102:e208050. [PMID: 38165345 DOI: 10.1212/wnl.0000000000208050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Pediatric movement disorders (PMD) neurologists care for infants, children, and adolescents with conditions that disrupt typical movement; serving as important subspecialist child neurologists in both academic and private practice settings. In contrast to adult movement disorders neurologists whose "bread and butter" is hypokinetic Parkinson disease, PMD subspecialty practice is often dominated by hyperkinetic movement disorders including tics, dystonia, chorea, tremor, and myoclonus. PMD neurology practice intersects with a variety of subspecialties, including neonatology, developmental pediatrics, rehabilitation medicine, epilepsy, child & adolescent psychiatry, psychology, orthopedics, genetics & metabolism, and neurosurgery. Over the past several decades, significant advancements in the PMD field have included operationalizing definitions for distinct movement disorders, recognizing the spectrum of clinical phenotypes, expanding research on genetic and neuroimmunologic causes of movement disorders, and advancing available treatments. Subspecialty training in PMD provides trainees with advanced clinical, diagnostic, procedural, and management skills that reflect the complexities of contemporary practice. The child neurologist who is fascinated by the intricacies of child motor development, appreciates the power of observation skills coupled with a thoughtful physical examination, and is excited by the challenge of the unknown may be well-suited to a career as a PMD specialist.
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Affiliation(s)
- Simran Kahlon
- From the Pediatric Movement Disorders Program (M.C.K.), Division of Neurology (S.K.), Barrow Neurological Institute, Phoenix Children's Hospital, AZ; Division of Neurology (C.R.B.), Norton Children's Hospital, University of Louisville, KY; Department of Pediatrics (A.A.L.), Al-Balqa Applied University, Salt, Jordan; Department of Neurology (A.A.L.), University of Virginia, Charlottesville; Department of Neurology (J.A.O.M.), Stanford University School of Medicine, Palo Alto, CA; Division of Neurology (T.P.), Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH; Division of Pediatric Neurology (J.L.W.), Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX; Division of Neurology (S.W.W.), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH; Department of Neurology (A.G.Z.V.), Children's National Hospital; Department of Neurology and Pediatrics (A.G.Z.V.), George Washington University School of Medicine & Health Sciences, Washington, DC; Department of Child Health, Genetics, Neurology, and Cellular and Molecular Medicine (M.C.K.), University of Arizona College of Medicine, Phoenix, AZ; and Programs in Biomedical Informatics, Molecular & Cellular Biology and Neuroscience (M.C.K.), Arizona State University
| | - Christopher R Barton
- From the Pediatric Movement Disorders Program (M.C.K.), Division of Neurology (S.K.), Barrow Neurological Institute, Phoenix Children's Hospital, AZ; Division of Neurology (C.R.B.), Norton Children's Hospital, University of Louisville, KY; Department of Pediatrics (A.A.L.), Al-Balqa Applied University, Salt, Jordan; Department of Neurology (A.A.L.), University of Virginia, Charlottesville; Department of Neurology (J.A.O.M.), Stanford University School of Medicine, Palo Alto, CA; Division of Neurology (T.P.), Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH; Division of Pediatric Neurology (J.L.W.), Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX; Division of Neurology (S.W.W.), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH; Department of Neurology (A.G.Z.V.), Children's National Hospital; Department of Neurology and Pediatrics (A.G.Z.V.), George Washington University School of Medicine & Health Sciences, Washington, DC; Department of Child Health, Genetics, Neurology, and Cellular and Molecular Medicine (M.C.K.), University of Arizona College of Medicine, Phoenix, AZ; and Programs in Biomedical Informatics, Molecular & Cellular Biology and Neuroscience (M.C.K.), Arizona State University
| | - Amal Abu Libdeh
- From the Pediatric Movement Disorders Program (M.C.K.), Division of Neurology (S.K.), Barrow Neurological Institute, Phoenix Children's Hospital, AZ; Division of Neurology (C.R.B.), Norton Children's Hospital, University of Louisville, KY; Department of Pediatrics (A.A.L.), Al-Balqa Applied University, Salt, Jordan; Department of Neurology (A.A.L.), University of Virginia, Charlottesville; Department of Neurology (J.A.O.M.), Stanford University School of Medicine, Palo Alto, CA; Division of Neurology (T.P.), Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH; Division of Pediatric Neurology (J.L.W.), Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX; Division of Neurology (S.W.W.), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH; Department of Neurology (A.G.Z.V.), Children's National Hospital; Department of Neurology and Pediatrics (A.G.Z.V.), George Washington University School of Medicine & Health Sciences, Washington, DC; Department of Child Health, Genetics, Neurology, and Cellular and Molecular Medicine (M.C.K.), University of Arizona College of Medicine, Phoenix, AZ; and Programs in Biomedical Informatics, Molecular & Cellular Biology and Neuroscience (M.C.K.), Arizona State University
| | - Jennifer A O'Malley
- From the Pediatric Movement Disorders Program (M.C.K.), Division of Neurology (S.K.), Barrow Neurological Institute, Phoenix Children's Hospital, AZ; Division of Neurology (C.R.B.), Norton Children's Hospital, University of Louisville, KY; Department of Pediatrics (A.A.L.), Al-Balqa Applied University, Salt, Jordan; Department of Neurology (A.A.L.), University of Virginia, Charlottesville; Department of Neurology (J.A.O.M.), Stanford University School of Medicine, Palo Alto, CA; Division of Neurology (T.P.), Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH; Division of Pediatric Neurology (J.L.W.), Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX; Division of Neurology (S.W.W.), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH; Department of Neurology (A.G.Z.V.), Children's National Hospital; Department of Neurology and Pediatrics (A.G.Z.V.), George Washington University School of Medicine & Health Sciences, Washington, DC; Department of Child Health, Genetics, Neurology, and Cellular and Molecular Medicine (M.C.K.), University of Arizona College of Medicine, Phoenix, AZ; and Programs in Biomedical Informatics, Molecular & Cellular Biology and Neuroscience (M.C.K.), Arizona State University
| | - Toni Pearson
- From the Pediatric Movement Disorders Program (M.C.K.), Division of Neurology (S.K.), Barrow Neurological Institute, Phoenix Children's Hospital, AZ; Division of Neurology (C.R.B.), Norton Children's Hospital, University of Louisville, KY; Department of Pediatrics (A.A.L.), Al-Balqa Applied University, Salt, Jordan; Department of Neurology (A.A.L.), University of Virginia, Charlottesville; Department of Neurology (J.A.O.M.), Stanford University School of Medicine, Palo Alto, CA; Division of Neurology (T.P.), Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH; Division of Pediatric Neurology (J.L.W.), Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX; Division of Neurology (S.W.W.), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH; Department of Neurology (A.G.Z.V.), Children's National Hospital; Department of Neurology and Pediatrics (A.G.Z.V.), George Washington University School of Medicine & Health Sciences, Washington, DC; Department of Child Health, Genetics, Neurology, and Cellular and Molecular Medicine (M.C.K.), University of Arizona College of Medicine, Phoenix, AZ; and Programs in Biomedical Informatics, Molecular & Cellular Biology and Neuroscience (M.C.K.), Arizona State University
| | - Jeff L Waugh
- From the Pediatric Movement Disorders Program (M.C.K.), Division of Neurology (S.K.), Barrow Neurological Institute, Phoenix Children's Hospital, AZ; Division of Neurology (C.R.B.), Norton Children's Hospital, University of Louisville, KY; Department of Pediatrics (A.A.L.), Al-Balqa Applied University, Salt, Jordan; Department of Neurology (A.A.L.), University of Virginia, Charlottesville; Department of Neurology (J.A.O.M.), Stanford University School of Medicine, Palo Alto, CA; Division of Neurology (T.P.), Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH; Division of Pediatric Neurology (J.L.W.), Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX; Division of Neurology (S.W.W.), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH; Department of Neurology (A.G.Z.V.), Children's National Hospital; Department of Neurology and Pediatrics (A.G.Z.V.), George Washington University School of Medicine & Health Sciences, Washington, DC; Department of Child Health, Genetics, Neurology, and Cellular and Molecular Medicine (M.C.K.), University of Arizona College of Medicine, Phoenix, AZ; and Programs in Biomedical Informatics, Molecular & Cellular Biology and Neuroscience (M.C.K.), Arizona State University
| | - Steve W Wu
- From the Pediatric Movement Disorders Program (M.C.K.), Division of Neurology (S.K.), Barrow Neurological Institute, Phoenix Children's Hospital, AZ; Division of Neurology (C.R.B.), Norton Children's Hospital, University of Louisville, KY; Department of Pediatrics (A.A.L.), Al-Balqa Applied University, Salt, Jordan; Department of Neurology (A.A.L.), University of Virginia, Charlottesville; Department of Neurology (J.A.O.M.), Stanford University School of Medicine, Palo Alto, CA; Division of Neurology (T.P.), Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH; Division of Pediatric Neurology (J.L.W.), Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX; Division of Neurology (S.W.W.), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH; Department of Neurology (A.G.Z.V.), Children's National Hospital; Department of Neurology and Pediatrics (A.G.Z.V.), George Washington University School of Medicine & Health Sciences, Washington, DC; Department of Child Health, Genetics, Neurology, and Cellular and Molecular Medicine (M.C.K.), University of Arizona College of Medicine, Phoenix, AZ; and Programs in Biomedical Informatics, Molecular & Cellular Biology and Neuroscience (M.C.K.), Arizona State University
| | - Alonso G Zea Vera
- From the Pediatric Movement Disorders Program (M.C.K.), Division of Neurology (S.K.), Barrow Neurological Institute, Phoenix Children's Hospital, AZ; Division of Neurology (C.R.B.), Norton Children's Hospital, University of Louisville, KY; Department of Pediatrics (A.A.L.), Al-Balqa Applied University, Salt, Jordan; Department of Neurology (A.A.L.), University of Virginia, Charlottesville; Department of Neurology (J.A.O.M.), Stanford University School of Medicine, Palo Alto, CA; Division of Neurology (T.P.), Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH; Division of Pediatric Neurology (J.L.W.), Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX; Division of Neurology (S.W.W.), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH; Department of Neurology (A.G.Z.V.), Children's National Hospital; Department of Neurology and Pediatrics (A.G.Z.V.), George Washington University School of Medicine & Health Sciences, Washington, DC; Department of Child Health, Genetics, Neurology, and Cellular and Molecular Medicine (M.C.K.), University of Arizona College of Medicine, Phoenix, AZ; and Programs in Biomedical Informatics, Molecular & Cellular Biology and Neuroscience (M.C.K.), Arizona State University
| | - Michael C Kruer
- From the Pediatric Movement Disorders Program (M.C.K.), Division of Neurology (S.K.), Barrow Neurological Institute, Phoenix Children's Hospital, AZ; Division of Neurology (C.R.B.), Norton Children's Hospital, University of Louisville, KY; Department of Pediatrics (A.A.L.), Al-Balqa Applied University, Salt, Jordan; Department of Neurology (A.A.L.), University of Virginia, Charlottesville; Department of Neurology (J.A.O.M.), Stanford University School of Medicine, Palo Alto, CA; Division of Neurology (T.P.), Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH; Division of Pediatric Neurology (J.L.W.), Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX; Division of Neurology (S.W.W.), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH; Department of Neurology (A.G.Z.V.), Children's National Hospital; Department of Neurology and Pediatrics (A.G.Z.V.), George Washington University School of Medicine & Health Sciences, Washington, DC; Department of Child Health, Genetics, Neurology, and Cellular and Molecular Medicine (M.C.K.), University of Arizona College of Medicine, Phoenix, AZ; and Programs in Biomedical Informatics, Molecular & Cellular Biology and Neuroscience (M.C.K.), Arizona State University
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Eskandar M, Tochen L, Shin MR, Lavenstein B, Meltzer M, Gropman A, Sen K. Limitations of Multigene Next-Generation Sequencing Panel for "Cerebral Palsy" Phenotype and Other Complex Movement Disorders. Pediatr Neurol 2023; 149:15-18. [PMID: 37757660 DOI: 10.1016/j.pediatrneurol.2023.08.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/26/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023]
Abstract
In the past couple of decades, literature in pediatric neurology and clinical genetics has identified hundreds of monogenic disorders that can masquerade as infantile cerebral palsy (CP). Accurate and prompt diagnosis in such cases may be challenging due to several reasons. There are commercial multigene CP panels, but their diagnostic yield is often limited compared with exome sequencing because of diverse etiologies that may mimic CP. We report one such case where a patient with spastic hemiplegia underwent a long diagnostic journey before genetic diagnosis was established with exome sequencing and appropriate management was started. TTC19-related mitochondrial complex III deficiency is an ultrarare disorder of energy metabolism that presents with bilateral lesions in the basal ganglia and a degenerative neuropsychiatric phenotype.
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Affiliation(s)
- Marina Eskandar
- Division of Child Neurology, Children's National Hospital, Washington District of Columbia
| | - Laura Tochen
- Division of Child Neurology, Children's National Hospital, Washington District of Columbia
| | - Mi Ran Shin
- Rehabilitation Medicine, Children's National Hospital, Washington, District of Columbia
| | - Bennett Lavenstein
- Division of Child Neurology, Children's National Hospital, Washington District of Columbia
| | - Meira Meltzer
- Division of Neurogenetics and Neurodevelopmental Pediatrics, Children's National Hospital, Washington, District of Columbia
| | - Andrea Gropman
- Division of Neurogenetics and Neurodevelopmental Pediatrics, Children's National Hospital, Washington, District of Columbia
| | - Kuntal Sen
- Division of Neurogenetics and Neurodevelopmental Pediatrics, Children's National Hospital, Washington, District of Columbia.
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van Eyk CL, Fahey MC, Gecz J. Redefining cerebral palsies as a diverse group of neurodevelopmental disorders with genetic aetiology. Nat Rev Neurol 2023; 19:542-555. [PMID: 37537278 DOI: 10.1038/s41582-023-00847-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2023] [Indexed: 08/05/2023]
Abstract
Cerebral palsy is a clinical descriptor covering a diverse group of permanent, non-degenerative disorders of motor function. Around one-third of cases have now been shown to have an underlying genetic aetiology, with the genetic landscape overlapping with those of neurodevelopmental disorders including intellectual disability, epilepsy, speech and language disorders and autism. Here we review the current state of genomic testing in cerebral palsy, highlighting the benefits for personalized medicine and the imperative to consider aetiology during clinical diagnosis. With earlier clinical diagnosis now possible, we emphasize the opportunity for comprehensive and early genomic testing as a crucial component of the routine diagnostic work-up in people with cerebral palsy.
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Affiliation(s)
- Clare L van Eyk
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | - Michael C Fahey
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Jozef Gecz
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia.
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia.
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.
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Aravamuthan BR, Fehlings DL, Novak I, Gross P, Alyasiri N, Tilton A, Shevell M, Fahey M, Kruer M. Uncertainties regarding cerebral palsy diagnosis: opportunities to operationalize the consensus definition. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.06.29.23292028. [PMID: 37461618 PMCID: PMC10350155 DOI: 10.1101/2023.06.29.23292028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Background and Objectives Cerebral palsy (CP), the most common motor disability of childhood, is variably diagnosed. We hypothesized that child neurologists and neurodevelopmentalists, often on the frontlines of CP diagnosis in North America, harbor uncertainties regarding the practical application of the most recent CP consensus definition from 2006. Methods We conducted a cross-sectional survey of child neurologists and neurodevelopmentalists at the 2022 Child Neurology Society Annual Meeting. Attendees were provided the 2006 CP consensus definition and asked whether they had any uncertainties about the practical application of the definition across four hypothetical clinical vignettes. Results Of 230 attendees, 164 responded to the closing survey questions (71%). 145/164 (88%) expressed at least one uncertainty regarding the clinical application of the 2006 definition. Overwhelmingly, these areas of uncertainty focused on: 1) Age, both with regards to the minimum age of diagnosis and the maximum age of brain disturbance or motor symptom onset, (67/164, 41%), and 2) Interpretation of the term "non-progressive" (48/164, 29%). The vast majority of respondents (157/164, 96%) answered 'Yes' to the question: Do you think we should revise the 2006 consensus definition of CP? Discussion We propose that the uncertainties we identified could be addressed by operationalizing the 2006 consensus definition to support a more uniform CP diagnosis. To address the most common CP diagnostic uncertainties we identified, we propose 3 points of clarification based on the available literature: 1) Motor symptoms/signs should be present by 2 years old; 2) CP can and should be diagnosed as early as possible, even if activity limitation is not yet present, if motor symptoms/signs can be reasonably predicted to yield activity limitation (e.g. by using standardized examination instruments, Brain MRI, and a suggestive clinical history); and 3) The clinical motor disability phenotype should be non-progressive through 5 years old. We anticipate that operationalizing the 2006 definition of CP in this manner could clarify the uncertainties we identified among child neurologists and neurodevelopmentalists and reduce the diagnostic variability that currently exists.
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Affiliation(s)
- Bhooma R Aravamuthan
- Division of Pediatric Neurology, Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Darcy L Fehlings
- Holland Bloorview Kids Rehabilitation Hospital, Department of Paediatrics, University of Toronto
| | - Iona Novak
- Faculty of Medicine and Health, The University of Sydney, Sydney, AustraliaCerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, Australia
| | - Paul Gross
- The Cerebral Palsy Research Network, Salt Lake City, Utah, USA
| | - Noor Alyasiri
- Division of Pediatric Neurology, Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Ann Tilton
- Louisiana Health Science Center New Orleans, Children’s Hospital of New Orleans, New Orleans, LA, USA
| | - Michael Shevell
- Departments of Pediatrics and Neurology/Neurosurgery and Montreal Children’s Hospital, McGill University, Montreal, Quebec, Canada
| | - Michael Fahey
- Department of Paediatrics, Monash University Melbourne Australia
| | - Michael Kruer
- Barrow Neurological Institute, Phoenix Children’s, Phoenix, AZ USA; Departments of Cellular & Molecular Medicine, Child Health, Neurology and Program in, Genetics, University of Arizona College of Medicine – Phoenix, Phoenix, AZ USA
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Algabbani MF, Almass BA, Shaheen AAM, Alhusaini A, Almurdi MM, Alqabbani S. Psychometric properties of the Obstacles and Curb tests and their discriminative ability across functional levels in ambulatory children with spastic cerebral palsy. Int J Rehabil Res 2023; 46:178-186. [PMID: 37042182 PMCID: PMC10155681 DOI: 10.1097/mrr.0000000000000575] [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: 02/10/2023] [Accepted: 03/06/2023] [Indexed: 04/13/2023]
Abstract
The Obstacles and Curb tests are timed walking assessments that have emerged from the Spinal Cord Injury Functional Ambulation Profile and have been modified for children; however, their psychometric properties have not been adequately investigated. The aim of this research was to examine the psychometric properties of the Obstacles and Curb tests for children with cerebral palsy (CP). This cross-sectional study included 68 children aged 6-12 years; there were 34 children with CP and 34 age- and sex-matched typically developing children. Validity was examined by correlation with the 10-m Walk Test (10-MWT), Modified Time Up and Go test (mTUG), and Pediatric Balance Scale (PBS). Differences in the Obstacle and Curb test scores were calculated between children with CP and typically developing children and within different Gross Motor Function Classification System (GMFCS) levels. Children with CP completed the tests twice within a 30-min interval in the same session. The tests showed significant strong to very strong correlations with the 10-MWT, mTUG, and PBS. The within-session reliability was excellent, typically developing children were significantly faster than children with CP with high sensitivity and specificity, and the time differed significantly within the GMFCS level. Thus, the Obstacles and Curb tests can be considered valid, reliable, and sensitive walking tests for ambulatory children with CP.
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Affiliation(s)
- Maha F. Algabbani
- Department of Health Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh
| | - Banan A. Almass
- Department of Health Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh
- Department of Physical Therapy, College of Applied Medical Sciences, Majmaah University, Al-Majmaah, Saudi Arabia
| | - Afaf A. M. Shaheen
- Department of Health Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh
- Basic Sciences Department, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
| | - Adel Alhusaini
- Department of Health Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh
| | - Muneera M. Almurdi
- Department of Health Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh
| | - Samiah Alqabbani
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
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10
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Srivastava S, Lewis SA, Kruer MC, Poduri A. Underrepresentation of the term cerebral palsy in clinical genetics databases. Am J Med Genet A 2022; 188:3555-3557. [PMID: 35959765 PMCID: PMC9939051 DOI: 10.1002/ajmg.a.62930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 01/31/2023]
Affiliation(s)
- Siddharth Srivastava
- Department of Neurology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sara A. Lewis
- Pediatric Movement Disorders Program, Barrow Neurological Institute, Phoenix Children's Hospital; Departments of Child Health, Cellular & Molecular Medicine, and Neurology, and Program in Genetics, University of Arizona College of Medicine – Phoenix
| | - Michael C. Kruer
- Pediatric Movement Disorders Program, Barrow Neurological Institute, Phoenix Children's Hospital; Departments of Child Health, Cellular & Molecular Medicine, and Neurology, and Program in Genetics, University of Arizona College of Medicine – Phoenix
| | - Annapurna Poduri
- Department of Neurology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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11
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Srivastava S, Lewis SA, Cohen JS, Zhang B, Aravamuthan BR, Chopra M, Sahin M, Kruer MC, Poduri A. Molecular Diagnostic Yield of Exome Sequencing and Chromosomal Microarray in Cerebral Palsy: A Systematic Review and Meta-analysis. JAMA Neurol 2022; 79:1287-1295. [PMID: 36279113 PMCID: PMC9593320 DOI: 10.1001/jamaneurol.2022.3549] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/26/2022] [Indexed: 01/14/2023]
Abstract
Importance There are many known acquired risk factors for cerebral palsy (CP), but in some cases, CP is evident without risk factors (cryptogenic CP). Early CP cohort studies report a wide range of diagnostic yields for sequence variants assessed by exome sequencing (ES) and copy number variants (CNVs) assessed by chromosomal microarray (CMA). Objective To synthesize the emerging CP genetics literature and address the question of what percentage of individuals with CP have a genetic disorder via ES and CMA. Data Sources Searched articles were indexed by PubMed with relevant queries pertaining to CP and ES/CMA (query date, March 15, 2022). Study Selection Inclusion criteria were as follows: primary research study, case series with 10 or more nonrelated individuals, CP diagnosis, and ES and/or CMA data used for genetic evaluation. Nonblinded review was performed. Data Extraction and Synthesis Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were used for assessing data quality and validity. Data were extracted by a single observer. Main Outcomes and Measures A separate meta-analysis was performed for each modality (ES, CMA). The primary outcome was proportion/molecular diagnostic yield (number of patients with a discovered genetic disorder divided by the total number of patients in the cohort), evaluated via meta-analysis of single proportions using random-effects logistic regression. A subgroup meta-analysis was conducted, using risk factor classification as a subgroup. A forest plot was used to display diagnostic yields of individual studies. Results In the meta-analysis of ES yield in CP, the overall diagnostic yield of ES among the cohorts (15 study cohorts comprising 2419 individuals from 11 articles) was 23% (95% CI, 15%-34%). The diagnostic yield across cryptogenic CP cohorts was 35% (95% CI, 27%-45%), compared with 7% (95% CI, 4%-12%) across cohorts with known risk factors (noncryptogenic CP). In the meta-analysis of CMA yield in CP, the diagnostic yield of CMA among the cohorts (5 study cohorts comprising 294 individuals from 5 articles) was 5% (95% CI, 2%-12%). Conclusions and Relevance Results of this systematic review and meta-analysis suggest that for individuals with cryptogenic CP, ES followed by CMA to identify molecular disorders may be warranted.
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Affiliation(s)
- Siddharth Srivastava
- Rosamund Stone Zander Translational Neuroscience Center, Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts
| | - Sara A. Lewis
- Pediatric Movement Disorders Program, Barrow Neurological Institute, Phoenix Children’s Hospital, Phoenix, Arizona
- Department of Child Health, Program in Genetics, University of Arizona College of Medicine, Phoenix
- Department of Neurology, Program in Genetics, University of Arizona College of Medicine, Phoenix
- Department of Cellular & Molecular Medicine, Program in Genetics, University of Arizona College of Medicine, Phoenix
- Department of Program in Genetics, University of Arizona College of Medicine, Phoenix
| | - Julie S. Cohen
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, Maryland
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bo Zhang
- Rosamund Stone Zander Translational Neuroscience Center, Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts
| | | | - Maya Chopra
- Rosamund Stone Zander Translational Neuroscience Center, Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts
| | - Mustafa Sahin
- Rosamund Stone Zander Translational Neuroscience Center, Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts
| | - Michael C. Kruer
- Pediatric Movement Disorders Program, Barrow Neurological Institute, Phoenix Children’s Hospital, Phoenix, Arizona
- Department of Child Health, Program in Genetics, University of Arizona College of Medicine, Phoenix
- Department of Neurology, Program in Genetics, University of Arizona College of Medicine, Phoenix
- Department of Cellular & Molecular Medicine, Program in Genetics, University of Arizona College of Medicine, Phoenix
- Department of Program in Genetics, University of Arizona College of Medicine, Phoenix
| | - Annapurna Poduri
- Rosamund Stone Zander Translational Neuroscience Center, Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts
- Department of Epilepsy, Boston Children’s Hospital, Boston, Massachusetts
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12
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Coates J, Mulpuri K, Farr J, Miller SD. Cerebral palsy diagnosis and the impact on hip surveillance enrollment. Dev Med Child Neurol 2022; 64:890-896. [PMID: 35213730 DOI: 10.1111/dmcn.15188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 01/26/2022] [Accepted: 01/27/2022] [Indexed: 12/01/2022]
Abstract
AIM To investigate the diagnosis at enrollment in the Child Health British Columbia Hip Surveillance Program for Children with Cerebral Palsy (CP) and review the etiologies of children enrolled without a CP diagnosis. METHOD Data from 959 children (543 males, 416 females; mean [SD] age at enrollment 6 years 8 months [4 years 2 months]) enrolled in the program between September 2015 and December 2019 were retrospectively reviewed. Enrollment diagnosis, Gross Motor Function Classification System level, migration percentage, and age at enrollment were included. Chart reviews were completed to confirm diagnoses for all children. Etiologies were compared to a list of conditions that are included and excluded from CP registries. RESULTS Diagnosis at enrollment was CP for 612 (64%), possible CP for 120 (13%), and 'other' for 220 (23%). No diagnosis was provided for seven (<1%). CP was confirmed for 700 (73%), including 106 (11.1%) enrolled as 'possible CP' or 'other'; 56 (5.8%) did not have CP due to progressive conditions. Migration percentage was similar across all groups at enrollment. INTERPRETATION One in four children were enrolled in hip surveillance without a diagnosis of CP or possible CP. Encouraging participation in hip surveillance when children meet the clinical criteria for CP but do not have a confirmed CP diagnosis can improve access to care.
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Affiliation(s)
- Jaimy Coates
- Department of Orthopaedic Surgery, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Kishore Mulpuri
- Department of Orthopaedic Surgery, BC Children's Hospital, Vancouver, British Columbia, Canada.,Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jennifer Farr
- Department of Orthopaedic Surgery, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Stacey D Miller
- Department of Orthopaedic Surgery, BC Children's Hospital, Vancouver, British Columbia, Canada.,Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
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13
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Aravamuthan BR, Shusterman M, Green Snyder L, Lemmon ME, Bain JM, Gross P. Diagnostic preferences include discussion of etiology for adults with cerebral palsy and their caregivers. Dev Med Child Neurol 2022; 64:723-733. [PMID: 35092695 PMCID: PMC10091392 DOI: 10.1111/dmcn.15164] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 12/20/2021] [Indexed: 12/12/2022]
Abstract
AIM To determine the views of individuals with cerebral palsy (CP) and their caregivers (CP community members) about carrying a CP diagnosis, an etiological diagnosis, or both diagnoses together. METHOD We surveyed CP community members across two registries querying their views on carrying a CP diagnosis, one type of etiological diagnosis (specifically, a genetic diagnosis), or both. Open-ended responses were analyzed using a conventional content analysis approach. RESULTS Of 197 respondents (108 adults with CP and 89 caregivers), most (75%) valued knowing the cause of their CP. Of those with a diagnostic preference, most preferred carrying both CP and etiological diagnoses together (68%). When compared with carrying an etiological diagnosis alone, significantly more respondents felt a CP diagnosis helped anticipate symptom evolution (84% vs 54%), explain symptoms to others (86% vs 48%), access services (86% vs 48%), and join support communities (78% vs 50%) (p < 0.01, χ2 test). INTERPRETATION Most CP community members surveyed want to know the cause of their CP and would prefer carrying both CP and etiological diagnoses together. Clinical practice should evolve to meet these community needs.
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Affiliation(s)
- Bhooma R Aravamuthan
- Department of Neurology, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO, USA
| | | | | | - Monica E Lemmon
- Department of Pediatrics, Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Jennifer M Bain
- Department of Neurology, Division of Child Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Paul Gross
- The Cerebral Palsy Research Network, Salt Lake City, UT, USA.,University of Utah, Salt Lake City, UT, USA
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- Simons Foundation, New York, NY, USA
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- The Cerebral Palsy Research Network, Salt Lake City, UT, USA
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14
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Chopra M, Gable DL, Love‐Nichols J, Tsao A, Rockowitz S, Sliz P, Barkoudah E, Bastianelli L, Coulter D, Davidson E, DeGusmao C, Fogelman D, Huth K, Marshall P, Nimec D, Sanders JS, Shore BJ, Snyder B, Stone SSD, Ubeda A, Watkins C, Berde C, Bolton J, Brownstein C, Costigan M, Ebrahimi‐Fakhari D, Lai A, O'Donnell‐Luria A, Paciorkowski AR, Pinto A, Pugh J, Rodan L, Roe E, Swanson L, Zhang B, Kruer MC, Sahin M, Poduri A, Srivastava S. Mendelian etiologies identified with whole exome sequencing in cerebral palsy. Ann Clin Transl Neurol 2022; 9:193-205. [PMID: 35076175 PMCID: PMC8862420 DOI: 10.1002/acn3.51506] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/15/2021] [Accepted: 12/15/2021] [Indexed: 01/24/2023] Open
Abstract
Objectives Cerebral palsy (CP) is the most common childhood motor disability, yet its link to single‐gene disorders is under‐characterized. To explore the genetic landscape of CP, we conducted whole exome sequencing (WES) in a cohort of patients with CP. Methods We performed comprehensive phenotyping and WES on a prospective cohort of individuals with cryptogenic CP (who meet criteria for CP; have no risk factors), non‐cryptogenic CP (who meet criteria for CP; have at least one risk factor), and CP masqueraders (who could be diagnosed with CP, but have regression/progressive symptoms). We characterized motor phenotypes, ascertained medical comorbidities, and classified brain MRIs. We analyzed WES data using an institutional pipeline. Results We included 50 probands in this analysis (20 females, 30 males). Twenty‐four had cryptogenic CP, 20 had non‐cryptogenic CP, five had CP masquerader classification, and one had unknown classification. Hypotonic‐ataxic subtype showed a difference in prevalence across the classification groups (p = 0.01). Twenty‐six percent of participants (13/50) had a pathogenic/likely pathogenic variant in 13 unique genes (ECHS1, SATB2, ZMYM2, ADAT3, COL4A1, THOC2, SLC16A2, SPAST, POLR2A, GNAO1, PDHX, ACADM, ATL1), including one patient with two genetic disorders (ACADM, PDHX) and two patients with a SPAST‐related disorder. The CP masquerader category had the highest diagnostic yield (n = 3/5, 60%), followed by the cryptogenic CP category (n = 7/24, 29%). Fifteen percent of patients with non‐cryptogenic CP (n = 3/20) had a Mendelian disorder on WES. Interpretation WES demonstrated a significant prevalence of Mendelian disorders in individuals clinically diagnosed with CP, including in individuals with known CP risk factors.
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15
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Maitre NL, Byrne R, Duncan A, Dusing S, Gaebler-Spira D, Rosenbaum P, Winter S. "High-risk for cerebral palsy" designation: A clinical consensus statement. J Pediatr Rehabil Med 2022; 15:165-174. [PMID: 35275579 DOI: 10.3233/prm-220030] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Nathalie L Maitre
- Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | | | | | - Stacey Dusing
- University of Southern California, Los Angeles, CA, USA
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16
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Lewis SA, Shetty S, Wilson BA, Huang AJ, Jin SC, Smithers-Sheedy H, Fahey MC, Kruer MC. Insights From Genetic Studies of Cerebral Palsy. Front Neurol 2021; 11:625428. [PMID: 33551980 PMCID: PMC7859255 DOI: 10.3389/fneur.2020.625428] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 12/16/2020] [Indexed: 12/11/2022] Open
Abstract
Cohort-based whole exome and whole genome sequencing and copy number variant (CNV) studies have identified genetic etiologies for a sizable proportion of patients with cerebral palsy (CP). These findings indicate that genetic mutations collectively comprise an important cause of CP. We review findings in CP genomics and propose criteria for CP-associated genes at the level of gene discovery, research study, and clinical application. We review the published literature and report 18 genes and 5 CNVs from genomics studies with strong evidence of for the pathophysiology of CP. CP-associated genes often disrupt early brain developmental programming or predispose individuals to known environmental risk factors. We discuss the overlap of CP-associated genes with other neurodevelopmental disorders and related movement disorders. We revisit diagnostic criteria for CP and discuss how identification of genetic etiologies does not preclude CP as an appropriate diagnosis. The identification of genetic etiologies improves our understanding of the neurobiology of CP, providing opportunities to study CP pathogenesis and develop mechanism-based interventions.
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Affiliation(s)
- Sara A Lewis
- Pediatric Movement Disorders Program, Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, AZ, United States.,Departments of Child Health, Neurology, and Cellular & Molecular Medicine and Program in Genetics, University of Arizona College of Medicine, Phoenix, AZ, United States
| | - Sheetal Shetty
- Pediatric Movement Disorders Program, Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, AZ, United States.,Departments of Child Health, Neurology, and Cellular & Molecular Medicine and Program in Genetics, University of Arizona College of Medicine, Phoenix, AZ, United States
| | - Bryce A Wilson
- Pediatric Movement Disorders Program, Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, AZ, United States.,Departments of Child Health, Neurology, and Cellular & Molecular Medicine and Program in Genetics, University of Arizona College of Medicine, Phoenix, AZ, United States
| | - Aris J Huang
- Programs in Neuroscience and Molecular & Cellular Biology, School of Life Sciences, Arizona State University, Tempe, AZ, United States
| | - Sheng Chih Jin
- Department of Genetics, Washington University School of Medicine, St. Louis, MO, United States
| | - Hayley Smithers-Sheedy
- Cerebral Palsy Alliance, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Michael C Fahey
- Department of Paediatrics, Monash University, Melbourne, VIC, Australia
| | - Michael C Kruer
- Pediatric Movement Disorders Program, Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, AZ, United States.,Departments of Child Health, Neurology, and Cellular & Molecular Medicine and Program in Genetics, University of Arizona College of Medicine, Phoenix, AZ, United States.,Programs in Neuroscience and Molecular & Cellular Biology, School of Life Sciences, Arizona State University, Tempe, AZ, United States
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