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Bundy J, Zhao H, Kianirad Y. Alternating hemidystonia of childhood: a unique presentation of ATP1A3 treated with trihexyphenidyl. J Neurol 2024; 271:5656-5658. [PMID: 38839636 DOI: 10.1007/s00415-024-12487-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 05/27/2024] [Accepted: 05/28/2024] [Indexed: 06/07/2024]
Affiliation(s)
- Jonathan Bundy
- Department of Neurology and Rehabilitation, University of Illinois at Chicago, 912 S Wood St, RM 174, Chicago, IL, 60612, USA.
| | - Hongfei Zhao
- Department of Neurology and Rehabilitation, University of Illinois at Chicago, 912 S Wood St, RM 174, Chicago, IL, 60612, USA
| | - Yasaman Kianirad
- Department of Neurology and Rehabilitation, University of Illinois at Chicago, 912 S Wood St, RM 174, Chicago, IL, 60612, USA
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Ruan DD, Zou J, Liao LS, Ji MD, Wang RL, Zhang JH, Zhang L, Gao MZ, Chen Q, Yu HP, Wei W, Li YF, Li H, Lin F, Luo JW, Lin XF. In vitro study of ATP1A3 p.Ala275Pro mutant causing alternating hemiplegia of childhood and rapid-onset dystonia-parkinsonism. Front Neurosci 2024; 18:1415576. [PMID: 39145297 PMCID: PMC11322359 DOI: 10.3389/fnins.2024.1415576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 07/11/2024] [Indexed: 08/16/2024] Open
Abstract
Introduction We previously reported that ATP1A3 c.823G>C (p.Ala275Pro) mutant causes varying phenotypes of alternative hemiplegia of childhood and rapid-onset dystonia-parkinsonism in the same family. This study aims to investigate the function of ATP1A3 c.823G>C (p.Ala275Pro) mutant at the cellular and zebrafish models. Methods ATP1A3 wild-type and mutant Hela cell lines were constructed, and ATP1A3 mRNA expression, ATP1A3 protein expression and localization, and Na+-K+-ATPase activity in each group of cells were detected. Additionally, we also constructed zebrafish models with ATP1A3 wild-type overexpression (WT) and p.Ala275Pro mutant overexpression (MUT). Subsequently, we detected the mRNA expression of dopamine signaling pathway-associated genes, Parkinson's disease-associated genes, and apoptosisassociated genes in each group of zebrafish, and observed the growth, development, and movement behavior of zebrafish. Results Cells carrying the p.Ala275Pro mutation exhibited lower levels of ATP1A3 mRNA, reduced ATP1A3 protein expression, and decreased Na+-K+-ATPase activity compared to wild-type cells. Immunofluorescence analysis revealed that ATP1A3 was primarily localized in the cytoplasm, but there was no significant difference in ATP1A3 protein localization before and after the mutation. In the zebrafish model, both WT and MUT groups showed lower brain and body length, dopamine neuron fluorescence intensity, escape ability, swimming distance, and average swimming speed compared to the control group. Moreover, overexpression of both wild-type and mutant ATP1A3 led to abnormal mRNA expression of genes associated with the dopamine signaling pathway and Parkinson's disease in zebrafish, and significantly upregulated transcription levels of bad and caspase-3 in the apoptosis signaling pathway, while reducing the transcriptional level of bcl-2 and the bcl-2/bax ratio. Conclusion This study reveals that the p.Ala275Pro mutant decreases ATP1A3 protein expression and Na+/K+-ATPase activity. Abnormal expression of either wild-type or mutant ATP1A3 genes impairs growth, development, and movement behavior in zebrafish.
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Affiliation(s)
- Dan-dan Ruan
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Jing Zou
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Li-sheng Liao
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Hematology, Fujian Provincial Hospital, Fuzhou, China
| | - Ming-dong Ji
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Ruo-li Wang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Emergency, Fujian Provincial Hospital, Fuzhou, China
| | - Jian-hui Zhang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Li Zhang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Nephrology, Fujian Provincial Hospital, Fuzhou, China
| | - Mei-zhu Gao
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Nephrology, Fujian Provincial Hospital, Fuzhou, China
| | - Qian Chen
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Hong-ping Yu
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Wen Wei
- Department of Rehabilitation Medicine, Ganzhou Municipal Hospital, Ganzhou, China
| | - Yun-fei Li
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Neurology, Fujian Provincial Hospital, Fuzhou, China
| | - Hong Li
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Fan Lin
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Geriatric Medicine, Fujian Provincial Center for Geriatrics, Fujian Provincial Hospital, Fuzhou, China
| | - Jie-wei Luo
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Xin-fu Lin
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Pediatrics Department, Fujian Provincial Hospital, Fuzhou, China
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3
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Rissardo JP, Vora NM, Singh Y, Kishore S, Caprara ALF. Navigating the Complexity of Alternating Hemiplegia in Childhood: A Comprehensive Review. Rambam Maimonides Med J 2024; 15:RMMJ.10529. [PMID: 39088707 PMCID: PMC11294682 DOI: 10.5041/rmmj.10529] [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] [Indexed: 08/03/2024] Open
Abstract
Alternating hemiplegia of childhood (AHC) is a complex neurodevelopmental disorder characterized by paroxysmal and transient events of unilateral or bilateral paresis, usually occurring before 18 months of age. Mutations in the ATP1A3 gene, mainly p.Asp801Asn, p.Glu815Lys, and p.Gly947Arg at the protein level, are found in around 80% of the individuals with AHC. Interestingly, these mutations reflect the degree of severity of the neurological symptoms (p.Glu815Lys > p.Asp801Asn > p.Gly947Arg). Some channels involved in this disorder are N-type voltage-gated calcium channels, ATP-sensitive potassium channels, and the sodium/calcium exchanger. In this context, the management of AHC should be divided into the treatment of attacks, prophylactic treatment, and management of comorbidities commonly found in this group of individuals, including epilepsy, attention-deficit/hyperactivity disorder, aggressive behavior, cognitive impairment, movement disorders, and migraine. The importance of an integrated approach with a multidisciplinary team, such as neuropsychologists and dietitians, is worth mentioning, as well as the follow-up with a neurologist. In the present study, we propose new diagnostic criteria for AHC, dividing it into clinical, laboratory, supporting, and atypical features. Also, we review the location of the mutations in the ATP1A3 protein of individuals with AHC, rapid-onset dystonia-parkinsonism (RDP) variants, and early infantile epileptic encephalopathy (variants with hemiplegic attack). We also include a section about the animal models for ATP1A3 disorders.
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Affiliation(s)
| | - Nilofar Murtaza Vora
- Medicine Department, Terna Speciality Hospital and Research Centre, Navi Mumbai, India
| | - Yogendra Singh
- Medicine Department, Terna Speciality Hospital and Research Centre, Navi Mumbai, India
| | - Sweta Kishore
- Medicine Department, Terna Speciality Hospital and Research Centre, Navi Mumbai, India
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Ford CP, Littlejohn RO, German R, Vuocolo B, Aceves J, Vossaert L, Owen N, Wangler M, Schmid CA. Precision therapy for a medically actionable ATP1A3 variant from a genomic medicine program in an underserved population. Mol Genet Genomic Med 2023; 11:e2272. [PMID: 37614148 PMCID: PMC10724509 DOI: 10.1002/mgg3.2272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/21/2023] [Accepted: 08/08/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Genomic medicine is revolutionizing the diagnosis of rare diseases, but the implementation has not benefited underrepresented populations to the same degree. Here, we report the case of a 7-year-old boy with hypotonia, global developmental delay, strabismus, seizures, and previously suspected mitochondrial myopathy. This proband comes from an underrepresented minority and was denied exome sequencing by his public insurance. METHODS After informed consent was obtained, buccal cells from the proband were collected and whole exome sequencing was performed. Illumina Dragen and Emedgene software was used to analyze the data at Baylor Genetics. The variants were further intepreted according to ACMG guidelines and the patient's phenotype. RESULTS Through whole-exome sequencing (WES) under the Community Texome project, he was found to have a heterozygous de novo pathogenic variant in the ATP1A3 gene located on chromosome 19q13. CONCLUSION In retrospect, his symptomatology matches the known medical conditions associated with the ATP1A3 gene namely Alternating Hemiplegia of Childhood 2 (AHC), a rare autosomal dominant disorder with an incidence of 1 in one million. His single nucleotide variant, (c.2401G>A, p.D801N), is predicted to be damaging. The specific amino acid change p.D801N has been previously reported in ClinVar along with the allelic variant p.D801Y and both are considered pathogenic. The identification of this variant altered medical management for this patient as he was started on a calcium antagonist and has reported no further hemiplegic episodes. This case illustrates the value of implementing genomic medicine for precision therapy in underserved populations.
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Affiliation(s)
- Cara P. Ford
- School of MedicineMeharry Medical CollegeNashvilleTennesseeUSA
- Clinical Research Education Training Program at Baylor College of MedicineHoustonTexasUSA
| | - Rebecca O. Littlejohn
- Department of PediatricsBaylor College of MedicineSan AntonioTexasUSA
- Department of Molecular and Human GeneticsBaylor College of MedicineHoustonTexasUSA
| | - Ryan German
- Department of Molecular and Human GeneticsBaylor College of MedicineHoustonTexasUSA
- Jan and Dan Duncan Neurological Research Institute, Texas Children's HospitalHoustonTexasUSA
| | - Blake Vuocolo
- Department of Molecular and Human GeneticsBaylor College of MedicineHoustonTexasUSA
- Jan and Dan Duncan Neurological Research Institute, Texas Children's HospitalHoustonTexasUSA
| | - Jose Aceves
- Department of PediatricsBaylor College of MedicineSan AntonioTexasUSA
| | - Liesbeth Vossaert
- Department of Molecular and Human GeneticsBaylor College of MedicineHoustonTexasUSA
- Baylor GeneticsBaylor College of MedicineHoustonTexasUSA
| | - Nichole Owen
- Department of Molecular and Human GeneticsBaylor College of MedicineHoustonTexasUSA
- Baylor GeneticsBaylor College of MedicineHoustonTexasUSA
| | - Michael Wangler
- Department of Molecular and Human GeneticsBaylor College of MedicineHoustonTexasUSA
- Jan and Dan Duncan Neurological Research Institute, Texas Children's HospitalHoustonTexasUSA
| | - Carrie A. Schmid
- Department of PediatricsBaylor College of MedicineSan AntonioTexasUSA
- Department of Molecular and Human GeneticsBaylor College of MedicineHoustonTexasUSA
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Patel SH, Panagiotakaki E, Papadopoulou MT, Fons C, De Grandis E, Vezyroglou A, Balestrini S, Hong H, Liu B, Prange L, Arzimanoglou A, Vavassori R, Mikati MA. Methodology of a Natural History Study of a Rare Neurodevelopmental Disorder: Alternating Hemiplegia of Childhood as a Prototype Disease. J Child Neurol 2023; 38:597-610. [PMID: 37728088 DOI: 10.1177/08830738231197861] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
Here, we describe the process of development of the methodology for an international multicenter natural history study of alternating hemiplegia of childhood as a prototype disease for rare neurodevelopmental disorders. We describe a systematic multistep approach in which we first identified the relevant questions about alternating hemiplegia of childhood natural history and expected challenges. Then, based on our experience with alternating hemiplegia of childhood and on pragmatic literature searches, we identified solutions to determine appropriate methods to address these questions. Specifically, these solutions included development and standardization of alternating hemiplegia of childhood-specific spell video-library, spell calendars, adoption of tailored methodologies for prospective measurement of nonparoxysmal and paroxysmal manifestations, unified data collection protocols, centralized data platform, adoption of specialized analysis methods including, among others, Cohen kappa, interclass correlation coefficient, linear mixed effects models, principal component, propensity score, and ambidirectional analyses. Similar approaches can, potentially, benefit in the study of other rare pediatric neurodevelopmental disorders.
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Affiliation(s)
- Shital H Patel
- Department of Pediatrics, Division of Pediatric Neurology and Developmental Medicine, Duke University, Durham, NC, USA
| | - Eleni Panagiotakaki
- Department of Pediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, Member of the ERN EpiCARE, University Hospitals of Lyon (HCL), Lyon, France
| | - Maria T Papadopoulou
- Department of Pediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, Member of the ERN EpiCARE, University Hospitals of Lyon (HCL), Lyon, France
| | - Carmen Fons
- Department of Child Neurology, Sant Joan de Déu Children's Hospital, Member of the ERN EpiCARE, Barcelona, Spain
| | - Elisa De Grandis
- Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Aikaterini Vezyroglou
- Department of Developmental Neurosciences, UCL NIHR BRC Great Ormond Street Institute of Child Health, London, UK
| | - Simona Balestrini
- Department of Clinical and Experimental Epilepsy, University College of London (UCL), Queen Square Institute of Neurology, London, UK
| | - Hwanhee Hong
- Department of Biostatistics & Bioinformatics, Duke University, Durham, NC, USA
| | - Beiyu Liu
- Department of Biostatistics & Bioinformatics, Duke University, Durham, NC, USA
| | - Lyndsey Prange
- Department of Pediatrics, Division of Pediatric Neurology and Developmental Medicine, Duke University, Durham, NC, USA
| | - Alexis Arzimanoglou
- Department of Pediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, Member of the ERN EpiCARE, University Hospitals of Lyon (HCL), Lyon, France
| | - Rosaria Vavassori
- Euro Mediterranean Institute of Science and Technology IEMEST, Palermo, Italy
- Association AHC18+ e.V., member of the ERN EpiCARE Patient Advocacy Group (ePAG), Germany
| | - Mohamad A Mikati
- Department of Pediatrics, Division of Pediatric Neurology and Developmental Medicine, Duke University, Durham, NC, USA
- Department of Neurobiology, Duke University, Durham, NC, USA
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Alyamani SA, Aldhalaan HM, Almuhaizea MA, Abukhalid MF. Expanding the Allelic spectrum in ATP1A3-related disorders with 3 novel mutations and clinic features. NEUROSCIENCES (RIYADH, SAUDI ARABIA) 2023; 28:195-198. [PMID: 37482377 PMCID: PMC10519661 DOI: 10.17712/nsj.2023.3.20220131] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 06/13/2023] [Indexed: 07/25/2023]
Abstract
OBJECTIVES To describe the complex phenotype of ATP1A3 and second to report new mutation of ATP1A3. METHODS This is a retrospective chart review of 7 patients who was diagnosed with ATP1A3 mutation based on whole exome sequencing (WES) result and the following information were collected; age, age of onset, developmental ability, seizure type, family history, MRI, WES report. The data collection started a year ago January 2021 in King Faisal Specialist Hospital and Research Centre, Riyadh, KSA. This has been cleared for publication by the Office of Research Affairs, and the Publication Number is 2225429. RESULTS Five females and 2 males had onset ages of 0-3 years (mean=18 months). All had some degree of intellectual dysfunction, 6 had seizures (85%), 4 had neurologic abnormalities, 1 had autistic features and one had mild dystonia. CONCLUSION Our small-cohort observations confirm that ATP1A3 mutations express a wide range of phenotypes, usually including some degree of cognitive-behavioral dysfunction (100% of patients), seizures (85% of patients), and AHC (71% of patients). Moreover, they further expand the evolving allelic spectrum of these disorders by identifying 3 novel mutations.
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Affiliation(s)
- Suad A. Alyamani
- From the Department of Neuroscience Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Hesham M. Aldhalaan
- From the Department of Neuroscience Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed A. Almuhaizea
- From the Department of Neuroscience Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Musaad F. Abukhalid
- From the Department of Neuroscience Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
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7
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Shafique A, Arif B, Chu ML, Moran E, Hussain T, Zamora FM, Wohler E, Sobreira N, Klein C, Lohmann K, Naz S. MRM2 variants in families with complex dystonic syndromes: evidence for phenotypic heterogeneity. J Med Genet 2023; 60:352-358. [PMID: 36002240 DOI: 10.1136/jmg-2022-108521] [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: 02/22/2022] [Accepted: 07/25/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Dystonia involves repetitive movements and muscle contractions leading to abnormal postures. We investigated patients in two families, DYAF11 and M, exhibiting dystonic or involuntary movement disorders. METHODS Clinical investigations were performed for all patients. Genetic analyses included genome-wide linkage analysis and exome sequencing followed by Sanger sequencing validation. MRM2-specific transcripts were analysed from participants' blood samples in Family DYAF11 after cloning of gene-specific cDNA. RESULTS Four affected siblings in Family DYAF11 had progressive dystonic features. Two patients in Family M exhibited a neurodevelopmental disorder accompanied by involuntary movements. In Family DYAF11, linkage was detected to the telomere at chromosome 7p22.3, spanning <2 Mb. Exome sequencing identified a donor splice-site variant, c.8+1G>T in MRM2, which segregated with the phenotype, corresponding to the linkage data since all affected individuals were homozygous while the obligate unaffected carriers were heterozygous for the variant. In the MRM2 c.8+1G>T allele, an aberrant alternative acceptor splice-site located within exon 2 was used in a subset of the transcripts, creating a frameshift in the open reading frame. Exome sequencing in Family M revealed a rare missense variant c.242C>T, p.(Ala81Val), which affected a conserved amino acid. CONCLUSIONS Our results expand the clinical and allelic spectrum of MRM2 variants. Previously, these descriptions were based on observations in a single patient, diagnosed with mitochondrial DNA depletion syndrome 17, in whom movement disorder was accompanied by recurrent strokes and epilepsy. We also demonstrate a subset of correctly spliced tt-ag MRM2 transcripts, raising the possibility to develop treatment by understanding the disease mechanism.
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Affiliation(s)
- Anum Shafique
- School of Biological Sciences, University of the Punjab Quaid-i-Azam Campus, Lahore, Pakistan
| | - Beenish Arif
- School of Biological Sciences, University of the Punjab Quaid-i-Azam Campus, Lahore, Pakistan
| | - Mary Lynn Chu
- Department of Neurology, New York University Grossman School of Medicine, New York, New York, USA
- Langone Orthopedic Hospital, New York University, New York, New York, USA
| | - Ellen Moran
- Clinical Genetics, Center for Children, Hassenfeld Children's Hospital, New York University, New York, New York, USA
| | - Tooba Hussain
- School of Biological Sciences, University of the Punjab Quaid-i-Azam Campus, Lahore, Pakistan
| | | | - Elizabeth Wohler
- McKusick-Nathans Department of Genetic Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Nara Sobreira
- McKusick-Nathans Department of Genetic Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Christine Klein
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Katja Lohmann
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Sadaf Naz
- School of Biological Sciences, University of the Punjab Quaid-i-Azam Campus, Lahore, Pakistan
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8
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Nott E, Behl KE, Brambilla I, Green TE, Lucente M, Vavassori R, Watson A, Dalla Bernardina B, Hildebrand MS. Rare. The importance of research, analysis, reporting and education in 'solving' the genetic epilepsies: A perspective from the European patient advocacy group for EpiCARE. Eur J Med Genet 2023; 66:104680. [PMID: 36623768 DOI: 10.1016/j.ejmg.2022.104680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 11/14/2022] [Accepted: 12/11/2022] [Indexed: 01/09/2023]
Affiliation(s)
- E Nott
- European Patient Advocacy Group (ePAG) EpiCARE, France; Hope for Hypothalamic Hamartomas and Hope for Hypothalamic Hamartomas-UK, UK.
| | - K E Behl
- Alternating Hemiplegia of Childhood UK (AHCUK) and Alternating Hemiplegia of Childhood Federation of Europe (AHCFE), UK
| | - I Brambilla
- European Patient Advocacy Group (ePAG) EpiCARE, France; Dravet Italia Onlus; Epilepsy Research Centre, Department of Medicine, The University of Melbourne, Austin Health, Heidelberg, Victoria, 3084, Australia
| | - T E Green
- Epilepsy Research Centre, Department of Medicine, The University of Melbourne, Austin Health, Heidelberg, Victoria, 3084, Australia; Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Victoria, 3052, Australia
| | - M Lucente
- European Patient Advocacy Group (ePAG) EpiCARE, France; Associazione Italiana GLUT1 Onlus, Italy
| | - R Vavassori
- European Patient Advocacy Group (ePAG) EpiCARE, France; International Alternating Hemiplegia of Childhood Research Consortium (IAHCRC), USA; Alternating Hemiplegia of Childhood 18+ (AHC18+ e.V.) Association, Germany
| | - A Watson
- European Patient Advocacy Group (ePAG) EpiCARE, France; Ring20 Research and Support UK, UK
| | - B Dalla Bernardina
- Dravet Italia Onlus; Research Center for Pediatric Epilepsies Verona, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Italy
| | - M S Hildebrand
- Hope for Hypothalamic Hamartomas and Hope for Hypothalamic Hamartomas-UK, UK; Epilepsy Research Centre, Department of Medicine, The University of Melbourne, Austin Health, Heidelberg, Victoria, 3084, Australia; Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Victoria, 3052, Australia
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9
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Zou S, Lan YL, Gong Y, Chen Z, Xu C. The role of ATP1A3 gene in epilepsy: We need to know more. Front Cell Neurosci 2023; 17:1143956. [PMID: 36866063 PMCID: PMC9972585 DOI: 10.3389/fncel.2023.1143956] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 01/23/2023] [Indexed: 02/16/2023] Open
Abstract
The ATP1A3 gene, which encodes the Na+/K+-ATPase α3 catalytic subunit, plays a crucial role in both physiological and pathological conditions in the brain, and mutations in this gene have been associated with a wide variety of neurological diseases by impacting the whole infant development stages. Cumulative clinical evidence suggests that some severe epileptic syndromes have been linked to mutations in ATP1A3, among which inactivating mutation of ATP1A3 has been intriguingly found to be a candidate pathogenesis for complex partial and generalized seizures, proposing ATP1A3 regulators as putative targets for the rational design of antiepileptic therapies. In this review, we introduced the physiological function of ATP1A3 and summarized the findings about ATP1A3 in epileptic conditions from both clinical and laboratory aspects at first. Then, some possible mechanisms of how ATP1A3 mutations result in epilepsy are provided. We think this review timely introduces the potential contribution of ATP1A3 mutations in both the genesis and progression of epilepsy. Taken that both the detailed mechanisms and therapeutic significance of ATP1A3 for epilepsy are not yet fully illustrated, we think that both in-depth mechanisms investigations and systematic intervention experiments targeting ATP1A3 are needed, and by doing so, perhaps a new light can be shed on treating ATP1A3-associated epilepsy.
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Affiliation(s)
- Shuang Zou
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Science, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yu-Long Lan
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China,*Correspondence: Yu-Long Lan ✉
| | - Yiwei Gong
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Science, Zhejiang Chinese Medical University, Hangzhou, China
| | - Zhong Chen
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Science, Zhejiang Chinese Medical University, Hangzhou, China
| | - Cenglin Xu
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Science, Zhejiang Chinese Medical University, Hangzhou, China,Cenglin Xu ✉
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10
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Huang D, Song X, Ma J, Li X, Guo Y, Li M, Luo H, Fang Z, Yang C, Xie L, Jiang L. ATP1A3-related phenotypes in Chinese children: AHC, CAPOS, and RECA. Eur J Pediatr 2023; 182:825-836. [PMID: 36484864 DOI: 10.1007/s00431-022-04744-w] [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: 04/08/2022] [Revised: 11/13/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022]
Abstract
UNLABELLED The aim of this research is to study the phenotype, genotype, treatment strategies, and short-term prognosis of Chinese children with ATP1A3 (Na+/K+-ATPase alpha 3 gene)-related disorders in Southwest China. Patients with pathogenic ATP1A3 variants identified using next-generation sequencing were registered at the Children's Hospital of Chongqing Medical University from December 2015 to May 2019. We followed them as a cohort and analyzed their clinical data. Eleven patients were identified with de novo pathogenic ATP1A3 heterozygous variants. One (c.2542 + 1G > T, splicing) has not been reported. Eight patients with alternating hemiplegia of childhood (AHC), one with cerebellar ataxia, areflexia, pes cavus, optic atrophy, and sensorineural hearing loss (CAPOS), and two with relapsing encephalopathy with cerebellar ataxia (RECA) were included. The initial manifestations of AHC included hemiplegia, oculomotor abnormalities, and seizures, and the most common trigger was an upper respiratory tract infection without fever. All patients had paroxysmal hemiplegic attacks during their disease course. The brain MRI showed no abnormalities. Six out of eight AHC cases reached a stable disease state after treatment. The initial symptom of the patient with CAPOS was ataxia followed by developmental regression, seizures, deafness, visual impairment, and dysarthria, and the brain MRI indicated mild cerebellar atrophy. No fluctuation was noted after using Acetazolamide. The initial manifestations of the two RECA cases were dystonia and encephalopathy, respectively. One manifested a rapid-onset course of dystonia triggered by a fever followed by dysarthria and action tremors, and independent walking was impossible. The brain MRI image was normal. The other one presented with disturbance of consciousness, seizures, sleep disturbance, tremor, and dyskinesias. The EEG revealed a slow background (δ activity), and the brain MRI result was normal. No response to Flunarizine was noted for them, and it took 61 and 60 months for them to reach a stable disease state, respectively. CONCLUSION Pathogenic ATP1A3 variants play an essential role in the pathogenesis of Sodium-Potassium pump disorders, and AHC is the most common phenotype. The treatment strategies and prognosis depend on the phenotype categories caused by different variation sites and types. The correlation between the genotype and phenotype requires further exploration. WHAT IS KNOWN • Pathogenic heterozygous ATP1A3 variants cause a spectrum of neurological phenotypes, and ATP1A3-disorders are viewed as a phenotypic continuum presenting with atypical and overlapping features. • The genotype-phenotype correlation of ATP1A3-disorders remains unclear. WHAT IS NEW • In this study, the genotypes and phenotypes of ATP1A3-related disorders from Southwest of China were described. The splice-site variation c.2542+1G>T was detected for the first time in ATP1A3-related disorders. • The prognosis of twins with AHC p. Gly947Arg was more serious than AHC cases with other variants, which was inconsistent with previous reports. The phenomenon indicated the diversity of the correlation between the genotype and phenotype.
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Affiliation(s)
- Dishu Huang
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China.,National Clinical Research Center for Child Health and Disorders, Chongqing, People's Republic of China.,China International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing, People's Republic of China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, People's Republic of China.,Chongqing Key Laboratory of Pediatrics, Chongqing, People's Republic of China
| | - Xiaojie Song
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China.,National Clinical Research Center for Child Health and Disorders, Chongqing, People's Republic of China.,China International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing, People's Republic of China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, People's Republic of China.,Chongqing Key Laboratory of Pediatrics, Chongqing, People's Republic of China
| | - Jiannan Ma
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China.,National Clinical Research Center for Child Health and Disorders, Chongqing, People's Republic of China.,China International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing, People's Republic of China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, People's Republic of China.,Chongqing Key Laboratory of Pediatrics, Chongqing, People's Republic of China
| | - Xiujuan Li
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China.,National Clinical Research Center for Child Health and Disorders, Chongqing, People's Republic of China.,China International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing, People's Republic of China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, People's Republic of China.,Chongqing Key Laboratory of Pediatrics, Chongqing, People's Republic of China
| | - Yi Guo
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China.,National Clinical Research Center for Child Health and Disorders, Chongqing, People's Republic of China.,China International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing, People's Republic of China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, People's Republic of China.,Chongqing Key Laboratory of Pediatrics, Chongqing, People's Republic of China
| | - Mei Li
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China.,National Clinical Research Center for Child Health and Disorders, Chongqing, People's Republic of China.,China International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing, People's Republic of China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, People's Republic of China.,Chongqing Key Laboratory of Pediatrics, Chongqing, People's Republic of China
| | - Hanyu Luo
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China.,National Clinical Research Center for Child Health and Disorders, Chongqing, People's Republic of China.,China International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing, People's Republic of China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, People's Republic of China.,Chongqing Key Laboratory of Pediatrics, Chongqing, People's Republic of China
| | - Zhixu Fang
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China.,National Clinical Research Center for Child Health and Disorders, Chongqing, People's Republic of China.,China International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing, People's Republic of China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, People's Republic of China.,Chongqing Key Laboratory of Pediatrics, Chongqing, People's Republic of China
| | - Chen Yang
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China.,National Clinical Research Center for Child Health and Disorders, Chongqing, People's Republic of China.,China International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing, People's Republic of China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, People's Republic of China.,Chongqing Key Laboratory of Pediatrics, Chongqing, People's Republic of China
| | - Lingling Xie
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China. .,National Clinical Research Center for Child Health and Disorders, Chongqing, People's Republic of China. .,China International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing, People's Republic of China. .,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, People's Republic of China. .,Chongqing Key Laboratory of Pediatrics, Chongqing, People's Republic of China.
| | - Li Jiang
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China. .,National Clinical Research Center for Child Health and Disorders, Chongqing, People's Republic of China. .,China International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing, People's Republic of China. .,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, People's Republic of China. .,Chongqing Key Laboratory of Pediatrics, Chongqing, People's Republic of China.
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11
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Ananthavarathan P, Kamourieh S. Alternating hemiplegia of childhood. HANDBOOK OF CLINICAL NEUROLOGY 2023; 198:221-227. [PMID: 38043964 DOI: 10.1016/b978-0-12-823356-6.00005-6] [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: 12/05/2023]
Abstract
Alternating hemiplegia of childhood (AHC) is characterized by recurrent episodes of hemiplegia which may alternate sides between attacks. The condition is associated with severe neurodevelopmental disorder presenting in early infancy, and may encompass a wide range of other paroxysmal manifestations (e.g., dystonia, nystagmus, dysautonomia) and pervasive neurological disabilities (e.g., developmental delay, learning disabilities, choreoathetosis, and ataxia). Epileptic seizures are particularly common among patients with AHC. Diagnosis is usually based on history and clinical grounds using the Aicardi criteria. Mutations in the ATP1A3 gene are implicated in the disease pathology of the condition, as well as several other neurodevelopmental disorders, suggesting AHC forms part of a spectrum of overlapping clinical syndromes rather than a distinct clinical entity per se. Management of patients with AHC includes the rapid induction of sleep during paroxysmal attacks and the avoidance of identified triggers. Pharmacotherapeutic treatments have a role in managing epileptic seizures, as well as in the prevention of paroxysmal attacks wherein flunarizine remains the treatment of choice.
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Affiliation(s)
- Piriyankan Ananthavarathan
- Department of Neurology, Headache and Facial Pain Group, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Salwa Kamourieh
- Department of Neurology, Headache and Facial Pain Group, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom.
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12
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Frey J, Burns MR, Chiu SY, Wagle Shukla A, El Kouzi A, Jackson J, Arn PH, Malaty IA. TANGO2 Mutation: A Genetic Cause of Multifocal Combined Dystonia. Mov Disord Clin Pract 2022; 9:380-382. [PMID: 35402644 PMCID: PMC8974879 DOI: 10.1002/mdc3.13400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 12/06/2021] [Accepted: 12/08/2021] [Indexed: 01/07/2023] Open
Affiliation(s)
- Jessica Frey
- Department of NeurologyUniversity of FloridaGainesvilleFloridaUSA
| | - Matthew R. Burns
- Department of NeurologyUniversity of FloridaGainesvilleFloridaUSA
| | - Shannon Y. Chiu
- Department of NeurologyUniversity of FloridaGainesvilleFloridaUSA
| | | | - Ahmad El Kouzi
- Department of NeurologySouthern Illinois UniversitySpringfieldIllinoisUSA
| | - Jessica Jackson
- Department of Clinical GenomicsMayo ClinicJacksonvilleFloridaUSA
| | - Pamela H. Arn
- Department of PediatricsNemours Children's Specialty CareJacksonvilleFloridaUSA
| | - Irene A. Malaty
- Department of NeurologyUniversity of FloridaGainesvilleFloridaUSA
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13
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Different phenotypes of neurological diseases, including alternating hemiplegia of childhood and rapid-onset dystonia-parkinsonism, caused by de novo ATP1A3 mutation in a family. Neurol Sci 2021; 43:2555-2563. [PMID: 34783933 DOI: 10.1007/s10072-021-05673-6] [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: 02/23/2021] [Accepted: 10/15/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The spectrum of neurological diseases related to ATP1A3 gene mutations is highly heterogeneous and exhibits different phenotypes. Phenotype overlaps, including alternating hemiplegia of childhood (AHC), early infantile epileptic encephalopathy, and rapid-onset dystonia-parkinsonism (RDP), can also occur at extremely low incidences. Currently, over 90 types of pathogenic mutations have been identified in ATP1A3. PATIENTS AND METHODS The family of a 2-year-11-month-old proband with AHC was recruited for this clinical investigation. The proband was screened for candidate mutation gene sites using next-generation sequencing and target-region capture technology. Sanger sequencing was used to identify carriers among family members. RESULTS The mother of the proband with AHC was diagnosed with dystonia (later diagnosed as RDP). The biochemical and immune indices of the proband and the mother were not abnormal. Moreover, brain imaging of the proband revealed no significant abnormalities. However, the electroencephalogram of the mother was mildly abnormal, with no spike wave discharge. Brain MRI revealed slight cerebellar atrophy. Electromyography revealed neurogenic damage, with a decrease in the conduction velocity of the left ulnar and radial nerves. Based on the sequencing data, both the proband and her mother carried c.823G > C p. (Ala275Pro) heterozygotes; other family members were not identified as carriers. With a PolyPhen-2 score of 0.997 and SIFT score of 0.001, this mutation can be considered damaging. CONCLUSION Family genotype-phenotype correlation analysis revealed that the phenotype and gene mutation were co-segregated, suggesting that it may be a pathogenic mutation.
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14
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De Vrieze J, van de Laar IMBH, de Rijk-van Andel JF, Kamsteeg EJ, Kotsopoulos IAW, de Man SA. Expanding Phenotype of ATP1A3 - Related Disorders: A Case Series. Child Neurol Open 2021; 8:2329048X211048068. [PMID: 34761051 PMCID: PMC8573619 DOI: 10.1177/2329048x211048068] [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: 05/09/2021] [Revised: 08/08/2021] [Accepted: 09/03/2021] [Indexed: 11/16/2022] Open
Abstract
Neurologic disorders caused by mutations in the ATP1A3 gene were originally reported as three distinct rare clinical syndromes: Alternating Hemiplegia of Childhood (AHC), Rapid-onset Dystonia Parkinsonism (RDP) and Cerebellar ataxia, Areflexia, Pes cavus, Opticus atrophy and Sensorineural hearing loss (CAPOS). In this case series, we describe 3 patients. A mother and her daughter showed an intermediate phenotype different from each other with the same heterozygous missense mutation (p.[R756C]), recently described in literature as Relapsing Encephalopathy With Cerebellar Ataxia (RECA). In addition, a third patient showed an intermediate AHC-RDP phenotype and had a likely pathogenic novel de novo missense mutation (p.[L100 V]). These patients support the growing evidence that AHC, RDP and RECA are part of a continuous ATP1A3 mutation spectrum that is still expanding. Three common features were a sudden onset, asymmetrical neurological symptoms, as well as the presence of triggering factors. When present, the authors argue to perform exome sequencing in an early stage.
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Affiliation(s)
- Jelena De Vrieze
- Amphia Hospital, Breda, the Netherlands.,University Hospital of Antwerp, Antwerp, Belgium.,Heilig Hart Hospital Lier, Lier, Belgium
| | | | | | | | | | - Stella A de Man
- Amphia Hospital, Breda, the Netherlands.,Erasmus University Medical Center, Rotterdam, the Netherlands
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15
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Jung SY, Kang JW. Is it really a seizure? The challenge of paroxysmal nonepileptic events in young infants. Clin Exp Pediatr 2021; 64:384-392. [PMID: 32972054 PMCID: PMC8342880 DOI: 10.3345/cep.2020.00451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 09/03/2020] [Indexed: 12/27/2022] Open
Abstract
Paroxysmal nonepileptic events (PNE) comprise of a variety of nonepileptic behaviors and are divided into various types. A more accurate diagnosis is possible by examining the video clip provided by the caregiver. In infants, physiologic PNE accounts for the majority of the PNE. It is important to exclude epilepsy, for which blood tests, electroencephalography, and imaging tests can facilitate differential diagnosis. Since most PNE have a benign progress, symptoms often improve with age and without special treatment. Therefore, it is important to reassure the caregivers after making an accurate diagnosis.
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Affiliation(s)
- Seung Yeon Jung
- Department of Pediatrics, Chungnam National University Hospital, Daejeon, Korea
| | - Joon Won Kang
- Department of Pediatrics & Medical Science, Chungnam National University School of Medicine, Daejeon, Korea
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16
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García-Payá E, Gutiérrez-Agulló M, García-Prieto FF, Francés Ferre J. An 88.8-kb Novel Deletion of 19q13.2 Encompassing the ATP1A3 Gene Detected by Array CGH in a Patient with Delayed Psychomotor Development, Generalized Hypotonia and Macrocephaly. Mol Syndromol 2021; 12:234-239. [PMID: 34421501 PMCID: PMC8339483 DOI: 10.1159/000515043] [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: 11/07/2020] [Accepted: 02/04/2021] [Indexed: 11/19/2022] Open
Abstract
Many neurodevelopmental disorders are caused by the presence of CNVs. Chromosome microarray technology is widely used to accurately detect CNVs. We report the case of a male, aged 3 years, presenting with delayed psychomotor development, generalized hypotonia, encephalopathy, delayed myelination in the central nervous system, and poor motor coordination. The array CGH revealed an interstitial deletion of chromosome 19q13.2 with a size of 88.8 kb involving 3 OMIM genes: RABAC1, ARHGEF1, and ATP1A3. Heterozygous mutations in the ATP1A3 gene are associated with delayed psychomotor development, alternating hemiplegia of childhood type 2 (AHC2), dystonia type 12, and cerebellarataxia-areflexia-pes cavus-optic atrophy-sensorineural hearing loss syndrome, also called CAPOS syndrome. The phenotypic expression of partial ATP1A3 deletion is, however, poorly described in the literature. The deletion was confirmed by MLPA, and we identified a hitherto undescribed novel deletion of exons 3b-21 of the ATP1A3 gene. Our data suggest that the deletion of the ATP1A3 gene is a causative factor of the AHC2 phenotype in the patient.
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Affiliation(s)
- Elena García-Payá
- Laboratory of Molecular Cytogenetics, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Hospital General Universitario de Alicante, Alicante, Spain
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17
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Uchitel J, Wallace K, Tran L, Abrahamsen T, Hunanyan A, Prange L, Jasien J, Caligiuri L, Pratt M, Rikard B, Fons C, De Grandis E, Vezyroglou A, Heinzen EL, Goldstein DB, Vavassori R, Papadopoulou MT, Cocco I, Moré R, Arzimanoglou A, Panagiotakaki E, Mikati MA. Alternating hemiplegia of childhood: evolution over time and mouse model corroboration. Brain Commun 2021; 3:fcab128. [PMID: 34396101 PMCID: PMC8361420 DOI: 10.1093/braincomms/fcab128] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 03/05/2021] [Accepted: 06/03/2021] [Indexed: 11/30/2022] Open
Abstract
Alternating hemiplegia of childhood is a rare neurodevelopmental disorder caused by ATP1A3 mutations. Some evidence for disease progression exists, but there are few systematic analyses. Here, we evaluate alternating hemiplegia of childhood progression in humans and in the D801N knock-in alternating hemiplegia of childhood mouse, Mashlool, model. This study performed an ambidirectional (prospective and retrospective data) analysis of an alternating hemiplegia of childhood patient cohort (n = 42, age 10.24 ± 1.48 years) seen at one US centre. To investigate potential disease progression, we used linear mixed effects models incorporating early and subsequent visits, and Wilcoxon Signed Rank test comparing first and last visits. Potential early-life clinical predictors were determined via multivariable regression. We also compared EEG background at first encounter and at last follow-up. We then performed a retrospective confirmation study on a multicentre cohort of alternating hemiplegia of childhood patients from France (n = 52). To investigate disease progression in the Mashlool mouse, we performed behavioural testing on a cohort of Mashlool- mice at prepubescent and adult ages (n = 11). Results: US patients, over time, demonstrated mild worsening of non-paroxysmal disability index scores, but not of paroxysmal disability index scores. Increasing age was a predictor of worse scores: P < 0.0001 for the non-paroxysmal disability index, intellectual disability scale and gross motor scores. Earliest non-paroxysmal disability index score was a predictor of last visit non-paroxysmal disability index score (P = 0.022), and earliest intellectual disability score was a predictor of last intellectual disability score (P = 0.035). More patients with EEG background slowing were noted at last follow-up as compared to initial (P = 0.015). Similar worsening of disease with age was also noted in the French cohort: age was a significant predictor of non-paroxysmal disability index score (P = 0.001) and first and last non-paroxysmal disability index score scores significantly differed (P = 0.002). In animal studies, adult Mashlool mice had, as compared to younger Mashlool mice, (i) worse balance beam performance; (ii) wider base of support; (iii) higher severity of seizures and resultant mortality; and (iv) no increased predisposition to hemiplegic or dystonic spells. In conclusion, (i) non-paroxysmal alternating hemiplegia of childhood manifestations show, on average over time, progression associated with severity of early-life non-paroxysmal disability and age. (ii) Progression also occurs in Mashlool mice, confirming that ATP1A3 disease can lead to age-related worsening. (iii) Clinical findings provide a basis for counselling patients and for designing therapeutic trials. Animal findings confirm a mouse model for investigation of underlying mechanisms of disease progression, and are also consistent with known mechanisms of ATP1A3-related neurodegeneration.
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Affiliation(s)
- Julie Uchitel
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Duke University, Durham, NC 27710, USA
| | - Keri Wallace
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Duke University, Durham, NC 27710, USA
| | - Linh Tran
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Duke University, Durham, NC 27710, USA
| | - Tavis Abrahamsen
- Department of Statistical Science, Duke University, Durham, NC 27708, USA
| | - Arsen Hunanyan
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Duke University, Durham, NC 27710, USA
| | - Lyndsey Prange
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Duke University, Durham, NC 27710, USA
| | - Joan Jasien
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Duke University, Durham, NC 27710, USA
| | - Laura Caligiuri
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Duke University, Durham, NC 27710, USA
| | - Milton Pratt
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Duke University, Durham, NC 27710, USA
| | - Blaire Rikard
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Duke University, Durham, NC 27710, USA
| | - Carmen Fons
- Department of Child Neurology, Sant Joan de Déu Children’s Hospital, Member of the ERN EpiCARE, Barcelona 08950, Spain
| | - Elisa De Grandis
- Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, Genoa 16147, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa 16147, Italy
| | - Aikaterini Vezyroglou
- Department of Developmental Neurosciences, UCL NIHR BRC Great Ormond Street Institute of Child Health, London WC1N 3JH, UK
| | - Erin L Heinzen
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - David B Goldstein
- Institute of Genomic Medicine, Columbia University, New York, NY 10032, USA
| | - Rosaria Vavassori
- Euro Mediterranean Institute of Science and Technology I.E.ME.ST, Palermo 90139, Italy
| | - Maria T Papadopoulou
- Department of Pediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, Member of the ERN EpiCARE, University Hospitals of Lyon (HCL), Lyon 69500, France
| | - Isabella Cocco
- Department of Pediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, Member of the ERN EpiCARE, University Hospitals of Lyon (HCL), Lyon 69500, France
| | - Rebecca Moré
- Department of Paediatric Neurology Outpatient Clinic/Neonatal Paediatrics and Intensive Care, University Hospital of Rouen, Rouen 76000, France
| | | | | | - Alexis Arzimanoglou
- Department of Pediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, Member of the ERN EpiCARE, University Hospitals of Lyon (HCL), Lyon 69500, France
| | - Eleni Panagiotakaki
- Department of Pediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, Member of the ERN EpiCARE, University Hospitals of Lyon (HCL), Lyon 69500, France
| | - Mohamad A Mikati
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Duke University, Durham, NC 27710, USA
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18
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Bhardwaj NK, Gowda VK, Sardesai AV. Alternating Hemiplegia of Childhood: A Series of Genetically Confirmed Four Cases from Southern India with Review of Published Literature. J Pediatr Genet 2021; 10:111-115. [PMID: 33996181 PMCID: PMC8110357 DOI: 10.1055/s-0040-1714702] [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: 05/08/2020] [Accepted: 06/19/2020] [Indexed: 10/23/2022]
Abstract
Alternating hemiplegia of childhood (AHC) is a rare autosomal dominant neurodevelopmental disorder with mutation on ATP1A3 gene. Delay in diagnosis and inappropriate diagnosis are common. In this article, we described four genetically confirmed AHC patients to provide an improved understanding of the disorder. First symptom in two patients was seizures and in other two patients was abnormal eye deviation. All had onset of plegic attacks within the first 18 months of their life. Tone abnormalities and movement disorders were present in all patients. Electroencephalogram was abnormal in two patients and all had normal magnetic resonance imaging of the brain. Response to treatment of plegic attacks was poor and also epilepsy was drug resistant. All cases had significant development delay and disability as of last follow-up. Although there is no effective treatment so far, early diagnosis is required to avoid unnecessary treatment.
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Affiliation(s)
- Naveen Kumar Bhardwaj
- Department of Pediatric Neurology, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
| | - Vykuntaraju K. Gowda
- Department of Pediatric Neurology, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
| | - Ashwin Vivek Sardesai
- Department of Pediatric Neurology, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
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19
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Mikati MA, Panagiotakaki E, Arzimanoglou A. Revision of the diagnostic criteria of alternating hemiplegia of childhood. Eur J Paediatr Neurol 2021; 32:A4-A5. [PMID: 33975787 DOI: 10.1016/j.ejpn.2021.05.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Mohamad A Mikati
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, And Department of Neurobiology, Duke University, USA
| | - Eleni Panagiotakaki
- Department of Paediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, Member of the ERN EpiCARE, University Hospitals of Lyon (HCL), Lyon, France
| | - Alexis Arzimanoglou
- Department of Paediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, Member of the ERN EpiCARE, University Hospitals of Lyon (HCL), Lyon, France; Department of Child Neurology and Epilepsy Research Unit, Member of the ERN EpiCARE, Hospital San Juan de Dios, Barcelona, Spain.
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Cordani R, Stagnaro M, Pisciotta L, Tiziano FD, Calevo MG, Nobili L, De Grandis E. Alternating Hemiplegia of Childhood: Genotype-Phenotype Correlations in a Cohort of 39 Italian Patients. Front Neurol 2021; 12:658451. [PMID: 33897609 PMCID: PMC8060701 DOI: 10.3389/fneur.2021.658451] [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: 01/25/2021] [Accepted: 02/25/2021] [Indexed: 11/13/2022] Open
Abstract
Alternating hemiplegia of childhood is a rare neurological disease characterized by paroxysmal movement disorders and chronic neurological disturbances, with onset before 18 months of age. Mutations in the ATP1A3 gene have been identified in up to 80% of patients. Thirty-nine patients [20 females, 19 males, mean age 25.32 years (7.52–49.34)] have been recruited through the Italian Biobank and Clinical Registry for Alternating Hemiplegia of Childhood. Demographic data, genotype, paroxysmal movement disorders, chronic neurological features, and response to flunarizine have been analyzed. ATP1A3 gene mutations have been detected in 92.3% of patients. Patients have been divided into three groups—p.Asp801Asn mutation patients (26%), p.Glu815Lys cases (23%), and patients with other ATP1A3 mutations—and statistically compared. The Italian cohort has a higher percentage of ATP1A3 gene mutation than reported in literature (92.3%). Our data confirm a more severe phenotype in patients with p.Glu815Lys mutation, with an earlier age of onset of plegic (p = 0.02 in the correlation with other mutations) and tonic attacks. P.Glu815Lys patients most frequently present altered muscle tone, inability to walk (p = 0.01 comparing p.Glu815Lys and p.Asp801Asn mutations), epilepsy, and a more severe grade of dystonia (p < 0.05 comparing p.Glu815Lys and p.Asp801Asn mutations). They have moderate/severe intellectual disability and severe language impairment (p < 0.05). Interestingly, flunarizine seems to be more efficacious in patients with p.Glu815Lys mutation than p.Asp801Asn. In conclusion, our research suggests a genotype–phenotype correlation and provides information on this disorder's features, clinical course, and treatment.
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Affiliation(s)
- Ramona Cordani
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Michela Stagnaro
- Child Neuropsychiatry Unit, Department of Clinical and Surgical Neurosciences and Rehabilitation, Istituto di Ricovero e Cura a Carattere Scientifico Giannina Gaslini, Genova, Italy
| | - Livia Pisciotta
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy.,Child Neuropsychiatry Unit, Azienda Socio Sanitaria Territoriale Fatebenefratelli- Sacco, Milano, Italy
| | - Francesco Danilo Tiziano
- Section of Genomic Medicine, Department of Life Science and Public Health, Catholic University of Sacred Heart, Roma, Italy
| | - Maria Grazia Calevo
- Epidemiology, Biostatistics and Committees Unit, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Giannina Gaslini, Genoa, Italy
| | - Lino Nobili
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy.,Child Neuropsychiatry Unit, Department of Clinical and Surgical Neurosciences and Rehabilitation, Istituto di Ricovero e Cura a Carattere Scientifico Giannina Gaslini, Genova, Italy
| | | | - Elisa De Grandis
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy.,Child Neuropsychiatry Unit, Department of Clinical and Surgical Neurosciences and Rehabilitation, Istituto di Ricovero e Cura a Carattere Scientifico Giannina Gaslini, Genova, Italy
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21
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Salles PA, Mata IF, Brünger T, Lal D, Fernandez HH. ATP1A3-Related Disorders: An Ever-Expanding Clinical Spectrum. Front Neurol 2021; 12:637890. [PMID: 33868146 PMCID: PMC8047318 DOI: 10.3389/fneur.2021.637890] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/09/2021] [Indexed: 01/29/2023] Open
Abstract
The Na+/K+ ATPases are Sodium-Potassium exchanging pumps, with a heteromeric α-β-γ protein complex. The α3 isoform is required as a rescue pump, after repeated action potentials, with a distribution predominantly in neurons of the central nervous system. This isoform is encoded by the ATP1A3 gene. Pathogenic variants in this gene have been implicated in several phenotypes in the last decades. Carriers of pathogenic variants in this gene manifest neurological and non-neurological features in many combinations, usually with an acute onset and paroxysmal episodes triggered by fever or other factors. The first three syndromes described were: (1) rapid-onset dystonia parkinsonism; (2) alternating hemiplegia of childhood; and, (3) cerebellar ataxia, pes cavus, optic atrophy, and sensorineural hearing loss (CAPOS syndrome). Since their original description, an expanding number of cases presenting with atypical and overlapping features have been reported. Because of this, ATP1A3-disorders are now beginning to be viewed as a phenotypic continuum representing discrete expressions along a broadly heterogeneous clinical spectrum.
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Affiliation(s)
- Philippe A Salles
- Department of Neurology and Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States.,Centro de Trastornos del Movimiento, Centro de Trastornos del Movimiento (CETRAM), Santiago, Chile
| | - Ignacio F Mata
- Cleveland Clinic Foundation, Genomic Medicine, Lerner Research Institute, Cleveland, OH, United States
| | - Tobias Brünger
- Cologne Center for Genomics, University Cologne, Cologne, Germany
| | - Dennis Lal
- Cleveland Clinic Foundation, Genomic Medicine, Lerner Research Institute, Cleveland, OH, United States
| | - Hubert H Fernandez
- Department of Neurology and Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
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Koh NYT, Lim JYX, Kam S, Visruthan NK, Koh AL, Lee JH, Thomas T. Alternating hemiplegia of childhood presenting as recurrent apnoea in a term newborn infant. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2021; 50:174-176. [PMID: 33733261 DOI: 10.47102/annals-acadmedsg.2020414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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Moya-Mendez ME, Madden LL, Ruckart KW, Downes KM, Cook JF, Snively BM, Brashear A, Haq IU. Auditory-perceptual voice and speech evaluation in ATP1A3 positive patients. J Clin Neurosci 2020; 81:133-138. [PMID: 33222902 PMCID: PMC7683823 DOI: 10.1016/j.jocn.2020.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 07/27/2020] [Accepted: 09/06/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Bulbar symptoms are frequent in patients with rapid-onset dystonia-parkinsonism (RDP). RDP is caused by ATP1A3 mutations, with onset typically within 30 days of stressor exposure. Most patients have impairments in speech (dysarthria) and voice (dysphonia). These have not been quantified. We aimed to formally characterize these in RDP subjects as compared to mutation negative family controls. METHODS We analyzed recordings in 32 RDP subjects (male = 21, female = 11) and 29 mutation negative controls (male = 15, female = 14). Three raters, blinded to mutation status, rated speech and vocal quality. Dysarthria was classified by subtype. Dysphonia was rated via the GRBAS (Grade, Roughness, Breathiness, Asthenia, Strain) scale. We used general neurological exams and the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) to assess dysarthria, dystonia, and speech/swallowing dysfunction. RESULTS The presence of dysarthria was more frequent in RDP subjects compared to controls (72% vs. 17%, p < 0.0001). GRBAS voice ratings were worse in the RDP cohort across nearly all categories. Dysarthria in RDP was associated with concordant cranial nerve 9-11 dysfunction (54%, p = 0.048), speech/swallowing dysfunction (96%, p = 0.0003); and oral dystonia (88%, p = 0.001). CONCLUSIONS Quantitative voice and speech analyses are important in assessing RDP. Subjects frequently experience dysarthria and dysphonia. Dystonia is not the exclusive voice abnormality present in this population. In our analysis, RDP subjects more frequently experienced bulbar symptoms than controls. GRBAS scores are useful in quantifying voice impairment, potentially allowing for better assessments of progression or treatment effects. Future directions include using task-specific diagnostic and perceptual voice evaluation tools to further assess laryngeal dystonia.
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Affiliation(s)
- Mary E Moya-Mendez
- Department of Neurology Duke University School of Medicine Durham, North Carolina, United States
| | - Lyndsay L Madden
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest School of Medicine Winston-Salem, NC, United States
| | - Kathryn W Ruckart
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest School of Medicine Winston-Salem, NC, United States
| | - Karen M Downes
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest School of Medicine Winston-Salem, NC, United States
| | - Jared F Cook
- Department of Psychology, Wake Forest School of Medicine Winston-Salem, NC, United States
| | - Beverly M Snively
- Department of Biostatistics and Data Science, Wake Forest School of Medicine Winston-Salem, NC, United States
| | - Allison Brashear
- Department of Neurology, University of California at Davis, Sacramento, CA, United States
| | - Ihtsham U Haq
- Department of Neurology, Wake Forest School of Medicine Winston-Salem, NC, United States.
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Clinical and Genetic Overview of Paroxysmal Movement Disorders and Episodic Ataxias. Int J Mol Sci 2020; 21:ijms21103603. [PMID: 32443735 PMCID: PMC7279391 DOI: 10.3390/ijms21103603] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 05/11/2020] [Accepted: 05/13/2020] [Indexed: 12/15/2022] Open
Abstract
Paroxysmal movement disorders (PMDs) are rare neurological diseases typically manifesting with intermittent attacks of abnormal involuntary movements. Two main categories of PMDs are recognized based on the phenomenology: Paroxysmal dyskinesias (PxDs) are characterized by transient episodes hyperkinetic movement disorders, while attacks of cerebellar dysfunction are the hallmark of episodic ataxias (EAs). From an etiological point of view, both primary (genetic) and secondary (acquired) causes of PMDs are known. Recognition and diagnosis of PMDs is based on personal and familial medical history, physical examination, detailed reconstruction of ictal phenomenology, neuroimaging, and genetic analysis. Neurophysiological or laboratory tests are reserved for selected cases. Genetic knowledge of PMDs has been largely incremented by the advent of next generation sequencing (NGS) methodologies. The wide number of genes involved in the pathogenesis of PMDs reflects a high complexity of molecular bases of neurotransmission in cerebellar and basal ganglia circuits. In consideration of the broad genetic and phenotypic heterogeneity, a NGS approach by targeted panel for movement disorders, clinical or whole exome sequencing should be preferred, whenever possible, to a single gene approach, in order to increase diagnostic rate. This review is focused on clinical and genetic features of PMDs with the aim to (1) help clinicians to recognize, diagnose and treat patients with PMDs as well as to (2) provide an overview of genes and molecular mechanisms underlying these intriguing neurogenetic disorders.
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