1
|
Mingarelli A, Pipitone GB, Torini G, Patricelli MG, Totaro M, Colonna C, Carrera P, Raviglione F. Behavioral Phenotype, Electroclinical Features, and Treatment Options in Twins with Lrp2 Candidate Variants (Donnay-Barrow/Foar Syndrome). Case Rep Genet 2023; 2023:6679572. [PMID: 37810913 PMCID: PMC10560113 DOI: 10.1155/2023/6679572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 09/12/2023] [Accepted: 09/15/2023] [Indexed: 10/10/2023] Open
Abstract
The LRP2 gene encodes megalin (LRP-2/GP330), a large single-spanning transmembrane glycoprotein that serves as a multiligand endocytotic receptor and mediates the reabsorption of albumin in the proximal renal tubule. LRP2 is implicated in an autosomal recessive disorder characterized by dimorphisms, ocular anomalies, sensorineural deafness, proteinuria, epilepsy, and intellectual disability: a clinical condition called Donnai-Barrow syndrome (DBS) or facio-oculo-acoustico-renal (FOAR) syndrome. Pathogenic variants in LRP2 have been reported in fewer than 60 patients, but a detailed description of seizures, electroencephalographic patterns, imaging findings, behavioral phenotype, and long-term follow-up is still needed. We provide a clinical report of two mono-chorionic twins with LRP2-related disease manifesting developmental delay, autistic features, seizures, proteinuria, and sleep disorders. By sequencing clinical exome, LRP2 candidate rare variants, c.6815G > A, p. (Arg2272His), inherited from the mother and c.12725A > G, p. (Asp4242Gly), inherited from the father, were identified. During follow-up, at the age of 7, the main clinical features of the patients included insomnia, autistic features, severe psychomotor delay, and absent speech. The patients were under treatment with risperidone, antiseizure medications (ASMs), and supplementation of alpha-lactalbumin for self-injury and sleep disturbance. Our study confirmed the wide spectrum of behavioral and neurological and psychiatric features of this rare condition, suggesting new treatment options.
Collapse
Affiliation(s)
| | - Giovanni Battista Pipitone
- Laboratory of Molecular Genetics, Cytogenetics and Clinical Genetics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giacomo Torini
- Unit of Genomics for Diagnosis of Human Disease, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Grazia Patricelli
- Laboratory of Molecular Genetics, Cytogenetics and Clinical Genetics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Martina Totaro
- Hospital Neuropsychiatry Service, ASST Rhodense, Rho, Milan, Italy
| | - Clara Colonna
- Hospital Neuropsychiatry Service, ASST Rhodense, Rho, Milan, Italy
| | - Paola Carrera
- Laboratory of Molecular Genetics, Cytogenetics and Clinical Genetics, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Unit of Genomics for Diagnosis of Human Disease, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | |
Collapse
|
2
|
Lontano A, De Waure C, Marziali E, D'Ambrosio F, Galletti C, Mazza E, Mingarelli A, Urbani E, Galasso V, Laurenti P. An interdisciplinary intervention for health prevention and promotion in a Roman neighborhood. Eur J Public Health 2022. [PMCID: PMC9620524 DOI: 10.1093/eurpub/ckac130.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Influencing behavioral patterns through primary prevention, possibly addressing more risk factors at a time, is the most effective means to tackle cardiovascular diseases. Many interdisciplinary prevention activities have been coordinated by community nurses outside of specialist centers, resulting in a more effective control of risk factors. Our study aims at describing the impact of an 18-month prevention and promotion, interdisciplinary intervention on lifestyle habits and cardiovascular risk. From December 2018 to May 2020, patients were recruited by 4 General Practitioners (GPs) in the Roman neighborhood of Torresina and received nutritional, physical and psychological counselling to learn healthy lifestyles. Until May 2020 patients had to self-manage their new healthy habits, but during this phase the SARS-CoV-2 pandemic broke out. Patients were assessed at baseline, 6, 12 and 18 months by a nutritionist, a physiotherapist, a psychologist, the 4 GPs and community nurses, and the cardiovascular risk score (CRS) was estimated at every examination. 76 patients were included, with a mean age of 54,6 years. Mean CRS showed a significant reduction between baseline and 12 months (from 4.9 to 3.8, p < 0.001), but this trend was not maintained at 18 months. As for variables included in the calculation of the cardiovascular risk score, both total cholesterol and systolic blood pressure significantly decreased at 6 months of follow up (respectively, from 211.1 to 192 (p < 0.001) and from 133.1 to 123.1(p < 0.001)). Nontheless, the reduction was maintained in the remaining points in time only for systolic blood pressure. Our interdisciplinary educational intervention in a primary care setting resulted in a CRS improvement at 12 months, but this changes where not maintained at 18 months. Community nurses were facilitators in improving health outcomes and patient's satisfaction in the described primary care setting. Key messages
Collapse
Affiliation(s)
- A Lontano
- Hygene and Preventive Medicine, Università Cattolica del Sacro Cuore , Rome, Italy
| | - C De Waure
- Università degli Studi di Perugia , Perugia, Italy
| | - E Marziali
- Hygene and Preventive Medicine, Università Cattolica del Sacro Cuore , Rome, Italy
| | - F D'Ambrosio
- Hygene and Preventive Medicine, Università Cattolica del Sacro Cuore , Rome, Italy
| | - C Galletti
- Hygene and Preventive Medicine, Università Cattolica del Sacro Cuore , Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli , Rome, Italy
| | - E Mazza
- Azienda Ospedaliera San Camillo Forlanini , Rome, Italy
| | - A Mingarelli
- DiagnostiCare ONLUS , Rome, Italy
- Sapienza Università di Roma , Rome, Italy
| | - E Urbani
- DiagnostiCare ONLUS , Rome, Italy
| | | | - P Laurenti
- Hygene and Preventive Medicine, Università Cattolica del Sacro Cuore , Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli , Rome, Italy
| |
Collapse
|
3
|
Lontano A, D'ambrosio F, Marziali E, Galletti C, Mazza E, Boncompagni I, Del Bono C, Urbani E, Galasso V, Mingarelli A. Coping Styles in the SARS-CoV-2 national lockdown: impact on behaviors for cardiovascular prevention. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Coping styles are the ways in which people deal with different stressor situations. Coping strategies can be categorized into three types: task-oriented, emotion-oriented, and avoidance-oriented. Several studies showed a strong relationship between coping styles and cardiovascular diseases. The aim of the study was to evaluate how much the SARS-CoV-2 national lockdown has impacted the coping strategies on behaviors for cardiovascular prevention.
Methods
62 participants from Rome were recruited to assess the impact of prevention and promotion of health on Individual Cardiovascular Risk. The Coping Inventory to Stressful Situations (CISS, Endler & Parker, 1990) is a self-report questionnaire that measures the three strategies of coping. Behaviors dealing with cardiovascular prevention were evaluated at the beginning of the observation period, and after 6, 12, and 18 months. During 12 (February 2020) and 18 months (July 2020) the SARS-CoV-2 national lockdown enabled us to inquire into coping strategies in stressful situations and cardiovascular risk factors.
Results
The Pearson correlation analysis was used to assess the existence of a correlation between coping strategies and the variation of cardiovascular risk factors and alcohol consumption at 12 and 18 months. Interestingly, results showed relations between Emotional-oriented (r = 0.26 p < 0.05) and Task-oriented (r = -0.33 p < 0.01) coping styles and Differential Cardiovascular Risk Reduction (DCRR). Furthermore, a positive relation between Task-oriented (r = 0.34 p < 0.01) coping style and Differential Alcohol Consumption (DAC) was observed.
Conclusions
We found that the DCRR relates to the Emotional- and Task-oriented coping styles, while DAC is associated with the Task-oriented coping style. The strength of our study consists in the territorial and multidisciplinary dimension of the project, the main critical issue is represented by the small size of the patient sample.
Key messages
A relationship can be described between Differential Cardiovascular Risk Reduction and Emotional- and Task-oriented coping styles. There is a relationship between Differential Alcohol Consumption and the Task-oriented coping style.
Collapse
Affiliation(s)
- A Lontano
- Catholic University of the Sacred Heart, Rome, Italy
| | - F D'ambrosio
- Catholic University of the Sacred Heart, Rome, Italy
| | - E Marziali
- Catholic University of the Sacred Heart, Rome, Italy
| | - C Galletti
- Catholic University of the Sacred Heart, Rome, Italy
- Agostino Gemelli University Polyclinic, Rome, Italy
| | - E Mazza
- Catholic University of the Sacred Heart, Rome, Italy
- Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | - I Boncompagni
- DiagnostiCare ONLUS, Rome, Italy
- Sapienza University of Rome, Rome, Italy
| | | | - E Urbani
- DiagnostiCare ONLUS, Rome, Italy
| | | | - A Mingarelli
- DiagnostiCare ONLUS, Rome, Italy
- Sapienza University of Rome, Rome, Italy
| |
Collapse
|
4
|
Raviglione F, Douzgou S, Scala M, Mingarelli A, D'Arrigo S, Freri E, Darra F, Giglio S, Bonaglia MC, Pantaleoni C, Mastrangelo M, Epifanio R, Elia M, Saletti V, Morlino S, Vari MS, De Liso P, Pavaine J, Spaccini L, Cattaneo E, Gardella E, Møller RS, Marchese F, Colonna C, Gandioli C, Gobbi G, Ram D, Palumbo O, Carella M, Germano M, Tonduti D, De Angelis D, Caputo D, Bergonzini P, Novara F, Zuffardi O, Verrotti A, Orsini A, Bonuccelli A, De Muto MC, Trivisano M, Vigevano F, Granata T, Bernardina BD, Tranchina A, Striano P. Electroclinical features of MEF2C haploinsufficiency-related epilepsy: A multicenter European study. Seizure 2021; 88:60-72. [PMID: 33831796 DOI: 10.1016/j.seizure.2021.03.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 03/23/2021] [Accepted: 03/25/2021] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Epilepsy is a main manifestation in the autosomal dominant mental retardation syndrome caused by heterozygous variants in MEF2C. We aimed to delineate the electro-clinical features and refine the genotype-phenotype correlations in patients with MEF2C haploinsufficiency. METHODS We thoroughly investigated 25 patients with genetically confirmed MEF2C-syndrome across 12 different European Genetics and Epilepsy Centers, focusing on the epileptic phenotype. Clinical features (seizure types, onset, evolution, and response to therapy), EEG recordings during waking/sleep, and neuroimaging findings were analyzed. We also performed a detailed literature review using the terms "MEF2C", "seizures", and "epilepsy". RESULTS Epilepsy was diagnosed in 19 out of 25 (~80%) subjects, with age at onset <30 months. Ten individuals (40%) presented with febrile seizures and myoclonic seizures occurred in ~50% of patients. Epileptiform abnormalities were observed in 20/25 patients (80%) and hypoplasia/partial agenesis of the corpus callosum was detected in 12/25 patients (~50%). Nine patients harbored a 5q14.3 deletion encompassing MEF2C and at least one other gene. In 7 out of 10 patients with myoclonic seizures, MIR9-2 and LINC00461 were also deleted, whereas ADGRV1 was involved in 3/4 patients with spasms. CONCLUSION The epileptic phenotype of MEF2C-syndrome is variable. Febrile and myoclonic seizures are the most frequent, usually associated with a slowing of the background activity and irregular diffuse discharges of frontally dominant, symmetric or asymmetric, slow theta waves with interposed spike-and-waves complexes. The haploinsufficiency of ADGRV1, MIR9-2, and LINC00461 likely contributes to myoclonic seizures and spasms in patients with MEF2C syndrome.
Collapse
Affiliation(s)
| | - Sofia Douzgou
- Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicines and Health, University of Manchester, Manchester, UK; Manchester Centre for Genomic Medicine, Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK; Member of ERN-ITHACA
| | - Marcello Scala
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy; Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Stefano D'Arrigo
- Department of Pediatric Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Elena Freri
- Department of Pediatric Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Member of ERN EpiCARE
| | - Francesca Darra
- Child Neuropsychiatry Unit, Department of Life and Reproduction Sciences, University of Verona, Verona, Italy
| | - Sabrina Giglio
- Department of Biomedical Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Maria C Bonaglia
- Cytogenetics Laboratory, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy
| | - Chiara Pantaleoni
- Department of Pediatric Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Massimo Mastrangelo
- Paediatric Neurology Unit, Department of Pediatrics, Children's Hospital Vittore Buzzi, Milan, Italy
| | - Roberta Epifanio
- Clinical Neurophysiology Unit, IRCCS, E Medea Scientific Institute, Bosisio Parini, Lecco, Italy
| | | | - Veronica Saletti
- Department of Pediatric Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Silvia Morlino
- Division of Medical Genetics, Fondazione IRCCS Casa Sollievo della Sofferenza, Poliambulatorio "Giovanni Paolo II", Viale Padre Pio, snc, San Giovanni Rotondo 71013, Italy
| | - Maria Stella Vari
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy; Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Paola De Liso
- Department of Neuroscience, Bambino Gesù Children's Hospital, IRRCS, Rome, Italy; Member of ERN EpiCARE
| | - Julija Pavaine
- Academic Unit of Paediatric Radiology, Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, University of Manchester, Manchester, UK
| | - Luigina Spaccini
- Clinical Genetics Service, Department of Pediatrics, Vittore Buzzi Hospital, Milan, Italy
| | - Elisa Cattaneo
- Clinical Genetics Service, Department of Pediatrics, Vittore Buzzi Hospital, Milan, Italy
| | - Elena Gardella
- The Danish Epilepsy Centre Filadelfia, Dianalund, Denmark; Institute for Regional Health Services, University of Southern Denmark, Odense, Denmark; Member of ERN EpiCARE
| | - Rikke S Møller
- The Danish Epilepsy Centre Filadelfia, Dianalund, Denmark; Institute for Regional Health Services, University of Southern Denmark, Odense, Denmark; Member of ERN EpiCARE
| | - Francesca Marchese
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy; Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Clara Colonna
- Hospital Neuropsychiatry Service, ASST Rhodense, Rho, Milan, Italy
| | - Claudia Gandioli
- Hospital Neuropsychiatry Service, ASST Rhodense, Rho, Milan, Italy
| | - Giuseppe Gobbi
- Child Neurology Unit, IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
| | - Dipak Ram
- Department of Paediatric Neurology, Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Orazio Palumbo
- Division of Medical Genetics, Fondazione IRCCS Casa Sollievo della Sofferenza, Poliambulatorio "Giovanni Paolo II", Viale Padre Pio, snc, San Giovanni Rotondo 71013, Italy
| | - Massimo Carella
- Division of Medical Genetics, Fondazione IRCCS Casa Sollievo della Sofferenza, Poliambulatorio "Giovanni Paolo II", Viale Padre Pio, snc, San Giovanni Rotondo 71013, Italy
| | - Michele Germano
- Maternal and Pediatric Department, Fondazione IRCCS Casa Sollievo della Sofferenza, Poliambulatorio "Giovanni Paolo II", Viale Padre Pio, snc, San Giovanni Rotondo (FG) 71013, Italy
| | - Davide Tonduti
- Paediatric Neurology Unit, Department of Pediatrics, Children's Hospital Vittore Buzzi, Milan, Italy
| | - Diego De Angelis
- Pediatric Department, "Sapienza" University of Rome, Rome 00185, Italy
| | - Davide Caputo
- Department of Health Sciences, Child Neuropsychiatry Unit - Epilepsy Center, San Paolo Hospital, University of Medicine, Milan, Italy; Member of ERN EpiCARE
| | | | - Francesca Novara
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Orsetta Zuffardi
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Alberto Verrotti
- Department of Pediatrics, San Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | - Alessandro Orsini
- Pediatric Neurology Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Alice Bonuccelli
- Pediatric Neurology Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | | | - Marina Trivisano
- Department of Neuroscience, Bambino Gesù Children's Hospital, IRRCS, Rome, Italy; Member of ERN EpiCARE
| | - Federico Vigevano
- Department of Neuroscience, Bambino Gesù Children's Hospital, IRRCS, Rome, Italy; Member of ERN EpiCARE
| | - Tiziana Granata
- Department of Pediatric Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Member of ERN EpiCARE
| | - Bernardo Dalla Bernardina
- Child Neuropsychiatry Unit, Department of Life and Reproduction Sciences, University of Verona, Verona, Italy
| | - Antonia Tranchina
- Department of Pediatric Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Pasquale Striano
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy; Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| |
Collapse
|
5
|
D'Ambrosio F, Tamburrano A, Galletti C, Mazza E, Gambioli S, Galasso V, Mingarelli A, Rubei F, Gambioli C, Laurenti P. Multidisciplinary community approach to reduce cardiovascular risk factors in a neighborhood in Rome. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Cardiovascular Diseases (CVDs) are one of the main causes of death and morbidity worldwide. To reduce the risk of occurrence it is necessary to promote a healthy lifestyle and consider health as a collective benefit. This study aims to evaluate how the implementation of preventive interventions and health promotion could reduce the impact of CVDs on the involved population.
This prospective study started 1 year ago and will last 18 months (July 2020). Participants have been recruited in General Practice clinic in Torresina neighbourhood in Rome. The intervention was a full year of multidisciplinary meetings scheduled with general practitioners, community nurses, dedicated professionals (nutritionist, physiotherapist, psychologist) and outdoor events with a coach to promote group physical activity, assisted by the use of social networks. Anthropometric data, blood chemistry tests and information about lifestyle, nutritional habits and physical activity were collected at time 0 and every 2-month follow-up and, additionally, the individual cardiovascular risk score (CVRS) was calculated. After 12 and up to 18 months, instead, the self-management ability of a correct lifestyle will be evaluated on the basis of the measured outcomes. Statistical analysis was performed using a paired t test with Jamovi software.
The sample size was 62 patients, 50% male with an average age of 54.6 years (±7.8). During the analyzed period there was a reduction in the percentage of smokers from 30.6% at baseline to 22.6% after 12 months. The baseline CVRS was 4.9% (±6.3). At 12 months the CVRS significantly decreased to 3.8% (±4.0) (p < 0.01). Total cholesterol level was 211.1 mg/dl (±32.8) at baseline, with a significant reduction at 12 months (202.5 ± 37.8) (p = 0.01). The results are preliminary.
Multidisciplinary interventions resulted in a significant reduction of CVRS and cholesterol levels during the study period. Further studies are necessary to evaluate our approach.
Key messages
Cardiovascular Diseases are the main causes of deaths among the population, so primary prevention through tailored educational interventions is fundamental. A multidisciplinary approach has proven to be effective in reducing the risk of cardiovascular disease and the level of cholesterol.
Collapse
Affiliation(s)
- F D'Ambrosio
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Tamburrano
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - C Galletti
- Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - E Mazza
- Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | | | - A Mingarelli
- DiagnostiCare ONLUS, Rome, Italy
- Scuola di Specializzazione in Psicologia della Salute ‘Sapienza’ Università di Roma, Rome, Italy
| | - F Rubei
- DiagnostiCare ONLUS, Rome, Italy
| | | | - P Laurenti
- Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| |
Collapse
|
6
|
Savini MN, Mingarelli A, Peron A, La Briola F, Cervi F, Alfano RM, Canevini MP, Vignoli A. Electro-clinical and neurodevelopmental outcome in six children with early diagnosis of tuberous sclerosis complex and role of the genetic background. Ital J Pediatr 2020; 46:36. [PMID: 32216820 PMCID: PMC7099780 DOI: 10.1186/s13052-020-0801-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 03/17/2020] [Indexed: 11/10/2022] Open
Abstract
Background Seizures in individuals affected by tuberous sclerosis complex (TSC) commonly develop in the first year of life, are often preceded by a progressive deterioration of the electroencephalogram (EEG), and likely influence developmental outcome. Although early diagnosis of TSC has offered a tremendous opportunity to monitor affected patients before seizure onset, reports of the neurological manifestations of TSC in infants before seizure onset are still scarce. Here we describe early EEG activity, clinical and genetic data and developmental assessment in a group of TSC infants, with the aim of identifying possible prognostic factors for neurodevelopmental outcome. Methods We report on six infants diagnosed with TSC pre- or perinatally, who underwent serial Video-EEG recordings during the first two years of life. EEGs were classified based on distribution and intensity of interictal epileptiform discharges, and Vigabatrin was introduced in case of ictal discharges. Psychomotor development, cognitive functioning and behavioral problems were assessed through standardized scales. Molecular testing included analysis for point mutations and deletions/duplications in TSC1 and TSC2. Results EEG abnormalities appeared at a mean age of 4 months. Four of the six patients developed seizures. EEG abnormalities preceded the onset of clinical seizures in all of them. The two individuals with good seizure control showed normal development, while the other two exhibited psychomotor delays. The patients who did not develop seizures had normal development. A pathogenic variant in the TSC2 gene was detected in all patients but one. The one without a mutation identified did not develop seizures and showed normal neurodevelopment. Of note, the two patients presenting with the worst outcome (that is, poor seizure control and intellectual/behavioral disability) both carried pathogenic variants in the GAP domain of TSC2. Conclusion Our report supports the importance of EEG monitoring before seizure onset in patients with TSC, and the correlation between prompt seizure control and positive neurodevelopmental outcome, regardless of seizure type. Our results also indicate a possible role of the genetic background in influencing the outcome.
Collapse
Affiliation(s)
- M N Savini
- Child Neuropsychiatric Unit - Epilepsy Center, San Paolo Hospital, Department of Health Sciences, Università degli Studi di Milano, Via di Rudinì 8, 20142, Milan, Italy
| | - A Mingarelli
- Child Neuropsychiatric Unit - Epilepsy Center, San Paolo Hospital, Milan, Italy
| | - A Peron
- Child Neuropsychiatric Unit - Epilepsy Center, San Paolo Hospital, Department of Health Sciences, Università degli Studi di Milano, Via di Rudinì 8, 20142, Milan, Italy. .,Department of Pediatrics, Division of Medical Genetics, University of Utah School of Medicine, Salt Lake City, UT, USA. .,Human Pathology and Molecular Pathology Unit, San Paolo Hospital, Milan, Italy.
| | - F La Briola
- Child Neuropsychiatric Unit - Epilepsy Center, San Paolo Hospital, Milan, Italy
| | - F Cervi
- Child Neuropsychiatric Unit - Epilepsy Center, San Paolo Hospital, Milan, Italy
| | - R M Alfano
- Human Pathology and Molecular Pathology Unit, San Paolo Hospital, Milan, Italy
| | - M P Canevini
- Child Neuropsychiatric Unit - Epilepsy Center, San Paolo Hospital, Department of Health Sciences, Università degli Studi di Milano, Via di Rudinì 8, 20142, Milan, Italy
| | - A Vignoli
- Child Neuropsychiatric Unit - Epilepsy Center, San Paolo Hospital, Department of Health Sciences, Università degli Studi di Milano, Via di Rudinì 8, 20142, Milan, Italy
| |
Collapse
|
7
|
Savini MN, Mingarelli A, Vignoli A, La Briola F, Chiesa V, Peron A, Mai R, Tassi L, Mastrangelo M, Zambrelli E, Turner K, Canevini MP. Ictal signs in tuberous sclerosis complex: Clinical and video-EEG features in a large series of recorded seizures. Epilepsy Behav 2018; 85:14-20. [PMID: 29906696 DOI: 10.1016/j.yebeh.2018.05.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 04/26/2018] [Accepted: 05/14/2018] [Indexed: 11/26/2022]
Abstract
Epilepsy is the most common neurological symptom in tuberous sclerosis complex (TSC), occurring in 72-85% of affected individuals. Despite the large number of patients reported, their electroclinical phenotype has been rarely described. We analyzed seizure semiology through ictal video-electroencephalography (V-EEG) recordings in a large series of patients. In this multicenter study, we reviewed V-EEGs of 51 patients: ictal recordings were analyzed in correlation with their clinical variables. The median age of epilepsy onset was six months (one day-16 years), with onset in the first year of life in 71% patients (36/51), in 10 of them during the neonatal period. Sixty-five percent of patients (33/51) experienced epileptic spasms in their life, with late-onset (>two years) in five; 42% of the epileptic spasms persisted after age two years, despite the onset in the first year of life. We identified four different electroclinical subsets: focal epilepsy (35%, 18/51), Lennox-Gastaut Syndrome evolution (27%, 14/51), focal seizures with persisting spasms (33%, 17/51), and spasms only (4%, 2/51). We reviewed 45 focal seizures, 13 clusters of epileptic spasms, and seven generalized seizures. In 12 patients, we recorded different seizure types. In 71% of the focal seizures (32/45), the ictal pattern was focal without diffusion. In 38% of the patients (5/13) epileptic spasms were related to typical diffuse slow wave pattern associated with superimposed fast activity, with focal predominance. Focal seizures and focal spasms resulted as the most frequent seizure types in TSC. Seizure onset was variable but showing a predominant involvement of the frontocentral regions (40%). Discrete clinical signs characterized the seizures, and behavioral arrest was the predominant first clinical objective sign. Epileptic spasms were a typical presentation at all ages, frequently asymmetrical and associated with lateralizing features, especially in older patients.
Collapse
Affiliation(s)
- Miriam Nella Savini
- Epilepsy Center-Child Neuropsychiatric Unit, ASST Santi Paolo e Carlo, Milan, Italy; Department of Health Sciences, University of Milan, Italy
| | - Alessia Mingarelli
- Epilepsy Center-Child Neuropsychiatric Unit, ASST Santi Paolo e Carlo, Milan, Italy
| | - Aglaia Vignoli
- Epilepsy Center-Child Neuropsychiatric Unit, ASST Santi Paolo e Carlo, Milan, Italy; Department of Health Sciences, University of Milan, Italy.
| | - Francesca La Briola
- Epilepsy Center-Child Neuropsychiatric Unit, ASST Santi Paolo e Carlo, Milan, Italy
| | - Valentina Chiesa
- Epilepsy Center-Child Neuropsychiatric Unit, ASST Santi Paolo e Carlo, Milan, Italy
| | - Angela Peron
- Epilepsy Center-Child Neuropsychiatric Unit, ASST Santi Paolo e Carlo, Milan, Italy; Department of Health Sciences, University of Milan, Italy
| | - Roberto Mai
- "C. Munari" Epilepsy Surgery Center, GOM Niguarda, Milan, Italy
| | - Laura Tassi
- "C. Munari" Epilepsy Surgery Center, GOM Niguarda, Milan, Italy
| | | | - Elena Zambrelli
- Epilepsy Center-Child Neuropsychiatric Unit, ASST Santi Paolo e Carlo, Milan, Italy
| | - Katherine Turner
- Epilepsy Center-Child Neuropsychiatric Unit, ASST Santi Paolo e Carlo, Milan, Italy
| | - Maria Paola Canevini
- Epilepsy Center-Child Neuropsychiatric Unit, ASST Santi Paolo e Carlo, Milan, Italy; Department of Health Sciences, University of Milan, Italy
| |
Collapse
|
8
|
Mingarelli A, Vignoli A, La Briola F, Peron A, Giordano L, Banderali G, Canevini MP. Dramatic relapse of seizures after everolimus withdrawal. Eur J Paediatr Neurol 2018; 22:203-206. [PMID: 28888335 DOI: 10.1016/j.ejpn.2017.07.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 02/14/2017] [Accepted: 07/25/2017] [Indexed: 11/15/2022]
Abstract
Tuberous sclerosis complex (TSC) is an autosomal dominant multisystemic disorder caused by deregulation of the mTOR pathway, and represents one of the leading genetic causes of epilepsy. mTOR inhibitors (Sirolimus and Everolimus) are currently approved only for the treatment of growing subependymal giant cell astrocytomas, renal angiomyolipomas and lymphangioleiomyomatosis in TSC. However, preclinical and clinical evidence supports their potential role in effectively treating TSC-associated epilepsy, but no consensus on its use in seizures has been reached yet and there are few data on epilepsy outcome after the suspension of mTOR inhibitors treatment. We report for the first time on a patient in whom discontinuation of Everolimus (prescribed for growing subependymal giant cell astrocytomas) was associated with a relapse of seizures twice, and control of seizures was regained after reintroducing the medicine. This clinical report supports the promising potential of Everolimus in treating epilepsy in TSC, and specifically underlines the non-permanent effect on seizures after withdrawal.
Collapse
Affiliation(s)
- Alessia Mingarelli
- Child Neuropsychiatry Unit - Epilepsy Center, ASST Santi Paolo e Carlo Hospital, Milan, Italy
| | - Aglaia Vignoli
- Child Neuropsychiatry Unit - Epilepsy Center, ASST Santi Paolo e Carlo Hospital, Department of Health Sciences, University of Milan, Italy.
| | - Francesca La Briola
- Child Neuropsychiatry Unit - Epilepsy Center, ASST Santi Paolo e Carlo Hospital, Milan, Italy
| | - Angela Peron
- Child Neuropsychiatry Unit - Epilepsy Center, ASST Santi Paolo e Carlo Hospital, Department of Health Sciences, University of Milan, Italy
| | - Lucio Giordano
- Child Neuropsychiatry Unit - Civile Hospital, Brescia, Italy
| | - Giuseppe Banderali
- Department of Pediatrics, ASST Santi Paolo e Carlo Hospital, Department of Health Science, University of Milan, Italy
| | - Maria Paola Canevini
- Child Neuropsychiatry Unit - Epilepsy Center, ASST Santi Paolo e Carlo Hospital, Department of Health Sciences, University of Milan, Italy
| |
Collapse
|
9
|
Mingarelli A, Casagrande M, Di Pirchio R, Nizzi S, Parisi C, Loy BC, Solano L, Rampello A, Di Paolo C. Alexithymia partly predicts pain, poor health and social difficulties in patients with temporomandibular disorders. J Oral Rehabil 2013; 40:723-30. [PMID: 23869944 DOI: 10.1111/joor.12084] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2013] [Indexed: 11/28/2022]
Abstract
Temporomandibular disorders (TMD) are functional diseases of the masticatory system; their symptoms are clicking, difficulty opening the mouth wide, ear pain, facial pain and headaches. The relationships among distress, emotional factors and TMD are well known. It was shown that patients with TMD have little awareness of their inner states and emotions, and it was found that those reporting oro-facial pain presented higher alexithymia than did asymptomatic people. Other authors confirmed that alexithymia was higher in the painful TMD group than controls. This study was aimed to evaluate whether alexithymia and its components can be considered as predisposing factors for pain severity, poor health and greater social difficulties in patients with TMD. One hundred thirty-three patients received a diagnosis of TMD and completed the 20-item Toronto Alexithymia Scale. Multiple stepwise regressions showed that alexithymia and age explained 10% of the pain and 31% of poor health and also that alexithymia explained 7% of social difficulty. A direct comparison of patients with TMD based on alexithymia revealed a higher presence of pain in alexithymic patients with TMD than in those characterised by moderate or no alexithymia. In conclusion, alexithymia partly predicts pain, poor health and social difficulties in patients with TMD. Furthermore, alexithymic patients have more pain than those with moderate or low alexithymia.
Collapse
Affiliation(s)
- A Mingarelli
- Dipartimento di Psicologia, 'Sapienza' Università di Roma, Rome, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Mingarelli A, Casagrande M, Benevento M, Stella E, Germanò G, Solano L, Bertini M. From Health Education to Health Promotion: Promoting Emotional Regulation Skills in Hypertensive Patients. High Blood Press Cardiovasc Prev 2007. [DOI: 10.2165/00151642-200714030-00149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
|
11
|
Casagrande M, Poma R, Mingarelli A, Barbato P, Germanò G, Bertini M. Problem Solving Strategies and Abilities in Normotensive Subjects. High Blood Press Cardiovasc Prev 2007. [DOI: 10.2165/00151642-200714030-00147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
|
12
|
Poma R, Casagrande M, Mingarelli A, Barbato P, Germanò G, Bertini M. Hypertension and Problem Solving Ability: What is the Relationship? High Blood Press Cardiovasc Prev 2007. [DOI: 10.2165/00151642-200714030-00148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
|
13
|
Casagrande M, Mingarelli A, Germanò G, Dema L, Benevento M, Stella E, Bertini M. Blood Pressure (BP) and Antihypertensive Drugs (AD): Effects on Quality of Life (QOL). High Blood Press Cardiovasc Prev 2007. [DOI: 10.2165/00151642-200714030-00164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
|
14
|
Casagrande M, German?? G, Cannav?? F, Mingarelli A, Benevento M, Montuori C, De Berardinis E, Mirante N, Bertini M. Stress Management and Hypertension. High Blood Press Cardiovasc Prev 2005. [DOI: 10.2165/00151642-200512030-00121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
|
15
|
Casagrande M, Mingarelli A, German?? G, Benevento M, Bertini M. Alexithymia and Hypertension. High Blood Press Cardiovasc Prev 2005. [DOI: 10.2165/00151642-200512030-00110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
|