1
|
Suzuki T, Natsume J, Ito Y, Ito T, Noritake K, Kinoshita F, Fukasawa T, Tsuji T, Itomi K, Kurahashi H, Kubota K, Okanishi T, Saitoh S, Sugiura H, Watanabe H, Takahashi Y, Kidokoro H. Effect of levodopa on pathological gait in Dravet syndrome: A randomized crossover trial using three-dimensional gait analysis. Epilepsia 2024. [PMID: 38469885 DOI: 10.1111/epi.17888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 01/04/2024] [Accepted: 01/05/2024] [Indexed: 03/13/2024]
Abstract
OBJECTIVE Individuals with Dravet syndrome (DS) exhibit progressive gait disturbance. No quantitative studies have been conducted to evaluate the effectiveness of medication for gait disturbance. Therefore, the aim of this study was to evaluate the effectiveness of levodopa for pathological gait in people with DS using three-dimensional gait analysis (3DGA). METHODS Nine individuals with DS, ages 6-20 years, participated in a crossover study of levodopa and were randomly assigned to the levodopa precedence or no levodopa precedence group. Levodopa/carbidopa hydrate was prescribed at a dose of 5 mg/kg/day (body weight <60 kg) or 300 mg/day (body weight ≥60 kg). The medication was taken for 4-6 weeks (4-week washout period). 3DGA was performed three times before the study, with and without levodopa. A mixed-effects model was used to evaluate the effectiveness of levodopa. The primary outcome was the change in the Gait Deviation Index (GDI). In addition, spatiotemporal gait parameters, 6-minute walking distance (6MD), and balance were evaluated. The correlation between the effectiveness of levodopa and age or gait performance before starting levodopa was analyzed. RESULTS Levodopa improved the GDI by 4.2 points, (p = .029), 6MD by 52 m (p = .002), and balance test result by 4.1 mm (p = .011) in participants with DS. No severe adverse events were observed, with the exception of one participant, who exhibited fever and consequently stopped taking levodopa. Levodopa was more effective in younger participants with a higher baseline gait performance. SIGNIFICANCE Our randomized crossover trial showed that levodopa has the potential to improve gait disturbance in people with DS.
Collapse
Affiliation(s)
- Takeshi Suzuki
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Jun Natsume
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Developmental Disability Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuji Ito
- Department of Pediatrics, Aichi Prefectural Mikawa Aoitori Medical and Rehabilitation Center for Developmental Disabilities, Okazaki, Japan
| | - Tadashi Ito
- Three-dimensional Motion Analysis Room, Aichi Prefectural Mikawa Aoitori Medical and Rehabilitation Center for Developmental Disabilities, Okazaki, Japan
| | - Koji Noritake
- Department of Orthopedic Surgery, Aichi Prefectural Mikawa Aoitori Medical and Rehabilitation Center for Developmental Disabilities, Okazaki, Japan
| | - Fumie Kinoshita
- Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | | | - Takeshi Tsuji
- Department of Pediatrics, Okazaki City Hospital, Okazaki, Japan
| | - Kazuya Itomi
- Department of Neurology, Aichi Children's Health and Medical Center, Obu, Japan
| | | | - Kazuo Kubota
- Department of Pediatrics, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Tohru Okanishi
- Department of Child Neurology, Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
- Division of Child Neurology, Institute of Neurological Sciences, Tottori University School of Medicine, Yonago, Japan
| | - Shinji Saitoh
- Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hideshi Sugiura
- Department of Physical Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hirohisa Watanabe
- Department of Neurology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Yoshiyuki Takahashi
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroyuki Kidokoro
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| |
Collapse
|
2
|
Mori A, Kawano Y, Hara S, Numoto S, Kurahashi H, Okumura A. A nationwide survey of human metapneumovirus-associated encephalitis/encephalopathy in Japan. Brain Dev 2023; 45:197-204. [PMID: 36702664 DOI: 10.1016/j.braindev.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 08/22/2022] [Revised: 12/13/2022] [Accepted: 01/03/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND As there have been no comprehensive reports of human metapneumovirus-associated encephalopathy (hMPVE), this study examined the clinical features of hMPVE in children in Japan. METHOD A nationwide survey of children with hMPVE was conducted using a structured research form. An initial survey asked pediatricians about children with hMPVE treated between 2014 and 2018. A second survey obtained patient information from hospitals that responded to the initial survey and those identified as having treated cases from a literature search. We collected demographic data, symptoms of hMPV infection, neurological symptoms, laboratory data, treatment, and outcomes. Outcomes were determined using the Pediatric Cerebral Performance Category Score. RESULT Clinical information was available for 16 children. Their median age was 37 months. Six had preexisting neurological disorders. The interval between the onsets of infection and hMPVE was 4 days. Outcomes were good in 11 patients and poor in 5. There were no significant differences in demographic data, neurological symptoms, or laboratory data between the patients with good and poor outcomes. The encephalopathy subtypes were acute encephalopathy with biphasic seizures and late reduced diffusion in 3, clinically mild encephalitis/encephalopathy with a reversible splenial lesion in 3, hemorrhagic shock and encephalopathy syndrome in 2, and others in 8. CONCLUSION The outcomes of children with hMPVE were not very different from those of acute encephalopathy due to other viruses. We found no factors associated with poor outcomes.
Collapse
Affiliation(s)
- Ayumi Mori
- Department of Pediatrics, Toyota Memorial Hospital, Japan
| | | | - Shinya Hara
- Department of Pediatrics, Toyota Memorial Hospital, Japan
| | - Shingo Numoto
- Department of Pediatrics, Aichi Medical University, Japan
| | | | | |
Collapse
|
3
|
Mariya T, Sugimoto T, Miyai S, Kato T, Toshiaki E, Kurahashi H. P-545 The age-related required number of zygotes estimated from prior clinical studies of preimplantation genetic testing for aneuploidy (PGT-A). Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.503] [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
Study question
How many eggs will be required to optimize the chances of a live birth with or without PGT-A?
Summary answer
The number of zygotes required for live birth is higher in women with an advanced age, and the use of PGT-A does not provide improvement.
What is known already
Women who are undergoing PGT-A often wish to know how many eggs will be required to optimize the chances of a live birth. This important information could be provided as part of prior genetic counseling, but there are no precise data on this at present. If the number of eggs required to give the best chance of a successful live birth was known, treatment plans with or without PGT-A could be better determined.
Study design, size, duration
We estimated the optimal number of eggs required for IVF treatment with PGT-A to produce at least a single live birth, stratified by maternal age, on the basis of information from prior studies and in current databases.
Participants/materials, setting, methods
We derived our calculation parameters from three prior large-scale clinical investigations associated with PGT-A. We estimated a live birth rate using the following factors: rate of zygotes that develop a useful blastocyst, euploid rate in PGT-A, and the live birth rate after euploid embryo transfer. All of these factors were assumed to be statistically independent in this study for the purposes of our calculations and the live birth rate per single zygote was calculated.
Main results and the role of chance
The estimations in our present analyses however indicate a probability of less than 10% that woman over 40 years of age will have a live birth from a single zygote, regardless of whether PGT-A is performed or not. We used a negative binomial distribution approach to calculate how many zygotes are needed to obtain at least one live birth. The plot of these results is provided in Figure 2. To achieve a 50% chance of getting at least one live birth, patients required 8 zygotes at age of 40 and 21 zygotes at the age of 43. Furthermore, to achieve an 80% chance of obtaining a live birth, our calculations estimate that 18 and 47 zygotes would be required at these two ages, respectively, which would be challenging to achieve. On the other hand, by avoiding unnecessary transplants using PGT-A, women may have to wait a shorter period to accomplish a live birth or may be able to avoid wasting their limited remaining reproductive period, particularly if they are older than 42.
Limitations, reasons for caution
The reference data from PGT-A studies that have estimated of the live birth rate include chromosomal quantitative PCR, microarray analysis, and next generation sequencing (NGS). There is a high possibility that the embryos designated as “euploid” in those studies include mosaic embryos, which represents a limitation of our present meta-analysis.
Wider implications of the findings
More details on the clinical outcomes of PGT-A will be revealed as clinical studies progress in the future. It is our hope that the results of this present study will assist with future genetic counseling strategies for PGT-A in the meantime.
Trial registration number
not applicable
Collapse
Affiliation(s)
- T Mariya
- Sapporo Medical University, Obstetrics and Gynecology , Sapporo, Japan
| | - T Sugimoto
- Fujita Health University, Division of Molecular Genetics- Institute for Comprehensive Medical Science , Toyoake, Japan
| | - S Miyai
- Fujita Health University, Division of Molecular Genetics- Institute for Comprehensive Medical Science , Toyoake, Japan
| | - T Kato
- Fujita Health University, Division of Molecular Genetics- Institute for Comprehensive Medical Science , Toyoake, Japan
| | - E Toshiaki
- Sapporo Medical University, Obstetrics and Gynecology , Sapporo, Japan
| | - H Kurahashi
- Fujita Health University, Division of Molecular Genetics- Institute for Comprehensive Medical Science , Toyoake, Japan
| |
Collapse
|
4
|
Watanabe S, Yoshikai K, Tomida M, Suzuki S, Matsuda Y, Miyai S, Nakano E, Kurahashi H, Sawada T. P-131 The fate of irregularly divided blastomeres: why does “Direct cleavage” reduce blastocyst development rate but not blastocyst euploid rate? Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.126] [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
Study question
How do the blastomeres formed by direct cleavage (dynamics of one cell dividing into three or more cells) subsequently develop?
Summary answer
About half of the blastomeres by direct cleavage did not form blastocysts.
What is known already
There are many reports that embryos with direct cleavage in the early development have a lower blastocyst development rate because direct cleavage produces chromosomal abnormal cells. However, when such embryos develop into blastocysts, there have been some reports that the transfer pregnancy rate and euploid rate did not decrease, but the reasons for this have not been clarified.
Study design, size, duration
This is a retrospective study of 89 blastocysts obtained during 2013-18. These embryos were those that patients requested to be discarded and consented to be used in this study. All target embryos were time-lapse monitored by EmbryoScope (Vitrolife, Sweden), and several trophectoderms were biopsied and examined for euploidy.
Participants/materials, setting, methods
The target embryos were classified into three groups: embryos with normal first and second cleavage (NC group), embryos with irregular division (one cell dividing into three or more cells) called direct cleavage at the first cleavage (DC1 group), and embryos with direct cleavage of one blastomere at the second cleavage (DC2 group). It was recorded whether the blastomeres of the embryos subsequently developed into blastocysts or not. NGS analysis was performed on the embryos.
Main results and the role of chance
The target embryos were classified as 48 in the NC group, 32 in the DC1 group, and 9 in the DC2 group. Whether the blastomeres in the target embryos subsequently formed blastocysts or not was recorded one by one by time-lapse images, resulting in the blastomeres’ blastocyst formation rate was 95.1% in the NC group and 55.9% in the DC1 group, which was significantly lower in the DC1 group (P < 0.01). In the DC2 group, blastomeres formed by normal division and those by direct cleavage at the second cleavage were recorded separately, and the blastocyst formation rate was 90.8% for normal cleavage blastomeres and 46.0% for direct cleavage blastomeres, with significantly lower rates for direct cleavage blastomeres (P < 0.01). Therefore, about half of the blastomeres generated by direct cleavage at the first or second cleavage did not form blastocysts. The results of NGS analysis were as follows: NC group: 35.4% euploid, 45.8% aneuploid, and 18.8% mosaic; DC1 group: 37.5%, 53.1%, and 9.4%, respectively; and DC2 group: 55.6%, 33.3%, and 11.1%, respectively. There was no significant difference in any of the items, suggesting that direct cleavage does not affect the euploidy of blastocysts.
Limitations, reasons for caution
For the purpose of NGS analysis, all the target embryos in this study were blastocysts, but if all the cultured embryos were included, arrested embryos would be included, which would probably result in more blastomeres formed by direct cleavage not developing into blastocysts.
Wider implications of the findings
The blastomeres generated by direct cleavage were often excluded from blastocyst formation. This may be an exclusion of chromosomally abnormal cells and may be one of the reasons why direct cleavage decreases blastocyst development rate but does not decrease blastocyst euploid rate.
Trial registration number
not applicable
Collapse
Affiliation(s)
- S Watanabe
- Sawada Women's Clinic, ART Lab. , Nagoya, Japan
| | - K Yoshikai
- Sawada Women's Clinic, ART Lab. , Nagoya, Japan
| | - M Tomida
- Sawada Women's Clinic, ART Lab. , Nagoya, Japan
| | - S Suzuki
- Sawada Women's Clinic, ART Lab. , Nagoya, Japan
| | - Y Matsuda
- Sawada Women's Clinic, ART Lab. , Nagoya, Japan
| | - S Miyai
- Fujita Health University, Institute for Comprehensive Medical Science , Toyoake, Japan
| | - E Nakano
- Sawada Women's Clinic, ART Lab. , Nagoya, Japan
| | - H Kurahashi
- Fujita Health University, Institute for Comprehensive Medical Science , Toyoake, Japan
| | - T Sawada
- Sawada Women's Clinic, ART Lab. , Nagoya, Japan
| |
Collapse
|
5
|
Muto T, Masuda Y, Nakamura N, Numoto S, Kodama S, Miyamoto R, Miyata K, Hayakawa T, Mori H, Kuroyanagi Y, Akaihata M, Iwayama H, Kurahashi H, Shimomura Y, Nagai T, Hori T, Agata H, Okumura A. Usefulness of brain natriuretic peptide to distinguish Kawasaki disease from cervical lymphadenitis. Pediatr Int 2022; 64:e15050. [PMID: 34739174 DOI: 10.1111/ped.15050] [Citation(s) in RCA: 1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 09/22/2021] [Accepted: 10/24/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Cervical lymphadenitis (CL) cannot be easily distinguished from Kawasaki disease (KD). We therefore explored whether brain natriuretic peptide (BNP) levels are useful in this context. METHODS We retrospectively analyzed 14 children with CL and 177 children with KD. Patients with KD were divided into three groups according to their clinical symptoms at hospitalization - 97 patients had typical KD, 35 had node-first KD (NFKD), and 45 had KD without lymphadenopathy. We reviewed data on clinical and laboratory parameters, including serum BNP levels, at hospitalization together with factors that might distinguish KD from CL. RESULTS Patients with CL were older than those with KD. Serum BNP levels were higher in all the KD groups than in the CL group. Multivariate logistic regression analyses indicated that higher BNP levels were associated with NFKD (odds ratio: 1.12, 95% confidence interval: 1.01-1.25). The receiver operating characteristic curve yielded a BNP cutoff of 18.3 pg/mL, with a sensitivity of 0.680, a specificity of 0.857, and an area under the curve of 0.806 (95% confidence interval: 0.665-0.947). CONCLUSIONS Serum BNP levels can be used to distinguish KD from CL, especially in patients with NFKD.
Collapse
Affiliation(s)
- Taichiro Muto
- Department of Pediatrics, Aichi Medical University, Nagakute, Japan
| | - Yu Masuda
- Department of Pediatrics, Aichi Medical University, Nagakute, Japan
| | - Nami Nakamura
- Department of Pediatrics, Aichi Medical University, Nagakute, Japan
| | - Shingo Numoto
- Department of Pediatrics, Aichi Medical University, Nagakute, Japan
| | - Shunsuke Kodama
- Department of Pediatrics, Aichi Medical University, Nagakute, Japan
| | - Ryosuke Miyamoto
- Department of Pediatrics, Aichi Medical University, Nagakute, Japan
| | - Kenji Miyata
- Department of Pediatrics, Aichi Medical University, Nagakute, Japan
| | | | - Hiromitsu Mori
- Department of Pediatrics, Aichi Medical University, Nagakute, Japan
| | | | - Mitsuko Akaihata
- Department of Pediatrics, Aichi Medical University, Nagakute, Japan
| | - Hideyuki Iwayama
- Department of Pediatrics, Aichi Medical University, Nagakute, Japan
| | | | | | - Takuhito Nagai
- Department of Pediatrics, Aichi Medical University, Nagakute, Japan
| | - Toshinori Hori
- Department of Pediatrics, Aichi Medical University, Nagakute, Japan
| | - Hiroatsu Agata
- Department of Pediatrics, Aichi Medical University, Nagakute, Japan
| | - Akihisa Okumura
- Department of Pediatrics, Aichi Medical University, Nagakute, Japan
| |
Collapse
|
6
|
Numoto S, Kakita H, Takeshita S, Ueda H, Kondo T, Kurahashi H, Wakatsuki A, Yamada Y, Okumura A. Effects of maternal magnesium sulfate treatment on newborns. Pediatr Int 2022; 64:e14747. [PMID: 33904213 DOI: 10.1111/ped.14747] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 10/16/2020] [Revised: 03/03/2021] [Accepted: 04/09/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Antenatal magnesium sulfate (MgSO4 ) has been used with mothers, but the influence of MgSO4 on the fetus is unclear. The purpose of this study is to determine whether longer antenatal MgSO4 exposure correlates with adverse effects in newborns. METHODS The clinical data of 77 infants born to mothers treated with MgSO4 were collected. The infants were divided into two groups according to (1) the serum Mg concentration, (2) cumulative Mg dose, and (3) duration of antenatal maternal Mg treatment, respectively. RESULTS The serum Mg level of the infants correlated with that of the mothers but not with the duration of Mg treatment or the cumulative dose of Mg. There were no significant differences in the infants' clinical variables according to either the duration of Mg treatment or the cumulative dose of Mg. By contrast, enteral feeding tolerance began at a significantly later age and the heart rate on admission was significantly lower in infants with a serum Mg level ≥4.0 mmol/L than in those with a serum Mg level <4.0 mmol/L. CONCLUSIONS Modest effects on the clinical variables of infants with higher serum Mg levels were determined, whereas neither the duration of Mg treatment nor the cumulative Mg dose correlated with the clinical variables of the infants. Thus, in newborns with only moderately elevated serum Mg levels, serious adverse effects are unlikely.
Collapse
Affiliation(s)
- Shingo Numoto
- Department of Pediatrics, Aichi Medical University, Nagakute, Japan
| | - Hiroki Kakita
- Department of Perinatal and Neonatal Medicine, Aichi Medical University, Nagakute, Japan
| | - Satoru Takeshita
- Department of Perinatal and Neonatal Medicine, Aichi Medical University, Nagakute, Japan
| | - Hiroko Ueda
- Department of Perinatal and Neonatal Medicine, Aichi Medical University, Nagakute, Japan
| | - Tomoko Kondo
- Department of Perinatal and Neonatal Medicine, Aichi Medical University, Nagakute, Japan
| | | | - Akihiko Wakatsuki
- Department of Obstetrics and Gynecology, Aichi Medical University, Nagakute, Japan
| | - Yasumasa Yamada
- Department of Perinatal and Neonatal Medicine, Aichi Medical University, Nagakute, Japan
| | - Akihisa Okumura
- Department of Pediatrics, Aichi Medical University, Nagakute, Japan
| |
Collapse
|
7
|
Saito M, Nakazawa T, Toriumi S, Takasu M, Yagisawa H, Murano Y, Miyazaki N, Kurahashi H, Okumura A, Shimizu T. Case report: Mild encephalitis with a reversible splenial lesion associated with SARS-CoV-2 infection in a patient with MYRF variant. Front Pediatr 2022; 10:971432. [PMID: 35990002 PMCID: PMC9386134 DOI: 10.3389/fped.2022.971432] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 06/20/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
We report a 14-year-old girl with a heterozygous p. Gln403Arg variant in the MYRF gene, who had five episodes of encephalopathy. She experienced reduced consciousness, numbness in the arm, and impaired verbal communication from day 4 of SARS-CoV-2 infection. Magnetic resonance imaging of her head showed reduced water diffusion in the corpus callosum and deep white matter. These features were similar to those seen in her previous episodes of encephalopathy. She was treated with methylprednisolone pulse therapy and recovered completely within a week.
Collapse
Affiliation(s)
- Mizuho Saito
- Department of Pediatrics, Toshima Hospital, Tokyo, Japan
| | | | - Shun Toriumi
- Department of Pediatrics, Toshima Hospital, Tokyo, Japan
| | | | | | - Yayoi Murano
- Department of Pediatrics, Toshima Hospital, Tokyo, Japan
| | - Nao Miyazaki
- Department of Pediatrics, Toshima Hospital, Tokyo, Japan
| | | | - Akihisa Okumura
- Department of Pediatrics, Aichi Medical University, Nagakute, Japan
| | - Toshiaki Shimizu
- Department of Pediatrics, Faculty of Medicine, Juntendo University, Tokyo, Japan
| |
Collapse
|
8
|
Muto T, Nakamura N, Masuda Y, Numoto S, Kodama S, Miyamoto R, Hayakawa T, Mori H, Iwayama H, Kurahashi H, Agata H, Okumura A. Serum free carnitine levels in children with Kawasaki disease. Pediatr Int 2022; 64:e14849. [PMID: 33999460 DOI: 10.1111/ped.14849] [Citation(s) in RCA: 4] [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: 02/04/2021] [Revised: 04/30/2021] [Accepted: 05/12/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Carnitine plays an essential role in the transfer of long-chain fatty acids to the mitochondria for β-oxidation. No study has characterized carnitine in children with Kawasaki disease (KD). The objective of this study was to elucidate the characteristics of serum free carnitine (FC) in hospitalized pediatric patients with KD. METHODS We retrospectively analyzed 45 patients with KD in whom serum FC levels were measured. We investigated the clinical and laboratory parameters before intravenous immunoglobulin was administered, including serum FC levels, according to the response to intravenous immunoglobulin (IVIG). We also analyzed the relationship among serum FC, laboratory data, and clinical variables. RESULTS IVIG was effective in 33 children (responders) and was ineffective in 12 children (non-responders). Serum FC levels were higher in non-responders than in responders: 35.3 μmol/L (range, 26.8-118.4 μmol/L) vs 31.4 μmol/L (range, 20.9-81.2 μmol/L), P <0.05. FC levels before IVIG in 80% of responders were below the normal range. The levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin, and FC were higher in non-responders than in responders. FC levels were correlated with AST (R2 = 0.364, P = 0.0015) and ALT (R2 = 0.423, P < 0.001) levels. CONCLUSIONS Free carnitine levels were elevated in some patients with KD, especially in those who were refractory to IVIG. Additionally, FC levels in children with KD correlated with ASL and ALT levels.
Collapse
Affiliation(s)
- Taichiro Muto
- Department of Pediatrics, Aichi Medical University, Aichi, Japan
| | - Nami Nakamura
- Department of Pediatrics, Aichi Medical University, Aichi, Japan
| | - Yu Masuda
- Department of Pediatrics, Aichi Medical University, Aichi, Japan
| | - Shingo Numoto
- Department of Pediatrics, Aichi Medical University, Aichi, Japan
| | - Shunsuke Kodama
- Department of Pediatrics, Aichi Medical University, Aichi, Japan
| | - Ryosuke Miyamoto
- Department of Pediatrics, Aichi Medical University, Aichi, Japan
| | | | - Hiromitsu Mori
- Department of Pediatrics, Aichi Medical University, Aichi, Japan
| | - Hideyuki Iwayama
- Department of Pediatrics, Aichi Medical University, Aichi, Japan
| | | | - Hiroatsu Agata
- Department of Pediatrics, Aichi Medical University, Aichi, Japan
| | - Akihisa Okumura
- Department of Pediatrics, Aichi Medical University, Aichi, Japan
| |
Collapse
|
9
|
Numoto S, Kurahashi H, Takagi M, Azuma Y, Iwayama H, Okumura A. Sodium channel blockers are effective for benign infantile epilepsy. Seizure 2021; 92:207-210. [PMID: 34592700 DOI: 10.1016/j.seizure.2021.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/09/2021] [Accepted: 09/12/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To examine the efficacy and tolerance of the antiseizure medications lacosamide (LCM) and levetiracetam (LEV) in patients with benign infantile epilepsy (BIE). METHODS The clinical data of 24 children with BIE seen between 2014 and 2020 were collected retrospectively, and treatment, effectiveness, and adverse effects were examined. PRRT2 gene analysis was performed using Sanger sequencing. RESULTS Of the 24 children with BIE, 14 were treated with antiseizure medications. PRRT2 gene analysis was performed in 14 children, and mutations were identified in 4, including a pair of siblings. All five children treated with LCM became seizure-free, similar to those treated with carbamazepine. The LCM does was 2 mg/kg/day in all cases. There were no adverse effects in any patient treated with LCM. By contrast, both patients treated with LEV had seizure recurrence. In one patient, LEV was replaced with CBZ, resulting in seizure freedom. CONCLUSIONS Low-dose LCM was effective and well tolerated in patients with BIE, whereas LEV was insufficiently effective.
Collapse
Affiliation(s)
- Shingo Numoto
- Aichi Medical University, Department of Pediatrics, Nagakute, Japan.
| | | | - Mizuki Takagi
- Aichi Medical University, Department of Pediatrics, Nagakute, Japan
| | - Yoshiteru Azuma
- Aichi Medical University, Department of Pediatrics, Nagakute, Japan
| | - Hideyuki Iwayama
- Aichi Medical University, Department of Pediatrics, Nagakute, Japan
| | - Akihisa Okumura
- Aichi Medical University, Department of Pediatrics, Nagakute, Japan
| |
Collapse
|
10
|
Okumura A, Takagi M, Numoto S, Iwayama H, Azuma Y, Kurahashi H. Effects of l-carnitine supplementation in patients with childhood-onset epilepsy prescribed valproate. Epilepsy Behav 2021; 122:108220. [PMID: 34371461 DOI: 10.1016/j.yebeh.2021.108220] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 07/08/2021] [Accepted: 07/09/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND The benefits of carnitine supplementation in patients treated with valproate (VPA) are not clear. Therefore, we retrospectively explored the benefits of carnitine supplementation by analyzing laboratory data. METHODS We measured the serum-free carnitine (FC), VPA, aspartate aminotransferase, alanine aminotransferase, amylase, and ammonia levels, and the platelet count, in 69 patients with childhood-onset epilepsy treated with VPA. Eight patients had received carnitine supplementation. The serum FC and acylcarnitine levels were measured using an enzyme cycling method. We compared laboratory values between patients with and without carnitine supplementation and analyzed the correlations between serum FC levels and laboratory values. RESULTS The serum FC levels were normal (median, 48.8 μmol/L; range: 41.9-68.3 μmol/L) in all eight patients with carnitine supplementation, but below normal in 32 of 61 patients without supplementation. The median serum amylase levels were lower in the patients with carnitine supplementation (median, 48 U/L; range: 27-149 U/L) than in those without (median, 7 U/L; range: 14-234 U/L). The platelet count and serum ammonia levels did not differ significantly between patients with and without supplementation. There was no significant correlation between the serum FC level and the platelet count, serum amylase level, or ammonia level. CONCLUSIONS Carnitine supplementation helps maintain serum FC levels in patients treated with VPA. The lower serum amylase levels in patients with carnitine supplementation may reflect protective effects of carnitine against latent pancreatic injury.
Collapse
Affiliation(s)
- Akihisa Okumura
- Department of Pediatrics, Aichi Medical University, 1-1 Yazako Karimata, Nagakute, Aichi 480-1195, Japan.
| | - Mizuki Takagi
- Department of Pediatrics, Aichi Medical University, 1-1 Yazako Karimata, Nagakute, Aichi 480-1195, Japan
| | - Shingo Numoto
- Department of Pediatrics, Aichi Medical University, 1-1 Yazako Karimata, Nagakute, Aichi 480-1195, Japan
| | - Hideyuki Iwayama
- Department of Pediatrics, Aichi Medical University, 1-1 Yazako Karimata, Nagakute, Aichi 480-1195, Japan
| | - Yoshiteru Azuma
- Department of Pediatrics, Aichi Medical University, 1-1 Yazako Karimata, Nagakute, Aichi 480-1195, Japan
| | - Hirokazu Kurahashi
- Department of Pediatrics, Aichi Medical University, 1-1 Yazako Karimata, Nagakute, Aichi 480-1195, Japan
| |
Collapse
|
11
|
Iwayama H, Kitagawa S, Sada J, Miyamoto R, Hayakawa T, Kuroyanagi Y, Muto T, Kurahashi H, Ohashi W, Takagi J, Okumura A. Insulin-like growth factor-1 level is a poor diagnostic indicator of growth hormone deficiency. Sci Rep 2021; 11:16159. [PMID: 34373538 PMCID: PMC8352887 DOI: 10.1038/s41598-021-95632-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 07/27/2021] [Indexed: 01/16/2023] Open
Abstract
We evaluated the diagnostic accuracy of insulin-like growth factor-1 (IGF-1) for screening growth hormone deficiency (GHD) to determine the usefulness of IGF-1 as a screening test. Among 298 consecutive children who had short stature or decreased height velocity, we measured IGF-1 levels and performed growth hormone (GH) secretion test using clonidine, arginine, and, in cases with different results of the two tests, L-dopa. Patients with congenital abnormalities were excluded. GHD was defined as peak GH ≤ 6.0 ng/mL in the two tests. We identified 60 and 238 patients with and without GHD, respectively. The mean IGF-1 standard deviation (SD) was not significantly different between the GHD and non-GHD groups (p = 0.23). Receiver operating characteristic curve analysis demonstrated the best diagnostic accuracy at an IGF-1 cutoff of − 1.493 SD, with 0.685 sensitivity, 0.417 specificity, 0.25 positive and 0.823 negative predictive values, and 0.517 area under the curve. Correlation analysis revealed that none of the items of patients’ characteristics increased the diagnostic power of IGF-1. IGF-1 level had poor diagnostic accuracy as a screening test for GHD. Therefore, IGF-1 should not be used alone for GHD screening. A predictive biomarker for GHD should be developed in the future.
Collapse
Affiliation(s)
- Hideyuki Iwayama
- Department of Paediatrics, Aichi Medical University, Nagakute, Aichi, Japan.
| | - Sachiko Kitagawa
- Department of Paediatrics, Daiyukai General Hospital, Ichinomiya, Aichi, Japan
| | - Jyun Sada
- Department of Paediatrics, Aichi Medical University, Nagakute, Aichi, Japan
| | - Ryosuke Miyamoto
- Department of Paediatrics, Aichi Medical University, Nagakute, Aichi, Japan
| | - Tomohito Hayakawa
- Department of Paediatrics, Aichi Medical University, Nagakute, Aichi, Japan
| | | | - Taichiro Muto
- Department of Paediatrics, Aichi Medical University, Nagakute, Aichi, Japan
| | - Hirokazu Kurahashi
- Department of Paediatrics, Aichi Medical University, Nagakute, Aichi, Japan
| | - Wataru Ohashi
- Division of Biostatistics, Clinical Research Center, Aichi Medical University, Nagakute, Japan
| | - Junko Takagi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Aichi Medical University, Nagakute, Aichi, Japan
| | - Akihisa Okumura
- Department of Paediatrics, Aichi Medical University, Nagakute, Aichi, Japan
| |
Collapse
|
12
|
Muto T, Nakamura N, Masuda Y, Numoto S, Kodama S, Miyamoto R, Hayakawa T, Mori H, Iwayama H, Kurahashi H, Agata H, Okumura A. Usefulness of Q-probe PCR in Children with Mycoplasma pneumniae infection. Jpn J Infect Dis 2021; 75:89-91. [PMID: 34193662 DOI: 10.7883/yoken.jjid.2021.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
To investigate the usefulness of quenching probe polymerase chain reaction (Q-probe PCR) for detection of macrolides-resistant Mycoplasma pneumoniae (MP), we retrospectively analyzed the clinical course of 21 children with MP infection. The rate of macrolides resistant MP was 66.7%. The duration of pyrexia after the initial antibiotics treatment was longer in patients with macrolides-resistant MP infection than in those with macrolides-sensitive MP infection. The duration of pyrexia after Q-probe PCR was not significantly different between patients with macrolides-resistant MP infection and those with macrolides-sensitive MP infection. These results suggest that antibiotic use based on Q-probe PCR will reduce duration of pyrexia. Q-probe PCR contributes to determine appropriate antibiotics and to improve the clinical course of MP infections.
Collapse
Affiliation(s)
- Taichiro Muto
- Department of Pediatrics, Aichi Medical University, Japan
| | - Nami Nakamura
- Department of Pediatrics, Aichi Medical University, Japan
| | - Yu Masuda
- Department of Pediatrics, Aichi Medical University, Japan
| | - Shingo Numoto
- Department of Pediatrics, Aichi Medical University, Japan
| | | | | | | | - Hiromitsu Mori
- Department of Pediatrics, Aichi Medical University, Japan
| | | | | | - Hiroatsu Agata
- Department of Pediatrics, Aichi Medical University, Japan
| | | |
Collapse
|
13
|
Okumura A, Numoto S, Iwayama H, Azuma Y, Kurahashi H. Carnitine supplementation prevents carnitine deficiency caused by pivalate-conjugated antibiotics in patients with epilepsy prescribed valproate. Epilepsy Behav 2021; 117:107883. [PMID: 33714931 DOI: 10.1016/j.yebeh.2021.107883] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 01/06/2021] [Revised: 02/17/2021] [Accepted: 02/17/2021] [Indexed: 11/08/2022]
Abstract
We measured carnitine levels before and after pivalate-conjugated antibiotic (PCA) use in six patients with epilepsy who were prescribed valproate (VPA). Three of the patients were on carnitine supplementation when PCA use started. Serum FC levels were within the normal range (37.2-49.0 μmol/L) in all six patients before PCA use. After PCA use, the serum free carnitine (FC) levels remained within the normal range (48.0-68.2 μmol/L) in all three patients on carnitine supplementation, but were below the normal range (18.7-30.8 μmol/L) in the three patients not on carnitine supplementation. No remarkable changes in serum VPA levels, platelet count, amylase or ammonia level was evident in any patients in relation to PCA use. Carnitine deficiency due to PCA use was prevented by carnitine supplementation in patients with epilepsy who were taking VPA. Carnitine supplementation can support patients at risk of carnitine deficiency.
Collapse
Affiliation(s)
| | - Shingo Numoto
- Department of Pediatrics, Aichi Medical University, Japan
| | | | | | | |
Collapse
|
14
|
Numoto S, Kurahashi H, Sato A, Kubota M, Shiihara T, Okanishi T, Tanaka R, Kuki I, Fukuyama T, Kashiwagi M, Ikeno M, Kubota K, Akasaka M, Mimaki M, Okumura A. Acute encephalopathy in children with tuberous sclerosis complex. Orphanet J Rare Dis 2021; 16:5. [PMID: 33407677 PMCID: PMC7789140 DOI: 10.1186/s13023-020-01646-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 12/09/2020] [Indexed: 11/10/2022] Open
Abstract
Objective We examined the clinical manifestations of acute encephalopathy (AE) and identify risk factors for AE in children with tuberous sclerosis complex (TSC). Methods The clinical data of 11 children with clinically diagnosed TSC associated with AE and 109 children with clinically diagnosed TSC alone aged 4 years or older were collected from 13 hospitals. Results Of the 11 children with AE, 5 had histories of febrile seizures (FS), and all had histories of febrile status epilepticus (FSE). AE developed within 24 h after fever onset in all children with seizures lasting 30 min or longer. All children developed coma after seizure cessation. Head magnetic resonance imaging (MRI) revealed widespread abnormalities in the cerebral cortex, subcortical white matter, corpus callosum, basal ganglia, and thalamus. One child died; seven had severe neurological sequelae; and the other three, mild sequelae. Logistic regression analysis revealed that a history of FSE was correlated with the development of AE. Significance AE in children with TSC was characterized by sudden onset after fever, followed by coma, widespread brain edema evident on MRI, and poor outcomes. A history of FSE was a risk factor for the development of AE.
Collapse
Affiliation(s)
- Shingo Numoto
- Department of Pediatrics, Aichi Medical University, 1-1 Yazako Karimata, Nagakute, Aichi, 480-1195, Japan.
| | - Hirokazu Kurahashi
- Department of Pediatrics, Aichi Medical University, 1-1 Yazako Karimata, Nagakute, Aichi, 480-1195, Japan
| | - Atsushi Sato
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
| | - Masaya Kubota
- Division of Neurology, National Center for Child Health and Development, Tokyo, Japan
| | - Takashi Shiihara
- Department of Neurology, Gunma Children's Medical Center, Shibukawa, Gunma, Japan
| | - Tohru Okanishi
- Department of Child Neurology, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Ryuta Tanaka
- Department of Child Health, Ibaraki Pediatric Education and Training Station, University of Tsukuba, Mito, Japan
| | - Ichiro Kuki
- Department of Pediatric Neurology, Osaka City General Hospital, Osaka, Japan
| | | | | | - Mitsuru Ikeno
- Department of Pediatrics, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Kazuo Kubota
- Department of Pediatrics, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Manami Akasaka
- Department of Pediatrics, School of Medicine, Iwate Medical University, Morioka, Japan
| | - Masakazu Mimaki
- Department of Pediatrics, Teikyo University School of Medicine, Tokyo, Japan
| | - Akihisa Okumura
- Department of Pediatrics, Aichi Medical University, 1-1 Yazako Karimata, Nagakute, Aichi, 480-1195, Japan
| |
Collapse
|
15
|
Iwayama H, Wakao N, Kurahashi H, Kubota N, Hattori A, Kumagai T, Okumura A. Administration of nusinersen via paramedian approach for spinal muscular atrophy. Brain Dev 2021; 43:121-126. [PMID: 32773161 DOI: 10.1016/j.braindev.2020.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 04/28/2020] [Revised: 07/07/2020] [Accepted: 07/21/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To assess the success rate, procedure time, and adverse events of intrathecal administration of nusinersen via the paramedian approach in adolescents and adults with spinal muscular atrophy (SMA) associated with scoliosis. METHODS Seven patients with genetically confirmed SMA (age, 12-40 years) were included. Intrathecal administration of nusinersen was performed via paramedian approach using fluoroscopy after determination of the largest interlaminal foramen among L2-L3, L3-L4, or L4-L5 by three-dimensional computed tomography. We measured the times for preparation, positioning, and puncture, and the total time of stay. Adverse effects of intrathecal administration were noted. RESULTS Intrathecal administration via paramedian approach was successful for all 38 opportunities. The median total time of stay was 44.0 min (interquartile range, 37.3-50.0 min). The total time of stay was significantly longer in patients with SMA type 1 than in those with SMA type 2, but was not different according to the severity of scoliosis. Adverse effects included oxygen supplementation, headache, and back pain. Sedation was correlated with oxygen supplementation and headache. CONCLUSIONS Intrathecal administration of nusinersen via the paramedian approach had the advantages of a high success rate and short procedure time with fewer adverse events in SMA patients associated with scoliosis.
Collapse
Affiliation(s)
- Hideyuki Iwayama
- Department of Pediatrics, Aichi Medical University, Aichi, Japan.
| | - Norimitsu Wakao
- Department of Orthopedics, Aichi Medical University, Aichi, Japan
| | - Hirokazu Kurahashi
- Department of Pediatrics, Aichi Medical University, Aichi, Japan; Department of Pediatric Neurology, Aichi Prefectural Colony Central Hospital, Aichi, Japan
| | - Norika Kubota
- Department of Pediatrics, Matsue Medical Center, Shimane, Japan
| | - Ayako Hattori
- Department of Pediatrics and Neonatology, Nagoya City University, Aichi, Japan
| | - Toshiyuki Kumagai
- Department of Pediatric Neurology, Aichi Prefectural Colony Central Hospital, Aichi, Japan; Kuma Home Medical Care Clinic, Aichi, Japan
| | - Akihisa Okumura
- Department of Pediatrics, Aichi Medical University, Aichi, Japan
| |
Collapse
|
16
|
Kidokoro H, Shiraki A, Torii Y, Tanaka M, Yamamoto H, Kurahashi H, Maruyama K, Okumura A, Natsume J, Ito Y. MRI findings in children with congenital cytomegalovirus infection retrospectively diagnosed with dried umbilical cord. Neuroradiology 2020; 63:761-768. [PMID: 33205317 DOI: 10.1007/s00234-020-02603-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 08/30/2020] [Accepted: 11/10/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Brain MRI provides important information about suspected congenital CMV infection in neonatally underdiagnosed children. This study aimed to describe MRI findings in children in whom congenital CMV infection was not suspected during the neonatal period and was proven retrospectively. METHODS We enrolled 31 children referred to the pediatric neurology clinic with neurological symptoms who were proven to have congenital CMV infection based on dried umbilical cord samples. Upon diagnosis, MR and CT images were assessed using the van der Knaap scoring system integrated with additional variables. Two investigators independently assessed all images. RESULTS The age at diagnosis was < 12 months in 14, 12-24 months in 11, and > 24 months in 6 patients. The initial symptom triggering clinic referral was delayed development in 22, seizure in 5, deafness in 3, and hemiplegia in 1 patient. Of the 31 children, 30 had a white matter (WM) abnormality predominant in the deep WM of the parietal lobe (n = 25). Anterior temporal lesions were observed in 21 children. Cortical lesions were observed in 7 children, suggestive of polymicrogyria. No child had cerebellar or brainstem abnormalities. Brain CT was performed in 22 of 31 children, and 11 showed punctate cerebral calcification in the periventricular and/or deep WM. CONCLUSION Patients with congenital CMV infection with delayed neurological symptoms show a relatively uniform pattern of parietal-dominant multifocal WM lesions and anterior temporal lesions, with or without polymicrogyria.
Collapse
Affiliation(s)
- Hiroyuki Kidokoro
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan.
| | - Anna Shiraki
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan
| | - Yuka Torii
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan
| | - Masaharu Tanaka
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan
| | - Hiroyuki Yamamoto
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan
| | | | - Koichi Maruyama
- Division of Pediatric Neurology, Aichi Developmental Disability Center, Kasugai, Japan
| | - Akihisa Okumura
- Department of Pediatrics, Aichi Medical University, Nagakute, Japan
| | - Jun Natsume
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan
| | - Yoshinori Ito
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan
| |
Collapse
|
17
|
Numoto S, Kurahashi H, Iwayama H, Okumura A. A trial of lacosamide for benign convulsions with gastroenteritis. Brain Dev 2020; 42:551-554. [PMID: 32279898 DOI: 10.1016/j.braindev.2020.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 02/06/2020] [Revised: 03/05/2020] [Accepted: 03/25/2020] [Indexed: 11/30/2022]
Abstract
Benign convulsions with gastroenteritis are characterized by a cluster of seizures. Sodium channel blockers are efficacious. We prescribed lacosamide, a new channel blocker, for five patients. Patient age ranged from 17 to 33 months; all five experienced 1-4 generalized convulsions persisting for 30-120 s. One patient exhibited a transient splenial lesion on head magnetic resonance imaging. All received one dose (2 mg/kg) of lacosamide. The convulsions ceased, and no adverse drug effect was noted. A single dose of lacosamide was effective and well-tolerated in five patients with benign convulsions with gastroenteritis.
Collapse
Affiliation(s)
- Shingo Numoto
- Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, Japan; Department of Pediatrics, Daiyukai General Hospital, Ichinomiya, Aichi, Japan
| | - Hirokazu Kurahashi
- Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, Japan
| | - Hideyuki Iwayama
- Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, Japan
| | - Akihisa Okumura
- Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, Japan.
| |
Collapse
|
18
|
Ogawa C, Kidokoro H, Ishihara N, Tsuji T, Kurahashi H, Hattori A, Suzuki M, Ogaya S, Ito Y, Fukasawa T, Kubota T, Okumura A, Saitoh S, Natsume J. Splenial Lesions in Benign Convulsions With Gastroenteritis Associated With Rotavirus Infection. Pediatr Neurol 2020; 109:79-84. [PMID: 32303390 DOI: 10.1016/j.pediatrneurol.2019.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 02/27/2019] [Revised: 04/28/2019] [Accepted: 05/02/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To investigate clinical risk factors for acute magnetic resonance imaging (MRI) abnormalities in patients with benign convulsions with mild gastroenteritis or benign infantile epilepsy. STUDY DESIGN We investigated clinical and diffusion-weighted imaging findings in 32 patients with benign convulsions with mild gastroenteritis and 22 patients with benign infantile epilepsy who underwent MRI within seven days of seizure onset between 2010 and 2015. RESULTS Diffusion-weighted imaging showed signal hyperintensity in the splenium of the corpus callosum in seven patients with benign convulsions with mild gastroenteritis, but no abnormalities in patients with benign infantile epilepsy. Patients with benign convulsions with mild gastroenteritis with splenial lesions showed a higher rate of rotavirus detection from feces (P = 0.006), higher serum level of C-reactive protein (P = 0.04), and shorter interval between seizure onset and MRI (P = 0.002) than patients with benign convulsions with mild gastroenteritis without splenial lesions. Multivariate analysis revealed rotavirus infection as a significant risk factor for splenial lesions on diffusion-weighted imaging in patients with benign convulsions with mild gastroenteritis (P = 0.02). CONCLUSIONS Splenial lesions are often seen during acute period in patients with benign convulsions with mild gastroenteritis. Rotavirus infection is a risk factor for splenial lesions in patients with benign convulsions with mild gastroenteritis, suggesting the role of rotavirus to cause edema in the corpus callosum. From our observations, benign convulsions with mild gastroenteritis with a splenial lesion on diffusion-weighted imaging suggests good outcomes, and extensive evaluation of these patients may be unnecessary.
Collapse
Affiliation(s)
- Chikako Ogawa
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroyuki Kidokoro
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan; Brain and Mind Research Center, Nagoya University, Nagoya, Japan
| | - Naoko Ishihara
- Department of Pediatrics, Fujita Health University, Toyoake, Japan
| | - Takeshi Tsuji
- Department of Pediatrics, Okazaki City Hospital, Okazaki, Japan
| | | | - Ayako Hattori
- Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Motomasa Suzuki
- Department of Neurology, Aichi Children's Health and Medical Center, Obu, Japan
| | - Shunsuke Ogaya
- Department of Pediatrics, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan
| | - Yuji Ito
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | - Tetsuo Kubota
- Department of Pediatrics, Anjo Kosei Hospital, Anjo, Japan
| | - Akihisa Okumura
- Department of Pediatrics, Aichi Medical University, Nagakute, Japan
| | - Shinji Saitoh
- Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Jun Natsume
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan; Brain and Mind Research Center, Nagoya University, Nagoya, Japan; Department of Developmental Disability Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| |
Collapse
|
19
|
Okumura A, Numoto S, Iwayama H, Kurahashi H, Natsume J, Saitoh S, Yoshikawa T, Fukao T, Hirayama M, Takahashi Y. Respiratory illness and acute flaccid myelitis in the Tokai district in 2018. Pediatr Int 2020; 62:337-340. [PMID: 31886594 DOI: 10.1111/ped.14128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/03/2019] [Revised: 12/25/2019] [Accepted: 12/26/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND An outbreak of acute flaccid myelitis was chronologically correlated with an outbreak of severe respiratory illness in Japan in 2015. We hypothesized that increases in children hospitalized with severe respiratory illnesses might also be associated with increase in acute flaccid myelitis in autumn 2018. METHODS We explored the temporal correlations between respiratory illness outbreaks and acute flaccid myelitis during autumn season between 2016 and 2018 using questionnaire surveys. One questionnaire explored the monthly numbers of children with acute flaccid myelitis, Guillain-Barré syndrome, and other acute flaccid paralyses. The other questionnaire explored the monthly numbers of children hospitalized with respiratory illnesses associated with wheezing. A correlation between the monthly numbers of children with acute flaccid myelitis and those with respiratory illness was analyzed using the Pearson correlation test. RESULTS Although the number of patients hospitalized with respiratory illness did not correlate with the number of those admitted with myelitis, increases in children aged 7-12 and 13-19 years requiring intensive care unit admission correlated temporally with an outbreak of acute flaccid myelitis. CONCLUSIONS An increase in intensive care unit admissions to treat respiratory disease occurred in association with a cluster of acute flaccid myelitis. An increase in the number of intensive care unit admissions due to respiratory illness may be a clue to expect the occurrence of acute flaccid myelitis.
Collapse
Affiliation(s)
- Akihisa Okumura
- Department of Pediatrics, Aichi Medical University, Nagakute, Japan
| | - Shingo Numoto
- Department of Pediatrics, Aichi Medical University, Nagakute, Japan
| | - Hideyuki Iwayama
- Department of Pediatrics, Aichi Medical University, Nagakute, Japan
| | | | - Jun Natsume
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shinji Saitoh
- Department of Pediatrics, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Tetsushi Yoshikawa
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Japan
| | - Toshiyuki Fukao
- Department of Pediatrics, Gifu University Graduate School of Medical Sciences, Gifu City, Japan
| | - Masahiro Hirayama
- Department of Pediatrics, Mie University Graduate School of Medical Sciences, Tsu, Japan
| | - Yoshiyuki Takahashi
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| |
Collapse
|
20
|
Okumura A, Saitoh S, Natsume J, Yamamoto H, Kurahashi H, Numoto S. Attitudes of school teachers toward epilepsy in Nagoya, Japan. Epilepsy Behav 2020; 103:106359. [PMID: 31668579 DOI: 10.1016/j.yebeh.2019.06.005] [Citation(s) in RCA: 8] [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: 04/19/2019] [Revised: 05/25/2019] [Accepted: 06/02/2019] [Indexed: 10/25/2022]
Abstract
We conducted a questionnaire survey to examine the knowledge about and attitudes toward epilepsy among school teachers in an urban area in Japan. The questionnaire consisted of six questions: two questions about contact with children with epilepsy, one about knowledge about emergency care, and three about attitudes toward the participation of children with epilepsy in school events. The respondents answered each question using a five-point Likert scale: strongly agree, agree, undecided, disagree, or strongly disagree. A total of 713 teachers completed the questionnaire. More than one-third of the teachers had taught children with epilepsy, and more than half had witnessed a seizure. Although 36% thought that one should "put something in the mouth during a seizure", fewer believed in restricting swimming, out-of-school activities, and sports. Special school teachers were less likely to suggest putting something in the mouth during a seizure and restrict swimming than were normal school teachers. The answers did not differ according to teacher age or contact with children with epilepsy. Contact with children with epilepsy was relatively common among school teachers, whereas knowledge about epilepsy was insufficient. Negative attitudes toward epilepsy were uncommon. Special school teachers knew more about epilepsy than normal school teachers.
Collapse
Affiliation(s)
| | - Shinji Saitoh
- Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Jun Natsume
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Japan
| | - Hiroyuki Yamamoto
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Japan
| | | | - Shingo Numoto
- Department of Pediatrics, Aichi Medical University, Japan
| |
Collapse
|
21
|
Muto T, Masuda Y, Numoto S, Kodama S, Yamakawa K, Takasu M, Hayakawa T, Miyata K, Miyamoto R, Akaihata M, Iwayama H, Kitagawa Y, Kurahashi H, Shimomura Y, Hori T, Okuda M, Agata H, Okumura A. White Blood Cell and Neutrophil Counts and Response to Intravenous Immunoglobulin in Kawasaki Disease. Glob Pediatr Health 2019; 6:2333794X19884826. [PMID: 31696148 PMCID: PMC6820171 DOI: 10.1177/2333794x19884826] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 08/20/2019] [Accepted: 09/13/2019] [Indexed: 12/28/2022] Open
Abstract
We explored parameters to predicting the efficacy of intravenous immunoglobulin (IVIG) therapy for patients with Kawasaki disease (KD). We retrospectively analyzed the laboratory data of 77 children with KD treated with IVIG. Data obtained before and within 24 hours after IVIG therapy were compared between responders and nonresponders. The white blood cell (WBC) and neutrophil counts were significantly lower in responders than nonresponders within 24 hours after IVIG. The areas under the receiver operating characteristics curves of the WBC and neutrophil counts were 0.846 and 0.754, respectively. The WBC and neutrophil counts differed significantly between responders and nonresponders (the latter developed recurrent pyrexia after transient fever resolution). In conclusion, WBC and neutrophil counts within 24 hours after IVIG usefully predict the efficacy of IVIG therapy for those with KD, and identify nonresponders to such therapy.
Collapse
Affiliation(s)
| | - Yu Masuda
- Aichi Medical University, Nagakute, Aichi, Japan
| | | | | | | | | | | | - Kenji Miyata
- Aichi Medical University, Nagakute, Aichi, Japan
| | | | | | | | | | | | | | | | - Masumi Okuda
- Aichi Medical University, Nagakute, Aichi, Japan
| | | | | |
Collapse
|
22
|
Yamamoto T, Imaizumi T, Yamamoto-Shimojima K, Lu Y, Yanagishita T, Shimada S, Chong PF, Kira R, Ueda R, Ishiyama A, Takeshita E, Momosaki K, Ozasa S, Akiyama T, Kobayashi K, Oomatsu H, Kitahara H, Yamaguchi T, Imai K, Kurahashi H, Okumura A, Oguni H, Seto T, Okamoto N. Genomic backgrounds of Japanese patients with undiagnosed neurodevelopmental disorders. Brain Dev 2019; 41:776-782. [PMID: 31171384 DOI: 10.1016/j.braindev.2019.05.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [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: 11/26/2018] [Revised: 05/08/2019] [Accepted: 05/21/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Recently, many genes related to neurodevelopmental disorders have been identified by high-throughput genomic analysis; however, a comprehensive understanding of the mechanism underlying neurodevelopmental disorders remains to be established. To further understand these underlying mechanisms, we performed a comprehensive genomic analysis of patients with undiagnosed neurodevelopmental disorders. METHODS Genomic analysis using next-generation sequencing with a targeted panel was performed for a total of 133 Japanese patients (male/female, 81/52) with previously undiagnosed neurodevelopmental disorders, including developmental delay (DD), intellectual disability (ID), autism spectrum disorder (ASD), and epilepsy. Genomic copy numbers were also analyzed using the eXome Hidden Markov Model (XHMM). RESULTS Thirty-nine patients (29.3%) exhibited pathogenic or likely pathogenic findings with single-gene variants or chromosomal aberrations. Among them, 20 patients were presented here. Pathogenic or likely pathogenic variants were identified in 18 genes, including ACTG1, CACNA1A, CHD2, CDKL5, DNMT3A, EHMT1, GABRB3, GABRG2, GRIN2B, KCNQ3, KDM5C, MED13L, SCN2A, SHANK3, SMARCA2, STXBP1, SYNGAP1, and TBL1XR1. CONCLUSION A diagnostic yield of 29.3% in this study was nearly the same as that previously reported from other countries. Thus, we suggest that there is no difference in genomic backgrounds in Japanese patients with undiagnosed neurodevelopmental disabilities. Although most of the patients possessed de novo variants, one of the patients showed an X-linked inheritance pattern. As X-linked recessive disorders exhibit the possibility of recurrent occurrence in the family, comprehensive molecular diagnosis is important for genetic counseling.
Collapse
Affiliation(s)
- Toshiyuki Yamamoto
- Institute of Medical Genetics, Tokyo Women's Medical University, Tokyo, Japan; Tokyo Women's Medical University Institute of Integrated Medical Sciences, Tokyo, Japan.
| | - Taichi Imaizumi
- Institute of Medical Genetics, Tokyo Women's Medical University, Tokyo, Japan; Department of Pediatrics, St. Mariannna University School of Medicine, Kawasaki, Japan
| | - Keiko Yamamoto-Shimojima
- Institute of Medical Genetics, Tokyo Women's Medical University, Tokyo, Japan; Tokyo Women's Medical University Institute of Integrated Medical Sciences, Tokyo, Japan
| | - Yongping Lu
- Institute of Medical Genetics, Tokyo Women's Medical University, Tokyo, Japan
| | - Tomoe Yanagishita
- Institute of Medical Genetics, Tokyo Women's Medical University, Tokyo, Japan; Department of Pediatrics, Tokyo Women's Medical University, Tokyo, Japan
| | - Shino Shimada
- Department of Pediatrics, Tokyo Women's Medical University, Tokyo, Japan
| | - Pin Fee Chong
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Ryutaro Kira
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Riyo Ueda
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Akihiko Ishiyama
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Eri Takeshita
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Ken Momosaki
- Department of Pediatrics, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Shiro Ozasa
- Department of Pediatrics, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Tomoyuki Akiyama
- Department of Child Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Katsuhiro Kobayashi
- Department of Child Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hiroo Oomatsu
- Department of Pediatrics, National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Japan
| | - Hikaru Kitahara
- Department of Pediatrics, National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Japan
| | - Tokito Yamaguchi
- Department of Pediatrics, National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Japan
| | - Katsumi Imai
- Department of Pediatrics, National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Japan
| | | | - Akihisa Okumura
- Department of Pediatrics, Aichi Medical University, Nagakute, Japan
| | - Hirokazu Oguni
- Department of Pediatrics, Tokyo Women's Medical University, Tokyo, Japan
| | - Toshiyuki Seto
- Department of Pediatrics, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Nobuhiko Okamoto
- Department of Medical Genetics, Osaka Women's and Children's Hospital, Izumi, Japan
| |
Collapse
|
23
|
Hori I, Tsuji T, Miyake M, Ueda K, Kataoka E, Suzuki M, Kobayashi S, Kurahashi H, Takahashi Y, Okumura A, Yoshikawa T, Saitoh S, Natsume J. Delayed recognition of childhood arterial ischemic stroke. Pediatr Int 2019; 61:895-903. [PMID: 31295764 DOI: 10.1111/ped.13966] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 08/23/2018] [Revised: 02/03/2019] [Accepted: 04/05/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Few population-based surveys of childhood arterial ischemic stroke (AIS) have been conducted in Asian countries. The aim of this study was to investigate the clinical features, time to diagnosis, and prognosis of childhood AIS in a population-based cohort in Japan. METHODS Children aged 29 days-15 years 11 months old, residing in the Aichi Prefecture of Japan with radiologically confirmed AIS during 2010-2014, were identified retrospectively through questionnaires. We analyzed 40 children (23 boys, 17 girls; median age, 7 years 3 months), and collected time interval information of 26 patients. The time from clinical onset to first physician assessment and the time to AIS diagnosis were calculated. RESULTS The most common presentation was paralysis or paresis in 27 patients (71%). No underlying disorders or possible trigger factors were identified in 14 patients (35%). The median time from symptom onset to first physician assessment was 2.9 h. The median time from symptom onset to the confirmed AIS diagnosis was 27.0 h. The diagnosis of AIS was made in the first 6 h after onset of symptoms in 27% of patients for whom the time was available. Radiological diagnosis took longer than 24 h in 54% of these patients. CONCLUSIONS Long in-hospital delays exist in the diagnosis of AIS in children, likely due to lack of awareness of stroke by doctors. Further efforts to increase public and physician awareness of childhood stroke are needed to ensure early diagnosis and treatment.
Collapse
Affiliation(s)
- Ikumi Hori
- Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan.,Pediatric Stroke Study Group in Aichi Prefecture, Nagoya, Aichi, Japan
| | - Takeshi Tsuji
- Pediatric Stroke Study Group in Aichi Prefecture, Nagoya, Aichi, Japan.,Department of Pediatrics, Okazaki City Hospital, Okazaki, Aichi, Japan
| | - Misa Miyake
- Pediatric Stroke Study Group in Aichi Prefecture, Nagoya, Aichi, Japan.,Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Kazuto Ueda
- Pediatric Stroke Study Group in Aichi Prefecture, Nagoya, Aichi, Japan.,Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Erina Kataoka
- Pediatric Stroke Study Group in Aichi Prefecture, Nagoya, Aichi, Japan.,Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Michio Suzuki
- Pediatric Stroke Study Group in Aichi Prefecture, Nagoya, Aichi, Japan.,Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Satoru Kobayashi
- Pediatric Stroke Study Group in Aichi Prefecture, Nagoya, Aichi, Japan.,Department of Pediatrics, Nagoya City West Medical Center, Nagoya, Aichi, Japan
| | - Hirokazu Kurahashi
- Pediatric Stroke Study Group in Aichi Prefecture, Nagoya, Aichi, Japan.,Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, Japan
| | - Yoshiyuki Takahashi
- Pediatric Stroke Study Group in Aichi Prefecture, Nagoya, Aichi, Japan.,Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Akihisa Okumura
- Pediatric Stroke Study Group in Aichi Prefecture, Nagoya, Aichi, Japan.,Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, Japan
| | - Tetsushi Yoshikawa
- Pediatric Stroke Study Group in Aichi Prefecture, Nagoya, Aichi, Japan.,Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Shinji Saitoh
- Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan.,Pediatric Stroke Study Group in Aichi Prefecture, Nagoya, Aichi, Japan
| | - Jun Natsume
- Pediatric Stroke Study Group in Aichi Prefecture, Nagoya, Aichi, Japan.,Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| |
Collapse
|
24
|
Okumura A, Kurahashi H, Iwayama H, Numoto S. Serum carnitine levels of children with epilepsy: Related factors including valproate. Brain Dev 2019; 41:516-521. [PMID: 30827788 DOI: 10.1016/j.braindev.2019.02.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 12/25/2018] [Revised: 02/17/2019] [Accepted: 02/21/2019] [Indexed: 01/27/2023]
Abstract
OBJECTIVE This study measured the serum carnitine levels in patients with epilepsy and determined the factors contributing to low carnitine levels. METHODS We measured the serum carnitine levels in 94 consecutive patients with epilepsy, including the free carnitine (FC) and acylcarnitine fractions, using an enzyme cycling method. We defined a low FC as a serum FC level < 36 μmol/L. Age, body mass index (BMI), standard deviation score of BMI (BMI-SDS), use of valproate, cognitive disorder, and feeding problems differed between patients with low and normal FC. In patients taking valproate, the associations of the serum FC level with the platelet count and serum ammonia and amylase levels were analyzed. RESULTS Univariate analysis showed that a low BMI and BMI-SDS, the use of valproate, and cognitive disorder were more frequent in patients with a low FC. Logistic regression analysis revealed that a low BMI-SDS and cognitive disorders were independently associated with a low FC. Among the patients taking valproate, a low BMI-SDS and age were associated with a low FC. The serum FC and ammonia levels were inversely correlated, whereas no correlation was observed between the serum FC level and platelet count or serum amylase level. CONCLUSION A low BMI and cognitive disorders were related to a low FC in patients with epilepsy and the serum carnitine levels should be monitored in these patients.
Collapse
Affiliation(s)
| | | | | | - Shingo Numoto
- Department of Pediatrics, Aichi Medical University, Japan
| |
Collapse
|
25
|
Shima T, Okumura A, Kurahashi H, Numoto S, Abe S, Ikeno M, Shimizu T. A nationwide survey of norovirus-associated encephalitis/encephalopathy in Japan. Brain Dev 2019; 41:263-270. [PMID: 30798941 DOI: 10.1016/j.braindev.2018.11.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 07/23/2018] [Revised: 10/14/2018] [Accepted: 11/01/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Norovirus is a major pathogen of gastroenteritis and is known to cause encephalitis/encephalopathy. The aim of this national survey was to clarify the clinical features of norovirus-associated encephalitis/encephalopathy (NoVE) among children in Japan. METHODS A nationwide survey of children with NoVE was conducted using a structured research form. The initial survey asked pediatricians about children with NoVE treated between January 2011 and March 2016. The second survey obtained patient information from two sources: hospitals that responded to the initial survey and those identified as having treated cases from a literature search. RESULTS Clinical information was available for 29 children. Their median age was 2 y 8 m. The outcome was good in 13 patients and poor in 15. The interval between the onset of gastrointestinal symptoms and that of encephalitis/encephalopathy was significantly shorter in those with a poor outcome. At the onset of an elevated serum creatinine level and an abnormal blood glucose level were correlated with a poor outcome. Regarding the subtypes of encephalitis/encephalopathy, acute encephalopathy with biphasic seizures and late reduced diffusion and hemorrhagic shock and encephalopathy syndrome were frequent. CONCLUSION The outcome of children with NoVE was poor. Early onset of neurological symptoms, an elevated serum creatinine level, and an abnormal blood glucose level were associated with a poor outcome. No effective treatment was identified and this should be the subject of future studies.
Collapse
Affiliation(s)
- Taiki Shima
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Japan.
| | | | | | - Shingo Numoto
- Department of Pediatrics, Aichi Medical University, Japan
| | - Shinpei Abe
- Department of Pediatrics, Juntendo University Faculty of Medicine, Japan
| | - Mitsuru Ikeno
- Department of Pediatrics, Juntendo University Faculty of Medicine, Japan
| | - Toshiaki Shimizu
- Department of Pediatrics, Juntendo University Faculty of Medicine, Japan
| | | |
Collapse
|
26
|
Mizuguchi T, Nakashima M, Kato M, Okamoto N, Kurahashi H, Ekhilevitch N, Shiina M, Nishimura G, Shibata T, Matsuo M, Ikeda T, Ogata K, Tsuchida N, Mitsuhashi S, Miyatake S, Takata A, Miyake N, Hata K, Kaname T, Matsubara Y, Saitsu H, Matsumoto N. Loss-of-function and gain-of-function mutations in PPP3CA cause two distinct disorders. Hum Mol Genet 2019; 27:1421-1433. [PMID: 29432562 DOI: 10.1093/hmg/ddy052] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 02/05/2018] [Indexed: 02/07/2023] Open
Abstract
Calcineurin is a calcium (Ca2+)/calmodulin-regulated protein phosphatase that mediates Ca2+-dependent signal transduction. Here, we report six heterozygous mutations in a gene encoding the alpha isoform of the calcineurin catalytic subunit (PPP3CA). Notably, mutations were observed in different functional domains: in addition to three catalytic domain mutations, two missense mutations were found in the auto-inhibitory (AI) domain. One additional frameshift insertion that caused premature termination was also identified. Detailed clinical evaluation of the six individuals revealed clinically unexpected consequences of the PPP3CA mutations. First, the catalytic domain mutations and frameshift mutation were consistently found in patients with nonsyndromic early onset epileptic encephalopathy. In contrast, the AI domain mutations were associated with multiple congenital abnormalities including craniofacial dysmorphism, arthrogryposis and short stature. In addition, one individual showed severe skeletal developmental defects, namely, severe craniosynostosis and gracile bones (severe bone slenderness and perinatal fractures). Using a yeast model system, we showed that the catalytic and AI domain mutations visibly result in decreased and increased calcineurin signaling, respectively. These findings indicate that different functional effects of PPP3CA mutations are associated with two distinct disorders and suggest that functional approaches using a simple cellular system provide a tool for resolving complex genotype-phenotype correlations.
Collapse
Affiliation(s)
- Takeshi Mizuguchi
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan
| | - Mitsuko Nakashima
- Department of Biochemistry, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan
| | - Mitsuhiro Kato
- Department of Pediatrics, Showa University School of Medicine, Tokyo 142-8666, Japan
| | - Nobuhiko Okamoto
- Department of Medical Genetics, Osaka Women's and Children's Hospital, Osaka 594-1101, Japan
| | - Hirokazu Kurahashi
- Department of Pediatrics, Aichi Medical University, Aichi 480-1195, Japan
| | - Nina Ekhilevitch
- The Genetics Institute, Rambam Health Care Campus, Haifa 3109601, Israel
| | - Masaaki Shiina
- Department of Biochemistry, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan
| | - Gen Nishimura
- Center for Intractable Diseases, Saitama Medical University Hospital, Saitama 350-0495, Japan
| | - Takashi Shibata
- Department of Child Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Muneaki Matsuo
- Department of Pediatrics, Saga University Faculty of Medicine, Saga 849-8501, Japan
| | - Tae Ikeda
- Department of Pediatric Neurology, Osaka Women's and Children's Hospital, Osaka 594-1101, Japan
| | - Kazuhiro Ogata
- Department of Biochemistry, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan
| | - Naomi Tsuchida
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan
| | - Satomi Mitsuhashi
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan
| | - Satoko Miyatake
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan.,Clinical Genetics Department, Yokohama City University Hospital, Yokohama 236-0004, Japan
| | - Atsushi Takata
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan
| | - Noriko Miyake
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan
| | - Kenichiro Hata
- Department of Maternal-Fetal Biology, National Research Institute for Child Health and Development, Tokyo 157-8535, Japan
| | - Tadashi Kaname
- Department of Genome Medicine, National Center for Child Health and Development, Tokyo 157-8535, Japan
| | - Yoichi Matsubara
- Department of Medical Genetics, Tohoku University School of Medicine, Sendai 980-8574, Japan.,National Research Institute for Child Health and Development, Tokyo 157-8535, Japan
| | - Hirotomo Saitsu
- Department of Biochemistry, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan
| | - Naomichi Matsumoto
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan
| |
Collapse
|
27
|
Goto T, Kakita H, Takasu M, Takeshita S, Ueda H, Muto D, Kondo T, Kurahashi H, Okumura A, Yamada Y. A rare case of fetal extensive intracranial hemorrhage and whole-cerebral hypoplasia due to latent maternal vitamin K deficiency. J Neonatal Perinatal Med 2018; 11:191-194. [PMID: 29843264 DOI: 10.3233/npm-181745] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We present here a late preterm infant with extensive brain lesions resulting from vitamin K deficiency. A female infant was born after 35 weeks of gestation by emergent cesarean section because of non-reassuring fetal status. Her mother had severe eating disorder and recurrent vomiting since early pregnancy. She was immediately intubated and ventilated because she was extremely pale, hypotonic, and non-reactive. Cerebral magnetic resonance imaging immediately after birth showed intraparenchymal hemorrhage in the left frontal lobe and cerebellum, marked cerebral edema, and cerebellar hypoplasia. Coagulation studies of the infant showed hepaplastin test <5%, prolonged PT and APTT, and a marked elevation of protein induced by vitamin K absence or antagonist-II. This case highlighted a potential risk of intracranial bleeding due to maternal vitamin K deficiency and difficulty in its prediction before delivery. Vitamin K supplementation to high risk mothers might be indispensable for preventing severe fetal vitamin K deficiency. Even when coagulation studies in mothers is normal, it is imperative to provide vitamin K supplementation for total protection.
Collapse
Affiliation(s)
- T Goto
- Department of Perinatal and Neonatal Medicine, Aichi Medical University Sciences, Karimata, Nagakute, Aichi, Japan
| | - H Kakita
- Department of Perinatal and Neonatal Medicine, Aichi Medical University Sciences, Karimata, Nagakute, Aichi, Japan
| | - M Takasu
- Department of Pediatrics, Aichi Medical University Sciences, Karimata, Nagakute, Aichi, Japan
| | - S Takeshita
- Department of Perinatal and Neonatal Medicine, Aichi Medical University Sciences, Karimata, Nagakute, Aichi, Japan
| | - H Ueda
- Department of Perinatal and Neonatal Medicine, Aichi Medical University Sciences, Karimata, Nagakute, Aichi, Japan
| | - D Muto
- Department of Perinatal and Neonatal Medicine, Aichi Medical University Sciences, Karimata, Nagakute, Aichi, Japan
| | - T Kondo
- Department of Perinatal and Neonatal Medicine, Aichi Medical University Sciences, Karimata, Nagakute, Aichi, Japan
| | - H Kurahashi
- Department of Pediatrics, Aichi Medical University Sciences, Karimata, Nagakute, Aichi, Japan
| | - A Okumura
- Department of Pediatrics, Aichi Medical University Sciences, Karimata, Nagakute, Aichi, Japan
| | - Y Yamada
- Department of Perinatal and Neonatal Medicine, Aichi Medical University Sciences, Karimata, Nagakute, Aichi, Japan
| |
Collapse
|
28
|
Okumura A, Maruyama K, Shibata M, Kurahashi H, Ishii A, Numoto S, Hirose S, Kawai T, Iso M, Kataoka S, Okuno Y, Muramatsu H, Kojima S. A patient with a GNAO1 mutation with decreased spontaneous movements, hypotonia, and dystonic features. Brain Dev 2018; 40:926-930. [PMID: 29935962 DOI: 10.1016/j.braindev.2018.06.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 05/08/2018] [Accepted: 06/06/2018] [Indexed: 11/30/2022]
Abstract
We report on a 4-year-old girl with a de novo GNAO1 mutation who had neurological findings, including decreased spontaneous movements, hypotonia, and dystonic features. She was referred to our hospital because of delayed psychomotor development. She showed hypotonia and decreased spontaneous movements. Voluntary movements of the limbs were more frequent in the lower extremities than in the upper extremities. Occasional dyskinetic features, such as awkward hand/foot posturing and grimacing, were seen during the voluntary movements. Serum metabolic screening, head magnetic resonance imaging, and electroencephalography were unremarkable. Whole-exome sequencing revealed a de novo mutation in the patient's GNAO1 gene, c.709 G > A (p.E237K). We calculated the free-energy change using the FoldX Suite to evaluate the impact of the E237K mutation. The FoldX calculations showed an increased free-energy change in the active state of the GNAO1 protein, indicating that the E237K mutation destabilizes the active state complexes. No seizures, chorea, tremor, or myoclonia, which are frequently reported in patients with GNAO1 mutations, were observed as of the last follow up. Our patient will improve the understanding of early neurological features in patients with GNAO1 mutations.
Collapse
Affiliation(s)
| | - Koichi Maruyama
- Department of Pediatric Neurology, Aichi Prefectural Colony Central Hospital, Japan
| | - Mami Shibata
- Research Institute for the Molecular Pathomechanisms of Epilepsy, Fukuoka University, Japan
| | - Hirokazu Kurahashi
- Department of Pediatrics, Aichi Medical University, Japan; Department of Pediatric Neurology, Aichi Prefectural Colony Central Hospital, Japan
| | | | - Shingo Numoto
- Department of Pediatrics, Aichi Medical University, Japan
| | | | - Tomoko Kawai
- Department of Maternal-Fetal Biology, National Research Institute for Child Health and Development, Japan
| | - Manami Iso
- Department of Genome Medicine, National Center for Child Health and Development, Japan
| | - Shinsuke Kataoka
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Japan
| | - Yusuke Okuno
- Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Japan
| | - Hideki Muramatsu
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Japan
| | - Seiji Kojima
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Japan
| |
Collapse
|
29
|
Muto T, Nago N, Kurahashi H, Minagawa H, Okumura A. A One-Month-Old Boy With a Seizure During a Febrile Illness. Clin Pediatr (Phila) 2018; 57:355-357. [PMID: 28952354 DOI: 10.1177/0009922817691827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Nozomi Nago
- 1 Aichi Medical University, Nagakute, Aichi, Japan
| | | | - Hiroko Minagawa
- 2 Aichi Prefectural Institute of Public Health, Nagoya, Japan
| | | |
Collapse
|
30
|
Kurahashi H, Azuma Y, Masuda A, Okuno T, Nakahara E, Imamura T, Saitoh M, Mizuguchi M, Shimizu T, Ohno K, Okumura A. MYRF is associated with encephalopathy with reversible myelin vacuolization. Ann Neurol 2018; 83:98-106. [PMID: 29265453 DOI: 10.1002/ana.25125] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 12/14/2017] [Accepted: 12/15/2017] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Reversible myelin vacuolization is associated with variable conditions including mild encephalitis/encephalopathy with a reversible splenial lesion (MERS), which is characterized by mildly impaired consciousness and transient splenial lesion. Familial and/or recurrent cases with a clinical diagnosis of MERS suggest the presence of genetic factors. METHODS We examined a family in which the proband presented with a history of recurrent encephalopathy with extensive but reversible cerebral myelin vacuolization and neurological symptoms similar to those of MERS spanning 3 generations. Whole-exome sequencing was performed in family members. RESULTS Eight rare nonsynonymous single-nucleotide variants shared by all patients were identified. By filtering genes expressed in the corpus callosum, we identified a heterozygous c.1208A>G predicting p.Gln403Arg in the highly conserved DNA-binding domain in the myelin regulatory factor (MYRF) gene. We subsequently screened the coding regions of MYRF by Sanger sequencing in our cohort comprised of 33 sporadic cases with MERS and 3 cases in another family with extensive myelin vacuolization, and identified the same heterozygous c.1208A>G in all affected members in the second family. Luciferase assay revealed that transcriptional activity of the N-terminal region of MYRF was significantly diminished by introducing the c.1208A>G variant. INTERPRETATION MYRF is a transcriptional regulator that is necessary for oligodendrocyte differentiation and myelin maintenance. Functional defects of MYRF are likely to be causally associated with encephalopathy with extensive myelin vacuolization. We propose the term "MYRF-related mild encephalopathy with reversible myelin vacuolization." Our findings provide a new perspective on the pathogenesis of myelin vacuolization. Ann Neurol 2018;83:98-106.
Collapse
Affiliation(s)
- Hirokazu Kurahashi
- Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, Japan
| | - Yoshiteru Azuma
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.,Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, Tyne and Wear, United Kingdom
| | - Akio Masuda
- Division of Neurogenetics, Center for Neurological Disease and Cancer, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Tatsuya Okuno
- Division of Neurogenetics, Center for Neurological Disease and Cancer, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Eri Nakahara
- Department of Pediatrics, Juntendo University Faculty of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Takuji Imamura
- Department of Pediatrics, PL General Hospital, Tondabayashi, Osaka, Japan
| | - Makiko Saitoh
- Department of Developmental Medical Sciences, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Masashi Mizuguchi
- Department of Developmental Medical Sciences, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Toshiaki Shimizu
- Department of Pediatrics, Juntendo University Faculty of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Kinji Ohno
- Division of Neurogenetics, Center for Neurological Disease and Cancer, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Akihisa Okumura
- Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, Japan.,Department of Pediatrics, Juntendo University Faculty of Medicine, Bunkyo-ku, Tokyo, Japan
| |
Collapse
|
31
|
Taniguchi-Ikeda M, Morisada N, Inagaki H, Ouchi Y, Takami Y, Tachikawa M, Satake W, Kobayashi K, Tsuneishi S, Takada S, Yamaguchi H, Nagase H, Nozu K, Okamoto N, Nishio H, Toda T, Morioka I, Wada H, Kurahashi H, Iijima K. Two patients with PNKP mutations presenting with microcephaly, seizure, and oculomotor apraxia. Clin Genet 2017; 93:931-933. [PMID: 29243230 DOI: 10.1111/cge.13106] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 07/22/2017] [Accepted: 07/24/2017] [Indexed: 11/28/2022]
Affiliation(s)
- M Taniguchi-Ikeda
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan.,Division of Genetic Counseling, Kobe University Hospital, Kobe, Japan
| | - N Morisada
- Department of Clinical Genetics, Hyogo Prefectural Kobe Children's Hospital Perinatal Center, Kobe, Japan
| | - H Inagaki
- Division of Molecular Genetics, Institute for Comprehensive Medical Science, Fujita Health University, Toyoake, Japan
| | - Y Ouchi
- Division of Molecular Genetics, Institute for Comprehensive Medical Science, Fujita Health University, Toyoake, Japan
| | - Y Takami
- Department of Pediatrics, Himeji Red Cross Hospital, Himeji, Japan
| | - M Tachikawa
- Division of Neurology/Molecular Brain Science, Kobe University Graduate School of Medicine, Kobe, Japan
| | - W Satake
- Division of Neurology/Molecular Brain Science, Kobe University Graduate School of Medicine, Kobe, Japan
| | - K Kobayashi
- Division of Neurology/Molecular Brain Science, Kobe University Graduate School of Medicine, Kobe, Japan
| | - S Tsuneishi
- Medical and Welfare Center Kizuna, Kasai, Japan
| | - S Takada
- Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - H Yamaguchi
- Department of Neonatology, Hyogo Prefectural Kobe Children's Hospital Perinatal Center, Kobe, Japan
| | - H Nagase
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - K Nozu
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - N Okamoto
- Department of Medical Genetics, Osaka Women's and Children's Hospital, Osaka, Japan
| | - H Nishio
- Department of Community Medicine and Social Healthcare Science, Kobe University Graduate School of Medicine, Kobe, Japan
| | - T Toda
- Division of Genetic Counseling, Kobe University Hospital, Kobe, Japan.,Division of Neurology/Molecular Brain Science, Kobe University Graduate School of Medicine, Kobe, Japan
| | - I Morioka
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - H Wada
- Medical and Welfare Center Sakura, Sanda, Japan
| | - H Kurahashi
- Division of Molecular Genetics, Institute for Comprehensive Medical Science, Fujita Health University, Toyoake, Japan
| | - K Iijima
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| |
Collapse
|
32
|
Kurahashi H, Takami A, Murotani K, Numoto S, Okumura A. Decreased platelet count in children with epilepsy treated with valproate and its relationship to the immature platelet fraction. Int J Hematol 2017; 107:105-111. [DOI: 10.1007/s12185-017-2323-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 08/14/2017] [Accepted: 08/22/2017] [Indexed: 11/30/2022]
|
33
|
Kurahashi N, Miyake N, Mizuno S, Koshimizu E, Kurahashi H, Yamada K, Natsume J, Aoki Y, Nakamura M, Taniai H, Maki Y, Abe-Hatano C, Matsumoto N, Maruyama K. Characteristics of epilepsy in patients with Kabuki syndrome with KMT2D mutations. Brain Dev 2017; 39:672-677. [PMID: 28404210 DOI: 10.1016/j.braindev.2017.03.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 01/18/2017] [Revised: 03/21/2017] [Accepted: 03/23/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND The characteristics of epilepsy in patients with Kabuki syndrome with KMT2D mutations (KABUK1) have not yet been well documented. This is the first review to explore this. MATERIALS & METHODS We enrolled 14 patients with KABUK1, whose median age was 13.6years (range=4.1-21.3years). Their medical records from October 1981 to May 2016 were retrospectively analyzed. RESULTS Epilepsy was present in 5 (36%) patients. Four of these patients presented with nonsense mutations and one with missense mutations. None presented with brain abnormalities. Four patients presented with annual or monthly focal seizures, of which three evolved to bilateral convulsive seizures. Median onset age of focal epilepsy was 11.8years (range=9.5-12.8years). One presented with monthly myoclonic seizures from age 11.2, whose mother with no other KABUK1 features, had focal epilepsy. The cumulative incidence of epilepsy related to KABUK1 up until age 13 was 45%. Interictal electroencephalogram revealed focal paroxysmal epileptiform discharges (in frontal, central, and parietal regions) in three patients, diffuse high-voltage spike-and-waves in one patient, and normal sleep record in one patient. Myoclonic seizures were rapidly controlled by levetiracetam. In contrast, focal seizures were not controlled in the early period of antiepileptic therapy. CONCLUSION This long-term follow-up of patients with KABUK1 revealed a higher prevalence of epilepsy than previously reported. The age of epilepsy onset and rate of focal seizures evolving to bilateral convulsive seizures in KABUK1 were also higher than previously reported in patients with clinically diagnosed Kabuki syndrome. Although seizure outcome is reported to be favorable in Kabuki syndrome, focal seizures in patients with KABUK1 were not immediately responsive to medication.
Collapse
Affiliation(s)
- Naoko Kurahashi
- Department of Pediatric Neurology, Aichi Prefectural Colony Central Hospital, Japan.
| | - Noriko Miyake
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Japan
| | - Seiji Mizuno
- Department of Pediatrics, Aichi Prefectural Colony Central Hospital, Japan
| | - Eriko Koshimizu
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Japan
| | - Hirokazu Kurahashi
- Department of Pediatric Neurology, Aichi Prefectural Colony Central Hospital, Japan; Department of Pediatrics, Aichi Medical University, Japan
| | - Keitaro Yamada
- Department of Pediatric Neurology, Aichi Prefectural Colony Central Hospital, Japan
| | - Jun Natsume
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Japan
| | - Yusuke Aoki
- Department of Neurology, Aichi Children's Health and Medical Center, Japan
| | - Miho Nakamura
- Department of Functioning Science, Institute for Developmental Research, Aichi Human Service Center, Japan
| | - Hiroko Taniai
- Department of Pediatrics, Aichi Prefectural Colony Central Hospital, Japan; Department of Pediatrics, Nagoya Central Care Center for Disabled Children, Japan
| | - Yuki Maki
- Department of Pediatric Neurology, Aichi Prefectural Colony Central Hospital, Japan
| | - Chihiro Abe-Hatano
- Department of Pediatric Neurology, Aichi Prefectural Colony Central Hospital, Japan
| | - Naomichi Matsumoto
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Japan
| | - Koichi Maruyama
- Department of Pediatric Neurology, Aichi Prefectural Colony Central Hospital, Japan
| |
Collapse
|
34
|
Abstract
OBJECTIVE To clarify the semiology of febrile seizures (FS) and to determine the frequency of FS with symptoms suggestive of focal onset. METHODS FS symptoms in children were reported within 24h of seizure onset by the parents using a structured questionnaire consisting principally of closed-ended questions. We focused on events at seizure commencement, including changes in behavior and facial expression, and ocular and oral symptoms. We also investigated the autonomic and motor symptoms developing during seizures. The presence or absence of focal and limbic features was determined for each patient. The associations of certain focal and limbic features with patient characteristics were assessed. RESULTS Information was obtained on FS in 106 children. Various events were recorded at seizure commencement. Behavioral changes were observed in 35 children, changes in facial expression in 53, ocular symptoms in 78, and oral symptoms in 90. In terms of events during seizures, autonomic symptoms were recognized in 78, and convulsive motor symptoms were recognized in 68 children. Focal features were evident in 81 children; 38 children had two or more such features. Limbic features were observed in 44 children, 9 of whom had two or more such features. There was no significant relationship between any patient characteristic and the numbers of focal or limbic features. SIGNIFICANCE The semiology of FS varied widely among children, and symptoms suggestive of focal onset were frequent. FS of focal onset may be more common than is generally thought.
Collapse
Affiliation(s)
| | - Tetsuo Kubota
- Department of Pediatrics, Anjo Kosei Hospital, Japan
| | - Takeshi Tsuji
- Department of Pediatrics, Okazaki City Hospital, Japan
| | | | - Shingo Numoto
- Department of Pediatrics, Aichi Medical University, Japan
| | - Kazuyoshi Watanabe
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Japan
| | | |
Collapse
|
35
|
Numoto S, Kurahashi H, Azuma Y, Numaguchi A, Nakahara K, Tainaka T, Takasu M, Yamakawa K, Nago N, Muto T, Kitagawa Y, Okumura A. Fournier's gangrene during ACTH therapy. Brain Dev 2017; 39:435-438. [PMID: 28007393 DOI: 10.1016/j.braindev.2016.11.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 09/26/2016] [Revised: 11/22/2016] [Accepted: 11/28/2016] [Indexed: 11/28/2022]
Abstract
Fournier's gangrene is an infectious necrotizing fasciitis of the perineal, genital, or perianal regions and is uncommon in children. Adrenocorticotropic hormone (ACTH) is effective for the treatment of infantile spasms; however, suppression of immune function is one of the major adverse effects of this approach. We encountered a 2-month-old boy with infantile spasms that had been treated with ACTH and had developed complicating Fournier's gangrene. Strangulation of a right inguinal hernia was observed after ACTH treatment. Although surgical repair was successful and no intestinal injuries were detected, swelling and discoloration of the right scrotum developed in association with pyrexia and a severe inflammatory response. A scrotal incision revealed pus with a putrid smell. The patient was subsequently diagnosed with Fournier's gangrene complicated by septic shock and disseminated intravascular coagulation. Extensive debridement and intensive care was performed. Enterobactor aerogenes, methicillin-resistant Staphylococcus aureus, and Enterococcus faecalis were isolated from the pus. Meropenem, teicoplanin, and clindamycin were administered to control the bacterial infection. The patient was discharged from the intensive care unit without any obvious neurological sequelae. Suppression of immune function associated with ACTH therapy may have been related to the development of Fournier's gangrene in this case.
Collapse
Affiliation(s)
- Shingo Numoto
- Department of Pediatrics, Aichi Medical University, Japan.
| | | | - Yoshiteru Azuma
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Japan
| | - Atsushi Numaguchi
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Japan; Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Japan
| | - Kozaburo Nakahara
- Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Japan
| | - Takahisa Tainaka
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Japan
| | | | | | - Nozomi Nago
- Department of Pediatrics, Aichi Medical University, Japan
| | - Taichiro Muto
- Department of Pediatrics, Aichi Medical University, Japan
| | | | | |
Collapse
|
36
|
Hirai M, Muramatsu Y, Mizuno S, Kurahashi N, Kurahashi H, Nakamura M. Preserved search asymmetry in the detection of fearful faces among neutral faces in individuals with Williams syndrome revealed by measurement of both manual responses and eye tracking. J Neurodev Disord 2017; 9:8. [PMID: 28270868 PMCID: PMC5335849 DOI: 10.1186/s11689-017-9190-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 03/09/2016] [Accepted: 02/10/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Individuals with Williams syndrome (WS) exhibit an atypical social phenotype termed hypersociability. One theory accounting for hypersociability presumes an atypical function of the amygdala, which processes fear-related information. However, evidence is lacking regarding the detection mechanisms of fearful faces for individuals with WS. Here, we introduce a visual search paradigm to elucidate the mechanisms for detecting fearful faces by evaluating the search asymmetry; the reaction time when both the target and distractors were swapped was asymmetrical. METHODS Eye movements reflect subtle atypical attentional properties, whereas, manual responses are unable to capture atypical attentional profiles toward faces in individuals with WS. Therefore, we measured both eye movements and manual responses of individuals with WS and typically developed children and adults in visual searching for a fearful face among neutral faces or a neutral face among fearful faces. Two task measures, namely reaction time and performance accuracy, were analyzed for each stimulus as well as gaze behavior and the initial fixation onset latency. RESULTS Overall, reaction times in the WS group and the mentally age-matched control group were significantly longer than those in the chronologically age-matched group. We observed a search asymmetry effect in all groups: when a neutral target facial expression was presented among fearful faces, the reaction times were significantly prolonged in comparison with when a fearful target facial expression was displayed among neutral distractor faces. Furthermore, the first fixation onset latency of eye movement toward a target facial expression showed a similar tendency for manual responses. CONCLUSIONS Although overall responses in detecting fearful faces for individuals with WS are slower than those for control groups, search asymmetry was observed. Therefore, cognitive mechanisms underlying the detection of fearful faces seem to be typical in individuals with WS. This finding is discussed with reference to the amygdala account explaining hypersociability in individuals with WS.
Collapse
Affiliation(s)
- Masahiro Hirai
- Institute for Developmental Research, Aichi Human Service Center, 713-8 Kagiya-cho, Kasugai, Aichi 480-0392 Japan.,Present Address: Center for Development of Advanced Medical Technology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 392-0498 Japan
| | - Yukako Muramatsu
- Institute for Developmental Research, Aichi Human Service Center, 713-8 Kagiya-cho, Kasugai, Aichi 480-0392 Japan
| | - Seiji Mizuno
- Department of Pediatrics, Central Hospital, Aichi Human Service Center, 713-8 Kagiya-cho, Kasugai, Aichi 480-0392 Japan
| | - Naoko Kurahashi
- Department of Pediatrics, Central Hospital, Aichi Human Service Center, 713-8 Kagiya-cho, Kasugai, Aichi 480-0392 Japan
| | - Hirokazu Kurahashi
- Department of Pediatrics, Central Hospital, Aichi Human Service Center, 713-8 Kagiya-cho, Kasugai, Aichi 480-0392 Japan
| | - Miho Nakamura
- Institute for Developmental Research, Aichi Human Service Center, 713-8 Kagiya-cho, Kasugai, Aichi 480-0392 Japan
| |
Collapse
|
37
|
Okumura A, Abe S, Kurahashi H, Takasu M, Ikeno M, Nakazawa M, Igarashi A, Shimizu T. Worsening of attitudes toward epilepsy following less influential media coverage of epilepsy-related car accidents: An infodemiological approach. Epilepsy Behav 2016; 64:206-211. [PMID: 27744246 DOI: 10.1016/j.yebeh.2016.09.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 08/02/2016] [Revised: 09/17/2016] [Accepted: 09/17/2016] [Indexed: 12/24/2022]
Abstract
To evaluate changes in the attitudes of nonmedical university students toward epilepsy in 2015, the present study compared the results of questionnaire surveys from four different time periods: before media coverage of epilepsy-related car accidents (2008-2010), during a period of abundant media coverage (2011-2012), after media coverage (2013-2014), and after novel media coverage (2015). The nonmedical students that completed the questionnaire were divided into four groups: 2008-2010, 2011-2012, 2013-2014, and 2015. The rates of students that had read or heard about epilepsy decreased significantly in 2015 compared with those in 2013-2014. Attitudes toward epilepsy had also worsened in 2015. The rates of students that would not oppose their children playing with or attending school alongside children with epilepsy and those who thought that people with epilepsy should be hired in the same way as other people had decreased significantly in 2015 compared with those in 2011-2012 and 2013-2014. Analyses of information-seeking behavior on the Internet showed that the increase in Google search volume and Wikipedia page views was much less in 2015 than in 2011 and 2012. These findings suggest that familiarity with epilepsy had worsened even after media coverage of novel epilepsy-related car accidents. This suggests that media coverage in 2015 was less influential than that in 2011 and 2012.
Collapse
Affiliation(s)
- Akihisa Okumura
- Department of Pediatrics, Aichi Medical University, Japan; Department of Pediatrics, Juntendo University Faculty of Medicine, Japan.
| | - Shinpei Abe
- Department of Pediatrics, Juntendo University Faculty of Medicine, Japan
| | | | | | - Mitsuru Ikeno
- Department of Pediatrics, Juntendo University Faculty of Medicine, Japan
| | - Mika Nakazawa
- Department of Pediatrics, Juntendo University Faculty of Medicine, Japan
| | - Ayuko Igarashi
- Department of Pediatrics, Juntendo University Faculty of Medicine, Japan
| | - Toshiaki Shimizu
- Department of Pediatrics, Juntendo University Faculty of Medicine, Japan
| |
Collapse
|
38
|
Hirai M, Muramatsu Y, Mizuno S, Kurahashi N, Kurahashi H, Nakamura M. Typical visual search performance and atypical gaze behaviors in response to faces in Williams syndrome. J Neurodev Disord 2016; 8:38. [PMID: 27795743 PMCID: PMC5075985 DOI: 10.1186/s11689-016-9172-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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: 11/29/2015] [Accepted: 10/16/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evidence indicates that individuals with Williams syndrome (WS) exhibit atypical attentional characteristics when viewing faces. However, the dynamics of visual attention captured by faces remain unclear, especially when explicit attentional forces are present. To clarify this, we introduced a visual search paradigm and assessed how the relative strength of visual attention captured by a face and explicit attentional control changes as search progresses. METHODS Participants (WS and controls) searched for a target (butterfly) within an array of distractors, which sometimes contained an upright face. We analyzed reaction time and location of the first fixation-which reflect the attentional profile at the initial stage-and fixation durations. These features represent aspects of attention at later stages of visual search. The strength of visual attention captured by faces and explicit attentional control (toward the butterfly) was characterized by the frequency of first fixations on a face or butterfly and on the duration of face or butterfly fixations. RESULTS Although reaction time was longer in all groups when faces were present, and visual attention was not dominated by faces in any group during the initial stages of the search, when faces were present, attention to faces dominated in the WS group during the later search stages. Furthermore, for the WS group, reaction time correlated with eye-movement measures at different stages of searching such that longer reaction times were associated with longer face-fixations, specifically at the initial stage of searching. Moreover, longer reaction times were associated with longer face-fixations at the later stages of searching, while shorter reaction times were associated with longer butterfly fixations. CONCLUSIONS The relative strength of attention captured by faces in people with WS is not observed at the initial stage of searching but becomes dominant as the search progresses. Furthermore, although behavioral responses are associated with some aspects of eye movements, they are not as sensitive as eye-movement measurements themselves at detecting atypical attentional characteristics in people with WS.
Collapse
Affiliation(s)
- Masahiro Hirai
- Institute for Developmental Research, Aichi Human Service Center, 713-8 Kagiya-cho, Kasugai, Aichi 480-0392 Japan ; Present address: Center for Development of Advanced Medical Technology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 392-0498 Japan
| | - Yukako Muramatsu
- Institute for Developmental Research, Aichi Human Service Center, 713-8 Kagiya-cho, Kasugai, Aichi 480-0392 Japan
| | - Seiji Mizuno
- Department of Pediatrics, Central Hospital, Aichi Human Service Center, 713-8 Kagiya-cho, Kasugai, Aichi 480-0392 Japan
| | - Naoko Kurahashi
- Department of Pediatrics, Central Hospital, Aichi Human Service Center, 713-8 Kagiya-cho, Kasugai, Aichi 480-0392 Japan
| | - Hirokazu Kurahashi
- Department of Pediatrics, Central Hospital, Aichi Human Service Center, 713-8 Kagiya-cho, Kasugai, Aichi 480-0392 Japan
| | - Miho Nakamura
- Institute for Developmental Research, Aichi Human Service Center, 713-8 Kagiya-cho, Kasugai, Aichi 480-0392 Japan
| |
Collapse
|
39
|
Hirai M, Muramatsu Y, Mizuno S, Kurahashi N, Kurahashi H, Nakamura M. Intact attentional orienting towards inverted faces revealed by both manual responses and eye-movement measurement in individuals with Williams syndrome. J Intellect Disabil Res 2016; 60:969-981. [PMID: 27476718 DOI: 10.1111/jir.12318] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 06/10/2016] [Accepted: 06/22/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Individuals with Williams syndrome (WS) exhibit atypical attentional characteristics when viewing faces. Although atypical configural processing of faces has been reported in WS, the relative strengths of configural and local feature information to capture visual attention in WS remains unclear. We previously demonstrated that attentional capture by target-unrelated upright faces differs depending on what response is measured. Whereas eye movements reflected subtle atypical attentional properties at the late stage of visual search, manual responses could not capture the atypical attentional profiles towards target-unrelated upright faces in individuals with WS. Here we used the same experimental paradigm to assess whether sensitivity to configural facial information is necessary for capturing attention in WS. METHODS We measured both eye movements and manual responses from 17 individuals with WS and 34 typically developing children and adults while they were actively involved in a visual search task with an inverted face distractor. Task measures (reaction time and performance accuracy) and gaze behaviour (initial direction of attention and fixation duration) were analysed for each stimulus. RESULTS When the target and the inverted face were displayed in the same search array, reaction times and accuracies in individuals with WS showed similar tendencies as typical controls. Analysis of task and gaze measures revealed that attentional orienting towards inverted faces was not atypical. CONCLUSION Although individuals with WS exhibited atypical gaze behaviour towards upright faces in our previous study, this unusual behaviour disappears if the faces are upside down. These findings suggest that local feature information alone (e.g. eyes) does not contribute to the heightened attention to faces, but configural information appears necessary for drawing attention to faces in individuals with WS, at least in the current experimental paradigm.
Collapse
Affiliation(s)
- M Hirai
- Institute for Developmental Research, Aichi Human Service Center, Kasugai, Aichi, Japan.
- Center for Development of Advanced Medical Technology, Jichi Medical University, Shimotsuke, Tochigi, Japan.
| | - Y Muramatsu
- Institute for Developmental Research, Aichi Human Service Center, Kasugai, Aichi, Japan
| | - S Mizuno
- Department of Pediatrics, Central Hospital, Aichi Human Service Center, Kasugai, Aichi, Japan
| | - N Kurahashi
- Department of Pediatrics, Central Hospital, Aichi Human Service Center, Kasugai, Aichi, Japan
| | - H Kurahashi
- Department of Pediatrics, Central Hospital, Aichi Human Service Center, Kasugai, Aichi, Japan
| | - M Nakamura
- Institute for Developmental Research, Aichi Human Service Center, Kasugai, Aichi, Japan
| |
Collapse
|
40
|
Takeuchi T, Natsume J, Kidokoro H, Ishihara N, Yamamoto H, Azuma Y, Ito Y, Kurahashi N, Tsuji T, Suzuki M, Itomi K, Yamada K, Kurahashi H, Abe S, Okumura A, Maruyama K, Negoro T, Watanabe K, Kojima S. The effects of co-medications on lamotrigine clearance in Japanese children with epilepsy. Brain Dev 2016; 38:723-30. [PMID: 27033151 DOI: 10.1016/j.braindev.2016.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 03/14/2016] [Accepted: 03/15/2016] [Indexed: 11/17/2022]
Abstract
PURPOSE Although it has been reported that some antiepileptic drugs have inducing or inhibiting effects on lamotrigine (LTG) clearance, whether they have the same effects in Asian epilepsy patients as in those in other countries has not been clarified, especially in children. The aim of this study was to determine the effects of co-medications on LTG clearance in Japanese children with epilepsy. METHODS A total of 342 routine serum concentration measurements of LTG in 102 Japanese epilepsy patients under 20years of age were reviewed. The dose-corrected concentration (DCC) of LTG was calculated as [concentration]/[dose/(body weight)], and the DCC of LTG was compared by co-medication. The difference in the DCC of LTG was compared between patients with and without valproic acid (VPA) and between those with and without drugs inducing glucuronic acid conjugation (phenytoin (PHT), carbamazepine (CBZ), and phenobarbital (PB)). RESULTS The DCC of LTG was significantly higher in patients on VPA and significantly lower in patients on drugs inducing glucuronic acid conjugation than in patients on LTG monotherapy. The DCC of LTG was significantly higher in patients on CBZ than in patients on PHT or PB. There was no correlation between the DCC of LTG and the concentration of VPA or metabolic inducers within the therapeutic range. Other antiepileptic drugs including clobazam, clonazepam, zonisamide, and levetiracetam had little effect on LTG concentration. CONCLUSION LTG concentration changes dramatically with concomitant antiepileptic drugs in Japanese children, as previously reported from other countries, and special attention is required. Although the dose of LTG should be adjusted when starting or discontinuing VPA or metabolic inducers, no adjustment is needed when changing the dose of VPA or metabolic inducers in the therapeutic range.
Collapse
Affiliation(s)
- Tomoya Takeuchi
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Jun Natsume
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroyuki Kidokoro
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoko Ishihara
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroyuki Yamamoto
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshiteru Azuma
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuji Ito
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoko Kurahashi
- Department of Pediatric Neurology, Central Hospital, Aichi Human Service Center, Kasugai, Japan
| | - Takeshi Tsuji
- Department of Pediatrics, Okazaki City Hospital, Okazaki, Japan
| | | | - Kazuya Itomi
- Aichi Children's Health and Medical Center, Ohbu, Japan
| | - Keitaro Yamada
- Department of Pediatric Neurology, Central Hospital, Aichi Human Service Center, Kasugai, Japan
| | - Hirokazu Kurahashi
- Department of Pediatric Neurology, Central Hospital, Aichi Human Service Center, Kasugai, Japan
| | - Shinpei Abe
- Department of Pediatrics, Juntendo University Hospital, Tokyo, Japan
| | - Akihisa Okumura
- Department of Pediatrics, Juntendo University Hospital, Tokyo, Japan
| | - Koichi Maruyama
- Department of Pediatric Neurology, Central Hospital, Aichi Human Service Center, Kasugai, Japan
| | - Tamiko Negoro
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuyoshi Watanabe
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan; Faculty of Health and Medical Sciences, Aichi Shukutoku University, Nagakute, Japan
| | - Seiji Kojima
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| |
Collapse
|
41
|
Kurahashi H, Okumura A, Kubota T, Kidokoro H, Maruyama K, Hayakawa M, Itakura A, Matsuzawa K, Yamamoto H, Kato T, Hayakawa F, Watanabe K. Increased fetal heart rate variability in periventricular leukomalacia. Brain Dev 2016; 38:196-203. [PMID: 26338690 DOI: 10.1016/j.braindev.2015.08.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 04/10/2015] [Revised: 07/15/2015] [Accepted: 08/24/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study used quantitative analysis to determine whether increased variability in fetal heart rate (FHR) is related to the risk of developing periventricular leukomalacia (PVL). METHODS We analyzed 124 FHR traces of neonates delivered preterm at 27-33 weeks' gestation to 105 mothers. FHR traces 1-3h before delivery were translated into power-spectrum curves using a fast Fourier transformation. The total power (the area under the curve of 1-10 cycles per minute), segmental power of every cycle per minute, peak power, and frequency edges were calculated, and their relationship with the subsequent development of PVL was examined. RESULTS Total power was significantly higher in the PVL group (n=9, median 1813, range 1064-2426) compared to the non-PVL group (n=114, median 1383, range 381-3324, p=0.029). Infants in the PVL group had greater segmental power in segments with 1-2, 2-3, and 9-10 cycles per minute, than those in the non-PVL group. Total power of ⩾1550 was significantly correlated with the subsequent development of PVL and premature rupture of membranes. Furthermore, the frequency of pregnancy-induced hypertension was significantly reduced in the fetuses with a total power of ⩾1550. CONCLUSION Our study suggests that a fetus with increased FHR variability is at risk of developing PVL. This study provides additional evidence supporting the contribution of antenatal factors to the subsequent development of PVL.
Collapse
Affiliation(s)
- Hirokazu Kurahashi
- Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, Japan; Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akihisa Okumura
- Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, Japan; Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan.
| | - Tetsuo Kubota
- Department of Pediatrics, Anjo Kosei Hospital, Anjo, Aichi, Japan
| | - Hiroyuki Kidokoro
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Pediatrics, Anjo Kosei Hospital, Anjo, Aichi, Japan
| | - Koichi Maruyama
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masahiro Hayakawa
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan; Maternity and Perinatal Care Center, Nagoya University Hospital, Nagoya, Japan
| | - Atsuo Itakura
- Maternity and Perinatal Care Center, Nagoya University Hospital, Nagoya, Japan; Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Katsuji Matsuzawa
- Department of Gynecology and Obstetrics, Anjo Kosei Hospital, Anjo, Aichi, Japan
| | - Hiroyuki Yamamoto
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toru Kato
- Department of Pediatrics, Okazaki City Hospital, Okazaki, Aichi, Japan
| | - Fumio Hayakawa
- Department of Pediatrics, Okazaki City Hospital, Okazaki, Aichi, Japan
| | | |
Collapse
|
42
|
Shi XY, Tomonoh Y, Wang WZ, Ishii A, Higurashi N, Kurahashi H, Kaneko S, Hirose S. Efficacy of antiepileptic drugs for the treatment of Dravet syndrome with different genotypes. Brain Dev 2016; 38:40-6. [PMID: 26183863 DOI: 10.1016/j.braindev.2015.06.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [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: 10/08/2014] [Revised: 06/28/2015] [Accepted: 06/30/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Evaluation of the efficacy of antiepileptic drugs (AEDs) used in the treatment of Dravet syndrome (DS) with different genotypes. METHODS Patients with DS were recruited from different tertiary hospitals. Using a direct sequencing method and Multiplex Ligation-Dependent Probe Amplification (MLPA), genetic abnormalities were assessed within the exons and flanking introns of SCN1A gene, which encodes the α1 subunit of neuronal sodium channels. Patients were divided into SCN1A-positive and SCN1A-negative groups according to the results of genetic tests. Medical records, including detailed treatment information, were surveyed to compare the effect of different AEDs on clonic or tonic-clonic seizures (GTCS). Efficacy variable was responder rate with regard to seizure reduction. RESULTS One hundred and sixty of 276 (57.97%) patients had mutation in SCN1A gene (only 128 of them had provided detailed medical records). Among the 116 patients without SCN1A mutations, 87 had provided detailed medical records. Both older AEDs (valproate, phenobarbital, bromide, carbamazepine, clonazepam, and clobazam) and newer AEDs such as zonisamide were used in these patients. Valproate was the most frequently used AED (86.72% in the SCN1A-positive group, 78.16% in the SCN1A-negative group), with 52.25% and 41.18% responder rates in SCN1A-positive and SCN1A-negative patients, respectively (P=0.15). Bromide was used in 40.63% of the SCN1A-positive patients and 20.69% of the SCN1A-negative patients, and its responder rates were 71.15% and 94.44% in SCN1A-positive and SCN1A-negative patients, respectively (P=0.05). Efficacy rates of clonazepam, clobazam, phenobarbital, and zonisamide ranged from 30% to 50%, and these rates were not correlated with different genotypes (P>0.05). Carbamazepine had either no effect or aggravated seizures in all SCN1A-positive patients. SIGNIFICANCE Bromide is most effective and is a well-tolerated drug among DS patients, especially among SCN1A-negative patients. Carbamazepine should be avoided in patients with SCN1A mutations.
Collapse
Affiliation(s)
- Xiu-Yu Shi
- Department of Pediatrics, School of Medicine, Fukuoka University, Fukuoka, Japan; Central Research Institute for the Molecular Pathomechanisms of Epilepsy, Fukuoka University, Fukuoka, Japan; Department of Pediatrics, Chinese PLA General Hospital, Beijing, China
| | - Yuko Tomonoh
- Department of Pediatrics, School of Medicine, Fukuoka University, Fukuoka, Japan; Central Research Institute for the Molecular Pathomechanisms of Epilepsy, Fukuoka University, Fukuoka, Japan
| | - Wen-Ze Wang
- Department of Pediatrics, School of Medicine, Fukuoka University, Fukuoka, Japan; Central Research Institute for the Molecular Pathomechanisms of Epilepsy, Fukuoka University, Fukuoka, Japan; Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Atsushi Ishii
- Department of Pediatrics, School of Medicine, Fukuoka University, Fukuoka, Japan; Central Research Institute for the Molecular Pathomechanisms of Epilepsy, Fukuoka University, Fukuoka, Japan
| | - Norimichi Higurashi
- Department of Pediatrics, School of Medicine, Fukuoka University, Fukuoka, Japan; Central Research Institute for the Molecular Pathomechanisms of Epilepsy, Fukuoka University, Fukuoka, Japan; Department of Pediatrics, Jikei University School of Medicine, Tokyo, Japan
| | - Hirokazu Kurahashi
- Department of Pediatric Neurology, Central Hospital of Aichi Welfare Center for Persons with Developmental Disabilities, Kasugai, Japan
| | - Sunao Kaneko
- Department of Neuropsychiatry, School of Medicine, Hirosaki University, Hirosaki, Japan
| | - Shinichi Hirose
- Department of Pediatrics, School of Medicine, Fukuoka University, Fukuoka, Japan; Central Research Institute for the Molecular Pathomechanisms of Epilepsy, Fukuoka University, Fukuoka, Japan.
| | | |
Collapse
|
43
|
Yamada K, Kurahashi H, Ogaya S, Kurahashi N, Umemura A, Kawamura Y, Kato M, Maruyama K, Nagasaka M. [Two pediatric cases of chronic progressive subdural hematoma with brain atrophy following acute encephalitis/encephalopathy requiring surgical hematoma removal]. No To Hattatsu 2016; 48:49-51. [PMID: 27012112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
|
44
|
Chaiwong T, Kurahashi H, Sanit S, Moophayak K, Sukontason K, Sukontason KL. Three Sarcophagid species (Diptera: Sarcophagidae) newly recorded in Thailand. Trop Biomed 2015; 32:625-635. [PMID: 33557452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This study contributed new records of three flesh fly species (Diptera: Sarcophagidae) to the fauna of Thailand - Miltogramma tibita Chao & Zhang (subfamily Miltogrammatinae), Myorhina situliformis (Zhong, Wu & Fan, 1982), and Iranihindia martellata (Senior-White, 1924) (subfamily Sarcophaginae). Collections of these species were performed using a sweep net and one-day old beef offal as bait. Miltogramma tibita differs from other known Miltogramma by having a fine long seta on the dorsal surface of tarsomeres 2-4. With this new record, the number of species belonging to the genus Miltogramma known from Thailand has increased to three which includes Miltogramma angustifrons (Townsend, 1933) and Miltogramma iberica Villeneuve, 1912. The new record of My. situliformis makes a total of three species for Myorhina and these include Myorhina otiophalla (Fan & Chen, 1981) and Myorhina caudagalli (Böttcher, 1912). Regarding Iranihindia, the recording of I. martellata makes a total of two species, the other being Iranihindia martellatoides (Baranov, 1931). This study provides a revised key of each genus where these newly recorded species were recorded, with their re-descriptions, illustrations, photographs, and scanning electron micrographs focusing on the male genitalia. The findings of these newly recorded species means that a total of 86 species of flesh flies have been recorded from Thailand.
Collapse
Affiliation(s)
- T Chaiwong
- College of Medicine and Public Health, Ubon Ratchathani University, Ubon Ratchathani 34190, Thailand
| | - H Kurahashi
- Department of Medical Entomology, National Institute of Infectious Diseases, Tokyo 162-8640, Japan
| | - S Sanit
- Department of Parasitology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - K Moophayak
- Mahidol University Nakhonsawan Campus, Nakhonsawan 60130, Thailand
| | - K Sukontason
- Department of Parasitology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - K L Sukontason
- Department of Parasitology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| |
Collapse
|
45
|
Affiliation(s)
- Toshiyuki Yamamoto
- Tokyo Women's Medical University Institute for Integrated Medical Sciences, Tokyo, Japan
| | - Hirokazu Kurahashi
- Department of Pediatrics, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan
| | - Michihiko Takasu
- Department of Pediatrics, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan
| | - Akihisa Okumura
- Department of Pediatrics, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan
| |
Collapse
|
46
|
Yagasaki H, Shichino H, Shimizu N, Ohye T, Kurahashi H, Yoshikawa T, Takahashi S. Nine-year follow-up in a child with chromosomal integration of human herpesvirus 6 transmitted from an unrelated donor through the Japan Marrow Donor Program. Transpl Infect Dis 2015; 17:160-1. [PMID: 25571778 DOI: 10.1111/tid.12338] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 12/04/2014] [Indexed: 11/30/2022]
Affiliation(s)
- H Yagasaki
- Pediatrics, School of Medicine, Nihon University, Tokyo, Japan
| | | | | | | | | | | | | |
Collapse
|
47
|
Kurahashi N, Tsuji T, Kato T, Ogaya S, Umemura A, Yamada K, Kurahashi H, Maruyama K, Takeuchi T, Kubota T, Saitoh S, Natsume J, Okumura A. Thalamic lesions in acute encephalopathy with biphasic seizures and late reduced diffusion. Pediatr Neurol 2014; 51:701-5. [PMID: 25193414 DOI: 10.1016/j.pediatrneurol.2014.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 05/18/2014] [Revised: 07/09/2014] [Accepted: 07/10/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND We aimed to assess the characteristics of thalamic lesions in children with acute encephalopathy with biphasic seizures and late reduced diffusion. METHODS Using the Tokai Pediatric Neurology Society database, we identified and enrolled 18 children with acute encephalopathy with biphasic seizures and late reduced diffusion from 2008 to 2010. Using diffusion-weighted images, we identified patients with thalamic lesions and compared their clinical factors with those of patients without thalamic lesions. We analyzed the time sequence of thalamic, sucortical, and cortical lesions. To study the topography of thalamic lesions, we divided the thalamus into five sections: anterior, medial, anterolateral, posterolateral, and posterior. Subsequently, we analyzed the relationship between the topography of thalamic lesions and the presence of central-sparing. RESULTS Seven children presented with symmetrical thalamic lesions associated with bilateral subcortical or cortical lesions. No statistical difference in the clinical features was observed between individuals with and without thalamic lesions. These lesions were observed only when subcortical or cortical lesions were present. In 5 children, thalamic lesions were present in bilateral anterior or anterolateral sections and were associated with subcortical or cortical lesions in bilateral frontal lobes with central-sparing. In the other two children, thalamic lesions were extensive and accompanied by diffuse subcortical and cortical lesions without central-sparing. CONCLUSION Thalamic lesions in patients with acute encephalopathy with biphasic seizures and late reduced diffusion involve the anterior sections. The thalamocortical network may play a role in development of thalamic lesions in patients with acute encephalopathy with biphasic seizures and late reduced diffusion.
Collapse
Affiliation(s)
- Naoko Kurahashi
- Department of Pediatric Neurology, Central Hospital, Aichi Human Service Center, Kasugai, Aichi, Japan.
| | - Takeshi Tsuji
- Department of Pediatrics, Okazaki City Hospital, Okazaki, Aichi, Japan
| | - Toru Kato
- Department of Pediatrics, Okazaki City Hospital, Okazaki, Aichi, Japan
| | - Shunsuke Ogaya
- Department of Pediatric Neurology, Central Hospital, Aichi Human Service Center, Kasugai, Aichi, Japan
| | - Ayako Umemura
- Department of Pediatric Neurology, Central Hospital, Aichi Human Service Center, Kasugai, Aichi, Japan
| | - Keitaro Yamada
- Department of Pediatric Neurology, Central Hospital, Aichi Human Service Center, Kasugai, Aichi, Japan
| | - Hirokazu Kurahashi
- Department of Pediatric Neurology, Central Hospital, Aichi Human Service Center, Kasugai, Aichi, Japan; Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, Japan
| | - Koichi Maruyama
- Department of Pediatric Neurology, Central Hospital, Aichi Human Service Center, Kasugai, Aichi, Japan
| | - Tomoya Takeuchi
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Tetsuo Kubota
- Department of Pediatrics, Anjo Kosei Hospital, Anjo, Aichi, Japan
| | - Shinji Saitoh
- Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Jun Natsume
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Akihisa Okumura
- Department of Pediatrics, Juntendo University Faculty of Medicine, Bunkyo-ku, Tokyo, Japan; Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, Japan
| |
Collapse
|
48
|
Samerjai C, Sanit S, Sukontason K, Klong-Klaew T, Kurahashi H, Tomberlin JK, Morakote N, Wannasan A, Sukontason KL. Morphology of puparia of flesh flies in Thailand. Trop Biomed 2014; 31:351-361. [PMID: 25134905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Puparia of five flesh fly species were investigated for forensic study. Boettcherisca nathani (Lopes, 1961), Boettcherisca peregrina (Robineau-Desvoidy, 1830), Lioproctia pattoni (Senior-White, 1924), Liopygia ruficornis (Fabricius, 1794) and Parasarcophaga (Liosarcophaga) dux (Thomson, 1869) were examined with a scanning electron microscopy (SEM). Differences between species were found in the number and arrangement of papillae in the anterior spiracle, the shape of intersegmental spines between the prothorax and mesothorax and the pattern of spiracular tufts at the posterior spiracle. The anterior spiracle of B. nathani had two rows, comprising 21-27 papillae; while those of B. peregrina and L. pattoni had one or two irregular rows with 24-26 and 20-28 papillae, respectively. Anterior spiracle of L. ruficornis and P. dux had one row of 10-15 papillae. Intersegmental spines between the prothorax and mesothorax and pattern of spiracular tufts at the posterior spiracle are morphologically different. L. ruficornis and P. dux puparia are similar, but the position of the interslit plate between the inner and middle spiracular slits was found to be an important attribute to separate both species. Morphometric analysis on the length and width of puparia of these species revealed statistically different among them. The key for identifying puparia of forensically important flesh flies has been provided.
Collapse
Affiliation(s)
- C Samerjai
- Department of Parasitology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - S Sanit
- Department of Parasitology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - K Sukontason
- Department of Parasitology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - T Klong-Klaew
- Department of Parasitology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - H Kurahashi
- Department of Medical Entomology, National Institute of Infectious Diseases, Tokyo 162-8640, Japan
| | - J K Tomberlin
- Department of Entomology, Texas A&M University, College Station, TX 77843, USA
| | - N Morakote
- Department of Parasitology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - A Wannasan
- Department of Parasitology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - K L Sukontason
- Department of Parasitology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| |
Collapse
|
49
|
Hirai M, Muramatsu Y, Mizuno S, Kurahashi N, Kurahashi H, Nakamura M. Developmental changes in mental rotation ability and visual perspective-taking in children and adults with Williams syndrome. Front Hum Neurosci 2014; 7:856. [PMID: 24376412 PMCID: PMC3858672 DOI: 10.3389/fnhum.2013.00856] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 11/22/2013] [Indexed: 11/13/2022] Open
Abstract
Williams syndrome (WS) is a genetic disorder caused by the partial deletion of chromosome 7. Individuals with WS have atypical cognitive abilities, such as hypersociability and compromised visuospatial cognition, although the mechanisms underlying these deficits, as well as the relationship between them, remain unclear. Here, we assessed performance in mental rotation (MR) and level 2 visual perspective taking (VPT2) tasks in individuals with and without WS. Individuals with WS obtained lower scores in the VPT2 task than in the MR task. These individuals also performed poorly on both the MR and VPT2 tasks compared with members of a control group. For the individuals in the control group, performance scores improved during development for both tasks, while the scores of those in the WS group improved only in the MR task, and not the VPT2 task. Therefore, we conducted a second experiment to explore the specific cognitive challenges faced by people with WS in the VPT2 task. In addition to asking participants to change their physical location (self-motion), we also asked them to adopt a third-person perspective by imagining that they had moved to a specified location (self-motion imagery). This enabled us to assess their ability to simulate the movement of their own bodies. The performance in the control group improved in both the self-motion and self-motion imagery tasks and both performances were correlated with verbal mental age. However, we did not find any developmental changes in performance for either task in the WS group. Performance scores for the self-motion imagery task in the WS group were low, similar to the scores observed for the VPT2 in this population. These results suggest that MR and VPT2 tasks involve different processes, and that these processes develop differently in people with WS. Moreover, difficulty completing VPT2 tasks may be partly because of an inability of people with WS to accurately simulate mental body motion.
Collapse
Affiliation(s)
- Masahiro Hirai
- Department of Functioning Science, Institute for Developmental Research, Aichi Human Service Center Aichi, Japan
| | - Yukako Muramatsu
- Department of Functioning Science, Institute for Developmental Research, Aichi Human Service Center Aichi, Japan
| | - Seiji Mizuno
- Department of Pediatrics, Central Hospital, Aichi Human Service Center Aichi, Japan
| | - Naoko Kurahashi
- Department of Pediatrics, Central Hospital, Aichi Human Service Center Aichi, Japan
| | - Hirokazu Kurahashi
- Department of Pediatrics, Central Hospital, Aichi Human Service Center Aichi, Japan
| | - Miho Nakamura
- Department of Functioning Science, Institute for Developmental Research, Aichi Human Service Center Aichi, Japan
| |
Collapse
|
50
|
Ota S, Miyamura H, Nishizawa H, Inagaki H, Inagaki A, Inuzuka H, Suzuki M, Miyazaki J, Sekiya T, Udagawa Y, Kurahashi H. Contribution of fetal ANXA5 gene promoter polymorphisms to the onset of pre-eclampsia. Placenta 2013; 34:1202-10. [PMID: 24140079 DOI: 10.1016/j.placenta.2013.09.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [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: 04/16/2013] [Revised: 09/14/2013] [Accepted: 09/16/2013] [Indexed: 12/30/2022]
Abstract
OBJECTIVE A common haplotype M2 consisting of minor SNP alleles located in the ANXA5 gene promoter region has been described as a risk factor for various obstetric complications such as recurrent pregnancy loss, pre-eclampsia and pregnancy-related thrombophilic disorder. However, the question of whether it is the maternal or fetal genotype that contributes to the onset of these disorders remains to be resolved. METHODS We analyzed ANXA5 gene variants in the blood and placental tissues from pre-eclampsia patients and normotensive controls. ANXA5 expression was examined by qRT-PCR, Western blotting and immunostaining. Results were compared between M2 and non-M2 carriers. RESULTS The M2 haplotype was found to be significantly frequent in placentas from pre-eclamptic patients relative to the controls (25.5% versus 10%, P = 0.044), In contrast, no significant differences were observed in maternal blood (13.0% versus 11.3%, P = 0.597). The placental expression of ANXA5 mRNA was found to be lower in M2 carriers. When examined by Western blot and immunostaining, the ANXA5 protein levels were found to be affected more by the placental than the maternal genotype. Histological examination of the placentas from the pre-eclamptic patients demonstrated that a placental M2 haplotype correlated more closely than maternal M2 with the severity of perivillous fibrin deposition. CONCLUSIONS Although preliminary, these results suggest that hypomorphic M2 alleles in the in placental ANXA5 promoter, whether transmitted maternally or paternally, might be an essential determinant of an increased risk of pre-eclampsia via local thrombophilia at the feto-maternal interface.
Collapse
Affiliation(s)
- S Ota
- Division of Molecular Genetics, Institute for Comprehensive Medical Science, Fujita Health University, Toyoake, Aichi 470-1192, Japan
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|