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Proietti J, Boylan GB, Walsh BH. Regional variability in therapeutic hypothermia eligibility criteria for neonatal hypoxic-ischemic encephalopathy. Pediatr Res 2024:10.1038/s41390-024-03184-6. [PMID: 38649726 DOI: 10.1038/s41390-024-03184-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 03/13/2024] [Accepted: 03/24/2024] [Indexed: 04/25/2024]
Abstract
Early induced therapeutic hypothermia represents the cornerstone treatment in neonates with probable hypoxic-ischemic encephalopathy. The selection of patients for treatment usually involves meeting criteria indicating evidence of perinatal hypoxia-ischemia and the presence of moderate or severe encephalopathy. In this review, we highlight the variability that exists between some of the different regional and national eligibility guidelines. Determining the potential presence of perinatal hypoxia-ischemia may require either one, two or three signs amongst history of acute perinatal event, prolonged resuscitation at delivery, abnormal blood gases and low Apgar score, with a range of cutoff values. Clinical neurological exams often define the severity of encephalopathy differently, with varying number of domains required for determining eligibility and blurred interpretation of findings assigned to different severity grades in different systems. The role of early electrophysiological assessment is weighted differently. A clinical implication is that infants may receive different care depending on the location in which they are born. This could also impact epidemiological data, as inference of rates of moderate-severe encephalopathy based on therapeutic hypothermia rates are misleading and influenced by different eligibility methods used. We would advocate that a universally endorsed single severity staging of encephalopathy is vital for standardizing management and neonatal outcome. IMPACT: Variability exists between regional and national therapeutic hypothermia eligibility guidelines for neonates with probable hypoxic-ischemic encephalopathy. Differences are common in both criteria indicating perinatal hypoxia-ischemia and criteria defining moderate or severe encephalopathy. The role of early electrophysiological assessment is also weighted unequally. This reflects in different individual care and impacts research data. A universally endorsed single severity staging of encephalopathy would be crucial for standardizing management.
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Affiliation(s)
- Jacopo Proietti
- INFANT Research Centre, University College Cork, Cork, Ireland
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
- Department of Engineering for Innovation Medicine, Innovation Biomedicine section, University of Verona, Verona, Italy
| | - Geraldine B Boylan
- INFANT Research Centre, University College Cork, Cork, Ireland
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Brian H Walsh
- INFANT Research Centre, University College Cork, Cork, Ireland.
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland.
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Proietti J, Fiorini E, Cantalupo G, Fontana E, Lo Barco T, Bonin C, Bernardina BD, Darra F. Refractory tonic-myoclonic status epilepticus with catamenial recurrence in epilepsy with myoclonic atonic seizures: A case report. Heliyon 2024; 10:e24747. [PMID: 38304836 PMCID: PMC10831770 DOI: 10.1016/j.heliyon.2024.e24747] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/08/2023] [Accepted: 01/12/2024] [Indexed: 02/03/2024] Open
Abstract
In epilepsy with myoclonic-atonic seizures (EMA), status epilepticus (SE) may occur during the onset phase, uncommonly in post-puberal patients. We report a post-puberal patient with EMA who presented SE with insidious onset and catamenial recurrence. She had a stormy epilepsy onset at 4 years, with tonic seizures, atypical absences, and myoclonic-atonic seizures, in the absence of SE. After the onset phase, sporadic nocturnal tonic seizures persisted and a mild intellectual disability appeared. At the age of 7, after gonadotropin-releasing hormone analog administration due to central precocious puberty, she presented with SE characterized by recurrent atypical absences, tonic seizures, and awareness impairment, which was successfully treated in 4 days. At 11 years, one week before menstruation, the patient presented with analogous SE that lasted 8 days. One week before the subsequent menstruation, she presented again with SE, initially characterized by atypical absences alternating with phases of awareness and motor impairment related to fast low-voltage EEG activity in the central regions; later, tonic and myoclonic seizures occurring even in the awake state increased, and the "atonic-akinetic status" related to fast EEG activity worsened. After conventional antiepileptic drugs had failed to control the seizures, a progestin was added, with subsequent gradual complete recovery.
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Affiliation(s)
- Jacopo Proietti
- UOC Neuropsichiatria Infantile, Dipartimento Materno-Infantile, Azienda Ospedaliero-Universitaria Integrata, Verona, Italy - Full member of ERN EpiCARE
- Innovation biomedicine Section, Department of Engineering for Innovation Medicine, University of Verona, Verona, Italy
- Center for Research on Epilepsies in Pediatric age (CREP), Verona, Italy
| | - Elena Fiorini
- UOC Neuropsichiatria Infantile, Dipartimento Materno-Infantile, Azienda Ospedaliero-Universitaria Integrata, Verona, Italy - Full member of ERN EpiCARE
- Center for Research on Epilepsies in Pediatric age (CREP), Verona, Italy
| | - Gaetano Cantalupo
- UOC Neuropsichiatria Infantile, Dipartimento Materno-Infantile, Azienda Ospedaliero-Universitaria Integrata, Verona, Italy - Full member of ERN EpiCARE
- Innovation biomedicine Section, Department of Engineering for Innovation Medicine, University of Verona, Verona, Italy
- Center for Research on Epilepsies in Pediatric age (CREP), Verona, Italy
| | - Elena Fontana
- UOC Neuropsichiatria Infantile, Dipartimento Materno-Infantile, Azienda Ospedaliero-Universitaria Integrata, Verona, Italy - Full member of ERN EpiCARE
- Center for Research on Epilepsies in Pediatric age (CREP), Verona, Italy
| | - Tommaso Lo Barco
- UOC Neuropsichiatria Infantile, Dipartimento Materno-Infantile, Azienda Ospedaliero-Universitaria Integrata, Verona, Italy - Full member of ERN EpiCARE
- Center for Research on Epilepsies in Pediatric age (CREP), Verona, Italy
| | - Cecilia Bonin
- U.O.C. Ostetricia e Ginecologia B, Dipartimento di Ostetricia e Ginecologia, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Francesca Darra
- UOC Neuropsichiatria Infantile, Dipartimento Materno-Infantile, Azienda Ospedaliero-Universitaria Integrata, Verona, Italy - Full member of ERN EpiCARE
- Innovation biomedicine Section, Department of Engineering for Innovation Medicine, University of Verona, Verona, Italy
- Center for Research on Epilepsies in Pediatric age (CREP), Verona, Italy
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Nucera B, Rinaldi F, Dono F, Evangelista G, Consoli S, Proietti J, Lanzone J, Lo Barco T, Tappatà M, Cossu A, Narducci F, Zaboli A, Cantalupo G, Brigo F. Let the EEG speak my language: Italian translation of Standardized Computer-based Organized Reporting of EEG (SCORE). Epileptic Disord 2023; 25:919-922. [PMID: 37597157 DOI: 10.1002/epd2.20151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 08/14/2023] [Indexed: 08/21/2023]
Affiliation(s)
- Bruna Nucera
- Department of Neurology, Hospital of Merano-Meran (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Merano-Meran, Italy
- Paracelsus Medical University, Salzburg, Austria
| | - Fabrizio Rinaldi
- Department of Neurology, Hospital of Merano-Meran (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Merano-Meran, Italy
- Paracelsus Medical University, Nuernberg, Germany
| | - Fedele Dono
- Department of Neuroscience, Imaging and Clinical Science, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Giacomo Evangelista
- Department of Neuroscience, Imaging and Clinical Science, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Stefano Consoli
- Department of Neuroscience, Imaging and Clinical Science, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Jacopo Proietti
- Child Neuropsychiatry Unit, Department of Surgical Sciences, Dentistry, Gynaecology and Pediatrics, University of Verona, Full Member of European Reference Network EpiCARE, Verona, Italy
- Center for Research on Epilepsy in Pediartic age (CREP) - Department of Surgery, Dentistry, Paediatrics and Gynecology, University of Verona, Verona, Italy
| | - Jacopo Lanzone
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Department of the Milano Institute, Milan, Italy
| | - Tommaso Lo Barco
- Child Neuropsychiatry Unit, Department of Mental Health and Pathological Addictions, Azienda USL di Parma, Parma, Italy
| | - Maria Tappatà
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Alberto Cossu
- Child Neuropsychiatry Unit, Department of Surgical Sciences, Dentistry, Gynaecology and Pediatrics, University of Verona, Full Member of European Reference Network EpiCARE, Verona, Italy
- Center for Research on Epilepsy in Pediartic age (CREP) - Department of Surgery, Dentistry, Paediatrics and Gynecology, University of Verona, Verona, Italy
| | - Flavia Narducci
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico, Rome, Italy
| | - Arian Zaboli
- Department of Emergency Medicine, Hospital of Merano-Meran (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Merano-Meran, Italy
- Innovation, Research and Teaching Service (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano-Bozen, Italy
| | - Gaetano Cantalupo
- Child Neuropsychiatry Unit, Department of Surgical Sciences, Dentistry, Gynaecology and Pediatrics, University of Verona, Full Member of European Reference Network EpiCARE, Verona, Italy
- Center for Research on Epilepsy in Pediartic age (CREP) - Department of Surgery, Dentistry, Paediatrics and Gynecology, University of Verona, Verona, Italy
- Innovation Biomedicine section, Department of Engineering for Innovation Medicine, University of Verona, Verona, Italy
| | - Francesco Brigo
- Department of Neurology, Hospital of Merano-Meran (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Merano-Meran, Italy
- Innovation, Research and Teaching Service (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano-Bozen, Italy
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Lundy C, Boylan GB, Mathieson S, Proietti J, O'Toole JM. Quantitative analysis of high-frequency activity in neonatal EEG. Comput Biol Med 2023; 165:107468. [PMID: 37722158 DOI: 10.1016/j.compbiomed.2023.107468] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 08/23/2023] [Accepted: 09/04/2023] [Indexed: 09/20/2023]
Abstract
OBJECTIVE To determine the presence and potential utility of independent high-frequency activity recorded from scalp electrodes in the electroencephalogram (EEG) of newborns. METHODS We compare interburst intervals and continuous activity at different frequencies for EEGs retrospectively recorded at 256 Hz from 4 newborn groups: 1) 36 preterms (<32 weeks' gestational age, GA); 2) 12 preterms (32-37 weeks' GA); 3) 91 healthy full terms; 4) 15 full terms with hypoxic-ischemic encephalopathy (HIE). At 4 standard frequency bands (delta, 0.5-3 Hz; theta, 3-8 Hz; alpha, 8-15 Hz; beta, 15-30 Hz) and 3 higher-frequency bands (gamma1, 30-48 Hz; gamma2, 52-99 Hz; gamma3, 107-127 Hz), we compared power spectral densities (PSDs), quantitative features, and machine learning model performance. Feature selection and further machine learning methods were performed on one cohort. RESULTS We found significant (P < 0.01) differences in PSDs, quantitative analysis, and machine learning modelling at the higher-frequency bands. Machine learning models using only high-frequency features performed best in preterm groups 1 and 2 with a median (95% confidence interval, CI) Matthews correlation coefficient (MCC) of 0.71 (0.12-0.88) and 0.66 (0.36-0.76) respectively. Interburst interval-detector models using both high- and standard-bandwidths produced the highest median MCCs in all four groups. High-frequency features were largely independent of standard-bandwidth features, with only 11/84 (13.1%) of correlations statistically significant. Feature selection methods produced 7 to 9 high-frequency features in the top 20 feature set. CONCLUSIONS This is the first study to identify independent high-frequency activity in newborn EEG using in-depth quantitative analysis. Expanding the EEG bandwidths of analysis has the potential to improve both quantitative and machine-learning analysis, particularly in preterm EEG.
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Affiliation(s)
- Christopher Lundy
- INFANT Research Centre, University College Cork, Cork, Ireland; Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Geraldine B Boylan
- INFANT Research Centre, University College Cork, Cork, Ireland; Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Sean Mathieson
- INFANT Research Centre, University College Cork, Cork, Ireland; Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Jacopo Proietti
- INFANT Research Centre, University College Cork, Cork, Ireland; Department of Neurosciences, Biomedicine and Movement, University of Verona, Italy
| | - John M O'Toole
- INFANT Research Centre, University College Cork, Cork, Ireland; Department of Paediatrics and Child Health, University College Cork, Cork, Ireland.
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Specchio N, Trivisano M, Lenge M, Ferretti A, Mei D, Parrini E, Napolitano A, Rossi-Espagnet C, Talenti G, Longo D, Proietti J, Ragona F, Freri E, Solazzi R, Granata T, Darra F, Bernardina BD, Vigevano F, Guerrini R. CDKL5 deficiency disorder: progressive brain atrophy may be part of the syndrome. Cereb Cortex 2023; 33:9709-9717. [PMID: 37429835 PMCID: PMC10472491 DOI: 10.1093/cercor/bhad235] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/17/2023] [Accepted: 06/19/2023] [Indexed: 07/12/2023] Open
Abstract
The clinical phenotype of Cyclin-Dependent Kinase-Like 5 (CDKL5) deficiency disorder (CDD) has been delineated but neuroimaging features have not been systematically analyzed. We studied brain magnetic resonance imaging (MRI) scans in a cohort of CDD patients and reviewed age at seizure onset, seizure semiology, head circumference. Thirty-five brain MRI from 22 unrelated patients were included. The median age at study entry was 13.4 years. In 14/22 patients (85.7%), MRI in the first year of life was unremarkable in all but two. In 11/22, we performed MRI after 24 months of age (range 2.5-23 years). In 8 out of 11 (72.7%), MRI showed supratentorial atrophy and in six cerebellar atrophy. Quantitative analysis detected volumetric reduction of the whole brain (-17.7%, P-value = 0.014), including both white matter (-25.7%, P-value = 0.005) and cortical gray matter (-9.1%, P-value = 0.098), with a reduction of surface area (-18.0%, P-value = 0.032), mainly involving the temporal regions, correlated with the head circumference (ρ = 0.79, P-value = 0.109). Both the qualitative structural assessment and the quantitative analysis detected brain volume reduction involving the gray and white matter. These neuroimaging findings may be related to either progressive changes due to CDD pathogenesis, or to the extreme severity of epilepsy, or both. Larger prospective studies are needed to clarify the bases for the structural changes we observed.
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Affiliation(s)
- Nicola Specchio
- Clinical and Experimental Neurology, Bambino Gesù Children’s Hospital IRCCS, Rome 00165, Italy
| | - Marina Trivisano
- Clinical and Experimental Neurology, Bambino Gesù Children’s Hospital IRCCS, Rome 00165, Italy
| | - Matteo Lenge
- Neuroscience Department, Meyer Children's Hospital IRCCS, Florence, 50139, Italy
| | - Alessandro Ferretti
- Clinical and Experimental Neurology, Bambino Gesù Children’s Hospital IRCCS, Rome 00165, Italy
| | - Davide Mei
- Neuroscience Department, Meyer Children's Hospital IRCCS, Florence, 50139, Italy
| | - Elena Parrini
- Neuroscience Department, Meyer Children's Hospital IRCCS, Florence, 50139, Italy
| | - Antonio Napolitano
- Medical Physics Unit, Enterprise Risk Management, Bambino Gesù Children's Hospital, IRCCS, Rome 00165, Italy
| | - Camilla Rossi-Espagnet
- Functional and Interventional Neuroimaging Unit, Bambino Gesù Children's Hospital, IRCCS, Rome 00165, Italy
| | - Giacomo Talenti
- Neuroradiology Unit, Neuroradiology Unit, Azienda Ospedale-Università di Padova, Padova 35128, Italy
| | - Daniela Longo
- Functional and Interventional Neuroimaging Unit, Bambino Gesù Children's Hospital, IRCCS, Rome 00165, Italy
| | - Jacopo Proietti
- Child Neuropsychiatry Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona 37121, Italy
| | - Francesca Ragona
- Department of Pediatric Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano 20133, Italy
| | - Elena Freri
- Department of Pediatric Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano 20133, Italy
| | - Roberta Solazzi
- Department of Pediatric Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano 20133, Italy
| | - Tiziana Granata
- Department of Pediatric Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano 20133, Italy
| | - Francesca Darra
- Child Neuropsychiatry Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona 37121, Italy
| | - Bernardo Dalla Bernardina
- Child Neuropsychiatry Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona 37121, Italy
| | - Federico Vigevano
- Research Area on Neurology and Neurorehabilitation, Bambino Gesù Children’s Hospital IRCCS, Rome 00050, Italy
| | - Renzo Guerrini
- Neuroscience Department, Meyer Children's Hospital IRCCS, Florence, 50139, Italy
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Musto E, Liao VWY, Johannesen KM, Fenger CD, Lederer D, Kothur K, Fisk K, Bennetts B, Vrielynck P, Delaby D, Ceulemans B, Weckhuysen S, Sparber P, Bouman A, Ardern-Holmes S, Troedson C, Battaglia DI, Goel H, Feyma T, Bakhtiari S, Tjoa L, Boxill M, Demina N, Shchagina O, Dadali E, Kruer M, Cantalupo G, Contaldo I, Polster T, Isidor B, Bova SM, Fazeli W, Wouters L, Miranda MJ, Darra F, Pede E, Le Duc D, Jamra RA, Küry S, Proietti J, McSweeney N, Brokamp E, Andrews PI, Gouray Garcia M, Chebib M, Møller RS, Ahring PK, Gardella E. GABRA1-Related Disorders: From Genetic to Functional Pathways. Ann Neurol 2023; 95:27-41. [PMID: 37606373 DOI: 10.1002/ana.26774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 08/18/2023] [Accepted: 08/18/2023] [Indexed: 08/23/2023]
Abstract
OBJECTIVE Variants in GABRA1 have been associated with a broad epilepsy spectrum, ranging from genetic generalized epilepsies to developmental and epileptic encephalopathies. However, our understanding of what determines the phenotype severity and best treatment options remains inadequate. We therefore aimed to analyze the electroclinical features and the functional effects of GABRA1 variants to establish genotype-phenotype correlations. METHODS Genetic and electroclinical data of 27 individuals (22 unrelated and 2 families) harboring 20 different GABRA1 variants were collected and accompanied by functional analysis of 19 variants. RESULTS Individuals in this cohort could be assigned into different clinical subgroups based on the functional effect of their variant and its structural position within the GABRA1 subunit. A homogenous phenotype with mild cognitive impairment and infantile onset epilepsy (focal seizures, fever sensitivity, and electroencephalographic posterior epileptiform discharges) was described for variants in the extracellular domain and the small transmembrane loops. These variants displayed loss-of-function (LoF) effects, and the patients generally had a favorable outcome. A more severe phenotype was associated with variants in the pore-forming transmembrane helices. These variants displayed either gain-of-function (GoF) or LoF effects. GoF variants were associated with severe early onset neurodevelopmental disorders, including early infantile developmental and epileptic encephalopathy. INTERPRETATION Our data expand the genetic and phenotypic spectrum of GABRA1 epilepsies and permit delineation of specific subphenotypes for LoF and GoF variants, through the heterogeneity of phenotypes and variants. Generally, variants in the transmembrane helices cause more severe phenotypes, in particular GoF variants. These findings establish the basis for a better understanding of the pathomechanism and a precision medicine approach in GABRA1-related disorders. Further studies in larger populations are needed to provide a conclusive genotype-phenotype correlation. ANN NEUROL 2023.
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Affiliation(s)
- Elisa Musto
- Department of Epilepsy Genetics and Personalized Medicine, Danish Epilepsy Center, Dianalund, Denmark
- Pediatric Neurology, Department of Woman and Child Health and Public Health, Child Health Area, Catholic University UCSC, Rome, Italy
- Epilepsy and Movement Disorder Neurology, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy
| | - Vivian W Y Liao
- Brain and Mind Centre, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Katrine M Johannesen
- Department of Epilepsy Genetics and Personalized Medicine, Danish Epilepsy Center, Dianalund, Denmark
- Department of Genetics, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Christina D Fenger
- Department of Epilepsy Genetics and Personalized Medicine, Danish Epilepsy Center, Dianalund, Denmark
- Amplexa Genetics, Odense, Denmark
| | - Damien Lederer
- Center for Human Genetics, Institut de Pathologie et de Génétique, Gosselies, Belgium
| | - Kavitha Kothur
- Kids Neuroscience Centre, Children's Hospital at Westmead, University of Sydney, Sydney, New South Wales, Australia
| | - Katrina Fisk
- Sydney Genome Diagnostics, Western Sydney Genetics Program, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Bruce Bennetts
- Sydney Genome Diagnostics, Western Sydney Genetics Program, Children's Hospital at Westmead, Sydney, New South Wales, Australia
- Specialty of Genomic Medicine, Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Pascal Vrielynck
- Reference Center for Refractory Epilepsy, Catholic University of Louvain, William Lennox Neurological Hospital, Ottignies, Belgium
| | - Delphine Delaby
- Reference Center for Refractory Epilepsy, Catholic University of Louvain, William Lennox Neurological Hospital, Ottignies, Belgium
| | - Berten Ceulemans
- Department of Pediatric Neurology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Sarah Weckhuysen
- Applied & Translational Neurogenomics Group, VIB-Department of Molecular Genetics, University of Antwerp, Antwerp, Belgium
- Department of Neurology, Antwerp University Hospital, Antwerp, Belgium
- Translational Neurosciences, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
| | - Peter Sparber
- Research Center for Medical Genetics Moskvorechie 1, Moscow, Russia
| | - Arjan Bouman
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Simone Ardern-Holmes
- Kids Neuroscience Centre, Children's Hospital at Westmead, University of Sydney, Sydney, New South Wales, Australia
- T. Y. Nelson Department of Neurology and Neurosurgery, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Christopher Troedson
- T. Y. Nelson Department of Neurology and Neurosurgery, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Domenica I Battaglia
- Pediatric Neurology, Department of Woman and Child Health and Public Health, Child Health Area, Catholic University UCSC, Rome, Italy
| | - Himanshu Goel
- Hunter Genetics, Newcastle, New South Wales, Australia
| | - Timothy Feyma
- Gillette Children's Specialty Healthcare, Saint Paul, MN, USA
| | - Somayeh Bakhtiari
- Pediatric Movement Disorders Program, Division of Pediatric Neurology, Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, AZ, USA
- Departments of Child Health, Neurology, and Cellular & Molecular Medicine and Program in Genetics, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Linda Tjoa
- Townsville University Hospital, Douglas, Queensland, Australia
| | - Martin Boxill
- Department of Pediatrics, Viborg Regional Hospital, Viborg, Denmark
| | - Nina Demina
- Research Center for Medical Genetics Moskvorechie 1, Moscow, Russia
| | - Olga Shchagina
- Research Center for Medical Genetics Moskvorechie 1, Moscow, Russia
| | - Elena Dadali
- Research Center for Medical Genetics Moskvorechie 1, Moscow, Russia
| | - Michael Kruer
- Pediatric Movement Disorders Program, Division of Pediatric Neurology, Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, AZ, USA
- Departments of Child Health, Neurology, and Cellular & Molecular Medicine and Program in Genetics, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Gaetano Cantalupo
- Child Neuropsychiatry Section, Department of Surgical Sciences, Dentistry, Gynecology and Paediatrics, University of Verona, Verona, Italy
- UOC Neuropsichiatria Infantile, Dipartimento Materno-Infantile, Azienda Ospedaliero-Universitaria Integrata (full member of the ERN EpiCare), Verona, Italy
- Center for Research on Epilepsies in Pediatric age (CREP), Verona, Italy
| | - Ilaria Contaldo
- Pediatric Neurology, Department of Woman and Child Health and Public Health, Child Health Area, Catholic University UCSC, Rome, Italy
| | - Tilman Polster
- Department of Epileptology (Krankenhaus Mara), Bielefeld University Medical School, Bielefeld, Germany
| | | | - Stefania M Bova
- Pediatric Neurology Unit, V. Buzzi Children's Hospital, Milan, Italy
| | - Walid Fazeli
- Department of Neuropediatrics, Children's Hospital, University of Bonn, Bonn, Germany
| | - Leen Wouters
- Department of Pediatrics, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Maria J Miranda
- Department of Pediatrics, Pediatric Neurology, Herlev University Hospital, Copenhagen University, Herlev, Denmark
| | - Francesca Darra
- Child Neuropsychiatry Section, Department of Surgical Sciences, Dentistry, Gynecology and Paediatrics, University of Verona, Verona, Italy
- UOC Neuropsichiatria Infantile, Dipartimento Materno-Infantile, Azienda Ospedaliero-Universitaria Integrata (full member of the ERN EpiCare), Verona, Italy
- Center for Research on Epilepsies in Pediatric age (CREP), Verona, Italy
| | - Elisa Pede
- Pediatric Neurology, Department of Woman and Child Health and Public Health, Child Health Area, Catholic University UCSC, Rome, Italy
| | - Diana Le Duc
- Department of Human Genetics, University of Leipzig Faculty of Medicine, Leipzig, Germany
| | - Rami Abou Jamra
- Department of Human Genetics, University of Leipzig Faculty of Medicine, Leipzig, Germany
| | - Sébastien Küry
- Service de Génétique Médicale, CHU Nantes, Nantes, France
- l'Institut du Thorax, INSERM, CNRS, Université de Nantes, Nantes, France
| | - Jacopo Proietti
- Child Neuropsychiatry Section, Department of Surgical Sciences, Dentistry, Gynecology and Paediatrics, University of Verona, Verona, Italy
- Irish Centre for Fetal and Neonatal Translational Research, Child Neuropsychiatry, Cork, Ireland
| | - Niamh McSweeney
- Department of Paediatrics, Cork University Hospital, Cork, Ireland
| | - Elly Brokamp
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Peter Ian Andrews
- Department of Neurology, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | | | - Mary Chebib
- Brain and Mind Centre, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Rikke S Møller
- Department of Epilepsy Genetics and Personalized Medicine, Danish Epilepsy Center, Dianalund, Denmark
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Philip K Ahring
- Brain and Mind Centre, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Elena Gardella
- Department of Epilepsy Genetics and Personalized Medicine, Danish Epilepsy Center, Dianalund, Denmark
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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7
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Lo Barco T, Corona L, Solazzi R, Fiorini E, Galati G, Cossu A, Proietti J, Francione S, Dalla Bernardina B, Darra F, Cantalupo G. Gelastic seizures and "smiling spasms": A peculiar ictal pattern. Epileptic Disord 2023; 25:269-273. [PMID: 37194193 DOI: 10.1002/epd2.20012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 05/18/2023]
Affiliation(s)
- Tommaso Lo Barco
- Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynaecology and Pediatrics, University of Verona, Full Member of European Reference Network EpiCARE, Verona, Italy
- Center for Research on Epilepsies in Pediatric age (CREP), Verona, Italy
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Laura Corona
- Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynaecology and Pediatrics, University of Verona, Full Member of European Reference Network EpiCARE, Verona, Italy
| | - Roberta Solazzi
- Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynaecology and Pediatrics, University of Verona, Full Member of European Reference Network EpiCARE, Verona, Italy
- Department of Pediatric Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta, Full Member of European Reference Network EpiCARE, Milan, Italy
| | - Elena Fiorini
- Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynaecology and Pediatrics, University of Verona, Full Member of European Reference Network EpiCARE, Verona, Italy
| | - Giulia Galati
- Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynaecology and Pediatrics, University of Verona, Full Member of European Reference Network EpiCARE, Verona, Italy
| | - Alberto Cossu
- Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynaecology and Pediatrics, University of Verona, Full Member of European Reference Network EpiCARE, Verona, Italy
| | - Jacopo Proietti
- Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynaecology and Pediatrics, University of Verona, Full Member of European Reference Network EpiCARE, Verona, Italy
| | - Stefano Francione
- "Claudio Munari" Centre for Epilepsy Surgery, ASST GOM Niguarda, Full Member of European Reference Network EpiCARE, Milan, Italy
| | | | - Francesca Darra
- Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynaecology and Pediatrics, University of Verona, Full Member of European Reference Network EpiCARE, Verona, Italy
- Center for Research on Epilepsies in Pediatric age (CREP), Verona, Italy
| | - Gaetano Cantalupo
- Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynaecology and Pediatrics, University of Verona, Full Member of European Reference Network EpiCARE, Verona, Italy
- Center for Research on Epilepsies in Pediatric age (CREP), Verona, Italy
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8
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Cossu A, Lo Barco T, Proietti J, Dalla Bernardina B, Cantalupo G, Ghobert L, Brambilla I, Giarola E, Costa A, De Benito T, Bethge S, Cardot S, Montwill I, Remonato E, Gramaglia S, Darra F. Clinical characteristics of 80 subjects with KCNQ2-related encephalopathy: Results from a family-driven survey. Epilepsy Behav 2023; 142:109153. [PMID: 36989566 DOI: 10.1016/j.yebeh.2023.109153] [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: 09/26/2022] [Revised: 02/17/2023] [Accepted: 02/19/2023] [Indexed: 03/31/2023]
Abstract
Variants of KCNQ2 are associated with a wide spectrum of disorders, ranging from Self-limiting Neonatal Epilepsy (SelNE) to Early Onset Developmental and Epileptic Encephalopathy (KCNQ2-DEE). Comorbidities associated with this end of the spectrum have been seldomly described and their impact on the life of patients and their families is yet to be investigated. Collaborating with caregivers from different European family associations, we have developed a questionnaire aimed at investigating the onset and frequency of epileptic seizures, anti-seizure medications (ASM), hospitalizations, stages of development, and comorbidities. Responses from 80 patients, 40 males, from 14 countries have been collected. Median age 7.6 years (4 months - 43.6 years). Of 76 epileptic patients (93.6%), 55.3% were seizure-free with a mean age at last seizure of 26.7 months. Among patients with active epilepsy, those older have a lower frequency of seizures (p > 0.05). We were able to identify three different clusters of varying severity (Mild, Severe, Profound), based on neurodevelopmental features and symptoms, excluding epilepsy. Patients in a higher severity cluster had a higher mean number of comorbidities, which had a higher impact on families. Notably, patients in different clusters presented different epilepsy onset and courses. This study constitutes the most extensive data collection of patients with KCNQ2-DEE, with a focus on comorbidities in a wide age group. The participation of caregivers helps to define the impact of the disease on the lives of patients and families and can help identify new primary and secondary outcomes beyond seizures in future studies.
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Affiliation(s)
- A Cossu
- Child Neuropsychiatry Unit, Department of Surgery, Dentistry, Paediatrics and Gynecology, University of Verona, Italy; Research Center for Pediatric Epilepsies (CREP) - Department of Surgery, Dentistry, Paediatrics and Gynecology, University of Verona, Italy
| | - T Lo Barco
- Child Neuropsychiatry Unit, Department of Surgery, Dentistry, Paediatrics and Gynecology, University of Verona, Italy; Research Center for Pediatric Epilepsies (CREP) - Department of Surgery, Dentistry, Paediatrics and Gynecology, University of Verona, Italy
| | - J Proietti
- Child Neuropsychiatry Unit, Department of Surgery, Dentistry, Paediatrics and Gynecology, University of Verona, Italy; Research Center for Pediatric Epilepsies (CREP) - Department of Surgery, Dentistry, Paediatrics and Gynecology, University of Verona, Italy
| | - B Dalla Bernardina
- Research Center for Pediatric Epilepsies (CREP) - Department of Surgery, Dentistry, Paediatrics and Gynecology, University of Verona, Italy
| | - G Cantalupo
- Child Neuropsychiatry Unit, Department of Surgery, Dentistry, Paediatrics and Gynecology, University of Verona, Italy; Research Center for Pediatric Epilepsies (CREP) - Department of Surgery, Dentistry, Paediatrics and Gynecology, University of Verona, Italy
| | - L Ghobert
- Child Neuropsychiatry Unit, Department of Surgery, Dentistry, Paediatrics and Gynecology, University of Verona, Italy; Research Center for Pediatric Epilepsies (CREP) - Department of Surgery, Dentistry, Paediatrics and Gynecology, University of Verona, Italy
| | - I Brambilla
- Research Center for Pediatric Epilepsies (CREP) - Department of Surgery, Dentistry, Paediatrics and Gynecology, University of Verona, Italy; Alleanza Epilessie Rare e Complesse, Italy; Dravet Italia Onlus, Italy; European KCNQ2 Association Odv, Italy
| | - E Giarola
- Research Center for Pediatric Epilepsies (CREP) - Department of Surgery, Dentistry, Paediatrics and Gynecology, University of Verona, Italy; Alleanza Epilessie Rare e Complesse, Italy; Dravet Italia Onlus, Italy
| | - A Costa
- European KCNQ2 Association Odv, Italy
| | | | | | - S Cardot
- KCNQ2 France Développement, France
| | | | - E Remonato
- Alleanza Epilessie Rare e Complesse, Italy; European KCNQ2 Association Odv, Italy
| | | | - F Darra
- Child Neuropsychiatry Unit, Department of Surgery, Dentistry, Paediatrics and Gynecology, University of Verona, Italy; Research Center for Pediatric Epilepsies (CREP) - Department of Surgery, Dentistry, Paediatrics and Gynecology, University of Verona, Italy.
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9
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Pavel AM, O'Toole JM, Proietti J, Livingstone V, Mitra S, Marnane WP, Finder M, Dempsey EM, Murray DM, Boylan GB. Machine learning for the early prediction of infants with electrographic seizures in neonatal hypoxic-ischemic encephalopathy. Epilepsia 2023; 64:456-468. [PMID: 36398397 PMCID: PMC10107538 DOI: 10.1111/epi.17468] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 10/26/2022] [Accepted: 11/15/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess if early clinical and electroencephalography (EEG) features predict later seizure development in infants with hypoxic-ischemic encephalopathy (HIE). METHODS Clinical and EEG parameters <12 h of birth from infants with HIE across eight European Neonatal Units were used to develop seizure-prediction models. Clinical parameters included intrapartum complications, fetal distress, gestational age, delivery mode, gender, birth weight, Apgar scores, assisted ventilation, cord pH, and blood gases. The earliest EEG hour provided a qualitative analysis (discontinuity, amplitude, asymmetry/asynchrony, sleep-wake cycle [SWC]) and a quantitative analysis (power, discontinuity, spectral distribution, inter-hemispheric connectivity) from full montage and two-channel amplitude-integrated EEG (aEEG). Subgroup analysis, only including infants without anti-seizure medication (ASM) prior to EEG was also performed. Machine-learning (ML) models (random forest and gradient boosting algorithms) were developed to predict infants who would later develop seizures and assessed using Matthews correlation coefficient (MCC) and area under the receiver-operating characteristic curve (AUC). RESULTS The study included 162 infants with HIE (53 had seizures). Low Apgar, need for ventilation, high lactate, low base excess, absent SWC, low EEG power, and increased EEG discontinuity were associated with seizures. The following predictive models were developed: clinical (MCC 0.368, AUC 0.681), qualitative EEG (MCC 0.467, AUC 0.729), quantitative EEG (MCC 0.473, AUC 0.730), clinical and qualitative EEG (MCC 0.470, AUC 0.721), and clinical and quantitative EEG (MCC 0.513, AUC 0.746). The clinical and qualitative-EEG model significantly outperformed the clinical model alone (MCC 0.470 vs 0.368, p-value .037). The clinical and quantitative-EEG model significantly outperformed the clinical model (MCC 0.513 vs 0.368, p-value .012). The clinical and quantitative-EEG model for infants without ASM (n = 131) had MCC 0.588, AUC 0.832. Performance for quantitative aEEG (n = 159) was MCC 0.381, AUC 0.696 and clinical and quantitative aEEG was MCC 0.384, AUC 0.720. SIGNIFICANCE Early EEG background analysis combined with readily available clinical data helped predict infants who were at highest risk of seizures, hours before they occur. Automated quantitative-EEG analysis was as good as expert analysis for predicting seizures, supporting the use of automated assessment tools for early evaluation of HIE.
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Affiliation(s)
- Andreea M. Pavel
- INFANT Research CentreUniversity College CorkCorkIreland
- Department of Paediatrics and Child HealthUniversity College CorkCorkIreland
| | - John M. O'Toole
- INFANT Research CentreUniversity College CorkCorkIreland
- Department of Paediatrics and Child HealthUniversity College CorkCorkIreland
| | | | - Vicki Livingstone
- INFANT Research CentreUniversity College CorkCorkIreland
- Department of Paediatrics and Child HealthUniversity College CorkCorkIreland
| | | | - William P. Marnane
- INFANT Research CentreUniversity College CorkCorkIreland
- Electrical & Electronic EngineeringSchool of EngineeringUniversity College CorkCorkIreland
| | - Mikael Finder
- Department of Neonatal MedicineKarolinska University HospitalStockholmSweden
- Division of Paediatrics, Department CLINTECKarolinska InstitutetStockholmSweden
| | - Eugene M. Dempsey
- INFANT Research CentreUniversity College CorkCorkIreland
- Department of Paediatrics and Child HealthUniversity College CorkCorkIreland
| | - Deirdre M. Murray
- INFANT Research CentreUniversity College CorkCorkIreland
- Department of Paediatrics and Child HealthUniversity College CorkCorkIreland
| | - Geraldine B. Boylan
- INFANT Research CentreUniversity College CorkCorkIreland
- Department of Paediatrics and Child HealthUniversity College CorkCorkIreland
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10
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Lo Barco T, Offredi F, Castino E, Proietti J, Cossu A, Fiorini E, Fontana E, Cantalupo G, Dalla Bernardina B, Darra F. Adaptive behaviour in adolescents and adults with Dravet syndrome. Dev Med Child Neurol 2022; 65:838-846. [PMID: 36316303 DOI: 10.1111/dmcn.15448] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 10/01/2022] [Accepted: 10/06/2022] [Indexed: 11/26/2022]
Abstract
AIM To explore the feasibility of using an adaptive behaviour profile (ABP) assessment generated from a well-known measure-the Vineland Adaptive Behavior Scales, Second Edition (VABS-II)-as an instrument for outcome measures in adolescents and adults with Dravet syndrome. METHOD We administered the VABS-II to 35 adolescents and adults with Dravet syndrome (15 males; mean age 24 years, SD 8 years, range: 12-46 years) and collected epilepsy history and neurological features at the time of assessment. We conducted a cross-sectional analysis of VABS-II raw scores and performed cluster analysis to identify different subgroups. We then explored possible relationships between clinical and epilepsy features, ABPs, and age. RESULTS Most participants obtained the minimum standard scores in the various VABS-II subdomains, while the raw score analysis outlined interindividual and intraindividual differences among skills. We found two subpopulations: one with a 'lower' ABP and one with a 'higher' ABP, corresponding respectively to individuals in whom myoclonic seizures or generalized spike-and-wave activity were present ('complete phenotype') or absent ('incomplete phenotype') on electroencephalography. INTERPRETATION This study further delineates the natural history of Dravet syndrome. The assessment of an ABP through the VABS-II raw score analysis provides a means by which to illustrate profiles of adaptive behaviour in adolescents and adults with Dravet syndrome but shows limitations related to poor sensitivity in measuring fine clinical details. There is a need for new and more specific tools to monitor patients with developmental and epileptic encephalopathies.
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Affiliation(s)
- Tommaso Lo Barco
- Child Neuropsychiatry Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy.,Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy.,Research Center for Pediatric Epilepsies Verona, Verona, Italy
| | - Francesca Offredi
- Child Neuropsychiatry Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Eva Castino
- Child Neuropsychiatry Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Jacopo Proietti
- Child Neuropsychiatry Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy.,Research Center for Pediatric Epilepsies Verona, Verona, Italy
| | - Alberto Cossu
- Child Neuropsychiatry Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Elena Fiorini
- Child Neuropsychiatry Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Elena Fontana
- Child Neuropsychiatry Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Gaetano Cantalupo
- Child Neuropsychiatry Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy.,Research Center for Pediatric Epilepsies Verona, Verona, Italy
| | - Bernardo Dalla Bernardina
- Child Neuropsychiatry Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy.,Research Center for Pediatric Epilepsies Verona, Verona, Italy
| | - Francesca Darra
- Child Neuropsychiatry Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy.,Research Center for Pediatric Epilepsies Verona, Verona, Italy
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11
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Lo Barco T, De Gaetano L, Santangelo E, Bravi T, Proietti J, Cantalupo G, Brambilla I, Darra F. SYNGAP1-related developmental and epileptic encephalopathy: The impact on daily life. Epilepsy Behav 2022; 127:108500. [PMID: 34954508 DOI: 10.1016/j.yebeh.2021.108500] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 10/24/2021] [Revised: 12/06/2021] [Accepted: 12/06/2021] [Indexed: 11/26/2022]
Abstract
SYNGAP1-developmental and epileptic encephalopathy (SYNGAP1-DEE) has been recently featured as a distinct genetic disease characterized by global psychomotor delay mainly involving language, moderate-to-severe cognitive impairment, autism spectrum disorder, and a generalized epilepsy with spontaneous and reflex seizures. The severity and variability of function impairment and the impact on patients' and caregivers' daily life are still poorly acknowledged. The SYNGAP1 Italian Family Association developed a survey, shared online with caregivers, exploring several issues, including: epilepsy outcome, comorbidities, daily-living skills, hospitalizations, rehabilitation treatments, economic burden, and COVID-19 pandemic impact. Caregivers of 13 children and adolescents participated in the survey. They most often show a fine and gross-motor impairment and a drug-resistant epilepsy with possibility to experience pluridaily absence seizures that may lead to periods of psychomotor regressions. Eating and sleep problems are reported in the majority. Most parents are concerned about language impairment, behavioral issues and lack of autonomy in daily-living activities. Specific neuropsychological evaluations for autism should be early considered in order to identify intervention strategies involving alternative communication strategies, which can positively affect behavior and quality of life. Rehabilitation treatment should aim to the acquisition and consolidation of personal autonomy.
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Affiliation(s)
- Tommaso Lo Barco
- Child Neuropsychiatry Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy; Research Center for Pediatric Epilepsies Verona, IT, Verona, Italy; PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy.
| | - Luciana De Gaetano
- Associazione Famiglie SYNGAP1, Italy; Faculty of Medicine and Surgery, University of Verona, Verona, Italy
| | - Elisabetta Santangelo
- Child Neuropsychiatry Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | | | - Jacopo Proietti
- Child Neuropsychiatry Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy; Research Center for Pediatric Epilepsies Verona, IT, Verona, Italy
| | - Gaetano Cantalupo
- Child Neuropsychiatry Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy; Research Center for Pediatric Epilepsies Verona, IT, Verona, Italy
| | - Isabella Brambilla
- Research Center for Pediatric Epilepsies Verona, IT, Verona, Italy; Dravet Italia Onlus, Italy; Rare Epilepsies Alliance, Italy; ERN EpiCare (Epag), Italy
| | - Francesca Darra
- Child Neuropsychiatry Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy; Research Center for Pediatric Epilepsies Verona, IT, Verona, Italy
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12
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Lo Barco T, Ghobert AL, Lucca F, Galati G, Proietti J, Cantalupo G. Reversible tremor in an infant with vitamin E deficiency and cystic fibrosis. Lancet 2021; 398:156. [PMID: 34246348 DOI: 10.1016/s0140-6736(21)01048-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/25/2021] [Accepted: 04/29/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Tommaso Lo Barco
- Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Verona, Italy; PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Anna Ludovica Ghobert
- Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Verona, Italy
| | - Francesca Lucca
- Cystic Fibrosis Centre of Verona, Azienda Ospedaliero Universitaria Integrata di Verona, Verona, Italy
| | - Giulia Galati
- Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Verona, Italy
| | - Jacopo Proietti
- Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Verona, Italy
| | - Gaetano Cantalupo
- Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Verona, Italy.
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