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Bolaño Díaz CF, Morosini M, Chloca F, Mesa L, Jáuregui A, Pirra L, Vazquez G, Flores D, Dubrovsky A. The difficult path to diagnosis of the patient with spinal muscular atrophy. ARCH ARGENT PEDIATR 2023; 121:e202102542. [PMID: 36287576 DOI: 10.5546/aap.2021-02542.eng] [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] [Indexed: 11/07/2022]
Abstract
Introduction. News treatments, make early diagnosis of spinal muscular atrophy (SMA) critical. The objective of this study is to analyze the different factors that influence delay in diagnosis. Population and methods. Patients with a molecular diagnosis of types I, II, and III SMA were included. Several parameters were studied, such as age at onset of first sign, what sign it was, and the time from recognition of first sign to confirmed diagnosis. Neurologists specialized in SMA conducted interviews, supported by the review of medical records when deemed necessary. Results. A total of 112 patients were interviewed. SMA I n = 40, SMA II n = 48, SMA III n = 24. The median age in months at the time of reporting the first sign was SMA I: 1.5 (R: 0-7), SMA II: 9 (R: 2-20), SMA III: 18 (R: 8-180). In all subtypes, first signs were identified by parents from 75% to 85% of the times. The median time from first sign to first medical consultation was less than a month in all 3 types. The median time in months, from first sign to confirmed molecular diagnosis in SMA I was: 2 (R: 0-11), in SMA II: 10 (R: 3-46), in SMA III: 31.5 (R: 4-288). Conclusions. There is a significant delay in SMA diagnosis mainly related to the absence of clinical suspicion. The delay is shorter in SMA I and longer in SMA III. Other factors include deficiencies in the health care system.
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Affiliation(s)
- Carla F Bolaño Díaz
- Institute of Neurosciences of Fundación Favaloro, City of Buenos Aires, Argentina
| | - Mariel Morosini
- Institute of Neurosciences of Fundación Favaloro, City of Buenos Aires, Argentina
| | - Fernando Chloca
- Institute of Neurosciences of Fundación Favaloro, City of Buenos Aires, Argentina
| | - Lilia Mesa
- Institute of Neurosciences of Fundación Favaloro, City of Buenos Aires, Argentina
| | - Agustín Jáuregui
- Institute of Neurosciences of Fundación Favaloro, City of Buenos Aires, Argentina
| | - Laura Pirra
- Institute of Neurosciences of Fundación Favaloro, City of Buenos Aires, Argentina
| | - Gabriel Vazquez
- Institute of Neurosciences of Fundación Favaloro, City of Buenos Aires, Argentina
| | - Daniel Flores
- Institute of Neurosciences of Fundación Favaloro, City of Buenos Aires, Argentina
| | - Alberto Dubrovsky
- Institute of Neurosciences of Fundación Favaloro, City of Buenos Aires, Argentina
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Diaz CB, Morosini M, Chloca F, Mesa L, Vazquez G, Jauregui A, Pirra L, Flores D, Dubrovsky A. Diagnostic journey of patients with spinal muscular atrophy in Argentina. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.118427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Dubrovsky A, Fulgenzi E, De Vito EL, Barroso F, Berardo A, Bettini M, Binaghi D, Calabrese E, Carlés D, Chaves M, Chloca F, Conti E, Corderi J, Di Gennaro F, Ferradás N, Jáuregui A, Lubieniecki F, Mazia C, Medina M, Pirra L, Politei J, Reisin R, Rosa AL, Rugiero M, Salutto V, Schenone A, Sussini M, Taratuto AL. [Argentine consensus on late-onset Pompe's disease]. Medicina (B Aires) 2018; 78 Suppl 1:1-23. [PMID: 30179846] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
Pompe's disease (PD) is an infrequent metabolic autosomic recessive disorder produced by the lack or deficiency of the acid alpha-glucosidase lysosomal enzyme in tissues of involved individuals. Delayed-onset PD is considered whenever symptoms onset start after one year of age. We present an update of the recommendations for the management of delayed-onset PD, taking as reference the guidelines from the Argentine Consensus for diagnosis, treatment and follow-up of PD published in 2013. The present consensus gathered several experts in PD in the areas of internal medicine, laboratory diagnosis, neuropathology, pulmonology, nutrition, neurology, metabolic and neuromuscular disorders as well as rehabilitation to perform an update of the literature of delayed-onset PD, with special attention on relevant information published within the last 4 years. The entire working group approved the final version of the consensus. Each participant provided a declaration of conflict of interest. As a result, it is an update of the previous Argentine PD Consensus with focus on the delayed-onset presentation of the disease. Being such infrequent disorder, available data were rather limited and thus, the recommendations represent expert opinions.
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Affiliation(s)
- Alberto Dubrovsky
- Instituto de Neurociencias, Fundación Favaloro, Buenos Aires, Argentina
| | - Ernesto Fulgenzi
- Servicio de Neurología, Hospital General de Agudos Dr. Ignacio Pirovano, Buenos Aires, Argentina. E-mail:
| | - Eduardo L De Vito
- Instituto de Investigaciones Médicas Alfredo Lanari, Universidad de Buenos Aires, Argentina
- Cuidados Respiratorios, Centro del Parque, Buenos Aires, Argentina
| | - Fabio Barroso
- Servicio de Enfermedades Neuromusculares, Instituto de Investigaciones Neurológicas-FLENI, Buenos Aires, Argentina
| | - Andrés Berardo
- Unidad de Neurociencias, Instituto Conci Carpinella, Córdoba, Argentina
| | - Mariela Bettini
- Servicio de Enfermedades Neuromusculares, Hospital Italiano de Buenos Aires, Argentina
| | - Daniela Binaghi
- Departamento de Imágenes, Fundación Favaloro, Buenos Aires, Argentina
| | - Esteban Calabrese
- Servicio de Enfermedades Neuromusculares, INECO, Rosario, Santa Fe, Argentina
| | - Daniel Carlés
- Servicio de Neumonología, Hospital Perrando, Resistencia, Chaco, Argentina
| | - Marcelo Chaves
- Servicio de Enfermedades Neuromusculares, Hospital San Martín, Paraná, Entre Ríos, Argentina
| | - Fernando Chloca
- Servicio de Neurología, Hospital Malvinas Argentinas, Buenos Aires, Argentina
| | - Eugenia Conti
- Servicio de Neurología, área de Enfermedades Neuromusculares, Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | - José Corderi
- Departamento de Kinesiología, Fundación Favaloro, Buenos Aires, Argentina
| | | | - Nélida Ferradás
- International Life Sciences Institute (ILSI), Buenos Aires, Argentina
| | - Agustín Jáuregui
- Departamento de Neurología, Fundación Favaloro, Buenos Aires, Argentina
| | - Fabiana Lubieniecki
- Servicio de Patología, Hospital de Pediatría Prof. Dr. J. P. Garrahan, Buenos Aires, Argentina
| | - Claudio Mazia
- Departamento de Neurología, Instituto de Investigaciones Médicas Alfredo Lanari, Universidad de Buenos Aires, Argentina
| | - Marta Medina
- Servicio de Neurología, Hospital Córdoba, Córdoba, Argentina
| | - Laura Pirra
- Instituto de Neurociencias, Fundación Favaloro, Buenos Aires, Argentina
| | - Juan Politei
- Laboratorio de Neuroquímica Dr. N. A. Chamoles, Fundación para el Estudio de Enfermedades Neurometabólicas (FESEN), Buenos Aires, Argentina
| | - Ricardo Reisin
- Sección de Enfermedades Neuromusculares, Hospital Británico, Buenos Aires, Argentina
| | - Alberto L Rosa
- Servicio de Genética Médica, Laboratorio Diagnóstico de Genética y Biología Molecular, Sanatorio Allende, Laboratorio de Biología Celular y Molecular, Fundación Allende, IRNASUS-CONICET, Universidad Católica de Córdoba, Córdoba, Argentina
| | - Marcelo Rugiero
- Servicio de Enfermedades Neuromusculares, Hospital Italiano de Buenos Aires, Argentina
| | - Valeria Salutto
- Departamento de Neurología, Instituto de Investigaciones Médicas Alfredo Lanari, Universidad de Buenos Aires, Argentina
| | - Andrea Schenone
- Laboratorio de Neuroquímica Dr. N. A. Chamoles, Fundación para el Estudio de Enfermedades Neurometabólicas (FESEN), Buenos Aires, Argentina
| | - Mario Sussini
- Servicio de Neumonología, Hospital Escuela de Corrientes, Corrientes, Argentina
| | - Ana L Taratuto
- Consultora del Departamento de Neuropatología, Instituto de Investigaciones Neurológicas-FLENI y Hospital Nacional de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
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León Cejas L, Binaghi D, Socolovsky M, Dubrovsky A, Pirra L, Marchesoni C, Pardal A, Monges S, Peretti G, Taratuto AL, Lubinieki F, Reisin R. Intraneural perineuriomas: diagnostic value of magnetic resonance neurography. J Peripher Nerv Syst 2017; 23:23-28. [PMID: 29094786 DOI: 10.1111/jns.12240] [Citation(s) in RCA: 11] [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] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 10/29/2017] [Accepted: 10/29/2017] [Indexed: 12/23/2022]
Abstract
Intraneural perineurioma (IP) is an under-recognized hypertrophic peripheral nerve tumor. It affects young patients involving frequently the sciatic nerve and its branches and presents with a progressive, painless and predominantly motor deficit. Magnetic resonance neurography (MRN) is a useful tool to localize the lesion, evaluate its extension, and discriminate between different etiologies. We reviewed the clinical records of 11 patients with pathologically confirm IP. Eight patients were males with mean age 19 years. Initial complains were unilateral steppage (seven patients), bilateral steppage (one patient), unilateral gastrocnemius wasting (one patient), unilateral thigh atrophy (one patient), and unilateral hand weakness (one patient). Nine patients had mild painless sensory loss. Examinations revealed involvement of sciatic nerve extending into the peroneal nerve (eight patients), posterior tibial nerve (one patient), radial nerve (one patient), and femoral nerve (one patient). MRN revealed enlargement of the affected nerve isointense on T1-weighted, hyperintense on T2 fat-saturated images, and with avid enhancement on post-contrast imaging. In all patients, a nerve biopsy confirmed the diagnosis. MRN allows early and non-invasive identification of this tumor and is a key tool providing localization and differential diagnosis in patients with slowly progressive focal neuropathies.
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Affiliation(s)
| | - Daniela Binaghi
- Department of Radiology, Favaloro Foundation, Buenos Aires, Argentina
| | | | - Alberto Dubrovsky
- Department of Neurology, Favaloro Foundation, Buenos Aires, Argentina
| | - Laura Pirra
- Department of Neurology, Favaloro Foundation, Buenos Aires, Argentina
| | - Cintia Marchesoni
- Department of Neurology, Británico Hospital, Buenos Aires, Argentina
| | - Ana Pardal
- Department of Neurology, Británico Hospital, Buenos Aires, Argentina
| | - Soledad Monges
- Department of Neurology, Garrahan Hospital, Buenos Aires, Argentina
| | - Gabriela Peretti
- Department of Neurology, Garrahan Hospital, Buenos Aires, Argentina
| | - Ana L Taratuto
- Garrahan Hospital Neuropathology Laboratory, Buenos Aires, Argentina
| | - Fabiana Lubinieki
- Garrahan Hospital Neuropathology Laboratory, Buenos Aires, Argentina
| | - Ricardo Reisin
- Department of Neurology, Británico Hospital, Buenos Aires, Argentina
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Krieger M, Roos A, Stendel C, Claeys KG, Sonmez FM, Baudis M, Bauer P, Bornemann A, de Goede C, Dufke A, Finkel RS, Goebel HH, Häussler M, Kingston H, Kirschner J, Medne L, Muschke P, Rivier F, Rudnik-Schöneborn S, Spengler S, Inzana F, Stanzial F, Benedicenti F, Synofzik M, Lia Taratuto A, Pirra L, Tay SKH, Topaloglu H, Uyanik G, Wand D, Williams D, Zerres K, Weis J, Senderek J. SIL1 mutations and clinical spectrum in patients with Marinesco-Sjogren syndrome. ACTA ACUST UNITED AC 2013; 136:3634-44. [PMID: 24176978 DOI: 10.1093/brain/awt283] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [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: 12/19/2022]
Abstract
Marinesco-Sjögren syndrome is a rare autosomal recessive multisystem disorder featuring cerebellar ataxia, early-onset cataracts, chronic myopathy, variable intellectual disability and delayed motor development. More recently, mutations in the SIL1 gene, which encodes an endoplasmic reticulum resident co-chaperone, were identified as the main cause of Marinesco-Sjögren syndrome. Here we describe the results of SIL1 mutation analysis in 62 patients presenting with early-onset ataxia, cataracts and myopathy or combinations of at least two of these. We obtained a mutation detection rate of 60% (15/25) among patients with the characteristic Marinesco-Sjögren syndrome triad (ataxia, cataracts, myopathy) whereas the detection rate in the group of patients with more variable phenotypic presentation was below 3% (1/37). We report 16 unrelated families with a total of 19 different SIL1 mutations. Among these mutations are 15 previously unreported changes, including single- and multi-exon deletions. Based on data from our screening cohort and data compiled from the literature we found that SIL1 mutations are invariably associated with the combination of a cerebellar syndrome and chronic myopathy. Cataracts were observed in all patients beyond the age of 7 years, but might be missing in infants. Six patients with SIL1 mutations had no intellectual disability, extending the known wide range of cognitive capabilities in Marinesco-Sjögren syndrome to include normal intelligence. Modestly constant features were somatic growth retardation, skeletal abnormalities and pyramidal tract signs. Examination of mutant SIL1 expression in cultured patient lymphoblasts suggested that SIL1 mutations result in severely reduced SIL1 protein levels irrespective of the type and position of mutations. Our data broaden the SIL1 mutation spectrum and confirm that SIL1 is the major Marinesco-Sjögren syndrome gene. SIL1 patients usually present with the characteristic triad but cataracts might be missing in young children. As cognitive impairment is not obligatory, patients without intellectual disability but a Marinesco-Sjögren syndrome-compatible phenotype should receive SIL1 mutation analysis. Despite allelic heterogeneity and many families with private mutations, the phenotype related to SIL1 mutations is relatively homogenous. Based on SIL1 expression studies we speculate that this may arise from a uniform effect of different mutations on protein expression.
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Affiliation(s)
- Michael Krieger
- 1 Institute of Human Genetics, Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen University, 52074 Aachen, Germany
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Rugiero M, Bettini M, Salutto VL, Gomez H, Pirra L, Politei J, Dubrovsky A, Reisin R, Nogues M, Mazia C. Clinical and Demographical Findings of MuSK Myasthenia Gravis in Argentina (P05.175). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p05.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Pirra L, Dubrovsky A, Bitoun M, Guicheney P, Romero N, Sacolitti M, Taratuto A. C.P.4.11 Ragged red fibres finding in muscle biopsy of dynamin 2-related centronuclear myopathy. Neuromuscul Disord 2007. [DOI: 10.1016/j.nmd.2007.06.401] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Quiroga RC, Pirra L, Podestá C, Leiguarda RC, Rabinowicz AL. Time distribution of epileptic seizures during video-EEG monitoring. Implications for health insurance systems in developing countries. Seizure 1997; 6:475-7. [PMID: 9530944 DOI: 10.1016/s1059-1311(97)80023-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
An attempt was made to identify guidelines to help establish epilepsy monitoring units in developing countries. We assessed the time distribution of seizures during video-EEG monitoring and we also estimated the minimum time required for such a procedure and the impact of these variables upon the health insurance system. Mean time for recording five stereotyped clinical events was 72 hours, with a significant number of events recorded between midnight and 0600 hours (P < 0.05). This pilot study may help to establish local policies that will warrant an adequate work-up for our patients.
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Affiliation(s)
- R C Quiroga
- Department of Neurology and Epilepsy Program, Instituto de Investigaciones, Neurológicas Raúl Carrea (FLENI), Buenos Aires, Argentina
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