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Harmatz P, Giugliani R, Martins AM, Hamazaki T, Kubo T, Kira R, Minami K, Ikeda T, Moriuchi H, Kawashima S, Takasao N, So S, Sonoda H, Hirato T, Tanizawa K, Schmidt M, Sato Y. α-L-iduronidase fused with humanized anti-human transferrin receptor antibody (lepunafusp alfa) for mucopolysaccharidosis type I: A phase 1/2 trial. Mol Ther 2024; 32:609-618. [PMID: 38204164 PMCID: PMC10928130 DOI: 10.1016/j.ymthe.2024.01.009] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/11/2023] [Accepted: 01/05/2024] [Indexed: 01/12/2024] Open
Abstract
Mucopolysaccharidosis type I (MPS I) causes systemic accumulation of glycosaminoglycans due to a genetic deficiency of α-L-iduronidase (IDUA), which results in progressive systemic symptoms affecting multiple organs, including the central nervous system (CNS). Because the blood-brain barrier (BBB) prevents enzymes from reaching the brain, enzyme replacement therapy is effective only against the somatic symptoms. Hematopoietic stem cell transplantation can address the CNS symptoms, but the risk of complications limits its applicability. We have developed a novel genetically modified protein consisting of IDUA fused with humanized anti-human transferrin receptor antibody (lepunafusp alfa; JR-171), which has been shown in nonclinical studies to be distributed to major organs, including the brain, bringing about systemic reductions in heparan sulfate (HS) and dermatan sulfate concentrations. Subsequently, a first-in-human study was conducted to evaluate the safety, pharmacokinetics, and exploratory efficacy of JR-171 in 18 patients with MPS I. No notable safety issues were observed. Plasma drug concentration increased dose dependently and reached its maximum approximately 4 h after the end of drug administration. Decreased HS in the cerebrospinal fluid suggested successful delivery of JR-171 across the BBB, while suppressed urine and serum concentrations of the substrates indicated that its somatic efficacy was comparable to that of laronidase.
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Affiliation(s)
- Paul Harmatz
- UCSF Benioff Children's Hospital Oakland, Oakland, CA 94609, USA
| | - Roberto Giugliani
- Department of Genetics, Universidade Federal do Rio Grande do Sul, Medical Genetics Service, Hospital de Clinicas de Porto Alegre, INAGEMP, Dasa, and Casa dos Raros, Porto Alegre 90035-903, Brazil
| | - Ana Maria Martins
- Centro de Referência em Erros Inatos do Metabolismo, Universidade Federal de São Paulo, São Paulo 04021-001, Brazil
| | - Takashi Hamazaki
- Department of Pediatrics, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka-City, Osaka 545-8585, Japan
| | - Toru Kubo
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, 185-1 Kohasu, Oko-cho, Nankoku-shi 783-8505, Japan
| | - Ryutaro Kira
- Department of Pediatric Neurology, Fukuoka Children's Hospital, 5-1-1 Kashii Teriha, Higashi-ku, Fukuoka 813-0017, Japan
| | - Kohtaro Minami
- JCR Pharmaceuticals, 3-19 Kasuga-Cho, Ashiya, Hyogo 659-0021, Japan
| | - Toshiaki Ikeda
- JCR Pharmaceuticals, 3-19 Kasuga-Cho, Ashiya, Hyogo 659-0021, Japan
| | - Hiroaki Moriuchi
- JCR Pharmaceuticals, 3-19 Kasuga-Cho, Ashiya, Hyogo 659-0021, Japan
| | | | - Naoko Takasao
- JCR Pharmaceuticals, 3-19 Kasuga-Cho, Ashiya, Hyogo 659-0021, Japan
| | - Sairei So
- JCR Pharmaceuticals, 3-19 Kasuga-Cho, Ashiya, Hyogo 659-0021, Japan
| | - Hiroyuki Sonoda
- JCR Pharmaceuticals, 3-19 Kasuga-Cho, Ashiya, Hyogo 659-0021, Japan
| | - Tohru Hirato
- JCR Pharmaceuticals, 3-19 Kasuga-Cho, Ashiya, Hyogo 659-0021, Japan
| | | | - Mathias Schmidt
- JCR Pharmaceuticals, 3-19 Kasuga-Cho, Ashiya, Hyogo 659-0021, Japan
| | - Yuji Sato
- JCR Pharmaceuticals, 3-19 Kasuga-Cho, Ashiya, Hyogo 659-0021, Japan.
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Yuan JH, Cheng X, Matsuura E, Higuchi Y, Ando M, Hashiguchi A, Yoshimura A, Nakachi R, Mine J, Taketani T, Maeda K, Kawakami S, Kira R, Tanaka S, Kanai K, Dib-Hajj F, Dib-Hajj SD, Waxman SG, Takashima H. Genetic, electrophysiological, and pathological studies on patients with SCN9A-related pain disorders. J Peripher Nerv Syst 2023; 28:597-607. [PMID: 37555797 DOI: 10.1111/jns.12590] [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: 07/13/2023] [Revised: 08/06/2023] [Accepted: 08/07/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND AND AIMS Voltage-gated sodium channel Nav1.7, encoded by the SCN9A gene, has been linked to diverse painful peripheral neuropathies, represented by the inherited erythromelalgia (EM) and paroxysmal extreme pain disorder (PEPD). The aim of this study was to determine the genetic etiology of patients experiencing neuropathic pain, and shed light on the underlying pathogenesis. METHODS We enrolled eight patients presenting with early-onset painful peripheral neuropathies, consisting of six cases exhibiting EM/EM-like disorders and two cases clinically diagnosed with PEPD. We conducted a gene-panel sequencing targeting 18 genes associated with hereditary sensory and/or autonomic neuropathy. We introduced novel SCN9A mutation (F1624S) into a GFP-2A-Nav1.7rNS plasmid, and the constructs were then transiently transfected into HEK293 cells. We characterized both wild-type and F1624S Nav1.7 channels using an automated high-throughput patch-clamp system. RESULTS From two patients displaying EM-like/EM phenotypes, we identified two SCN9A mutations, I136V and P1308L. Among two patients diagnosed with PEPD, we found two additional mutations in SCN9A, F1624S (novel) and A1632E. Patch-clamp analysis of Nav1.7-F1624S revealed depolarizing shifts in both steady-state fast inactivation (17.4 mV, p < .001) and slow inactivation (5.5 mV, p < .001), but no effect on channel activation was observed. INTERPRETATION Clinical features observed in our patients broaden the phenotypic spectrum of SCN9A-related pain disorders, and the electrophysiological analysis enriches the understanding of genotype-phenotype association caused by Nav1.7 gain-of-function mutations.
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Affiliation(s)
- Jun-Hui Yuan
- Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Xiaoyang Cheng
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut, USA
- Center for Neuroscience and Regeneration Research, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Eiji Matsuura
- Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Yujiro Higuchi
- Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Masahiro Ando
- Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Akihiro Hashiguchi
- Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Akiko Yoshimura
- Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Ryo Nakachi
- Department of Neurology, National Hospital Organization Okinawa Hospital, Okinawa, Japan
| | - Jun Mine
- Department of Pediatrics, Shimane University Faculty of Medicine, Shimane, Japan
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan
| | - Takeshi Taketani
- Department of Pediatrics, Shimane University Faculty of Medicine, Shimane, Japan
| | - Kenichi Maeda
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Saori Kawakami
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Ryutaro Kira
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Shoko Tanaka
- Department of Neurology, Fukushima Medical University, Fukushima, Japan
| | - Kazuaki Kanai
- Department of Neurology, Fukushima Medical University, Fukushima, Japan
| | - Fadia Dib-Hajj
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut, USA
- Center for Neuroscience and Regeneration Research, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Sulayman D Dib-Hajj
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut, USA
- Center for Neuroscience and Regeneration Research, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Stephen G Waxman
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut, USA
- Center for Neuroscience and Regeneration Research, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Hiroshi Takashima
- Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
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Torio M, Maeda K, Akamine S, Kawakami S, Matsubara Y, Miya F, Kato M, Kira R. A case of infantile epileptic spasms syndrome and autism spectrum disorder with an RFX3 mutation. Seizure 2023; 112:11-14. [PMID: 37717291 DOI: 10.1016/j.seizure.2023.09.004] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 08/15/2023] [Accepted: 09/04/2023] [Indexed: 09/19/2023] Open
Affiliation(s)
- Michiko Torio
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan; Department of General Pediatrics and Interdisciplinary Medicine, Fukuoka Children's Hospital, Fukuoka, Japan.
| | - Kenichi Maeda
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Satoshi Akamine
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Saori Kawakami
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Yoshie Matsubara
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Fuyuki Miya
- Center for Medical Genetics, Keio University School of Medicine, Tokyo, Japan
| | - Mitsuhiro Kato
- Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan
| | - Ryutaro Kira
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
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Yonemoto K, Fujii F, Taira R, Ohgidani M, Eguchi K, Okuzono S, Ichimiya Y, Sonoda Y, Chong PF, Goto H, Kanemasa H, Motomura Y, Ishimura M, Koga Y, Tsujimura K, Hashiguchi T, Torisu H, Kira R, Kato TA, Sakai Y, Ohga S. Heterogeneity and mitochondrial vulnerability configurate the divergent immunoreactivity of human induced microglia-like cells. Clin Immunol 2023; 255:109756. [PMID: 37678717 DOI: 10.1016/j.clim.2023.109756] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/02/2023] [Indexed: 09/09/2023]
Abstract
Microglia play versatile roles in progression of and protection against neuroinflammatory diseases. Little is known, however, about the mechanisms underlying the diverse reactivity of microglia to inflammatory conditions. We investigated how human induced microglia-like (iMG) cells respond to innate immune ligands. Quantitative PCR showed that poly-I:C and lipopolysaccharide (LPS) activated the expression of IL1B and TNF. Immunoreactivity of iMG did not differ between controls (n = 11) and patients with neuroinflammatory diseases (n = 24). Flow cytometry revealed that CD14high cells expressed interleukin (IL) -1β after LPS treatment. Immunoblotting showed that poly-I:C and LPS differentially activated inflammatory pathways but commonly induced mitochondrial instability and the expression of pyruvate kinase isoform M2 (PKM2). Furthermore, a potent stimulator of PKM2 (DASA-58) alleviated IL-1β production after LPS treatment. These data indicate that heterogeneous cell populations and mitochondrial stability underlie the divergent immunoreactivity of human iMG in environments.
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Affiliation(s)
- Kousuke Yonemoto
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Fumihiko Fujii
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ryoji Taira
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masahiro Ohgidani
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Functional Anatomy and Neuroscience, Asahikawa Medical University, Hokkaido, Japan
| | - Katsuhide Eguchi
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Sayaka Okuzono
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Section of Pediatrics, Department of Medicine, Fukuoka Dental College, Fukuoka, Japan
| | - Yuko Ichimiya
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuri Sonoda
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Pin Fee Chong
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hironori Goto
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hikaru Kanemasa
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshitomo Motomura
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masataka Ishimura
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuhki Koga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Keita Tsujimura
- Group of Brain Function and Development, Neuroscience Institute of the Graduate School of Science, Nagoya University, Aichi, Japan; Research Unit for Developmental Disorders, Institute for Advanced Research, Nagoya University, Aichi, Japan
| | - Takao Hashiguchi
- Laboratory of Medical Virology, Institute for Life and Medical Sciences, Kyoto University, Kyoto, Japan
| | - Hiroyuki Torisu
- Section of Pediatrics, Department of Medicine, Fukuoka Dental College, Fukuoka, Japan
| | - Ryutaro Kira
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Takahiro A Kato
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasunari Sakai
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Shouichi Ohga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Omatsu H, Watanabe T, Kira R, Ishiba K, Patten A, Takase T, Ngo LY. Open-label study to investigate the safety and efficacy of adjunctive perampanel in pediatric patients (aged 4 to <12 years) with inadequately controlled focal-onset seizures: Japanese subgroup analysis. Seizure 2023; 110:109-116. [PMID: 37336055 DOI: 10.1016/j.seizure.2023.06.004] [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: 03/23/2023] [Revised: 05/30/2023] [Accepted: 06/05/2023] [Indexed: 06/21/2023] Open
Abstract
PURPOSE To evaluate the safety and tolerability of adjunctive perampanel in a Japanese subpopulation of Study 311 (NCT02849626), which was a global, multicenter, open-label, single-arm study of children (aged 4 to <12 years) with inadequately controlled focal-onset seizures (FOS), with or without focal to bilateral tonic-clonic seizures (FBTCS) or generalized tonic-clonic seizures (GTCS). METHODS Study 311 comprised a Core Study, Extension A, and Extension B; this report focuses on the Japanese patient subgroup in the Core Study only. In the Core Study, Japanese patients (FOS only) received adjunctive perampanel ≤12 mg/day in a 23-week Treatment Phase. Endpoints included safety/tolerability (primary) and median percent change in seizure frequency per 28 days from baseline. Patients were stratified by age and concomitant enzyme-inducing anti-seizure medication (EIASM) use. RESULTS Of 65 enrolled Japanese patients, 56 completed the Core Study and nine withdrew. The most common reason for discontinuation was adverse events (AEs) (n = 4 [6.2%]). The mean (standard deviation) daily dose of perampanel in Japanese FOS patients was 5.8 (2.2) mg/day. During the Core Study, treatment-emergent AEs (TEAEs) were reported by 89% of Japanese patients, most commonly nasopharyngitis (28%) and somnolence (28%). The median percent reduction in seizure frequency per 28 days from baseline was 37% and the lower limit of the 95% CI was greater than 10.5%, satisfying the pre-defined efficacy criteria. Perampanel was effective regardless of age or concomitant EIASM use. CONCLUSION Perampanel as adjunctive therapy is generally safe, well-tolerated, and efficacious in Japanese children aged 4 to <12 years with FOS (with/without FBTCS).
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Affiliation(s)
- Hirowo Omatsu
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan.
| | - Toshihide Watanabe
- Hokkaido Medical Center for Child Health and Rehabilitation, Hokkaido, Japan.
| | | | | | - Anna Patten
- Eisai Europe Ltd., Hatfield, Hertfordshire, United Kingdom.
| | | | - Leock Y Ngo
- Eisai Inc., Nutley, NJ, United States of America.
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Ichimiya Y, Chong PF, Sonoda Y, Tocan V, Watanabe M, Torisu H, Kira R, Takahashi T, Kira JI, Isobe N, Sakai Y, Ohga S. Long-lasting pain and somatosensory disturbances in children with myelin oligodendrocyte glycoprotein antibody-associated disease. Eur J Pediatr 2023:10.1007/s00431-023-04989-z. [PMID: 37119299 DOI: 10.1007/s00431-023-04989-z] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/22/2023] [Accepted: 04/17/2023] [Indexed: 05/01/2023]
Abstract
Myelin oligodendrocyte glycoprotein antibody (MOG-Ab) is an autoantibody associated with acquired demyelinating syndrome (ADS) in childhood and adults. The pathogenic roles of MOG-Ab and long-term outcomes of children with MOG-Ab-associated disease (MOGAD) remain elusive. We investigated the clinical features of children with ADS during follow-up in our institute. Clinical data were retrospectively analyzed using medical charts of patients managed in Kyushu University Hospital from January 1st, 2001, to March 31st, 2022. Participants were children of < 18 years of age when they received a diagnosis of ADS in our hospital. Cell-based assays were used to detect MOG-Ab in serum or cerebrospinal fluid at the onset or recurrence of ADS. The clinical and neuroimaging data of MOG-Ab-positive and MOG-Ab-negative patients were statistically analyzed. Among 31 patients enrolled in this study, 22 (13 females, 59%) received tests for MOG antibodies. Thirteen cases (59%) were MOG-Ab-positive and were therefore defined as MOGAD; 9 (41%) were MOG-Ab-negative. There were no differences between MOGAD and MOG-Ab-negative patients in age at onset, sex, diagnostic subcategories, or duration of follow-up. MOGAD patients experienced headache and/or somatosensory symptoms more frequently than MOG-Ab-negative patients (12/13 (92%) vs. 3/9 (22%); p = 0.0066). Somatosensory problems included persistent pain with hyperesthesia in the left toe, perineal dysesthesia, and facial hypesthesia. No specific neuroimaging findings were associated with MOGAD or the presence of somatosensory symptoms. CONCLUSIONS Long-lasting somatosensory disturbances are prominent comorbidities in children with MOGAD. Prospective cohorts are required to identify molecular and immunogenetic profiles associated with somatosensory problems in MOGAD. WHAT IS KNOWN • Recurrence of demyelinating events occurs in a group of children with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). WHAT IS NEW • Long-lasting headache and somatosensory problems are frequent comorbidities with pediatric MOGAD. Pain and somatosensory problems may persist for more than 5 years. • Neuroimaging data do not indicate specific findings in children with somatic disturbances.
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Affiliation(s)
- Yuko Ichimiya
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
| | - Pin Fee Chong
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
| | - Yuri Sonoda
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
- Research Center for Environment and Developmental Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Vlad Tocan
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
| | - Mitsuru Watanabe
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroyuki Torisu
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
- Section of Pediatrics, Department of Medicine, Fukuoka Dental College, Fukuoka, Japan
| | - Ryutaro Kira
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Toshiyuki Takahashi
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Neurology, National Hospital Organization, Yonezawa National Hospital, Yonezawa, Japan
| | - Jun-Ichi Kira
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Neurology, Brain and Nerve Center, Fukuoka Central Hospital, Fukuoka, Japan
| | - Noriko Isobe
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasunari Sakai
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan.
| | - Shouichi Ohga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
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Tetsuhara K, Akamine S, Matsubara Y, Fujii S, Kashimada W, Marutani K, Torio M, Morooka Y, Hanaoka N, Fujimoto T, Nakamura-Miwa H, Arai S, Tanaka-Taya K, Furuno K, Mizuno Y, Kira R. Severe encephalopathy associated with SARS-CoV-2 Omicron BA.1 variant infection in a neonate. Brain Dev 2022; 44:743-747. [PMID: 35835638 PMCID: PMC9273474 DOI: 10.1016/j.braindev.2022.06.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 04/18/2022] [Revised: 06/12/2022] [Accepted: 06/27/2022] [Indexed: 12/04/2022]
Abstract
INTRODUCTION The coronavirus disease 2019 (COVID-19), including the Omicron variant, is less severe in children than in adults. To date, there has been no detailed description of COVID-19-associated severe encephalopathy due to the Omicron variant during the neonatal and early infantile periods. CASE PRESENTATION During the outbreak of the Omicron variant, a 29-day-old male presented with a pale and ill appearance. The patient was intubated for mechanical ventilation owing to recurrent apnea, which subsequently turned out to be a breath-holding that may have been caused by seizure. In addition, nonconvulsive status epilepticus was observed. Total duration of repetitive seizure activities was approximately 30 min per hour when seizures were most severe. Brain magnetic resonance imaging (MRI) on day 14 revealed extensive hyperintensity in the T2 sequence, hypointensity in the fluid-attenuated inversion recovery (FLAIR) sequence in the deep and subcortical white matter, and diffusion restriction in the corpus callosum. The Omicron BA.1 variant of the severe acute respiratory syndrome coronavirus 2 was detected in his respiratory sample. Follow-up MRI on day 45 revealed multiple cystic cavitations. CONCLUSION Although COVID-19 is not severe in most children, life-threatening conditions such as COVID-19-associated severe encephalopathy can occur during the neonatal and early infantile periods.
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Affiliation(s)
- Kenichi Tetsuhara
- Department of Critical Care Medicine, Fukuoka Children's Hospital, Fukuoka, Japan.
| | - Satoshi Akamine
- Department of Pediatric Neurology, Fukuoka Children’s Hospital, Fukuoka, Japan
| | - Yoshie Matsubara
- Department of Pediatric Neurology, Fukuoka Children’s Hospital, Fukuoka, Japan
| | - Shunsuke Fujii
- Department of Critical Care Medicine, Fukuoka Children’s Hospital, Fukuoka, Japan
| | - Wataru Kashimada
- Department of Cardiology, Fukuoka Children’s Hospital, Fukuoka, Japan
| | - Kentaro Marutani
- Department of Critical Care Medicine, Fukuoka Children’s Hospital, Fukuoka, Japan
| | - Michiko Torio
- Department of Pediatric Neurology, Fukuoka Children’s Hospital, Fukuoka, Japan,Department of General Pediatrics and Interdisciplinary Medicine, Fukuoka Children’s Hospital, Fukuoka, Japan
| | - Yuya Morooka
- Department of General Pediatrics and Interdisciplinary Medicine, Fukuoka Children’s Hospital, Fukuoka, Japan
| | - Nozomu Hanaoka
- Center for Emergency Preparedness and Response, National Institute of Infectious Diseases, Tokyo, Japan
| | - Tsuguto Fujimoto
- Center for Emergency Preparedness and Response, National Institute of Infectious Diseases, Tokyo, Japan
| | - Haruna Nakamura-Miwa
- Center for Surveillance, Immunization, and Epidemiologic Research, National Institute of Infectious Diseases, Tokyo, Japan
| | - Satoru Arai
- Center for Surveillance, Immunization, and Epidemiologic Research, National Institute of Infectious Diseases, Tokyo, Japan
| | - Keiko Tanaka-Taya
- Center for Surveillance, Immunization, and Epidemiologic Research, National Institute of Infectious Diseases, Tokyo, Japan
| | - Kenji Furuno
- Department of General Pediatrics and Interdisciplinary Medicine, Fukuoka Children’s Hospital, Fukuoka, Japan
| | - Yumi Mizuno
- Department of Pediatric Infectious Disease and Immunology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Ryutaro Kira
- Department of Pediatric Neurology, Fukuoka Children’s Hospital, Fukuoka, Japan
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8
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Machida O, Shimojima KY, Shiihara T, Akamine S, Kira R, Hasegawa Y, Nishi E, Okamoto N, Nagata S, Yamamoto T. Interstitial deletions in the proximal regions of 6q: 12 original cases and a literature review. Intractable Rare Dis Res 2022; 11:143-148. [PMID: 36200032 PMCID: PMC9438003 DOI: 10.5582/irdr.2022.01065] [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: 06/08/2022] [Revised: 07/27/2022] [Accepted: 08/03/2022] [Indexed: 11/05/2022] Open
Abstract
Interstitial microdeletions in the proximal region of the long arm of chromosome 6 are rare. Herein we have reported 12 patients with developmental delays associated with interstitial microdeletions in 6q ranging from q12 to q22. The microdeletions were detected by chromosomal microarray testing. To confirm the clinical significance of these deletions, genotype-phenotype correlation analysis was performed using genetic and predicted loss-of-function data. SIM1 was recognized as the gene responsible for developmental delay, particularly in Prader-Willi syndrome-like phenotypes. Other genes possibly related to developmental delay were ZNF292, PHIP, KCNQ5, and NUS1. To further establish the correlation between the genotype and phenotype, more patient information is required.
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Affiliation(s)
- Osamu Machida
- Department of Genetic Medicine, Division of Advanced Biomedical Sciences, Graduate School of Medicine, Tokyo Women's Medical University, Tokyo, Japan
- Department of Pediatrics, Tokyo Women's Medical University, Tokyo, Japan
| | - Keiko Yamamoto Shimojima
- Department of Transfusion Medicine and Cell Processing, Tokyo Women's Medical University, Tokyo, Japan
- Institute of Medical Genetics, Tokyo Women's Medical University, Tokyo, Japan
| | - Takashi Shiihara
- Department of Pediatric Neurology, Gunma Children's Medical Center, Gunma, Japan
| | - Satoshi Akamine
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Ryutaro Kira
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Yuiko Hasegawa
- Department of Medical Genetics, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Eriko Nishi
- Department of Medical Genetics, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Nobuhiko Okamoto
- Department of Medical Genetics, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Satoru Nagata
- Department of Pediatrics, Tokyo Women's Medical University, Tokyo, Japan
| | - Toshiyuki Yamamoto
- Department of Genetic Medicine, Division of Advanced Biomedical Sciences, Graduate School of Medicine, Tokyo Women's Medical University, Tokyo, Japan
- Institute of Medical Genetics, Tokyo Women's Medical University, Tokyo, Japan
- Address correspondence to:Toshiyuki Yamamoto, Institute of Medical Genetics, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ward, Tokyo 162-8666, Japan. E-mail:
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9
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Saida K, Chong PF, Yamaguchi A, Saito N, Ikehara H, Koshimizu E, Miyata R, Ishiko A, Nakamura K, Ohnishi H, Fujioka K, Sakakibara T, Asada H, Ogawa K, Kudo K, Ohashi E, Kawai M, Abe Y, Tsuchida N, Uchiyama Y, Hamanaka K, Fujita A, Mizuguchi T, Miyatake S, Miyake N, Kato M, Kira R, Matsumoto N. Monogenic causes of pigmentary mosaicism. Hum Genet 2022; 141:1771-1784. [PMID: 35503477 DOI: 10.1007/s00439-022-02437-w] [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] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 01/28/2022] [Indexed: 12/30/2022]
Abstract
Pigmentary mosaicism of the Ito type, also known as hypomelanosis of Ito, is a neurocutaneous syndrome considered to be predominantly caused by somatic chromosomal mosaicism. However, a few monogenic causes of pigmentary mosaicism have been recently reported. Eleven unrelated individuals with pigmentary mosaicism (mostly hypopigmented skin) were recruited for this study. Skin punch biopsies of the probands and trio-based blood samples (from probands and both biological parents) were collected, and genomic DNA was extracted and analyzed by exome sequencing. In all patients, plausible monogenic causes were detected with somatic and germline variants identified in five and six patients, respectively. Among the somatic variants, four patients had MTOR variant (36%) and another had an RHOA variant. De novo germline variants in USP9X, TFE3, and KCNQ5 were detected in two, one, and one patients, respectively. A maternally inherited PHF6 variant was detected in one patient with hyperpigmented skin. Compound heterozygous GTF3C5 variants were highlighted as strong candidates in the remaining patient. Exome sequencing, using patients' blood and skin samples is highly recommended as the first choice for detecting causative genetic variants of pigmentary mosaicism.
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Affiliation(s)
- Ken Saida
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Pin Fee Chong
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Asuka Yamaguchi
- Department of Pediatrics, Tokyo-Kita Medical Center, Tokyo, Japan
| | - Naka Saito
- Department of Pediatrics, Tsuruoka Municipal Shonai Hospital, Yamagata, Japan
| | - Hajime Ikehara
- Department of Pediatrics, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Eriko Koshimizu
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Rie Miyata
- Department of Pediatrics, Tokyo-Kita Medical Center, Tokyo, Japan
| | - Akira Ishiko
- Department of Dermatology, Toho University School of Medicine, Tokyo, Japan
| | - Kazuyuki Nakamura
- Department of Pediatrics, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Hidenori Ohnishi
- Department of Pediatrics, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Kei Fujioka
- Center of General Internal Medicine and Rheumatology, Gifu Municipal Hospital, Gifu, Japan
| | - Takafumi Sakakibara
- Department of Pediatrics, Nara Medical University School of Medicine, Nara, Japan
| | - Hideo Asada
- Department of Dermatology, Nara Medical University School of Medicine, Nara, Japan
| | - Kohei Ogawa
- Department of Dermatology, Nara Medical University School of Medicine, Nara, Japan
| | - Kyoko Kudo
- Department of Dermatology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Eri Ohashi
- Division of Neurology, National Center for Child Health and Development, Tokyo, Japan
| | - Michiko Kawai
- Division of Neurology, National Center for Child Health and Development, Tokyo, Japan
| | - Yuichi Abe
- Division of Neurology, National Center for Child Health and Development, Tokyo, Japan
| | - Naomi Tsuchida
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.,Department of Rare Disease Genomics, Yokohama City University Hospital, Yokohama, Japan
| | - Yuri Uchiyama
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.,Department of Rare Disease Genomics, Yokohama City University Hospital, Yokohama, Japan
| | - Kohei Hamanaka
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Atsushi Fujita
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Takeshi Mizuguchi
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Satoko Miyatake
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.,Clinical Genetics Department, Yokohama City University Hospital, Yokohama, Japan
| | - Noriko Miyake
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.,Department of Human Genetics, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | - Mitsuhiro Kato
- Department of Pediatrics, Showa University School of Medicine, Shinagawa-ku, Tokyo, Japan
| | - Ryutaro Kira
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Naomichi Matsumoto
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
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10
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Katsuta T, Shimizu N, Okada K, Tanaka-Taya K, Nakano T, Kamiya H, Amo K, Ishiwada N, Iwata S, Oshiro M, Okabe N, Kira R, Korematsu S, Suga S, Tsugawa T, Nishimura N, Hishiki H, Fujioka M, Hosoya M, Mizuno Y, Mine M, Miyairi I, Miyazaki C, Morioka I, Morishima T, Yoshikawa T, Wada T, Azuma H, Kusuhara K, Ouchi K, Saitoh A, Moriuchi H. The clinical characteristics of pediatric coronavirus disease 2019 in 2020 in Japan. Pediatr Int 2022; 64:e14912. [PMID: 34233075 PMCID: PMC8446955 DOI: 10.1111/ped.14912] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/10/2021] [Accepted: 06/14/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND The COVID-19 pandemic has affected the lives of people of all ages. Most reports on pediatric cases suggest that children experience fewer and milder symptoms than do adults. This is the first nationwide study in Japan focusing on pediatric cases reported by pediatricians, including cases with no or mild symptoms. METHODS We analyzed the epidemiological and clinical characteristics and transmission patterns of 840 pediatric (<16 years old) COVID-19 cases reported between February and December 2020 in Japan, using a dedicated database which was maintained voluntarily by members of the Japan Pediatric Society. RESULTS Almost half of the patients (47.7%) were asymptomatic, while most of the others presented mild symptoms. At the time of admission or first outpatient clinic visit, 84.0% of the cases were afebrile (<37.5°C). In total, 609 cases (72.5%) were exposed to COVID-19-positive household members. We analyzed the influence of nationwide school closures that were introduced in March 2020 on COVID-19 transmission routes among children in Japan. Transmission within households occurred most frequently, with no significant difference between the periods before and after declaring nationwide school closures (70.9% and 74.5%, respectively). CONCLUSIONS COVID-19 symptoms in children are less severe than those in adults. School closure appeared to have a limited effect on transmission. Controlling household transmission from adult family members is the most important measure for prevention of COVID-19 among children.
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Affiliation(s)
- Tomohiro Katsuta
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Tokyo, Japan.,Department of Pediatrics, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Naoki Shimizu
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Tokyo, Japan.,Department of Pediatrics, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kenji Okada
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Tokyo, Japan.,Department of Nursing, Fukuoka Nursing College, Fukuoka, Japan
| | - Keiko Tanaka-Taya
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Tokyo, Japan.,Center for Surveillance, Immunization, and Epidemiologic Research, National Institute of Infectious Diseases, Tokyo, Japan
| | - Takashi Nakano
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Tokyo, Japan.,Department of Pediatrics, Kawasaki Medical School, Okayama, Japan
| | - Hajime Kamiya
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Tokyo, Japan.,Center for Field Epidemic Intelligence, Research and Professional Development, National Institute of Infectious Diseases, Tokyo, Japan
| | - Kiyoko Amo
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Tokyo, Japan.,Department of Pediatric emergency, Osaka City General Hospital, Osaka, Japan
| | - Naruhiko Ishiwada
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Tokyo, Japan.,Department of Infectious Diseases, Medical Mycology Research Center, Chiba University, Chiba, Japan
| | - Satoshi Iwata
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Tokyo, Japan.,Department of Infectious Diseases, National Cancer Center Hospital, Tokyo, Japan
| | - Makoto Oshiro
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Tokyo, Japan.,Department of Pediatrics, Japanese Red Cross Nagoya First Hospital, Aichi, Japan
| | - Nobuhiko Okabe
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Tokyo, Japan.,Kawasaki City Institute for Public Health, Kanagawa, Japan
| | - Ryutaro Kira
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Tokyo, Japan.,Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Seigo Korematsu
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Tokyo, Japan.,Department of Pediatrics, Nakatsu Municipal Hospital, Oita, Japan
| | - Shigeru Suga
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Tokyo, Japan.,Department of Clinical Research, Infectious Disease Center, National Hospital Organization Mie National Hospital, Mie, Japan
| | - Takeshi Tsugawa
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Tokyo, Japan.,Department of Pediatrics, Sapporo Medical University School of Medicine, Hokkaido, Japan
| | - Naoko Nishimura
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Tokyo, Japan.,Department of Pediatrics, Konan Kosei Hospital, Aichi, Japan
| | - Haruka Hishiki
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Tokyo, Japan.,Department of Pediatrics, Chiba University Hospital, Chiba, Japan
| | - Masashi Fujioka
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Tokyo, Japan.,Fujioka Pediatric Clinic, Osaka, Japan
| | - Mitsuaki Hosoya
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Tokyo, Japan.,Department of Pediatrics, Fukushima Medical University, Fukushima, Japan
| | - Yumi Mizuno
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Tokyo, Japan.,Department of Pediatric infectious diseases and immunology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Mahito Mine
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Tokyo, Japan.,Mine Pediatric Clinic, Saitama, Japan
| | - Isao Miyairi
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Tokyo, Japan.,Division of Infectious Diseases, National Center for Child Health and Development, Tokyo, Japan
| | - Chiaki Miyazaki
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Tokyo, Japan.,Fukuoka-city Social Welfare Agency, Fukuoka, Japan
| | - Ichiro Morioka
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Tokyo, Japan.,Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Tsuneo Morishima
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Tokyo, Japan.,Department of Pediatrics, Aichi Medical University, Aichi, Japan
| | - Tetsushi Yoshikawa
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Tokyo, Japan.,Department of Pediatrics, Fujita Health University School of Medicine, Aichi, Japan
| | - Taizo Wada
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Tokyo, Japan.,Department of Pediatrics, Kanazawa University, Ishikawa, Japan
| | - Hiroshi Azuma
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Tokyo, Japan.,Department of Pediatrics, Asahikawa Medical University, Hokkaido, Japan
| | - Koichi Kusuhara
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Tokyo, Japan.,Department of Pediatrics, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Kazunobu Ouchi
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Tokyo, Japan.,Department of Pediatrics, Kawasaki Medical School, Okayama, Japan
| | - Akihiko Saitoh
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Tokyo, Japan.,Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Hiroyuki Moriuchi
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Tokyo, Japan.,Department of Pediatrics, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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11
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Ichinose F, Nakamura T, Kira R, Furuno K, Ishii S, Takamura K, Hashiguchi M, Inoue T, Senju A, Ichimiya Y, Sakakibara T, Sugiyama N, Naitou T, Higuchi N, Togawa M, Torii KI, Toda S, Iwamatsu H, Sato T, Tsurui S, Tanaka H, Motobayashi M, Abe A, Kawaguchi A, Matsuo M. Incidence and risk factors of acute encephalopathy with biphasic seizures in febrile status epilepticus. Brain Dev 2022; 44:36-43. [PMID: 34362595 DOI: 10.1016/j.braindev.2021.07.004] [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: 01/20/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To clarify the incidence and risk factors of acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) in pediatric patients with febrile status epilepticus (FSE). METHODS We retrospectively surveyed patients with FSE (≥20 min and ≥40 min) who were younger than 6 years by mailing a questionnaire to 1123 hospitals in Japan. The survey period was 2 years. We then collected clinical data on patients with prolonged febrile seizures (PFS) ≥40 min and those with AESD, and compared clinical data between the PFS and AESD groups. RESULTS The response rate for the primary survey was 42.3%, and 28.0% of hospitals which had applicable cases responded in the secondary survey. The incidence of AESD was 4.3% in patients with FSE ≥20 min and 7.1% in those with FSE ≥40 min. In the second survey, a total of 548 patients had FSE ≥40 min (AESD group, n = 93; PFS group, n = 455). Univariate analysis revealed significant between-group differences in pH, aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, creatine kinase, NH3, procalcitonin (PCT), uric acid, blood urea nitrogen, creatinine (Cr), and lactate. Multivariate analysis using stratified values showed that high PCT was an only risk factor for AESD. A prediction score of ≥3 was indicative of AESD, as determined using the following indexes: HCO3- < 20 mmol/L (1 point), Cl <100 mEq/L (1 point), Cr ≥0.35 mg/dL (1 point), glucose ≥200 mg/dL (1 point), and PCT ≥1.7 pg/mL (2 points). The scoring system had sensitivity of 84.2% and specificity of 81.0%. CONCLUSION Incidence data and prediction scores for AESD will be useful for future intervention trials for AESD.
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Affiliation(s)
- Fumio Ichinose
- Department of Pediatrics, Faculty of Medicine, Saga University, Saga, Japan.
| | - Takuji Nakamura
- Department of Pediatrics, Faculty of Medicine, Saga University, Saga, Japan; Department of Pediatrics, National Hospital Organization Ureshino Medical Center, Saga, Japan
| | - Ryutaro Kira
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Kenji Furuno
- Department of General Medicine, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Shigeki Ishii
- Department of Pediatrics, Miyazaki Prefectural Miyazaki Hospital, Miyazaki, Japan
| | - Kazunari Takamura
- Department of Pediatrics, Miyazaki Prefectural Miyazaki Hospital, Miyazaki, Japan
| | - Marina Hashiguchi
- Department of Pediatrics, Japan Organization of Occupational Health and Safety, Yokohama Rosai Hospital, Kanagawa, Japan
| | - Takushi Inoue
- Department of Pediatrics, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Ayako Senju
- Department of Pediatrics, Kitakyushu General Hospital, Fukuoka, Japan
| | - Yuko Ichimiya
- Department of Pediatrics, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | - Nobuyoshi Sugiyama
- Department of Pediatrics, School of Medicine, Tokai University, Kanagawa, Japan
| | - Tomomi Naitou
- Department of Pediatrics, Saiseikai Kawaguchi General Hospital, Saitama, Japan
| | - Naoya Higuchi
- Department of Pediatrics, Faculty of Medicine, Saga University, Saga, Japan; Department of Pediatrics, Saga Prefectural Medical Center Koseikan, Saga, Japan
| | - Masami Togawa
- Department of Pediatrics, Tottori Prefectural Central Hospital, Tottori, Japan
| | - Ken-Ichi Torii
- Department of Pediatrics, Tokyo Metropolitan Ohtsuka Hospital, Tokyo, Japan
| | - Soichiro Toda
- Department of Pediatrics, Kameda Medical Center, Chiba, Japan
| | - Hiroko Iwamatsu
- Department of Pediatrics, Oita Prefectural Hospital, Oita, Japan
| | - Tatsuharu Sato
- Department of Pediatrics, Nagasaki University Hospital, Nagasaki, Japan
| | - Satoshi Tsurui
- Department of Pediatrics, Seirei Numazu Hospital, Shizuoka, Japan
| | - Hidenori Tanaka
- Department of Pediatrics, Komaki City Hospital, Aichi, Japan
| | - Mitsuo Motobayashi
- Department of Pediatric Neurology, Nagano Children's Hospital, Nagano, Japan
| | - Akiko Abe
- Department of Pediatrics, Yamagata City Hospital Saiseikan, Yamagata, Japan
| | - Atsushi Kawaguchi
- Education and Research Center for Community Medicine, Saga University, Saga, Japan
| | - Muneaki Matsuo
- Department of Pediatrics, Faculty of Medicine, Saga University, Saga, Japan
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12
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Torio M, Iwayama M, Sawano T, Inoue H, Ochiai M, Taira R, Yonemoto K, Ichimiya Y, Sonoda Y, Sasazuki M, Ishizaki Y, Sanefuji M, Yamane K, Yamashita H, Torisu H, Kira R, Hara T, Kanba S, Sakai Y, Ohga S. Neurodevelopmental Outcomes of High-Risk Preterm Infants: A Prospective Study in Japan. Neurol Clin Pract 2021; 11:398-405. [PMID: 34840866 DOI: 10.1212/cpj.0000000000000920] [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] [Received: 01/31/2020] [Accepted: 07/07/2020] [Indexed: 11/15/2022]
Abstract
Objectives To determine the neurodevelopmental outcomes of very-low-birth-weight infants (VLBWIs, birth weight <1,500 g) after 9 years of follow-up. Methods This study prospectively recruited 224 VLBWIs born from 2003 to 2009 in Kyushu University Hospital, Japan. Comorbidities of neurocognitive impairment, epilepsy, and autism spectrum disorder or attention-deficit hyperactivity disorder (ASD/ADHD) were assessed at age 3, 6, and 9 years. Results Neurodevelopmental profiles were obtained from 185 (83%), 150 (67%), and 119 (53%) participants at age 3, 6, and 9 years, respectively. At age 9 years, 25 (21%) VLBWIs showed intelligence quotient (IQ) <70, 11 (9%) developed epilepsy, and 14 (12%) had a diagnosis of ASD/ADHD. The prevalence of epilepsy was higher in children with an IQ <70 at age 9 years than in those with an IQ ≥70 (44% vs 0%). In contrast, ASD/ADHD appeared at similar frequencies in children with an IQ <70 (16%) and ≥70 (11%). Perinatal complications and severe brain lesions on MRI were considered common perinatal risks for developmental delay and epilepsy but not for ASD/ADHD. Male sex was identified as a unique risk factor for ASD/ADHD. Conclusion These data suggest that VLBWIs showed a higher prevalence of developmental delay, epilepsy, and ASD/ADHD at age 9 years than the general population. Distinct mechanisms might be involved in the pathogenic process of ASD/ADHD from those of developmental delay and epilepsy.
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Affiliation(s)
- Michiko Torio
- Department of Pediatrics (MT, MI, TS, HI, MO, RT, K. Yonemoto, Y. Ichimiya, Y. Sonoda, M. Sasazuki, Y. Ishizaki, M. Sanefuji, Y. Sakai, SO), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Health and Welfare (M. Sasazuki), Seinan Jogakuin University, Kitakyushu; Department of Neuropsychiatry (K. Yamane, HY, SK), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Section of Pediatrics (HT), Department of Medicine, Fukuoka Dental College; and Fukuoka Children's Hospital (RK, TH), Japan
| | - Mariko Iwayama
- Department of Pediatrics (MT, MI, TS, HI, MO, RT, K. Yonemoto, Y. Ichimiya, Y. Sonoda, M. Sasazuki, Y. Ishizaki, M. Sanefuji, Y. Sakai, SO), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Health and Welfare (M. Sasazuki), Seinan Jogakuin University, Kitakyushu; Department of Neuropsychiatry (K. Yamane, HY, SK), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Section of Pediatrics (HT), Department of Medicine, Fukuoka Dental College; and Fukuoka Children's Hospital (RK, TH), Japan
| | - Toru Sawano
- Department of Pediatrics (MT, MI, TS, HI, MO, RT, K. Yonemoto, Y. Ichimiya, Y. Sonoda, M. Sasazuki, Y. Ishizaki, M. Sanefuji, Y. Sakai, SO), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Health and Welfare (M. Sasazuki), Seinan Jogakuin University, Kitakyushu; Department of Neuropsychiatry (K. Yamane, HY, SK), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Section of Pediatrics (HT), Department of Medicine, Fukuoka Dental College; and Fukuoka Children's Hospital (RK, TH), Japan
| | - Hirosuke Inoue
- Department of Pediatrics (MT, MI, TS, HI, MO, RT, K. Yonemoto, Y. Ichimiya, Y. Sonoda, M. Sasazuki, Y. Ishizaki, M. Sanefuji, Y. Sakai, SO), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Health and Welfare (M. Sasazuki), Seinan Jogakuin University, Kitakyushu; Department of Neuropsychiatry (K. Yamane, HY, SK), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Section of Pediatrics (HT), Department of Medicine, Fukuoka Dental College; and Fukuoka Children's Hospital (RK, TH), Japan
| | - Masayuki Ochiai
- Department of Pediatrics (MT, MI, TS, HI, MO, RT, K. Yonemoto, Y. Ichimiya, Y. Sonoda, M. Sasazuki, Y. Ishizaki, M. Sanefuji, Y. Sakai, SO), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Health and Welfare (M. Sasazuki), Seinan Jogakuin University, Kitakyushu; Department of Neuropsychiatry (K. Yamane, HY, SK), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Section of Pediatrics (HT), Department of Medicine, Fukuoka Dental College; and Fukuoka Children's Hospital (RK, TH), Japan
| | - Ryoji Taira
- Department of Pediatrics (MT, MI, TS, HI, MO, RT, K. Yonemoto, Y. Ichimiya, Y. Sonoda, M. Sasazuki, Y. Ishizaki, M. Sanefuji, Y. Sakai, SO), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Health and Welfare (M. Sasazuki), Seinan Jogakuin University, Kitakyushu; Department of Neuropsychiatry (K. Yamane, HY, SK), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Section of Pediatrics (HT), Department of Medicine, Fukuoka Dental College; and Fukuoka Children's Hospital (RK, TH), Japan
| | - Kousuke Yonemoto
- Department of Pediatrics (MT, MI, TS, HI, MO, RT, K. Yonemoto, Y. Ichimiya, Y. Sonoda, M. Sasazuki, Y. Ishizaki, M. Sanefuji, Y. Sakai, SO), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Health and Welfare (M. Sasazuki), Seinan Jogakuin University, Kitakyushu; Department of Neuropsychiatry (K. Yamane, HY, SK), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Section of Pediatrics (HT), Department of Medicine, Fukuoka Dental College; and Fukuoka Children's Hospital (RK, TH), Japan
| | - Yuko Ichimiya
- Department of Pediatrics (MT, MI, TS, HI, MO, RT, K. Yonemoto, Y. Ichimiya, Y. Sonoda, M. Sasazuki, Y. Ishizaki, M. Sanefuji, Y. Sakai, SO), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Health and Welfare (M. Sasazuki), Seinan Jogakuin University, Kitakyushu; Department of Neuropsychiatry (K. Yamane, HY, SK), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Section of Pediatrics (HT), Department of Medicine, Fukuoka Dental College; and Fukuoka Children's Hospital (RK, TH), Japan
| | - Yuri Sonoda
- Department of Pediatrics (MT, MI, TS, HI, MO, RT, K. Yonemoto, Y. Ichimiya, Y. Sonoda, M. Sasazuki, Y. Ishizaki, M. Sanefuji, Y. Sakai, SO), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Health and Welfare (M. Sasazuki), Seinan Jogakuin University, Kitakyushu; Department of Neuropsychiatry (K. Yamane, HY, SK), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Section of Pediatrics (HT), Department of Medicine, Fukuoka Dental College; and Fukuoka Children's Hospital (RK, TH), Japan
| | - Momoko Sasazuki
- Department of Pediatrics (MT, MI, TS, HI, MO, RT, K. Yonemoto, Y. Ichimiya, Y. Sonoda, M. Sasazuki, Y. Ishizaki, M. Sanefuji, Y. Sakai, SO), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Health and Welfare (M. Sasazuki), Seinan Jogakuin University, Kitakyushu; Department of Neuropsychiatry (K. Yamane, HY, SK), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Section of Pediatrics (HT), Department of Medicine, Fukuoka Dental College; and Fukuoka Children's Hospital (RK, TH), Japan
| | - Yoshito Ishizaki
- Department of Pediatrics (MT, MI, TS, HI, MO, RT, K. Yonemoto, Y. Ichimiya, Y. Sonoda, M. Sasazuki, Y. Ishizaki, M. Sanefuji, Y. Sakai, SO), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Health and Welfare (M. Sasazuki), Seinan Jogakuin University, Kitakyushu; Department of Neuropsychiatry (K. Yamane, HY, SK), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Section of Pediatrics (HT), Department of Medicine, Fukuoka Dental College; and Fukuoka Children's Hospital (RK, TH), Japan
| | - Masafumi Sanefuji
- Department of Pediatrics (MT, MI, TS, HI, MO, RT, K. Yonemoto, Y. Ichimiya, Y. Sonoda, M. Sasazuki, Y. Ishizaki, M. Sanefuji, Y. Sakai, SO), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Health and Welfare (M. Sasazuki), Seinan Jogakuin University, Kitakyushu; Department of Neuropsychiatry (K. Yamane, HY, SK), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Section of Pediatrics (HT), Department of Medicine, Fukuoka Dental College; and Fukuoka Children's Hospital (RK, TH), Japan
| | - Kenichi Yamane
- Department of Pediatrics (MT, MI, TS, HI, MO, RT, K. Yonemoto, Y. Ichimiya, Y. Sonoda, M. Sasazuki, Y. Ishizaki, M. Sanefuji, Y. Sakai, SO), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Health and Welfare (M. Sasazuki), Seinan Jogakuin University, Kitakyushu; Department of Neuropsychiatry (K. Yamane, HY, SK), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Section of Pediatrics (HT), Department of Medicine, Fukuoka Dental College; and Fukuoka Children's Hospital (RK, TH), Japan
| | - Hiroshi Yamashita
- Department of Pediatrics (MT, MI, TS, HI, MO, RT, K. Yonemoto, Y. Ichimiya, Y. Sonoda, M. Sasazuki, Y. Ishizaki, M. Sanefuji, Y. Sakai, SO), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Health and Welfare (M. Sasazuki), Seinan Jogakuin University, Kitakyushu; Department of Neuropsychiatry (K. Yamane, HY, SK), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Section of Pediatrics (HT), Department of Medicine, Fukuoka Dental College; and Fukuoka Children's Hospital (RK, TH), Japan
| | - Hiroyuki Torisu
- Department of Pediatrics (MT, MI, TS, HI, MO, RT, K. Yonemoto, Y. Ichimiya, Y. Sonoda, M. Sasazuki, Y. Ishizaki, M. Sanefuji, Y. Sakai, SO), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Health and Welfare (M. Sasazuki), Seinan Jogakuin University, Kitakyushu; Department of Neuropsychiatry (K. Yamane, HY, SK), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Section of Pediatrics (HT), Department of Medicine, Fukuoka Dental College; and Fukuoka Children's Hospital (RK, TH), Japan
| | - Ryutaro Kira
- Department of Pediatrics (MT, MI, TS, HI, MO, RT, K. Yonemoto, Y. Ichimiya, Y. Sonoda, M. Sasazuki, Y. Ishizaki, M. Sanefuji, Y. Sakai, SO), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Health and Welfare (M. Sasazuki), Seinan Jogakuin University, Kitakyushu; Department of Neuropsychiatry (K. Yamane, HY, SK), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Section of Pediatrics (HT), Department of Medicine, Fukuoka Dental College; and Fukuoka Children's Hospital (RK, TH), Japan
| | - Toshiro Hara
- Department of Pediatrics (MT, MI, TS, HI, MO, RT, K. Yonemoto, Y. Ichimiya, Y. Sonoda, M. Sasazuki, Y. Ishizaki, M. Sanefuji, Y. Sakai, SO), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Health and Welfare (M. Sasazuki), Seinan Jogakuin University, Kitakyushu; Department of Neuropsychiatry (K. Yamane, HY, SK), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Section of Pediatrics (HT), Department of Medicine, Fukuoka Dental College; and Fukuoka Children's Hospital (RK, TH), Japan
| | - Shigenobu Kanba
- Department of Pediatrics (MT, MI, TS, HI, MO, RT, K. Yonemoto, Y. Ichimiya, Y. Sonoda, M. Sasazuki, Y. Ishizaki, M. Sanefuji, Y. Sakai, SO), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Health and Welfare (M. Sasazuki), Seinan Jogakuin University, Kitakyushu; Department of Neuropsychiatry (K. Yamane, HY, SK), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Section of Pediatrics (HT), Department of Medicine, Fukuoka Dental College; and Fukuoka Children's Hospital (RK, TH), Japan
| | - Yasunari Sakai
- Department of Pediatrics (MT, MI, TS, HI, MO, RT, K. Yonemoto, Y. Ichimiya, Y. Sonoda, M. Sasazuki, Y. Ishizaki, M. Sanefuji, Y. Sakai, SO), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Health and Welfare (M. Sasazuki), Seinan Jogakuin University, Kitakyushu; Department of Neuropsychiatry (K. Yamane, HY, SK), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Section of Pediatrics (HT), Department of Medicine, Fukuoka Dental College; and Fukuoka Children's Hospital (RK, TH), Japan
| | - Shouichi Ohga
- Department of Pediatrics (MT, MI, TS, HI, MO, RT, K. Yonemoto, Y. Ichimiya, Y. Sonoda, M. Sasazuki, Y. Ishizaki, M. Sanefuji, Y. Sakai, SO), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Health and Welfare (M. Sasazuki), Seinan Jogakuin University, Kitakyushu; Department of Neuropsychiatry (K. Yamane, HY, SK), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Section of Pediatrics (HT), Department of Medicine, Fukuoka Dental College; and Fukuoka Children's Hospital (RK, TH), Japan
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13
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Chong PF, Torisu H, Yasumoto S, Okumura A, Mori H, Sato T, Kimura J, Ohga S, Tanaka-Taya K, Kira R. Clinical and electrophysiological features of acute flaccid myelitis: A national cohort study. Clin Neurophysiol 2021; 132:2456-2463. [PMID: 34454273 DOI: 10.1016/j.clinph.2021.07.013] [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: 07/02/2020] [Revised: 07/06/2021] [Accepted: 07/13/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To summarize the neurophysiological properties of acute flaccid myelitis (AFM) and evaluate limb-based motor outcomes. METHODS Nerve conduction studies (NCS) in 49 patients (21 females, 28 males; median age = 52 m) with AFM (median = 7 d after onset; range 1-122 d) were reviewed. Neurophysiological findings, together with treatment and prognosis, and neurophysiology-neuroimaging correlations were analyzed. RESULTS The findings indicated that 64% of paralytic limbs during the acute stage (≤14 d after onset) showed diminished or absent compound muscle action potentials (CMAPs), 79% showed normal motor nerve conduction velocities, 55% showed decreased persistence or absent F-waves, and 95% showed normal sensory nerve conduction velocities. The rate of CMAP abnormalities increased from 41% on days 1-2 to 83% on days 13-14. The reduction in CMAP amplitude was correlated with weaker muscle strength at both the peak neurological deficit and the last follow-up. The baseline limb-based muscle strength at nadir and anterior horn-localized magnetic resonance imaging lesions at recovery stage (>14 d) were strong predictors of outcome at the last follow-up. CONCLUSIONS AFM typically shows neurophysiological features of neuronopathy. SIGNIFICANCE NCS is probably useful in the diagnosis and evaluation of AFM.
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Affiliation(s)
- Pin Fee Chong
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan; Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroyuki Torisu
- Section of Pediatrics, Department of Medicine, Fukuoka Dental College, Fukuoka, Japan
| | - Sawa Yasumoto
- Medical Education Center, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Akihisa Okumura
- Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, Japan
| | - Harushi Mori
- Department of Radiology, Jichi Medical University, Tochigi, Japan
| | - Tatsuharu Sato
- Department of Pediatrics, Nagasaki University Hospital, Nagasaki, Japan
| | - Jun Kimura
- Division of Clinical Electrophysiology, Department of Neurology, University of Iowa Health Care, Iowa City, IA, USA
| | - Shouichi Ohga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Keiko Tanaka-Taya
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Ryutaro Kira
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan.
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14
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Sonoda Y, Sonoda M, Yonemoto K, Sanefuji M, Taira R, Motomura Y, Ishimura M, Torisu H, Kira R, Kusuhara K, Sakai Y, Ohga S. Favorable outcomes of interferon-α and ribavirin treatment for a male with subacute sclerosing panencephalitis. J Neuroimmunol 2021; 358:577656. [PMID: 34304142 DOI: 10.1016/j.jneuroim.2021.577656] [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: 03/15/2021] [Revised: 06/21/2021] [Accepted: 07/05/2021] [Indexed: 10/20/2022]
Abstract
Subacute sclerosing panencephalitis (SSPE) is a slow virus infection associated with mutant measles virus (MeV). The long-term outcome of antiviral treatments remains to be determined. We herein present a Japanese boy who was diagnosed with SSPE at 10 years of age. Intraventricular infusions of interferon-α effectively prevented the progress of symptoms during 14 years of follow-up period. Flow-cytometric analysis demonstrated higher proportion of T helper 17 cells (Th17, 18.2%) than healthy controls (4.8-14.5%) despite the normal subpopulation of peripheral lymphocytes. These data suggest that a group of patients with SSPE may show favorable responses to intraventricular infusions of interferon-α.
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Affiliation(s)
- Yuri Sonoda
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Research Center for Environment and Developmental Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Motoshi Sonoda
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kousuke Yonemoto
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masafumi Sanefuji
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Research Center for Environment and Developmental Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ryoji Taira
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshitomo Motomura
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masataka Ishimura
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroyuki Torisu
- Section of Pediatrics, Department of Medicine, Fukuoka Dental College, Fukuoka, Japan
| | - Ryutaro Kira
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Koichi Kusuhara
- Department of Pediatrics, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yasunari Sakai
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Shouichi Ohga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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15
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Kira R, Bilung LM, Ngui R, Apun K, Su'ut L. Spatially varying correlation between environmental conditions and human leptospirosis in Sarawak, Malaysia. Trop Biomed 2021; 38:31-39. [PMID: 33973570 DOI: 10.47665/tb.38.2.034] [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: 11/21/2022]
Abstract
The spatial distribution of environmental conditions may influence the dynamics of vectorborne diseases like leptospirosis. This study aims to investigate the global and localised relationships between leptospirosis with selected environmental variables. The association between environmental variables and the spatial density of geocoded leptospirosis cases was determined using global Poisson regression (GPR) and geographically weighted Poisson regression (GWPR). A higher prevalence of leptospirosis was detected in areas with higher water vapour pressure (exp(â): 1.12; 95% CI: 1.02 - 1.25) and annual precipitation (exp(â): 1.15; 95% CI: 1.02 - 1.31), with lower precipitation in the driest month (exp(â): 0.85; 95% CI: 0.75 - 0.96) and the wettest quarter (exp(â): 0.88; 95% CI: 0.77 - 1.00). Water vapor pressure (WVP) varied the most in the hotspot regions with a standard deviation of 0.62 (LQ: 0.15; UQ; 0.99) while the least variation was observed in annual precipitation (ANNP) with a standard deviation of 0.14 (LQ: 0.11; UQ; 0.30). The reduction in AICc value from 519.73 to 443.49 indicates that the GWPR model is able to identify the spatially varying correlation between leptospirosis and selected environmental variables. The results of the localised relationships in this study could be used to formulate spatially targeted interventions. This would be particularly useful in localities with a strong environmental or socio-demographical determinants for the transmission of leptospirosis.
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Affiliation(s)
- R Kira
- Faculty of Resource Science and Technology, Universiti Malaysia Sarawak, 94300 Kota Samarahan, Sarawak, Malaysia
| | - L M Bilung
- Faculty of Resource Science and Technology, Universiti Malaysia Sarawak, 94300 Kota Samarahan, Sarawak, Malaysia
| | - R Ngui
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - K Apun
- Faculty of Resource Science and Technology, Universiti Malaysia Sarawak, 94300 Kota Samarahan, Sarawak, Malaysia
| | - L Su'ut
- Faculty of Medicine and Health Science, Universiti Malaysia Sarawak, 94300 Kota Samarahan, Sarawak, Malaysia
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16
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Yada Y, Torio M, Koga Y, Yamashita F, Ichimura T, Eguchi K, Ishimura M, Mushimoto Y, Hiwatashi A, Sasazuki M, Kira R, Sakai Y, Ohga S. Brain-sparing cord blood transplantation for the borderline stage of adrenoleukodystrophy. Mol Genet Metab Rep 2021; 28:100778. [PMID: 34221897 PMCID: PMC8242033 DOI: 10.1016/j.ymgmr.2021.100778] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 06/17/2021] [Accepted: 06/17/2021] [Indexed: 11/30/2022] Open
Abstract
Background Adrenoleukodystrophy (ALD) is an X-linked disorder characterized by rapidly progressive deterioration of neurocognitive functions and premature death. In addition to the difficulty in identifying the earliest signs of ALD, treatment-associated exacerbation of neurological symptoms has been an obstacle to achieve successful hematopoietic cell transplantation (HCT) for affected children. Case report We report a 9-year-boy with ALD. He presented with impairment in social skills compatible to the diagnosis of autism spectrum disorder from 3 years of age. He showed progressive strabismus, slurred speech and dysmetria at 6 years of age. The head MRI showed symmetrical T2-hyperintense lesions in the occipital white matters with a gadolinium enhancement, which extended to the internal capsules. The Loes score was thus calculated as 13. Very-long-chain-fatty-acids were increased to 1.800 (C24:0/C22:0) and 0.077 (C26:0/C22:0) in leukocytes. Sanger sequencing confirmed the pathogenic variant in ABCD1 (NM_000033.4:p.Gly512Ser). After multidisciplinary discussions over the treatment options, we performed a cord blood HCT with a reduced intensity conditioning (fludarabine, melphalan and brain-sparing total body irradiation). He was fully recovered with >90% chimerism of donor leukocytes at 55 days after HCT. He experienced three times of generalized seizures after discharge, that has been well controlled for 2 years without other complications or neurocognitive deteriorations. Conclusion For patients with ALD on a borderline indication for HCT, brain-sparing irradiation might be an alternative option in reduced intensity conditioning. Careful decision-making process and tailored conditioning are critical for the successful outcome of HCT for children with ALD. Therapeutic strategies remain to be established for adrenoleukodystrophy. Multidisciplinary discussions are necessary for making a decision of treatment. A 6-year-old boy achieved a successful engraftment after the transplantation. The brain-sparing method might provide favorable outcomes for adrenoleukodystrophy.
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Affiliation(s)
- Yutaro Yada
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Michiko Torio
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Yuhki Koga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Fumiya Yamashita
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka 813-0017, Japan
| | - Takuya Ichimura
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan.,Department of Pediatrics, Yamaguchi University, Ube 755-8505, Japan
| | - Katsuhide Eguchi
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Masataka Ishimura
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Yuichi Mushimoto
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Akio Hiwatashi
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Momoko Sasazuki
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Ryutaro Kira
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka 813-0017, Japan
| | - Yasunari Sakai
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Shouichi Ohga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
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17
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Azumagawa K, Nakashima I, Kaneko K, Torisu H, Sakai Y, Kira R, Sakuma H, Tanaka K, Shigeri Y, Tanaka Y, Nakajima H, Shimakawa S, Tamai H. A nation-wide survey of Japanese pediatric MOG antibody-associated diseases. Brain Dev 2021; 43:705-713. [PMID: 33610339 DOI: 10.1016/j.braindev.2021.01.008] [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: 07/12/2020] [Revised: 01/20/2021] [Accepted: 01/26/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To elucidate the clinical characteristics of Japanese pediatric patients with acquired demyelinating diseases (ADS), positive for myelin oligodendrocyte glycoprotein antibody (MOG-IgG), we conducted a nation-wide survey. METHODS Information about pediatric patients under 18 years old with ADS was solicited with surveys sent to 323 facilities. In an initial survey, we asked whether the center had any patients with ADS, and the MOG-IgG serostatus of the patients. In a follow-up survey, we requested more precise information on patients with ADS. RESULTS Initial survey: 263 replies providing information on 175 patients were received. MOG-IgG were examined in 78 patients and 54 of those (69%) were positive for MOG-IgG. Follow-up survey: The characteristic involvement was optic neuritis, with visual disturbance and optic pain as characteristic symptoms. The relapse rate was 44% in patients positive for MOG-IgG, which was higher than that in seronegative patients (38%). For acute phase treatments, corticosteroid (CS), plasma exchange, and intravenous immunoglobulin (IVIG) were useful. To prevent relapse, CS, intermittent IVIG, immunosuppressants, and monoclonal antibodies were useful, but the efficacies of disease modifying drugs were uncertain. Sequelae such as visual disturbance, cognitive impairment, motor dysfunction, and epilepsy were observed in 11% of patients with MOG-IgG. CONCLUSIONS MOG antibody-associated diseases were found to be common among pediatric ADS patients. Since a variety of sequelae were observed in these patients, it is important to identify the appropriate treatment to ensure the best outcome. The presence of the MOG autoantibody should be taken into consideration as part of the diagnostic criteria for pediatric ADS.
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Affiliation(s)
- Kohji Azumagawa
- Department of Pediatrics, Seikeikai Hospital, Osaka, Japan; Department of Chemistry, Wakayama Medical University, Wakayama, Japan.
| | - Ichiro Nakashima
- Department of Neurology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Kimihiko Kaneko
- Department of Neurology, Tohoku University School of Medicine, Sendai, Japan
| | - Hiroyuki Torisu
- Department of Pediatrics, Fukuoka Dental College, Fukuoka, Japan
| | - Yasunari Sakai
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ryutaro Kira
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Hiroshi Sakuma
- Department of Brain & Neurosciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Keiko Tanaka
- Brain Research Institute, Niigata University, Niigata, Japan
| | - Yasushi Shigeri
- Department of Chemistry, Wakayama Medical University, Wakayama, Japan
| | - Yoshie Tanaka
- Department of Chemistry, Wakayama Medical University, Wakayama, Japan
| | - Hideto Nakajima
- Division of Neurology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | | | - Hiroshi Tamai
- Department of Pediatrics, Osaka Medical College, Osaka, Japan
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18
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Miyamoto S, Kato M, Hiraide T, Shiohama T, Goto T, Hojo A, Ebata A, Suzuki M, Kobayashi K, Chong PF, Kira R, Matsushita HB, Ikeda H, Hoshino K, Matsufuji M, Moriyama N, Furuyama M, Yamamoto T, Nakashima M, Saitsu H. Comprehensive genetic analysis confers high diagnostic yield in 16 Japanese patients with corpus callosum anomalies. J Hum Genet 2021; 66:1061-1068. [PMID: 33958710 DOI: 10.1038/s10038-021-00932-y] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/12/2021] [Accepted: 04/16/2021] [Indexed: 12/24/2022]
Abstract
Corpus callosum anomalies (CCA) is a common congenital brain anomaly with various etiologies. Although one of the most important etiologies is genetic factors, the genetic background of CCA is heterogenous and diverse types of variants are likely to be causative. In this study, we analyzed 16 Japanese patients with corpus callosum anomalies to delineate clinical features and the genetic background of CCAs. We observed the common phenotypes accompanied by CCAs: intellectual disability (100%), motor developmental delay (93.8%), seizures (60%), and facial dysmorphisms (50%). Brain magnetic resonance imaging showed colpocephaly (enlarged posterior horn of the lateral ventricles, 84.6%) and enlarged supracerebellar cistern (41.7%). Whole exome sequencing revealed genetic alterations in 9 of the 16 patients (56.3%), including 8 de novo alterations (2 copy number variants and variants in ARID1B, CDK8, HIVEP2, and TCF4) and a recessive variant of TBCK. De novo ARID1B variants were identified in three unrelated individuals, suggesting that ARID1B variants are major genetic causes of CCAs. A de novo TCF4 variant and somatic mosaic deletion at 18q21.31-qter encompassing TCF4 suggest an association of TCF4 abnormalities with CCAs. This study, which analyzes CCA patients usung whole exome sequencing, demonstrates that comprehensive genetic analysis would be useful for investigating various causal variants of CCAs.
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Affiliation(s)
- Sachiko Miyamoto
- Department of Biochemistry, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Mitsuhiro Kato
- Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan
| | - Takuya Hiraide
- Department of Biochemistry, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tadashi Shiohama
- Department of Pediatrics, Graduated School of Medicine, Chiba University, Chiba, Japan
| | - Tomohide Goto
- Division of Neurology, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Akira Hojo
- Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan
| | - Akio Ebata
- Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan
| | - Manabu Suzuki
- Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan
| | - Kozue Kobayashi
- Department of Pediatrics, Showa University School of Medicine, 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
| | | | - Hiroko Ikeda
- Department of Pediatrics, National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan
| | - Kyoko Hoshino
- Segawa Memorial Neurological Clinic for Children, Tokyo, Japan
| | - Mayumi Matsufuji
- Department of Pediatrics, Minami Kyushu National Hospital, Aira, Japan
| | - Nobuko Moriyama
- Department of Pediatrics, Hitachi, Ltd., Hitachinaka General Hospital, Hitachinaka, Japan
| | - Masayuki Furuyama
- Department of Pediatrics, Okitama Public General Hospital, Yamagata, Japan
| | - Tatsuya Yamamoto
- Department of Pediatrics, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Mitsuko Nakashima
- Department of Biochemistry, Hamamatsu University School of Medicine, Hamamatsu, Japan.
| | - Hirotomo Saitsu
- Department of Biochemistry, Hamamatsu University School of Medicine, Hamamatsu, Japan.
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19
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Chong PF, Kira R, Torisu H, Yasumoto S, Okumura A, Mori H, Tanaka-Taya K. Three-Year Longitudinal Motor Function and Disability Level of Acute Flaccid Myelitis. Pediatr Neurol 2021; 116:14-19. [PMID: 33388543 DOI: 10.1016/j.pediatrneurol.2020.11.019] [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: 08/17/2020] [Revised: 11/23/2020] [Accepted: 11/27/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND We summarize the long-term motor outcome and disability level in a cluster of pediatric patients with acute flaccid myelitis (AFM) associated with the enterovirus D68 outbreak in 2015. METHODS This is a nationwide follow-up questionnaire analysis study. Clinical data including the motor function (manual muscle strength test) and other neurological symptoms were collected at the acute (nadir), recovery (six months), and chronic (three years) stages. We use the Barthel index, which measures 10 variables describing activity of daily living and mobility to assess the disability level. RESULTS Clinical data of 33 patients with AFM (13 females, 20 males; median age = 4.1 years) were available. Among patients with tetraplegia or triplegia, paraplegia, and monoplegia at the acute stage, two of seven, four of thirteen, and two of thirteen exhibited complete recovery without paralysis; of those five of seven, eight of thirteen, and two of thirteen showed improvement with lesser limb involvement at the chronic stage, respectively. Nine patients (27%) demonstrated improvement at the recovery-to-chronic period. All six patients with positive isolation of enterovirus D68 from biological samples at the acute stage showed persistent motor deficits. Other neurological findings had better prognosis than motor weakness. Better Barthel index score at the chronic stage was observed (P < 0.001; median difference [95% confidence interval], 53 [40 to 63]), implying an improved disability level even in patients with persistent motor deficits. CONCLUSIONS AFM has a high rate of persistent motor deficits showing one- to two-limb paralysis. Disability level of patients with AFM, however, generally improved at the three-year time point.
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Affiliation(s)
- 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
| | - Hiroyuki Torisu
- Department of Pediatrics, Fukuoka Dental College Medical and Dental Hospital, Fukuoka, Japan
| | - Sawa Yasumoto
- Medical Education Center, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Akihisa Okumura
- Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, Japan
| | - Harushi Mori
- Department of Radiology, Graduate School and Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Keiko Tanaka-Taya
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan.
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20
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Matsubara Y, Akamine S, Chong PF, Kawakami S, Maehara K, Kaku Y, Kurokawa M, Morisada N, Iijima K, Kira R. Infantile spasms and early-onset progressive polycystic renal lesions associated with TSC2/PKD1 contiguous gene deletion syndrome. Seizure 2021; 86:82-84. [PMID: 33581549 DOI: 10.1016/j.seizure.2021.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 01/07/2021] [Accepted: 01/25/2021] [Indexed: 01/04/2023] Open
Affiliation(s)
- Yoshie Matsubara
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan.
| | - Satoshi Akamine
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Pin Fee Chong
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Saori Kawakami
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Kenji Maehara
- Department of Nephrology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Yoshitsugu Kaku
- Department of Nephrology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Mari Kurokawa
- Department of Nephrology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Naoya Morisada
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazumoto Iijima
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryutaro Kira
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
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21
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Murphy OC, Messacar K, Benson L, Bove R, Carpenter JL, Crawford T, Dean J, DeBiasi R, Desai J, Elrick MJ, Farias-Moeller R, Gombolay GY, Greenberg B, Harmelink M, Hong S, Hopkins SE, Oleszek J, Otten C, Sadowsky CL, Schreiner TL, Thakur KT, Van Haren K, Carballo CM, Chong PF, Fall A, Gowda VK, Helfferich J, Kira R, Lim M, Lopez EL, Wells EM, Yeh EA, Pardo CA. Acute flaccid myelitis: cause, diagnosis, and management. Lancet 2021; 397:334-346. [PMID: 33357469 PMCID: PMC7909727 DOI: 10.1016/s0140-6736(20)32723-9] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 09/15/2020] [Accepted: 09/17/2020] [Indexed: 12/20/2022]
Abstract
Acute flaccid myelitis (AFM) is a disabling, polio-like illness mainly affecting children. Outbreaks of AFM have occurred across multiple global regions since 2012, and the disease appears to be caused by non-polio enterovirus infection, posing a major public health challenge. The clinical presentation of flaccid and often profound muscle weakness (which can invoke respiratory failure and other critical complications) can mimic several other acute neurological illnesses. There is no single sensitive and specific test for AFM, and the diagnosis relies on identification of several important clinical, neuroimaging, and cerebrospinal fluid characteristics. Following the acute phase of AFM, patients typically have substantial residual disability and unique long-term rehabilitation needs. In this Review we describe the epidemiology, clinical features, course, and outcomes of AFM to help to guide diagnosis, management, and rehabilitation. Future research directions include further studies evaluating host and pathogen factors, including investigations into genetic, viral, and immunological features of affected patients, host-virus interactions, and investigations of targeted therapeutic approaches to improve the long-term outcomes in this population.
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Affiliation(s)
- Olwen C Murphy
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kevin Messacar
- Department of Pediatric Infectious Diseases, Children's Hospital Colorado, Aurora, CO, USA
| | - Leslie Benson
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Riley Bove
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Jessica L Carpenter
- Department of Neurology, Children's National Health System, Washington, DC, USA
| | - Thomas Crawford
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Janet Dean
- International Center for Spinal Cord Injury, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Roberta DeBiasi
- Department of Pediatric Infectious Diseases, Children's National Health System, Washington, DC, USA
| | - Jay Desai
- Division of Neurology, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Matthew J Elrick
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Raquel Farias-Moeller
- Department of Neurology, Children's Hospital of Wisconsin and the Medical College of Wisconsin, Milwaukee, WI, USA
| | - Grace Y Gombolay
- Department of Neurology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Benjamin Greenberg
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Matthew Harmelink
- Department of Neurology, Children's Hospital of Wisconsin and the Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sue Hong
- Division of Pediatric Critical Care, Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sarah E Hopkins
- Division of Neurology, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joyce Oleszek
- Department of Physical Medicine and Rehabilitation, Children's Hospital Colorado, Aurora, CO, USA
| | - Catherine Otten
- Department of Pediatric Neurology, Seattle Children's Hospital, Seattle, WA, USA
| | - Cristina L Sadowsky
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA; International Center for Spinal Cord Injury, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Teri L Schreiner
- Department of Child Neurology, Children's Hospital Colorado, Aurora, CO, USA
| | - Kiran T Thakur
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Keith Van Haren
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Carolina M Carballo
- Department of Infectious Diseases, Hospital de Niños "Ricardo Gutiérrez", Buenos Aires, Argentina
| | - Pin Fee Chong
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Amary Fall
- Institut Pasteur de Dakar, Département de Virologie, Dakar, Senegal
| | - Vykuntaraju K Gowda
- Department of Pediatric Neurology, Indira Gandhi Institute of Child Health, Bangalore, Karnataka, India
| | - Jelte Helfferich
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Ryutaro Kira
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Ming Lim
- Children's Neuroscience Center, Evelina London Children's Hospital, Guy's and St Thomas' NHS Trust, and Faculty of Life Sciences, King's College, London, UK
| | - Eduardo L Lopez
- Department of Infectious Diseases, Hospital de Niños "Ricardo Gutiérrez", Buenos Aires, Argentina
| | - Elizabeth M Wells
- Department of Neurology, Children's National Health System, Washington, DC, USA
| | - E Ann Yeh
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, ON, Canada
| | - Carlos A Pardo
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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22
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Maeda K, Chong PF, Akamine S, Yamashita F, Morooka Y, Mori H, Lee S, Mizuno Y, Kira R. Case Report: Acute Fulminant Cerebral Edema With Perivascular Abnormalities Related to Kawasaki Disease. Front Pediatr 2021; 9:732110. [PMID: 34604143 PMCID: PMC8484865 DOI: 10.3389/fped.2021.732110] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/25/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction: Kawasaki disease (KD) is an acute systemic vasculitis in children, but 0.4% of patients with KD exhibit central nervous system involvement. Acute encephalitis and encephalopathy accompanied with KD have been reported to be mostly self-limiting complications. Case Presentation: A 2-year-old girl developed recurrent vomiting, a cluster of generalized seizures, and decreased consciousness on day 12 after the onset of KD. Magnetic resonance imaging (MRI) T2-weighted images on day 13 showed high signal intensities in bilaterally symmetrical and subcortical white matter and thalamus, and linear radial hyperintensities parallel to the cerebral vessels of the periventricular white matter. Diffuse white matter hyperintensity on the apparent diffusion coefficient map suggested vasogenic edema. Subsequently, lethal cerebral edema rapidly progressed in 8 hrs after the MRI examination. Conclusion: To our knowledge, acute fulminant cerebral edema in patients with KD has not been previously reported. We should be aware of the possibility of severe encephalitis related to KD. Furthermore, diffuse white matter vasogenic edema with perivascular abnormalities on MRI may be an alerm, potentially leading to fatal cerebral edema.
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Affiliation(s)
- Kenichi Maeda
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Pin Fee Chong
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan.,Department of General Pediatrics and Interdisciplinary Medicine, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Satoshi Akamine
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Fumiya Yamashita
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Yuya Morooka
- Department of General Pediatrics and Interdisciplinary Medicine, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Harushi Mori
- Department of Radiology, School of Medicine, Jichi Medical University, Tochigi, Japan
| | - Sooyoung Lee
- Department of Intensive Care, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Yumi Mizuno
- Department of Pediatric Infectious Disease, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Ryutaro Kira
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
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23
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Saitoh A, Saitoh A, Katsuta T, Mine M, Kamiya H, Miyairi I, Ishiwada N, Oshiro M, Kira R, Shimizu N, Suga S, Tsugawa T, Fujioka M, Miyazaki C, Morioka I, Korematsu S, Nakano T, Tanaka-Taya K, Yoshikawa T, Iwata S, Kusuhara K, Azuma H, Moriuchi H, Okabe N, Hosoya M, Tsutsumi H, Okada K. Effect of a vaccine information statement (VIS) on immunization status and parental knowledge, attitudes, and beliefs regarding infant immunization in Japan. Vaccine 2020; 38:8049-8054. [PMID: 33139133 DOI: 10.1016/j.vaccine.2020.10.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 10/07/2020] [Accepted: 10/12/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Because of the overabundance of vaccination information on the internet, in the media, and on social media, providing clear and correct information on immunization is critical for parental decision-making. In 2018, the Japan Pediatric Society created and distributed a Vaccine Information Statement (VIS) to provide appropriate immunization information to caregivers. The objectives of the present study were to evaluate the effect of the VIS on immunization rates, adherence to schedule, and parental understanding of immunization in Japan. METHODS This cross-sectional study was conducted at 18 centers in 2 prefectures in Japan. Caregivers were assigned to an intervention group, which received the VIS and a questionnaire when their child reached the age of 1 month, and a control group, which received only the questionnaire. Using the self-reported questionnaires, we evaluated vaccination rates and schedule adherence at age 2 months, and parental knowledge, attitudes, and beliefs regarding immunization. Three months later, the questionnaires were returned, and the findings were compared between the 2 groups. RESULTS We contacted 422 and 428 persons in the intervention and control groups, respectively, and 111/422 (26.3%) and 119/428 (27.8%) returned the surveys. Vaccination rates and adherence rates for the first dose of 4 recommended vaccines did not differ significantly (P > 0.25); however, there were some positive effects on items related to vaccine knowledge (P = 0.03), perceived benefits (P = 0.02), perceived barriers (P < 0.001), and perceived behavioral control (P = 0.01). CONCLUSION The VIS improved parent comprehension of infant immunization. Future studies should examine if the effects of such an intervention persist and affect vaccine uptake throughout childhood.
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Affiliation(s)
- Aya Saitoh
- Department of Nursing, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
| | - Akihiko Saitoh
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Japan; Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Tomohiro Katsuta
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Japan; Department of Pediatrics, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Mahito Mine
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Japan; Mine Pediatric Clinic, Saitama, Japan
| | - Hajime Kamiya
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Japan; Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Isao Miyairi
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Japan; Division of Infectious Diseases, National Center for Child Health and Development, Tokyo, Japan
| | - Naruhiko Ishiwada
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Japan; Department of Infectious Diseases, Medical Mycology Research Center, Chiba University, Chiba, Japan
| | - Makoto Oshiro
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Japan; Department of Neonatology, Japanese Red Cross Nagoya Daiichi Hospital, Aichi, Japan
| | - Ryutaro Kira
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Japan; Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Naoki Shimizu
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Japan; Department of Pediatrics, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Shigeru Suga
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Japan; Infectious Disease Center and Department of Clinical Research, National Hospital Organization Mie Hospital, Mie, Japan
| | - Takeshi Tsugawa
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Japan; Department of Pediatrics, Sapporo Medical University School of Medicine, Hokkaido, Japan
| | - Masashi Fujioka
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Japan; Fujioka Pediatrics, Osaka, Japan
| | - Chiaki Miyazaki
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Japan; Fukuoka Welfare Center for the Disabled, Fukuoka, Japan
| | - Ichiro Morioka
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Japan; Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Seigo Korematsu
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Japan; Department of Pediatrics, University Faculty of Medicine, Oita, Japan
| | - Takashi Nakano
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Japan; Department of Pediatrics, Kawasaki Medical School, Okayama, Japan
| | - Keiko Tanaka-Taya
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Japan; Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Tetsushi Yoshikawa
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Japan; Department of Pediatrics, Fujita Health University School of Medicine, Aichi, Japan
| | - Satoshi Iwata
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Japan; Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan
| | - Koichi Kusuhara
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Japan; Department of Pediatrics, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Hiroshi Azuma
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Japan; Department of Pediatrics, Asahikawa Medical University, Hokkaido, Japan
| | - Hiroyuki Moriuchi
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Japan; Department of Pediatrics, Nagasaki University, Nagasaki, Japan
| | - Nobuhiko Okabe
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Japan; Kawasaki City Institute for Public Health, Kanagawa, Japan
| | - Mitsuaki Hosoya
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Japan; Department of Pediatrics, Fukushima Medical University, Fukushima, Japan
| | - Hiroyuki Tsutsumi
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Japan; Department of Pediatrics, Sapporo Medical University School of Medicine, Hokkaido, Japan
| | - Kenji Okada
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Japan; Division of Basic Nursing, Fukuoka Nursing College, Fukuoka, Japan
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24
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Hinokuma N, Nakashima M, Asai H, Nakamura K, Akaboshi S, Fukuoka M, Togawa M, Oana S, Ohno K, Kasai M, Ogawa C, Yamamoto K, Okumiya K, Chong PF, Kira R, Uchino S, Fukuyama T, Shinagawa T, Miyata Y, Abe Y, Hojo A, Kobayashi K, Maegaki Y, Ishikawa N, Ikeda H, Amamoto M, Mizuguchi T, Iwama K, Itai T, Miyatake S, Saitsu H, Matsumoto N, Kato M. Clinical and genetic characteristics of patients with Doose syndrome. Epilepsia Open 2020; 5:442-450. [PMID: 32913952 PMCID: PMC7469791 DOI: 10.1002/epi4.12417] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 06/19/2020] [Accepted: 06/28/2020] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE To elucidate the genetic background and genotype-phenotype correlations for epilepsy with myoclonic-atonic seizures, also known as myoclonic-astatic epilepsy (MAE) or Doose syndrome. METHODS We collected clinical information and blood samples from 29 patients with MAE. We performed whole-exome sequencing for all except one MAE case in whom custom capture sequencing identified a variant. RESULTS We newly identified four variants: SLC6A1 and HNRNPU missense variants and microdeletions at 2q24.2 involving SCN1A and Xp22.31 involving STS. Febrile seizures preceded epileptic or afebrile seizures in four patients, of which two patients had gene variants. Myoclonic-atonic seizures occurred at onset in four patients, of which two had variants, and during the course of disease in three patients. Variants were more commonly identified in patients with a developmental delay or intellectual disability (DD/ID), but genetic status was not associated with the severity of DD/ID. Attention-deficit/hyperactivity disorder and autistic spectrum disorder were less frequently observed in patients with variants than in those with unknown etiology. SIGNIFICANCE MAE patients had genetic heterogeneity, and HNRNPU and STS emerged as possible candidate causative genes. Febrile seizures prior to epileptic seizures and myoclonic-atonic seizure at onset indicate a genetic predisposition to MAE. Comorbid conditions were not related to genetic predisposition to MAE.
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Affiliation(s)
- Nodoka Hinokuma
- Department of PediatricsShowa University School of MedicineTokyoJapan
| | - Mitsuko Nakashima
- Department of BiochemistryHamamatsu University School of MedicineHamamatsuJapan
- Department of Human GeneticsYokohama City University Graduate School of MedicineYokohamaJapan
| | - Hideyuki Asai
- Department of PediatricsShowa University School of MedicineTokyoJapan
| | - Kazuyuki Nakamura
- Department of PediatricsYamagata University Faculty of MedicineYamagataJapan
| | | | - Masataka Fukuoka
- Shizuoka Institute of Epilepsy and Neurological DisordersShizuokaJapan
| | - Masami Togawa
- Department of PediatricsTottori Prefectural Central HospitalTottoriJapan
| | - Shingo Oana
- Department of PediatricsTokyo Medical UniversityTokyoJapan
| | - Koyo Ohno
- Division of Child NeurologyInstitute of Neurological SciencesFaculty of MedicineTottori UniversityYonagoJapan
| | - Mariko Kasai
- Department of Developmental Medical Sciences Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Chikako Ogawa
- Department of PediatricsNagoya University Graduate School of MedicineAichiJapan
| | - Kazuna Yamamoto
- Department of PediatricsTeikyo University School of MedicineTokyoJapan
| | - Kiyohito Okumiya
- Department of Pediatrics and Child HealthKurume University School of MedicineFukuokaJapan
| | - Pin Fee Chong
- Department of Pediatric NeurologyFukuoka Children's HospitalFukuokaJapan
| | - Ryutaro Kira
- Department of Pediatric NeurologyFukuoka Children's HospitalFukuokaJapan
| | - Shumpei Uchino
- Department of NeuropediatricsTokyo Metropolitan Neurological HospitalTokyoJapan
- Department of PediatricsThe University of TokyoTokyoJapan
| | - Tetsuhiro Fukuyama
- Department of PediatricsShinshu University School of MedicineMatsumotoJapan
| | | | - Yohane Miyata
- Department of PediatricsKyorin University Faculty of MedicineTokyoJapan
| | - Yuichi Abe
- Department of PediatricsSaitama Medical UniversityMoroyamaJapan
- Division of NeurologyNational Center for Child Health and DevelopmentTokyoJapan
| | - Akira Hojo
- Department of PediatricsShowa University School of MedicineTokyoJapan
| | - Kozue Kobayashi
- Department of PediatricsShowa University School of MedicineTokyoJapan
| | - Yoshihiro Maegaki
- Division of Child NeurologyInstitute of Neurological SciencesFaculty of MedicineTottori UniversityYonagoJapan
| | | | - Hiroko Ikeda
- Shizuoka Institute of Epilepsy and Neurological DisordersShizuokaJapan
| | - Masano Amamoto
- Kitakyushu City Yahata Hospital Pediatric Emergency/Children’s Medical CenterFukuokaJapan
| | - Takeshi Mizuguchi
- Department of Human GeneticsYokohama City University Graduate School of MedicineYokohamaJapan
| | - Kazuhiro Iwama
- Department of Human GeneticsYokohama City University Graduate School of MedicineYokohamaJapan
| | - Toshiyuki Itai
- Department of Human GeneticsYokohama City University Graduate School of MedicineYokohamaJapan
| | - Satoko Miyatake
- Department of Human GeneticsYokohama City University Graduate School of MedicineYokohamaJapan
| | - Hirotomo Saitsu
- Department of BiochemistryHamamatsu University School of MedicineHamamatsuJapan
- Department of Human GeneticsYokohama City University Graduate School of MedicineYokohamaJapan
| | - Naomichi Matsumoto
- Department of Human GeneticsYokohama City University Graduate School of MedicineYokohamaJapan
| | - Mitsuhiro Kato
- Department of PediatricsShowa University School of MedicineTokyoJapan
- Department of PediatricsYamagata University Faculty of MedicineYamagataJapan
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25
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Chong PF, Yoshida T, Yuasa S, Mori H, Tanaka-Taya K, Kira R. Acute Flaccid Myelitis With Neuroradiological Finding of Brachial Plexus Swelling. Pediatr Neurol 2020; 109:85-88. [PMID: 32409123 DOI: 10.1016/j.pediatrneurol.2020.04.004] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/03/2020] [Accepted: 04/04/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND Acute flaccid myelitis is a recently defined clinically distinct syndrome of polio-like acute flaccid paralysis. Acute flaccid myelitis cases show characteristic neuroradiological features of longitudinal spinal cord lesions with predominant gray matter involvement. Current evidence suggests injury to the anterior horn neurons as the underlying mechanism. METHODS We describe three patients with acute flaccid myelitis who developed flaccid upper limb weakness with diminished deep tendon reflexes after prodromal fever. Spinal magnetic resonance imaging (MRI) (axial and sagittal T1- and T2-weighted sequences) and brachial plexus MRI (coronal short tau inversion recovery sequence) at the acute stage were performed. RESULTS Spinal MRI showed extensive longitudinal lesion in the spinal cord with predominant gray matter involvement. We were able to demonstrate concurrent swelling and hyperintensity in the brachial plexus in all the three patients at the acute stage. CONCLUSION The coexisting signal intensities suggest an extension of acute flaccid myelitis pathology to the brachial plexus, highlighting the possible peripheral nerve involvement in acute flaccid myelitis.
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Affiliation(s)
- Pin Fee Chong
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan.
| | - Takeshi Yoshida
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shota Yuasa
- Department of Pediatrics, Kameda Medical Center, Chiba, Japan
| | - Harushi Mori
- Department of Radiology, Graduate School and Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Keiko Tanaka-Taya
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Ryutaro Kira
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
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26
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Nakamura R, Chong PF, Haraguchi K, Katano H, Tanaka-Taya K, Kira R. Disseminated cortical and subcortical lesions in neonatal enterovirus 71 encephalitis. J Neurovirol 2020; 26:790-792. [PMID: 32671810 DOI: 10.1007/s13365-020-00843-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 04/03/2020] [Accepted: 04/13/2020] [Indexed: 11/26/2022]
Abstract
Enteroviruses are one of the most important causes of viral encephalitis in the neonatal period. However, the non-specificity of the symptoms presented renders its diagnosis challenging. Intracranial MRI has been reported to be a very useful imaging modality that can detect the characteristic white matter lesions around the periventricular regions. In this study, we report a case of a patient with neonatal encephalitis who presented with normal white blood cell counts in the initial cerebrospinal fluid analysis. A lumbar puncture retap identified pleocytosis, and polymerase chain reaction assays detected enterovirus 71 in the blood and stool samples. Furthermore, MRI revealed atypical disseminated cortical and subcortical white matter lesions on diffusion weighted images, and neuroradiological re-evaluation showed necrotic changes 2 weeks later. This unique case expands our knowledge of the spectrum of neurological disorders due to enterovirus 71 infection in neonatal period.
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Affiliation(s)
- Ryoko Nakamura
- Department of Pediatric Neurology, Fukuoka Children's Hospital, 5-1-1 Kashiiteriha Higashi-ku, Fukuoka, 813-0017, Japan
| | - Pin Fee Chong
- Department of Pediatric Neurology, Fukuoka Children's Hospital, 5-1-1 Kashiiteriha Higashi-ku, Fukuoka, 813-0017, Japan.
| | - Kohei Haraguchi
- Department of Pediatric Neurology, Fukuoka Children's Hospital, 5-1-1 Kashiiteriha Higashi-ku, Fukuoka, 813-0017, Japan
| | - Harutaka Katano
- Department of Pathology, National Institute of Infectious Diseases, Tokyo, Japan
| | - Keiko Tanaka-Taya
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Ryutaro Kira
- Department of Pediatric Neurology, Fukuoka Children's Hospital, 5-1-1 Kashiiteriha Higashi-ku, Fukuoka, 813-0017, Japan
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27
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Kawakami S, Akamine S, Chong PF, Yamashita F, Maeda K, Takahashi T, Kira R. Isolated cranial neuritis of the oculomotor nerve: Expanding the MOG phenotype? Mult Scler Relat Disord 2020; 41:102040. [PMID: 32182468 DOI: 10.1016/j.msard.2020.102040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/21/2020] [Accepted: 03/02/2020] [Indexed: 11/24/2022]
Abstract
Autoantibody against myelin oligodendrocyte glycoprotein (MOG) has been reported in a range of demyelinating neurological entities. Recent studies demonstrate a wider spectrum of MOG-IgG-associated disorders with the discovery of MOG-IgG-positive brainstem encephalitis, cortical encephalitis, and cranial nerve involvement with concurrent central nervous system involvement. We present a MOG-IgG-positive pediatric patient diagnosed with isolated oculomotor neuritis without concurrent central nervous system neuroimaging lesions, in the absence of a demyelinating event. Brain MRI shows swelling and gadolinium enhancement of the left oculomotor nerve at the cisternal segment. This is the first report to demonstrate MOG-IgG seropositivity in isolated cranial nerve lesions. This case may expand the clinical phenotype of MOG-IgG-associated diseases, and clinicians should not hesitate to test for MOG-IgG in cases with neuroimaging features of cranial neuritis alone.
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Affiliation(s)
- Saori Kawakami
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan.
| | - Satoshi Akamine
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Pin Fee Chong
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Fumiya Yamashita
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Kenichi Maeda
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Toshiyuki Takahashi
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Neurology, National Hospital Organization Yonezawa Hospital, Yonezawa, Japan
| | - Ryutaro Kira
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
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28
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Chong PF, Kira R. Letter to the Editor. J Paediatr Child Health 2020; 56:348-349. [PMID: 32045130 DOI: 10.1111/jpc.14785] [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] [Received: 10/30/2019] [Revised: 12/23/2019] [Accepted: 01/08/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Pin F Chong
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Ryutaro Kira
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
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29
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Yigit G, Saida K, DeMarzo D, Miyake N, Fujita A, Yang Tan T, White SM, Wadley A, Toliat MR, Motameny S, Franitza M, Stutterd CA, Chong PF, Kira R, Sengoku T, Ogata K, Guillen Sacoto MJ, Fresen C, Beck BB, Nürnberg P, Dieterich C, Wollnik B, Matsumoto N, Altmüller J. The recurrent postzygotic pathogenic variant p.Glu47Lys in RHOA causes a novel recognizable neuroectodermal phenotype. Hum Mutat 2019; 41:591-599. [PMID: 31821646 DOI: 10.1002/humu.23964] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 11/29/2019] [Accepted: 12/02/2019] [Indexed: 01/24/2023]
Abstract
RHOA is a member of the Rho family of GTPases that are involved in fundamental cellular processes including cell adhesion, migration, and proliferation. RHOA can stimulate the formation of stress fibers and focal adhesions and is a key regulator of actomyosin dynamics in various tissues. In a Genematcher-facilitated collaboration, we were able to identify four unrelated individuals with a specific phenotype characterized by hypopigmented areas of the skin, dental anomalies, body asymmetry, and limb length discrepancy due to hemihypotrophy of one half of the body, as well as brain magnetic resonance imaging (MRI) anomalies. Using whole-exome and ultra-deep amplicon sequencing and comparing genomic data of affected and unaffected areas of the skin, we discovered that all four individuals carried the identical RHOA missense variant, c.139G>A; p.Glu47Lys, in a postzygotic state. Molecular modeling and in silico analysis of the affected p.Glu47Lys residue in RHOA indicated that this exchange is predicted to specifically alter the interaction of RHOA with its downstream effectors containing a PKN-type binding domain and thereby disrupts its ability to activate signaling. Our findings indicate that the recurrent postzygotic RHOA missense variant p.Glu47Lys causes a specific mosaic disorder in humans.
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Affiliation(s)
- Gökhan Yigit
- Institute of Human Genetics, University Medical Center Göttingen, Göttingen, Germany
| | - Ken Saida
- Department of Human Genetics, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Danielle DeMarzo
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Noriko Miyake
- Department of Human Genetics, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Atsushi Fujita
- Department of Human Genetics, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Tiong Yang Tan
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Susan M White
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Alexandrea Wadley
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Mohammad R Toliat
- Cologne Center for Genomics, University of Cologne, Cologne, Germany
| | - Susanne Motameny
- Cologne Center for Genomics, University of Cologne, Cologne, Germany
| | - Marek Franitza
- Cologne Center for Genomics, University of Cologne, Cologne, Germany
| | - Chloe A Stutterd
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Pin F Chong
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Ryutaro Kira
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Toru Sengoku
- Department of Biochemistry, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Kazuhiro Ogata
- Department of Biochemistry, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | | | - Christine Fresen
- Department of Psychosomatics and Psychotherapy, University Hospital Cologne, Cologne, Germany
| | - Bodo B Beck
- Institute of Human Genetics, University Hospital Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany.,Center for Rare Diseases Cologne (ZSEK), University of Cologne, Cologne, Germany
| | - Peter Nürnberg
- Cologne Center for Genomics, University of Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Christoph Dieterich
- Department of Internal Medicine III, Partner Site Heidelberg/Mannheim, DZHK (German Centre for Cardiovascular Research), University Hospital Heidelberg, Heidelberg, Germany
| | - Bernd Wollnik
- Institute of Human Genetics, University Medical Center Göttingen, Göttingen, Germany.,Cluster of Excellence "Multiscale Bioimaging: from Molecular Machines to Networks of Excitable Cells" (MBExC), University of Göttingen, Göttingen, Germany
| | - Naomichi Matsumoto
- Department of Human Genetics, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Janine Altmüller
- Cologne Center for Genomics, University of Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
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30
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Kinoshita K, Ishizaki Y, Yamamoto H, Sonoda M, Yonemoto K, Kira R, Sanefuji M, Ueda A, Matsui H, Ando Y, Sakai Y, Ohga S. De novo p.G696S mutation in COL4A1 causes intracranial calcification and late-onset cerebral hemorrhage: A case report and review of the literature. Eur J Med Genet 2019; 63:103825. [PMID: 31857254 DOI: 10.1016/j.ejmg.2019.103825] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 06/05/2019] [Revised: 11/16/2019] [Accepted: 12/14/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND The collagen type IV alpha 1 chain (COL4A1) is an essential component of the basement membrane in small vessels. Pathogenic variants in COL4A1 cause perinatal cerebral hemorrhages in an autosomal-dominant fashion. However, little is known about the long-term outcomes of patients with mildly affecting COL4A1 mutations. CASE REPORT We report a 17-year-old boy, who presented with recurrent intracranial hemorrhages in the periventricular white matter. He had been followed-up as a child with cerebral palsy bearing intracranial calcifications, developmental delay and epilepsy. Screening tests in infancy provided negative results for intrauterine infections. Severe motor and cognitive deficits persisted after admission. Carbazochrome was introduced on day 19 of admission, which appeared to prevent extension and reactivation of cerebral hemorrhages for over 6 months after discharge. RESULTS Targeted sequencing of NOTCH3 and TREX1 excluded causal mutations in these genes. The whole-exome sequencing revealed that he carried a de novo mutation in COL4A1 (p.Gly696Ser). An overview of the literature for 345 cases with COL4A1 mutations supported evidence that p.Gly696Ser is associated with the unique phenotype of late-onset hemorrhage among patients with COL4A1-associated cerebral angiopathy. CONCLUSIONS This case first demonstrates that infants with COL4A1-associated leukoencephalopathy and calcifications have a risk for developing the rupture of small vessels in the cerebral white matter after 10 years of age.
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Affiliation(s)
- Keishiro Kinoshita
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshito Ishizaki
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroyuki Yamamoto
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Motoshi Sonoda
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kousuke Yonemoto
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | - Masafumi Sanefuji
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akihiko Ueda
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hirotaka Matsui
- Department of Molecular Laboratory Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yukio Ando
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yasunari Sakai
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Shouichi Ohga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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31
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Maeda K, Chong PF, Yamashita F, Akamine S, Kawakami S, Saito K, Takahata Y, Kira R. Global Central Nervous System Atrophy in Spinal Muscular Atrophy Type 0. Ann Neurol 2019; 86:801-802. [DOI: 10.1002/ana.25596] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 08/16/2019] [Accepted: 08/16/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Kenichi Maeda
- Department of Pediatric NeurologyFukuoka Children's Hospital Fukuoka
| | - Pin Fee Chong
- Department of Pediatric NeurologyFukuoka Children's Hospital Fukuoka
| | - Fumiya Yamashita
- Department of Pediatric NeurologyFukuoka Children's Hospital Fukuoka
| | - Satoshi Akamine
- Department of Pediatric NeurologyFukuoka Children's Hospital Fukuoka
| | - Saori Kawakami
- Department of Pediatric NeurologyFukuoka Children's Hospital Fukuoka
| | - Kayoko Saito
- Institute of Medical GeneticsTokyo Women's Medical University Tokyo
| | - Yasushi Takahata
- Department of NeonatologyFukuoka Children's Hospital Fukuoka Japan
| | - Ryutaro Kira
- Department of Pediatric NeurologyFukuoka Children's Hospital Fukuoka
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32
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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.
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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
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Sasazuki M, Sakai Y, Kira R, Toda N, Ichimiya Y, Akamine S, Torio M, Ishizaki Y, Sanefuji M, Narama M, Itai K, Hara T, Takada H, Kizawa Y, Ohga S. Decision-making dilemmas of paediatricians: a qualitative study in Japan. BMJ Open 2019; 9:e026579. [PMID: 31431444 PMCID: PMC6707677 DOI: 10.1136/bmjopen-2018-026579] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To delineate the critical decision-making processes that paediatricians apply when treating children with life-threatening conditions and the psychosocial experience of paediatricians involved in such care. DESIGN We conducted semistructured, individual face-to-face interviews for each participant from 2014 to 2015. The content of each interview was subjected to a comprehensive qualitative analysis. The categories of dilemma were extracted from a second-round content analysis. PARTICIPANTS Participants were board-certified paediatricians with sufficient experience in making decisions in relation to children with severe illnesses or disabilities. We repeated purposive sampling and analyses until we reached saturation of the category data. RESULTS We performed interviews with 15 paediatricians. They each reported both unique and overlapping categories of dilemmas that they encountered when making critical decisions. The dilemmas included five types of causal elements: (1) paediatricians' convictions; (2) the quest for the best interests of patients; (3) the quest for medically appropriate plans; (4) confronting parents and families and (5) socioenvironmental issues. Dilemmas occurred and developed as conflicting interactions among these five elements. We further categorised these five elements into three principal domains: the decision-maker (decider); consensus making among families, colleagues and society (process) and the consequential output of the decision (consequence). CONCLUSIONS This is the first qualitative study to demonstrate the framework of paediatricians' decision-making processes and the complex structures of dilemmas they face. Our data indicate the necessity of establishing and implementing an effective support system for paediatricians, such as structured professional education and arguments for creating social consensus that assist them to reach the best plan for the management of severely ill children.
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Affiliation(s)
- Momoko Sasazuki
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Health and Welfare, Seinan Jogakuin University, Kitakyushu, Japan
| | - Yasunari Sakai
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ryutaro Kira
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Naoko Toda
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuko Ichimiya
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoshi Akamine
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Michiko Torio
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshito Ishizaki
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masafumi Sanefuji
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Miho Narama
- Department of Nursing, Kyoto Tachibana University, Kyoto, Japan
| | - Koichiro Itai
- Department of Bio/Medical Ethics, Interdisciplinary Graduate School of Medicine and Veterinary Medicine, University of Miyazaki, Miyazaki, Japan
| | - Toshiro Hara
- President, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Hidetoshi Takada
- Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yoshiyuki Kizawa
- Department of Palliative Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Shouichi Ohga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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34
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Affiliation(s)
- 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
| | - Keiko Tanaka-Taya
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
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35
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Ogata R, Chong PF, Maeda K, Imagi T, Nakamura R, Kawamura N, Kira R. Long surviving classical Menkes disease treated with weekly intravenous copper therapy. J Trace Elem Med Biol 2019; 54:172-174. [PMID: 31109608 DOI: 10.1016/j.jtemb.2019.04.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 10/11/2018] [Revised: 04/03/2019] [Accepted: 04/29/2019] [Indexed: 10/26/2022]
Abstract
Menkes diseases (MD) is an X-linked recessive neurodegenerative disorder of copper metabolism, characterized by progressive multisystemic involvement. Death in the early childhood is usually observed in classical patients. Although a definite cure has not been established, copper replacement therapy administered parenterally may modify the severity of MD and permitted survival into adolescence. Subcutaneous copper-histidine supplementation is the current choice of therapy, and long-term administration is not desirable because of the expected nephrotoxicity. We report here the case of a 29-year-old male with MD who tolerated long-term intravenous copper therapy initiated at 2 months. Molecular analysis revealed hemizygous deletion mutation of ATP7A previously reported in classical MD. Although neurodevelopement is poor, no major event of central nervous system is observed, and he enjoys a good social life by interacting using gestures. Optimum management is unknown, and closed follow-up is mandatory for clarification of this phenotype.
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Affiliation(s)
- Reina Ogata
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Pin Fee Chong
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan.
| | - Kenichi Maeda
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Toru Imagi
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Ryoko Nakamura
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Nobuko Kawamura
- Department of Clinical Radiology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Ryutaro Kira
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
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Takata A, Nakashima M, Saitsu H, Mizuguchi T, Mitsuhashi S, Takahashi Y, Okamoto N, Osaka H, Nakamura K, Tohyama J, Haginoya K, Takeshita S, Kuki I, Okanishi T, Goto T, Sasaki M, Sakai Y, Miyake N, Miyatake S, Tsuchida N, Iwama K, Minase G, Sekiguchi F, Fujita A, Imagawa E, Koshimizu E, Uchiyama Y, Hamanaka K, Ohba C, Itai T, Aoi H, Saida K, Sakaguchi T, Den K, Takahashi R, Ikeda H, Yamaguchi T, Tsukamoto K, Yoshitomi S, Oboshi T, Imai K, Kimizu T, Kobayashi Y, Kubota M, Kashii H, Baba S, Iai M, Kira R, Hara M, Ohta M, Miyata Y, Miyata R, Takanashi JI, Matsui J, Yokochi K, Shimono M, Amamoto M, Takayama R, Hirabayashi S, Aiba K, Matsumoto H, Nabatame S, Shiihara T, Kato M, Matsumoto N. Comprehensive analysis of coding variants highlights genetic complexity in developmental and epileptic encephalopathy. Nat Commun 2019; 10:2506. [PMID: 31175295 PMCID: PMC6555845 DOI: 10.1038/s41467-019-10482-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [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: 11/26/2018] [Accepted: 05/13/2019] [Indexed: 12/30/2022] Open
Abstract
Although there are many known Mendelian genes linked to epileptic or developmental and epileptic encephalopathy (EE/DEE), its genetic architecture is not fully explained. Here, we address this incompleteness by analyzing exomes of 743 EE/DEE cases and 2366 controls. We observe that damaging ultra-rare variants (dURVs) unique to an individual are significantly overrepresented in EE/DEE, both in known EE/DEE genes and the other non-EE/DEE genes. Importantly, enrichment of dURVs in non-EE/DEE genes is significant, even in the subset of cases with diagnostic dURVs (P = 0.000215), suggesting oligogenic contribution of non-EE/DEE gene dURVs. Gene-based analysis identifies exome-wide significant (P = 2.04 × 10−6) enrichment of damaging de novo mutations in NF1, a gene primarily linked to neurofibromatosis, in infantile spasm. Together with accumulating evidence for roles of oligogenic or modifier variants in severe neurodevelopmental disorders, our results highlight genetic complexity in EE/DEE, and indicate that EE/DEE is not an aggregate of simple Mendelian disorders. Many causative genes are known for epileptic or developmental and epileptic encephalopathies (EE/DEE) yet a genetic diagnosis cannot be made for many patients. Here, the authors analyse whole exome sequencing data from a Japanese case−control cohort to identify common, rare and ultra-rare coding variants associated with EE/DEE.
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Affiliation(s)
- Atsushi Takata
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
| | - Mitsuko Nakashima
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.,Department of Biochemistry, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan
| | - Hirotomo Saitsu
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.,Department of Biochemistry, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan
| | - Takeshi Mizuguchi
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Satomi Mitsuhashi
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Yukitoshi Takahashi
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, 886 Urushiyama, Aoi-ku, Shizuoka, 420-8688, Japan
| | - Nobuhiko Okamoto
- Department of Medical Genetics, Osaka Women's and Children's Hospital, 840 Murodo-cho, Izumi, Osaka, 594-1101, Japan
| | - Hitoshi Osaka
- Department of Pediatrics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, 329-0498, Japan
| | - Kazuyuki Nakamura
- Department of Pediatrics, Yamagata University Faculty of Medicine, 2-2-2 Iida-nishi, Yamagata, 990-9585, Japan
| | - Jun Tohyama
- Department of Child Neurology, NHO Nishiniigata Chuo Hospital, 1-14-1 Masago, Nishi-ku, Niigata, 950-2085, Japan
| | - Kazuhiro Haginoya
- Department of Pediatric Neurology, Miyagi Children's Hospital, 4-3-17 Ochiai, Aoba-ku, Sendai, 989-3126, Japan
| | - Saoko Takeshita
- Department of Pediatrics, Yokohama City University Medical Center, 4-57 Urafunecho, Minami-ku, Yokohama, 232-0024, Japan
| | - Ichiro Kuki
- Department of Pediatric Neurology, Osaka City General Hospital, 2-13-22 Miyakojimahondori, Miyakojima-ku, Osaka, 534-0021, Japan
| | - Tohru Okanishi
- Department of Child Neurology, Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Naka-ku, Hamamatsu, 430-8558, Japan
| | - Tomohide Goto
- Division of Neurology, Kanagawa Children's Medical Center, 2-138-4 Mutsukawa, Minami-ku, Yokohama, 232-8555, Japan
| | - Masayuki Sasaki
- Department of Child Neurology, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi, Kodaira, 187-8551, Japan
| | - Yasunari Sakai
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Noriko Miyake
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Satoko Miyatake
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Naomi Tsuchida
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Kazuhiro Iwama
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Gaku Minase
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Futoshi Sekiguchi
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Atsushi Fujita
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Eri Imagawa
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Eriko Koshimizu
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Yuri Uchiyama
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Kohei Hamanaka
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Chihiro Ohba
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Toshiyuki Itai
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Hiromi Aoi
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Ken Saida
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Tomohiro Sakaguchi
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Kouhei Den
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Rina Takahashi
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Hiroko Ikeda
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, 886 Urushiyama, Aoi-ku, Shizuoka, 420-8688, Japan
| | - Tokito Yamaguchi
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, 886 Urushiyama, Aoi-ku, Shizuoka, 420-8688, Japan
| | - Kazuki Tsukamoto
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, 886 Urushiyama, Aoi-ku, Shizuoka, 420-8688, Japan
| | - Shinsaku Yoshitomi
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, 886 Urushiyama, Aoi-ku, Shizuoka, 420-8688, Japan
| | - Taikan Oboshi
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, 886 Urushiyama, Aoi-ku, Shizuoka, 420-8688, Japan
| | - Katsumi Imai
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, 886 Urushiyama, Aoi-ku, Shizuoka, 420-8688, Japan
| | - Tomokazu Kimizu
- Department of Pediatric Neurology, Osaka Women's and Children's Hospital, 840 Murodo-cho, Izumi, Osaka, 594-1101, Japan
| | - Yu Kobayashi
- Department of Child Neurology, NHO Nishiniigata Chuo Hospital, 1-14-1 Masago, Nishi-ku, Niigata, 950-2085, Japan
| | - Masaya Kubota
- Division of Neurology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Hirofumi Kashii
- Division of Neurology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Shimpei Baba
- Department of Child Neurology, Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Naka-ku, Hamamatsu, 430-8558, Japan
| | - Mizue Iai
- Division of Neurology, Kanagawa Children's Medical Center, 2-138-4 Mutsukawa, Minami-ku, Yokohama, 232-8555, Japan
| | - Ryutaro Kira
- Department of Pediatric Neurology, Fukuoka Children's Hospital, 5-1-1 Kashiiteriha, Higashi-ku, Fukuoka, 813-0017, Japan
| | - Munetsugu Hara
- Department of Pediatrics and Child Health, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Masayasu Ohta
- Department of Neuropediatrics, Aiseikai Memorial Ibaraki Welfare Medical Center, 1872-1 Motoyoshida-cho, Mito, 310-0836, Japan
| | - Yohane Miyata
- Department of Neuropediatrics, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu, 183-0042, Japan
| | - Rie Miyata
- Department of Pediatrics, Tokyo-kita Medical Center, 4-17-56 Akabanedai, Kita-ku, Tokyo, 115-0053, Japan
| | - Jun-Ichi Takanashi
- Department of Pediatrics, Tokyo Women's Medical University Yachiyo Medical Center, 477-96 Owadashinden, Yachiyo, 276-8524, Japan
| | - Jun Matsui
- Department of Pediatrics, Shiga University of Medical Science, Setatsukinowacho, Otsu, 520-2192, Japan
| | - Kenji Yokochi
- Department of Pediatric Neurology, Seirei-Mikatahara General Hospital, 3453 Mikatahara-cho, Kita-ku, Hamamatsu, 431-1304, Japan
| | - Masayuki Shimono
- Department of Pediatrics, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Masano Amamoto
- Kutakyushu Municipal Yahata Hospital Pediatric Emergency Center, 4-18-1 Nishihonmachi, Yahatahigashi-ku, Kutakyushu, 805-8534, Japan
| | - Rumiko Takayama
- Hokkaido Medical Center for Child Health and Rehabilitation, 1-240-6 Kanayama 1-jo, Teine-ku, Sapporo, 006-0041, Japan
| | - Shinichi Hirabayashi
- Division of Neurology, Nagano Children's Hospital, 3100 Toyoshina, Azumino, 399-8288, Japan
| | - Kaori Aiba
- Department of Pediatrics, Toyohashi Municipal Hospital, 50 Aza Hachiken Nishi, Aotake-Cho, Toyohashi, 441-8570, Japan
| | - Hiroshi Matsumoto
- Department of Pediatrics, National Defense Medical College, 3-2 Namiki, Tokorozawa, 359-8513, Japan
| | - Shin Nabatame
- Department of Pediatrics, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, 565-0871, Japan
| | - Takashi Shiihara
- Department of Neurology, Gunma Children's Medical Center, 779 Shimohakoda, Hokkitsu-machi, Shibukawa, 377-8577, Japan
| | - Mitsuhiro Kato
- Department of Pediatrics, Yamagata University Faculty of Medicine, 2-2-2 Iida-nishi, Yamagata, 990-9585, Japan.,Department of Pediatrics, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan
| | - Naomichi Matsumoto
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
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Okumura A, Mori H, Fee Chong P, Kira R, Torisu H, Yasumoto S, Shimizu H, Fujimoto T, Tanaka-Taya K. Serial MRI findings of acute flaccid myelitis during an outbreak of enterovirus D68 infection in Japan. Brain Dev 2019; 41:443-451. [PMID: 30594353 DOI: 10.1016/j.braindev.2018.12.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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: 10/05/2018] [Revised: 11/21/2018] [Accepted: 12/06/2018] [Indexed: 12/31/2022]
Abstract
OBJECIVE To clarify the neuroimaging findings of children with acute flaccid myelitis during an outbreak of EV-D68 infection. METHODS We performed a detailed review of the spinal and cranial MRI results of 54 children with acute flaccid myelitis. We focused on the range of longitudinal lesions, the localization and appearance of lesions within a horizontal section, Gadolinium-enhancement, and changes over time. RESULTS All children had longitudinal spinal lesions involving central gray matter. Twenty-six children had lesions spanning the entire spine. Six of them had weakness in all limbs, whereas seven had weakness of only one limb. Thirty-eight children had lesions in both gray and white matter and limb weakness tended to be more severe in these children. During the acute period, spinal lesions showed bilateral ill-defined widespread T2 hyperintensity. During the subacute period, lesions were well defined and confined to the anterior horn. The distribution of limb weakness was correlated with the appearance of lesions during the subacute period. Gadolinium enhancement was performed in 37 children, and enhancement was seen in the cauda equina in 29 children. Enhancement was infrequent within 2 days after onset but was seen in almost all children thereafter. Twenty-two children had brainstem lesions continuous with spinal lesions. CONCLUSION Extensive longitudinal spinal lesions were characteristic in children with acute flaccid myelitis. Lesions were usually bilateral and widespread during the acute period, whereas localization to the anterior horn could become obvious. Although enhancement of the cauda equina was often observed, its appearance was sometimes delayed.
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Affiliation(s)
- Akihisa Okumura
- Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, Japan.
| | - Harushi Mori
- Department of Radiology, Graduate School and Faculty of Medicine, The University of Tokyo, 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
| | - Hiroyuki Torisu
- Department of Pediatrics, Fukuoka Dental College Medical and Dental Hospital, Fukuoka, Japan
| | - Sawa Yasumoto
- Medical Education Center, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Hiroyuki Shimizu
- Department of Virology II, National Institute of Infectious Diseases, Tokyo, Japan
| | - Tsuguto Fujimoto
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Keiko Tanaka-Taya
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
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Tomita Y, Chong PF, Yamamoto T, Akamine S, Imaizumi T, Kira R. Sequential radiologic findings in osteopathia striata with cranial sclerosis. Diagn Interv Imaging 2019; 100:529-531. [PMID: 31031202 DOI: 10.1016/j.diii.2019.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/04/2019] [Accepted: 04/04/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Y Tomita
- Department of Pediatric Neurology, Fukuoka Children's Hospital, 5-1-1, Kashiiteriha, Higashi-ku, Fukuoka, Japan
| | - P F Chong
- Department of Pediatric Neurology, Fukuoka Children's Hospital, 5-1-1, Kashiiteriha, Higashi-ku, Fukuoka, Japan.
| | - T Yamamoto
- Institute of Medical Genetics, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjyuku-ku, Tokyo, Japan
| | - S Akamine
- Department of Pediatric Neurology, Fukuoka Children's Hospital, 5-1-1, Kashiiteriha, Higashi-ku, Fukuoka, Japan
| | - T Imaizumi
- Institute of Medical Genetics, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjyuku-ku, Tokyo, Japan
| | - R Kira
- Department of Pediatric Neurology, Fukuoka Children's Hospital, 5-1-1, Kashiiteriha, Higashi-ku, Fukuoka, Japan
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Okuzono S, Fukai R, Noda M, Miyake N, Lee S, Kaku N, Sanefuji M, Akamine S, Kanno S, Ishizaki Y, Torisu H, Kira R, Matsumoto N, Sakai Y, Ohga S. An acute encephalopathy with reduced diffusion in BRAF-associated cardio-facio-cutaneous syndrome. Brain Dev 2019; 41:378-381. [PMID: 30414707 DOI: 10.1016/j.braindev.2018.10.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 05/02/2018] [Revised: 08/20/2018] [Accepted: 10/25/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cardio-facio-cutaneous syndrome (CFCS) is a rare genetic disorder characterized by cardiovascular anomalies, dysmorphic faces, ectodermal abnormalities and developmental delays. Mutations in BRAF and other RAS-MAPK pathway-associated genes are commonly identified in patients with CFCS. While this molecular pathway is known to be associated with neuro-inflammatory conditions, only one case with CFCS has been reported thus far to develop acute encephalopathy in childhood. CASE REPORT A 3-year-old boy with dysmorphic features and mild psychomotor delay developed acute encephalopathy. After a 45-min long, generalized seizure, the magnetic resonance imaging revealed that the restricted diffusion signals spread to the bilateral subcortical white matters on day 1 of illness. Despite the 14 days of intensive care, the acute symptoms of encephalopathy left him intractable epilepsy and severe neurocognitive impairments. The whole-exome sequencing analysis identified a de novo heterozygous mutation of BRAF (NM_004333:p.Thr241Met) in this case. CONCLUSION The present case suggests that the hyperactive condition of ERK signals might augment the development of acute encephalopathy and post-encephalopathic epilepsy in childhood.
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Affiliation(s)
- Sayaka Okuzono
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ryoko Fukai
- Department of Human Genetics, Yokohama City University School of Medicine, Yokohama, Japan
| | - Marie Noda
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Noriko Miyake
- Department of Human Genetics, Yokohama City University School of Medicine, Yokohama, Japan
| | - Sooyoung Lee
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Noriyuki Kaku
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masafumi Sanefuji
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoshi Akamine
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shunsuke Kanno
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshito Ishizaki
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroyuki Torisu
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ryutaro Kira
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Naomichi Matsumoto
- Department of Human Genetics, Yokohama City University School of Medicine, Yokohama, Japan
| | - Yasunari Sakai
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Shouichi Ohga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Morioka T, Suzuki SO, Murakami N, Mukae N, Shimogawa T, Haruyama H, Kira R, Iihara K. Surgical histopathology of limited dorsal myeloschisis with flat skin lesion. Childs Nerv Syst 2019; 35:119-128. [PMID: 29934704 DOI: 10.1007/s00381-018-3870-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 04/26/2018] [Accepted: 06/15/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE Limited dorsal myeloschisis (LDM) is characterized by two invariable features: a focal closed neural tube defect and a fibroneural stalk linking the skin lesion to the underlying spinal cord. Although detailed histopathological findings of the LDM stalk were originally described by Pang et al., the precise relationship between the histopathological findings and clinical manifestations including intraoperative findings has not been fully determined. METHODS We retrospectively analyzed the histopathological findings of the almost entire stalk and their relevance to the clinical manifestations in six Japanese LDM patients with flat skin lesions. RESULTS Glial fibrillary acidic protein (GFAP)-immunopositive neuroglial tissues were observed in three of the six patients. Unlike neuroglial tissues, peripheral nerve fibers were observed in every stalk. In four patients, dermal melanocytosis, "Mongolian spot," was seen surrounding the cigarette-burn lesion. In three of these four patients, numerous melanocytes were distributed linearly along the long axis of the LDM stalk, which might represent migration of melanocytes from trunk neural crest cells during formation of the LDM stalk. CONCLUSION Immunopositivity for GFAP in the LDM stalk was observed in as few as 50% of our patients, despite the relatively extensive histopathological examination. We confirm that the clinical diagnosis of LDM should be made based on comprehensive histopathological examination as well as clinical manifestations. The profuse network of peripheral nerve fibers in every stalk and the high incidence of melanocyte accumulation associated with dermal melanocytosis might assist the histopathological diagnosis of LDM.
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Affiliation(s)
- Takato Morioka
- Department of Neurosurgery, Fukuoka Children's Hospital, 5-1-1 Kashii-teriha, Higashi-ku, Fukuoka, 813-0017, Japan.
| | - Satoshi O Suzuki
- Department of Neuropathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Nobuya Murakami
- Department of Neurosurgery, Fukuoka Children's Hospital, 5-1-1 Kashii-teriha, Higashi-ku, Fukuoka, 813-0017, Japan
| | - Nobutaka Mukae
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takafumi Shimogawa
- Department of Neurosurgery, Fukuoka Children's Hospital, 5-1-1 Kashii-teriha, Higashi-ku, Fukuoka, 813-0017, Japan.,Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hironori Haruyama
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ryutaro Kira
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Koji Iihara
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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41
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Chong PF, Matsukura M, Fukui K, Watanabe Y, Matsumoto N, Kira R. West Syndrome in an Infant With Vitamin B12 Deficiency Born to Autoantibodies Positive Mother. Front Pediatr 2019; 7:531. [PMID: 31956646 PMCID: PMC6951394 DOI: 10.3389/fped.2019.00531] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 08/26/2019] [Accepted: 12/05/2019] [Indexed: 11/30/2022] Open
Abstract
Infantile vitamin B12 deficiency, a rare nutritional disorder in developed countries, is characterized by megaloblastic anemia and non-specific symptoms, including failure to thrive, hypotonia, and seizure. Symptoms usually develop at 6 months of age. Exclusively breast-fed infants of vegan-diet mothers are particularly at risk. We report the case of a 7-month-old boy with West syndrome born to a mother with subclinical vitamin B12 deficiency due to autoantibodies. Electroencephalography revealed the characteristic hypsarrhythmia pattern, whereas cranial magnetic resonance imaging revealed cerebral atrophy and hypomyelination. Biochemical analysis revealed elevated urinary methylmalonic acid and homocysteine and reduced plasma methionine. Serum vitamin B12 levels were extremely low in both the child and his mother. The mother tested positive for both anti-intrinsic factor and anti-parietal cell antibodies. Low-dose adrenocorticotropic hormone was effective for seizure control. Contrary to previous reports, age-appropriate neurodevelopment was not achieved despite rapid normalization of metabolic profile with vitamin B12 supplementation. Further investigations failed to detect any causative mutations in the genes associated with developmental and epileptic encephalopathy as well as metabolic and other identifiable disorders known to cause West syndrome. To the best of our knowledge, this is the first reported case in which maternal anti-intrinsic factor antibody was considered to be the reason for infantile vitamin B12 deficiency with West syndrome. Differential diagnosis of West syndrome should include vitamin B12 deficiency due to its treatable nature, and early diagnosis is essential to prevent permanent neurological consequences.
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Affiliation(s)
- Pin Fee Chong
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Masaru Matsukura
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Kaoru Fukui
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Japan
| | - Yoriko Watanabe
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Japan.,Research Institute of Medical Mass Spectrometry, Kurume University School of Medicine, Kurume, Japan
| | - Naomichi Matsumoto
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Ryutaro Kira
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
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42
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Tsuji M, Chong PF, Yamashita F, Maeda K, Kira R. Cytotoxic lesion of the corpus callosum exclusively at the genu in a case of callosal hypogenesis. J Neuroradiol 2018; 46:222-223. [PMID: 30500357 DOI: 10.1016/j.neurad.2018.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 10/22/2018] [Accepted: 11/15/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Moeri Tsuji
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Pin Fee Chong
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan.
| | - Fumiya Yamashita
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Kenichi Maeda
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Ryutaro Kira
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
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43
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Yamamoto T, Lu Y, Nakamura R, Shimojima K, Kira R. Novel A178P mutation in SLC16A2 in a patient with Allan-Herndon-Dudley syndrome. Congenit Anom (Kyoto) 2018; 58:143-144. [PMID: 28862359 DOI: 10.1111/cga.12251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 08/04/2017] [Accepted: 08/23/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Toshiyuki Yamamoto
- Institute of Medical Genetics, Tokyo Women's Medical University, Tokyo, Japan
| | - Yongping Lu
- Institute of Medical Genetics, Tokyo Women's Medical University, Tokyo, Japan
| | - Ryoko Nakamura
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Keiko Shimojima
- Institute of Medical Genetics, Tokyo Women's Medical University, Tokyo, Japan
| | - Ryutaro Kira
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
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44
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Chong PF, Nakamura K, Kira R. Mulberries in the urine: a tell-tale sign of Fabry disease. J Inherit Metab Dis 2018; 41:745-746. [PMID: 29488049 DOI: 10.1007/s10545-018-0155-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 01/11/2018] [Accepted: 02/02/2018] [Indexed: 11/27/2022]
Abstract
Fabry disease is a treatable progressive illness of inborn error causing eventual multiple organ dysfunction in advanced untreated cases. We report on a classic Fabry child patient presenting with urinary mulberry cells and bodies without renal involvement. This report emphasizes the usefulness of urinary microscopic findings in the early diagnosis of Fabry disease.
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Affiliation(s)
- Pin Fee Chong
- Department of Pediatric Neurology, Fukuoka Children's Hospital, 5-1-1 Kashiiteriha, Higashi-ku, Fukuoka, 813-0017, Japan.
| | - Kimitoshi Nakamura
- Department of Pediatrics, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, 860-8556, Japan
| | - Ryutaro Kira
- Department of Pediatric Neurology, Fukuoka Children's Hospital, 5-1-1 Kashiiteriha, Higashi-ku, Fukuoka, 813-0017, Japan
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45
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Chong PF, Saitsu H, Sakai Y, Imagi T, Nakamura R, Matsukura M, Matsumoto N, Kira R. Deletions of SCN2A and SCN3A genes in a patient with West syndrome and autistic spectrum disorder. Seizure 2018; 60:91-93. [PMID: 29929112 DOI: 10.1016/j.seizure.2018.06.012] [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] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 05/11/2018] [Accepted: 06/13/2018] [Indexed: 10/28/2022] Open
Abstract
SCN2A encodes the alpha-subunit of voltage-gated sodium channel, Nav1.2, which is highly expressed at an early stage of the postnatal brain. Genetic studies revealed that de novo heterozygous mutations of SCN2A caused severe developmental disorders in childhood, such as autism and epileptic encephalopathy. However, few reports have demonstrated the cases carrying segmental deletions at the SCN2A locus for those with epileptic disorders. In this study, we report a 1.8-year-old boy, who presented with West syndrome in infancy and developed the sequelae of psychomotor delay and autism. Since whole-exome sequencing did not detect pathogenic mutations, we extensively searched for microdeletions and duplications by applying the eXome Hidden Markov Model (XHMM) for read depths of sequenced intervals. Using this approach, we identified a de novo deletion spanning the 1.1-Mb region of chromosome 2q24.3. We found that the deleted interval included the SCN2A and SCN3A loci. These data validate the utility of XHMM and support that SCN2A is involved in the pathogenic processes underlying epileptic encephalopathy in childhood.
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Affiliation(s)
- Pin Fee Chong
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan.
| | - Hirotomo Saitsu
- Department of Biochemistry, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yasunari Sakai
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toru Imagi
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Ryoko Nakamura
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Masaru Matsukura
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Naomichi Matsumoto
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Ryutaro Kira
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
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46
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Chong PF, Kira R, Mori H, Okumura A, Torisu H, Yasumoto S, Shimizu H, Fujimoto T, Hanaoka N, Kusunoki S, Takahashi T, Oishi K, Tanaka-Taya K. Clinical Features of Acute Flaccid Myelitis Temporally Associated With an Enterovirus D68 Outbreak: Results of a Nationwide Survey of Acute Flaccid Paralysis in Japan, August-December 2015. Clin Infect Dis 2018; 66:653-664. [PMID: 29028962 PMCID: PMC5850449 DOI: 10.1093/cid/cix860] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 10/04/2017] [Indexed: 12/26/2022] Open
Abstract
Background Acute flaccid myelitis (AFM) is an acute flaccid paralysis syndrome with spinal motor neuron involvement of unknown etiology. We investigated the characteristics and prognostic factors of AFM clusters coincident with an enterovirus D68 (EV-D68) outbreak in Japan during autumn 2015. Methods An AFM case series study was conducted following a nationwide survey from August to December 2015. Radiographic and neurophysiologic data were subjected to centralized review, and virology studies were conducted for available specimens. Results Fifty-nine AFM cases (58 definite, 1 probable) were identified, including 55 children and 4 adults (median age, 4.4 years). The AFM epidemic curve showed strong temporal correlation with EV-D68 detection from pathogen surveillance, but not with other pathogens. EV-D68 was detected in 9 patients: 5 in nasopharyngeal, 2 in stool, 1 in cerebrospinal fluid (adult case), and 1 in tracheal aspiration, nasopharyngeal, and serum samples (a pediatric case with preceding steroid usage). Cases exhibited heterogeneous paralysis patterns from 1- to 4-limb involvement, but all definite cases had longitudinal spinal gray matter lesions on magnetic resonance imaging (median, 20 spinal segments). Cerebrospinal fluid pleocytosis was observed in 50 of 59 cases (85%), and 8 of 29 (28%) were positive for antiganglioside antibodies, as frequently observed in Guillain-Barré syndrome. Fifty-two patients showed variable residual weakness at follow-up. Good prognostic factors included a pretreatment manual muscle strength test unit score >3, normal F-wave persistence, and EV-D68-negative status. Conclusions EV-D68 may be one of the causative agents for AFM, while host susceptibility factors such as immune response could contribute to AFM development.
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Affiliation(s)
- Pin Fee Chong
- Department of Pediatric Neurology, Fukuoka Children’s Hospital
| | - Ryutaro Kira
- Department of Pediatric Neurology, Fukuoka Children’s Hospital
| | - Harushi Mori
- Department of Radiology, Graduate School and Faculty of Medicine, University of Tokyo
| | - Akihisa Okumura
- Department of Pediatrics, Aichi Medical University, Nagakute
| | - Hiroyuki Torisu
- Department of Pediatrics, Fukuoka Dental College Medical and Dental Hospital
| | - Sawa Yasumoto
- Medical Education Center, Fukuoka University School of Medicine
| | | | - Tsuguto Fujimoto
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo
| | - Nozomu Hanaoka
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo
| | - Susumu Kusunoki
- Department of Neurology, Kindai University Faculty of Medicine, Osaka-Sayama
| | - Toshiyuki Takahashi
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazunori Oishi
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo
| | - Keiko Tanaka-Taya
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo
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47
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Kira R. [Acute Flaccid Myelitis]. Brain Nerve 2018; 70:99-112. [PMID: 29433111 DOI: 10.11477/mf.1416200962] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Acute flaccid myelitis (AFM) is a newly defined, rare, but clinically distinct syndrome of acute flaccid paralysis with spinal motor neuron involvement of unknown etiology. Clusters of AFM coincided with a nationwide outbreak of enterovirus D68 (EV-D68) in the United States during autumn to winter of 2014 and in Japan during the autumn of 2015. Although EV-D68 was detected in only 20% of the AFM patients, mainly from respiratory specimens without apparent viral detection from blood and cerebrospinal fluid (CSF) samples, strong temporal associations were noted. Core symptoms of AFM are focal limb weakness and cranial nerve dysfunction with acute onset, although limb paralysis varied in type and severity. Most patients showed extensive longitudinal spinal involvement on magnetic resonance imaging, pleocytosis in CSF, and abnormal motor conduction and/or F-waves in neurophysiological investigations in the acute phase which was within two weeks after onset. Immunomodulation therapy consisting of high-dose intravenous immunoglobulin or pulse methylprednisolone did not improve prognosis. Only about 10% of the patients showed complete recovery of limb weakness, but others had variable residual weakness at follow-up. With no effective treatment identified in the acute stage, studies are required to elucidate the pathophysiology and pathomechanisms of AFM and to develop both preventive measures and novel therapeutic interventions.
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Affiliation(s)
- Ryutaro Kira
- Department of Pediatric Neurology, Fukuoka Children's Hospital
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48
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Lu Y, Chong PF, Kira R, Seto T, Ondo Y, Shimojima K, Yamamoto T. Mutations in NSD1 and NFIX in Three Patients with Clinical Features of Sotos Syndrome and Malan Syndrome. J Pediatr Genet 2017; 6:234-237. [PMID: 29142766 DOI: 10.1055/s-0037-1603194] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 04/12/2017] [Indexed: 12/19/2022]
Abstract
Mutations in nuclear receptor SET domain-containing protein 1 gene ( NSD1 ) are related to Sotos syndrome, which is characterized by overgrowth, macrocephaly, distinctive features, and neurodevelopmental disabilities. On the other hand, mutations in the nuclear factor I/X gene ( NFIX ) can lead to Malan syndrome, also known as Sotos-like syndrome, or to the Marshall-Smith syndrome. In this study, using next generation sequencing (NGS), we identified de novo mutations in NSD1 and NFIX in three patients with developmental disabilities associated with overgrowth or macrocephaly. Overall, we confirmed that clinical entities of congenital malformation syndromes can be expanded by molecular diagnoses via NGS.
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Affiliation(s)
- Yongping Lu
- Institute of Medical Genetics, 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
| | - Toshiyuki Seto
- Department of Pediatrics, Osaka City University, Osaka, Japan
| | - Yumiko Ondo
- Institute of Medical Genetics, Tokyo Women's Medical University, Tokyo, Japan
| | - Keiko Shimojima
- Institute of Medical Genetics, Tokyo Women's Medical University, Tokyo, Japan
| | - Toshiyuki Yamamoto
- Institute of Medical Genetics, Tokyo Women's Medical University, Tokyo, Japan
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49
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Noda M, Sonoda Y, Takemoto M, Kira R. [Successful treatment with topiramate in a case of idiopathic intracranial hypertension refractory to acetazolamide]. No To Hattatsu 2017; 49:207-210. [PMID: 30113799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
A 6-year-old girl experienced nausea and vomiting for 3 weeks and double vision for 1 week prior to her first visit to our hospital. She had bilateral ophthalmoplegia from sixth cranial nerve palsy and papilledema. Her brain MRI showed normal brain parenchyma. The lumbar cerebrospinal fluid (CSF) opening pressure was 1000 mm of water measured with normal CSF contents. From these findings, she was diagnosed with idiopathic intracranial hypertension (IIH). Initial lumbar puncture (LP) immediately improved her symptoms, but acetazolamide, a first line drug for the treatment of IIH, failed to maintain the remission, and three more periodical LP were required to relieve her symptoms every 2 weeks. After the fourth LP, acetazolamide was switched to a second line drug for IIH, topiramate, which was found to be highly effective in controlling IIH in a short time period. The long process of IIH causes vision loss, therefore, its prompt treatment is vital. In cases refractory to medical treatment, surgical treatments such as CSF shunt are considered. Acetazolamide is used in most IIH cases after the initial diagnosis, but in this case, it was ineffective, and topiramate was highly effective. Both acetazolamide and topiramate are inhibitors of carbonic anhydrase isoforms involved in CSF secretion. Inhibition of choroid plexus carbonic anhydrase by these drugs leads to decreased CSF secretion and the consequent control of intracranial pressure. Higher isoform specificity and increased lipophilic nature of topiramate, which are advantageous for passing through the blood brain barrier, may be the reasons for better activity than acetazolamide, at least in the present case. Topiramate might be effective and should be considered for refractory IIH cases before surgical treatments.
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50
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Murakami N, Morioka T, Kawamura N, Suzuki SO, Kira R. Venous anomaly analogous to vertical embryonic positioning of the straight sinus associated with atretic cephalocele at the suboccipital region. Childs Nerv Syst 2017; 33:179-182. [PMID: 27262313 DOI: 10.1007/s00381-016-3134-y] [Citation(s) in RCA: 7] [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: 05/19/2016] [Accepted: 05/27/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND The coexistence of venous anomalies, such as vertical embryonic positioning of the straight sinus (VEP of SS), has been reported in patients with atretic cephalocele (AC). VEP of SS has been exclusively encountered when the AC is found above the torcular. CLINICAL PRESENTATION We report a patient with suboccipital AC associated with venous anomalies analogous to VEP of SS, consisted of the Galenic venous system which did not drain into the straight sinus in the tentorium, but into the falcine sinus instead. Differences with VEP of SS in our case had no anatomical relationship between the falcine sinus and the suboccipital AC and no large cerebrospinal fluid space around the falcine sinus. A detailed neuroradiological examination was helpful for detecting these minute anomalies.
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Affiliation(s)
- Nobuya Murakami
- Department of Neurosurgery, Fukuoka Children's Hospital, 5-1-1 Kashii-teriha, Higashi-ku, Fukuoka, 813-0017, Japan.
| | - Takato Morioka
- Department of Neurosurgery, Fukuoka Children's Hospital, 5-1-1 Kashii-teriha, Higashi-ku, Fukuoka, 813-0017, Japan
| | - Nobuko Kawamura
- Department of Clinical Radiology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Satoshi O Suzuki
- Department of Neuropathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ryutaro Kira
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
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