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Falsaperla R, Sciacca M, Collotta AD, Tardino LG, Marino S, Marino SD, Privitera GF, Vitaliti G, Ruggieri M. PYRIDOXINE-dependent epilepsy (PDE): An observational study of neonatal cases on the role of pyridoxine in patients treated with standard anti-seizure medications. Seizure 2024; 118:156-163. [PMID: 38735085 DOI: 10.1016/j.seizure.2024.04.012] [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: 11/18/2023] [Revised: 04/09/2024] [Accepted: 04/12/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND The main objective of this study was to evaluate the neurological consequences of delayed pyridoxine administration in patients diagnosed with Pyridoxin Dependent Epilepsies (PDE). MATERIALS AND METHODS We reviewed 29 articles, comprising 52 genetically diagnosed PDE cases, ensuring data homogeneity. Three additional cases were included from the General Pediatric Operative Unit of San Marco Hospital. Data collection considered factors like age at the first seizure's onset, EEG reports, genetic analyses, and more. Based on the response to first-line antiseizure medications, patients were categorized into four distinct groups. Follow-up evaluations employed various scales to ascertain neurological, cognitive, and psychomotor developments. RESULTS Our study includes 55 patients (28 males and 27 females), among whom 15 were excluded for the lack of follow-up data. 21 patients were categorized as "Responder with Relapse", 11 as "Resistant", 6 as "Pyridoxine First Approach", and 2 as "Responders". The neurological outcome revealed 37,5 % with no neurological effects, 37,5 % showed complications in two developmental areas, 15 % in one, and 10 % in all areas. The statistical analysis highlighted a positive correlation between the time elapsed from the administration of pyridoxine after the first seizure and worse neurological outcomes. On the other hand, a significant association was found between an extended latency period (that is, the time that elapsed between the onset of the first seizure and its recurrence) and worse neurological outcomes in patients who received an unfavorable score on the neurological evaluation noted in a subsequent follow-up. CONCLUSIONS The study highlights the importance of early recognition and intervention in PDE. Existing medical protocols frequently overlook the timely diagnosis of PDE. Immediate administration of pyridoxine, guided by a swift diagnosis in the presence of typical symptoms, might improve long-term neurological outcomes, and further studies should evaluate the outcome of PDE neonates promptly treated with Pyridoxine.
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Affiliation(s)
- Raffaele Falsaperla
- General Pediatrics and Pediatric Emergency Department, "Policlinico G.Rodolico-San Marco" University Hospital, University of Catania, 95100 Catania, Italy; Unit of Neonatal Intensive Care and Neonatology, Policlinico "G. Rodolico-San Marco" University Hospital, University of Catania, 95100 Catania, Italy.
| | - Monica Sciacca
- General Pediatrics and Pediatric Emergency Department, "Policlinico G.Rodolico-San Marco" University Hospital, University of Catania, 95100 Catania, Italy
| | - Ausilia Desiree Collotta
- General Pediatrics and Pediatric Emergency Department, "Policlinico G.Rodolico-San Marco" University Hospital, University of Catania, 95100 Catania, Italy
| | - Lucia Giovanna Tardino
- General Pediatrics and Pediatric Emergency Department, "Policlinico G.Rodolico-San Marco" University Hospital, University of Catania, 95100 Catania, Italy
| | - Silvia Marino
- General Pediatrics and Pediatric Emergency Department, "Policlinico G.Rodolico-San Marco" University Hospital, University of Catania, 95100 Catania, Italy
| | - Simona Domenica Marino
- General Pediatrics and Pediatric Emergency Department, "Policlinico G.Rodolico-San Marco" University Hospital, University of Catania, 95100 Catania, Italy
| | - Greta Francesca Privitera
- Bioinformatics Unit, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Giovanna Vitaliti
- General Pediatrics and Pediatric Emergency Department, "Policlinico G.Rodolico-San Marco" University Hospital, University of Catania, 95100 Catania, Italy.
| | - Martino Ruggieri
- Department of Child and Experimental Medicine, Section of Paediatrics and Child Neuropsychiatry, University of Catania, Italy
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Falsaperla R, Sortino V, Marino SD, Collotta AD, Gammeri C, Sipala FM, Volti GL, Ruggieri M, Ronsisvalle S. Molecular Dynamic Simulations to Determine Individualized Therapy: Tetrabenazine for the GNAO1 Encephalopathy E246K Variant. Mol Diagn Ther 2024; 28:329-337. [PMID: 38581611 DOI: 10.1007/s40291-024-00706-0] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2024] [Indexed: 04/08/2024]
Abstract
INTRODUCTION GNAO1 encephalopathy is characterized by severe hypotonia, psychomotor retardation, epilepsy, and movement disorders. Genetic variations in GNAO1 have been linked to neurological symptoms including movement disorders like dystonia. The correlation between the E246K mutation in the Gα subunit and aberrant signal transduction of G proteins has been established but no data are reported regarding the efficacy of medical treatment with tetrabenazine. METHODS Molecular modeling studies were performed to elucidate the molecular mechanisms underlying this mutation. We developed drug efficacy models using molecular dynamic simulations that replicated the behavior of wild-type and mutated proteins in the presence or absence of ligands. RESULTS AND DISCUSSION We demonstrated that the absence of the mutation leads to normal signal transduction upon receptor activation by the endogenous ligand, but not in the presence of tetrabenazine. In contrast, the presence of the mutation resulted in abnormal signal transduction in the presence of the endogenous ligand, which was corrected by the drug tetrabenazine. Tetrabenazine was identified as a promising therapeutic option for pediatric patients suffering from encephalopathy due to an E246K mutation in the GNAO1 gene validated through molecular dynamics. This is a potential first example of the use of this technique in a rare neurological pediatric disease.
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Affiliation(s)
- Raffaele Falsaperla
- Neonatal Intensive Care Unit and Neonatal Accompaniment Unit, Azienda Ospedaliero-Universitaria Policlinico "Rodolico-San Marco", San Marco Hospital, University of Catania, Catania, Italy.
- Unit of Clinical Paediatrics, Azienda Ospedaliero-Universitaria Policlinico, "Rodolico-San Marco", San Marco Hospital, Catania, Italy.
- Pediatric Clinic, University of Ferrara, Ferrara, Italy.
| | - Vincenzo Sortino
- Unit of Clinical Paediatrics, Azienda Ospedaliero-Universitaria Policlinico, "Rodolico-San Marco", San Marco Hospital, Catania, Italy
| | - Simona Domenica Marino
- Unit of Clinical Paediatrics, Azienda Ospedaliero-Universitaria Policlinico, "Rodolico-San Marco", San Marco Hospital, Catania, Italy
| | - Ausilia Desiree Collotta
- Unit of Clinical Paediatrics, Azienda Ospedaliero-Universitaria Policlinico, "Rodolico-San Marco", San Marco Hospital, Catania, Italy
- Postgraduate Training Program in Pediatrics, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Carmela Gammeri
- Postgraduate Training Program in Pediatrics, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Federica Maria Sipala
- Department of Drug and Health Sciences, University of Catania, Viale A. Doria 6, 95125, Catania, Italy
| | - Giovanni Li Volti
- Department of Biomedical and Biotechnological Sciences, University of Catania, Via S. Sofia 87, 95125, Catania, Italy
| | - Martino Ruggieri
- Unit of Clinical Pediatrics, Unit of Rare Diseases, AOU "Policlinico", PO "G. Rodolico", University of Catania, Catania, Italy
| | - Simone Ronsisvalle
- Department of Drug and Health Sciences, University of Catania, Viale A. Doria 6, 95125, Catania, Italy
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Pavone P, Striano P, Cacciaguerra G, Marino SD, Parano E, Pappalardo XG, Falsaperla R, Ruggieri M. Case report: Structural brain abnormalities in TUBA1A-tubulinopathies: a narrative review. Front Pediatr 2023; 11:1210272. [PMID: 37744437 PMCID: PMC10515619 DOI: 10.3389/fped.2023.1210272] [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: 04/22/2023] [Accepted: 08/15/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction Tubulin genes have been related to severe neurological complications and the term "tubulinopathy" now refers to a heterogeneous group of disorders involving an extensive family of tubulin genes with TUBA1A being the most common. A review was carried out on the complex and severe brain abnormalities associated with this genetic anomaly. Methods A literature review of the cases of TUBA1A-tubulopathy was performed to investigate the molecular findings linked with cerebral anomalies and to describe the clinical and neuroradiological features related to this genetic disorder. Results Clinical manifestations of TUBA1A-tubulinopathy patients are heterogeneous and severe ranging from craniofacial dysmorphism, notable developmental delay, and intellectual delay to early-onset seizures, neuroradiologically associated with complex abnormalities. TUBA1A-tubulinopathy may display various and complex cortical and subcortical malformations. Discussion A range of clinical manifestations related to different cerebral structures involved may be observed in patients with TUBA1A-tubulinopathy. Genotype-phenotype correlations are discussed here. Individuals with cortical and subcortical anomalies should be screened also for pathogenic variants in TUBA1A.
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Affiliation(s)
- Piero Pavone
- Section of Pediatrics and Child Neuropsychiatry, Department of Child and Experimental Medicine, University of Catania, Catania, Italy
- National Council of Research, Institute for Biomedical Research and Innovation (IRIB), Unit of Catania, Catania, Italy
| | - Pasquale Striano
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genova, Italy
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto “G. Gaslini”, Genova, Italy
| | - Giovanni Cacciaguerra
- Section of Pediatrics and Child Neuropsychiatry, Department of Child and Experimental Medicine, University of Catania, Catania, Italy
| | - Simona Domenica Marino
- Pediatrics and Pediatric Emergency Department, University Hospital, A.U.O “Policlinico-Vittorio Emanuele”, Catania, Italy
| | - Enrico Parano
- National Council of Research, Institute for Biomedical Research and Innovation (IRIB), Unit of Catania, Catania, Italy
| | - Xena Giada Pappalardo
- National Council of Research, Institute for Biomedical Research and Innovation (IRIB), Unit of Catania, Catania, Italy
| | - Raffaele Falsaperla
- Pediatrics and Pediatric Emergency Department, University Hospital, A.U.O “Policlinico-Vittorio Emanuele”, Catania, Italy
| | - Martino Ruggieri
- Section of Pediatrics and Child Neuropsychiatry, Department of Child and Experimental Medicine, University of Catania, Catania, Italy
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Pavone P, Falsaperla R, Ruggieri M, Marino SD, Parano E, Pappalardo XG. A Young Boy with 21q21.1 Microdeletion Showing Speech Delay, Spastic Diplegia, and MRI Abnormalities: Original Case Report. Glob Med Genet 2023; 10:234-239. [PMID: 37663643 PMCID: PMC10471428 DOI: 10.1055/s-0043-1774291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023] Open
Abstract
Chromosome 21q deletion syndrome is a rare disorder affecting the long arm of chromosome 21 and manifesting with wide phenotypic features depending on the size and position of the deleted region. In the syndrome, three distinct deleted regions have been distinguished: region 1, from the centromere to approximately 31.2 Mb (21q11.2-q22.11); region 2, from 31.2 to 36 Mb (21q22.11-q22.12); and region 3, from 36 to 37.5 Mb to the telomere (21q22.12-q22.3). The clinical features are highly variable manifesting with mild, poorly recognizable signs or with severe symptoms including craniofacial dysmorphism, growth failure, developmental delay, behavioral/affective abnormalities, and systemic malformations. We report here the case of a young boy with speech delay, mild spastic diplegia, and brain anomalies on magnetic resonance imaging (MRI). The genetic analysis displayed a microdeletion of the long arm of chromosome 21 approximately extending up to 1.08 Mb. Clinical presentation of the patient and cases of 21q21 deletion reported by the literature are discussed.
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Affiliation(s)
- Piero Pavone
- Department of Child and Experimental Medicine, Section of Paediatrics and Child Neuropsychiatry, University of Catania, Italy
- National Council of Research, Institute for Biomedical Research and Innovation (IRIB), Unit of Catania, Italy
| | - Raffaele Falsaperla
- Unit of Pediatrics and Pediatric Emergency, University Hospital Policlinico “G. Rodolico-San Marco,” Catania, Italy
- Neonatal Intensive Care Unit, San Marco Hospital, University Hospital Policlinico “G. Rodolico-San Marco,” Catania, Italy
| | - Martino Ruggieri
- Department of Child and Experimental Medicine, Section of Paediatrics and Child Neuropsychiatry, University of Catania, Italy
| | - Simona Domenica Marino
- Neonatal Intensive Care Unit, San Marco Hospital, University Hospital Policlinico “G. Rodolico-San Marco,” Catania, Italy
| | - Enrico Parano
- National Council of Research, Institute for Biomedical Research and Innovation (IRIB), Unit of Catania, Italy
| | - Xena Giada Pappalardo
- National Council of Research, Institute for Biomedical Research and Innovation (IRIB), Unit of Catania, Italy
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Falsaperla R, Marino S, Moscheo C, Tardino LG, Marino SD, Sciuto C, Pavone P, Vitaliti G, Sullo F, Ruggieri M. Insights on palliative cares from birth to infancy in pediatric patients with neurological diseases. Clin Exp Pediatr 2023:cep.2023.00129. [PMID: 37321579 PMCID: PMC10397996 DOI: 10.3345/cep.2023.00129] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 05/04/2023] [Indexed: 06/17/2023] Open
Abstract
Background Palliative care, in pediatric age, is a comprehensive approach to treatment that guarantees patients and their families a whole healing process from diagnosis to death. The techniques used for neurologic patients in the field of palliative care can enhance the quality of care provided to all patients with neurologic disorders and support their families. Objective Our goal was to analyze palliative care protocols in use in our departments, describing the palliative course in our clinical setting and to present a proposal that allows implementation of hospital palliative care patients with neurologic diseases with a long-term prognosis. Methods In this retrospective observational study, we present our experience in the application of palliative care for neurologic patients from birth to early infancy. We studied 34 newborns with diseases affecting the nervous system, causing impairment of the prognosis. The study was conducted from 2016 to 2020, in Neonatology Intensive Care Unit and the Pediatric Unit of the San Marco University Hospital in Catania, Sicily, Italy. Results Despite the legislative rules, no palliative care network has been activated to meet the needs of the population. In our center, given the vast number of patients with neurologic conditions requiring palliative care interventions, it can be suggested to activate a straightforward departmental unit for neurologic pediatric palliative care. Conclusions The establishment of specialized reference centers that deal with significant neurological illnesses is due to the progress of neuroscience in recent decades. Integration with specialized palliative care is sparse but now seems essential.
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Affiliation(s)
- Raffaele Falsaperla
- Neonatal Intensive Care Unit (NICU), AOUP Rodolico-San Marco, PO San Marco, Catania, Italy
- Pediatric and Pediatric Emergency Department, AOUP Rodolico-San Marco, PO San Marco, Catania, Italy
| | - Silvia Marino
- Pediatric and Pediatric Emergency Department, AOUP Rodolico-San Marco, PO San Marco, Catania, Italy
| | - Carla Moscheo
- Pediatric and Pediatric Emergency Department, AOUP Rodolico-San Marco, PO San Marco, Catania, Italy
| | - Lucia Giovanna Tardino
- Pediatric and Pediatric Emergency Department, AOUP Rodolico-San Marco, PO San Marco, Catania, Italy
| | - Simona Domenica Marino
- Pediatric and Pediatric Emergency Department, AOUP Rodolico-San Marco, PO San Marco, Catania, Italy
| | - Concetta Sciuto
- Pediatric and Pediatric Emergency Department, AOUP Rodolico-San Marco, PO San Marco, Catania, Italy
| | - Piero Pavone
- Department of Pediatrics, AOUP Rodolico-San Marco, PO Rodolico, University of Catania, Catania, Italy
| | - Giovanna Vitaliti
- Pediatric and Pediatric Emergency Department, AOUP Rodolico-San Marco, PO San Marco, Catania, Italy
| | - Federica Sullo
- Pediatric and Pediatric Emergency Department, AOUP Rodolico-San Marco, PO San Marco, Catania, Italy
| | - Martino Ruggieri
- Department of Pediatrics, AOUP Rodolico-San Marco, PO Rodolico, University of Catania, Catania, Italy
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Falsaperla R, Collotta AD, Sortino V, Marino SD, Marino S, Pisani F, Ruggieri M. The Use of Midazolam as an Antiseizure Medication in Neonatal Seizures: Single Center Experience and Literature Review. CNS Neurol Disord Drug Targets 2023:CNSNDDT-EPUB-132399. [PMID: 37291779 DOI: 10.2174/1871527322666230608105206] [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] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 04/03/2023] [Accepted: 04/17/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Existing therapeutic alternatives for neonatal crises have expanded in recent decades, but no consensus has been reached on protocols based on neonatal seizures. In particular, little is known about the use of midazolam in newborns. AIM The aim of our study is to evaluate the response to midazolam, the appearance of side effects, and their impact on therapeutic decisions. METHODS This is a STROBE-conformed retrospective observational study of 10 patients with neonatal seizures unresponsive to common antiseizure drugs, admitted to San Marco University Hospital's neonatal intensive care (Catania, Italy) from September 2015 to October 2022. In our database search, 36 newborns were treated with midazolam, but only ten children met the selection criteria for this study. RESULTS Response was assessed both clinically and electrographic. Only 4 patients at the end of the treatment showed a complete electroclinical response; they were full-term infants with a postnatal age greater than 7 days. Non-responders and partial responders are all premature (4/10) or full-term neonates who started therapy in the first days of life (<7th day) (2/10). CONCLUSION Neonatal seizures in preterm show a lower response rate to midazolam than seizures in full-term infants, with poorer prognosis. Liver and renal function and central nervous system development are incomplete in premature infants and the first days of life. In this study, we show that midazolam, a short-acting benzodiazepine, appears to be most effective in full-term infants and after 7 days of life.
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Affiliation(s)
- Raffaele Falsaperla
- Neonatal Intensive Care Unit, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-San Marco", San Marco Hospital, University of Catania, Catania, Italy
- Pediatrics and Pediatric Emergency Operative Unit, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-San Marco", San Marco Hospital, University of Catania, Catania, Italy
| | - Ausilia Desiree Collotta
- Pediatrics and Pediatric Emergency Operative Unit, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-San Marco", San Marco Hospital, University of Catania, Catania, Italy
| | - Vincenzo Sortino
- Pediatrics and Pediatric Emergency Operative Unit, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-San Marco", San Marco Hospital, University of Catania, Catania, Italy
| | - Simona Domenica Marino
- Pediatrics and Pediatric Emergency Operative Unit, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-San Marco", San Marco Hospital, University of Catania, Catania, Italy
| | - Silvia Marino
- Pediatrics and Pediatric Emergency Operative Unit, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-San Marco", San Marco Hospital, University of Catania, Catania, Italy
| | - Francesco Pisani
- Child Neuropsychiatry Unit, Human Neuroscience Department, Sapienza University of Rome, Italy
| | - Martino Ruggieri
- Unit of Clinical Pediatrics, Department of Clinical and Experimental Medicine, AOU Policlinico "G. Rodolico-San Marco", University of Catania, Catania, Italy
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Falsaperla R, Marino SD, Salomone G, Madia F, Marino S, Tardino LG, Scalia B, Ruggieri M. Impressive efficacy of the ketogenic diet in a KCNQ2 encephalopathy infant: a case report and exhaustive literature review. Transl Pediatr 2023; 12:292-300. [PMID: 36891363 PMCID: PMC9986782 DOI: 10.21037/tp-22-258] [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: 06/05/2022] [Accepted: 12/09/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND KCNQ2 encephalopathy is characterized by neonatal-onset epilepsy and developmental impairment, due to "de novo" KCNQ2 pathogenic variants. According to literature data, sodium channel blocking agents appear to be the best treatment options for the disease. Reports describing the use of ketogenic diet (KD) in the KCNQ2 pediatric population are limited. The non-conservative amino acid substitution p.Ser122Leu in KCNQ2 is associated with a broad spectrum of inheritance modalities, clinical phenotypes and outcomes; no previous reports of the same variant treated with KD are available in literature. CASE DESCRIPTION We described a 22-month-old female with seizure onset on day 2 of life. At three months of age, she presented refractory status epilepticus (SE) that did not respond to midazolam and carbamazepine, which was added once a "de novo" p.Ser122Leu KCNQ2 variant was demonstrated. KD was the only treatment that led to cessation of seizures. The baby maintained seizures remission and achieved neurodevelopmental milestones. CONCLUSIONS To define an overt genotype-phenotype correlation for KCNQ2 pathogenic variants is a challenge; we propose the KD as a valuable treatment for refractory seizures and impaired neurodevelopment in infants harboring "de novo" mutations in the KCNQ2 gene.
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Affiliation(s)
- Raffaele Falsaperla
- Neonatology and Neonatal Intensive Care Unit, Hospital Policlinico "G. Rodolico-San Marco", University of Catania, Catania, Italy.,Unit of Pediatrics and Pediatric Emergency, Hospital Policlinico "G. Rodolico-San Marco", University of Catania, Catania, Italy
| | - Simona Domenica Marino
- Unit of Pediatrics and Pediatric Emergency, Hospital Policlinico "G. Rodolico-San Marco", University of Catania, Catania, Italy
| | | | - Francesca Madia
- Unit of Medical Genetics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Silvia Marino
- Unit of Pediatrics and Pediatric Emergency, Hospital Policlinico "G. Rodolico-San Marco", University of Catania, Catania, Italy
| | - Lucia Giovanna Tardino
- Unit of Pediatrics and Pediatric Emergency, Hospital Policlinico "G. Rodolico-San Marco", University of Catania, Catania, Italy
| | - Bruna Scalia
- Neonatology and Neonatal Intensive Care Unit, Hospital Policlinico "G. Rodolico-San Marco", University of Catania, Catania, Italy
| | - Martino Ruggieri
- Unit of Rare Diseases of the Nervous System in Childhood, Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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Falsaperla R, Marino S, Vitaliti G, Bonadies A, Marino SD, Pavone P, Romano C, Savoia F, Calì C, Ruggieri M, Lubrano R, Tipo V. Simple febrile seizures: new cut off for the duration of the crises. Acta Neurol Belg 2023:10.1007/s13760-023-02211-3. [PMID: 36829088 DOI: 10.1007/s13760-023-02211-3] [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: 08/15/2022] [Accepted: 02/12/2023] [Indexed: 02/26/2023]
Abstract
BACKGROUND Our study aimed to identify a new cut-off for febrile seizure (FS) with a good prognosis, thereby replacing the 15 min described in the standard definition of simple febrile seizure (SFS). METHODS Our study was a retrospective observational study (from January 2018 to December 2018) on children admitted to the Pediatric emergency room of the Santobono-Pausilipon Hospital, Naples, Italy, Pediatric Unit of Latina, Rome, Italy, and Policlinico-Vittorio-Emanuele University Hospital, Catania, Italy, for fever, which developed SFS during the hospitalization. All included patients had their seizures classified as SFS according to the international criteria for epilepsy. We assumed a duration cut-off, and we analyzed the EEG results, neurological follow-up at 12 months, and the recurrence of the febrile seizures the following year. Then, with another calculation, we identify an optimal cut-off of 6 min. Finally, we divided the population into two groups: children with seizures having a duration greater than or less than 6 min. RESULTS We found that the population with FS with a duration greater than 6 min presented EEG alteration at follow-up visits, neurological disorders, and a recurrence of FS during the following year. CONCLUSIONS We suggest to introduce a new cut-off for the duration of FS that better represents the benign nature of a simple febrile event.
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Affiliation(s)
- Raffaele Falsaperla
- Pediatric and Pediatric Emergency Department, University Hospital "Rodolico - San Marco", PO "San Marco", Via A. Ciampi, 2, 95100, Catania, Italy.,Unit of Intensive Care and Neonatology, University Hospital "Rodolico - San Marco", PO "San Marco", Catania, Italy
| | - Silvia Marino
- Pediatric and Pediatric Emergency Department, University Hospital "Rodolico - San Marco", PO "San Marco", Via A. Ciampi, 2, 95100, Catania, Italy.
| | - Giovanna Vitaliti
- Pediatric and Pediatric Emergency Department, University Hospital "Rodolico - San Marco", PO "San Marco", Via A. Ciampi, 2, 95100, Catania, Italy
| | - Anna Bonadies
- Department of Pediatric, AORN Santobono Pausilipon, Naples, Italy
| | - Simona Domenica Marino
- Pediatric and Pediatric Emergency Department, University Hospital "Rodolico - San Marco", PO "San Marco", Via A. Ciampi, 2, 95100, Catania, Italy
| | - Piero Pavone
- Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University Hospital "Rodolico - San Marco", PO "Rodolico", Catania, Italy
| | - Catia Romano
- Pediatric and Pediatric Emergency Department, University Hospital "Rodolico - San Marco", PO "San Marco", Via A. Ciampi, 2, 95100, Catania, Italy
| | - Fabio Savoia
- Evaluative Epidemiology-Childhood Cancer Registry of Campania, AORN "Santobono-Pausilipon Children's Hospital", Naples, Italy
| | - Camilla Calì
- Evaluative Epidemiology-Childhood Cancer Registry of Campania, AORN "Santobono-Pausilipon Children's Hospital", Naples, Italy
| | - Martino Ruggieri
- Unit of Rare Diseases of the Nervous System in Childhood, Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy
| | - Riccardo Lubrano
- Department of Paediatrics, University of Rome "La Sapienza", Rome, Italy
| | - Vincenzo Tipo
- Department of Pediatric, AORN Santobono Pausilipon, Naples, Italy
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Pavone P, Pappalardo XG, Mustafa N, Falsaperla R, Marino SD, Corsello G, Bianca S, Parano E, Ruggieri M. Pathogenic correlation between mosaic variegated aneuploidy 1 (MVA1) and a novel BUB1B variant: a reappraisal of a severe syndrome. Neurol Sci 2022; 43:6529-6538. [PMID: 35804254 PMCID: PMC9616775 DOI: 10.1007/s10072-022-06247-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 04/19/2022] [Indexed: 12/01/2022]
Abstract
Background The BUB 1 mitotic checkpoint serine/threonine kinase B (BUB1B) gene encodes a key protein in the mitotic spindle checkpoint, which acts as a surveillance mechanism, crucial for the maintenance of the correct chromosome number during cell deviation. Mutations of BUB1B gene are linked to mosaic variegated aneuploidy 1 (MVA1) syndrome, a rare autosomal recessive disorder characterized by widespread mosaic aneuploidies, involving different chromosomes and tissues. MVA1 is clinically characterized by intrauterine growth restriction, post-natal growth retardation, and severe neurologic impairment including microcephaly, developmental delay/intellectual disability, epileptic seizures, and generalized hypotonia. Malignancies are also serious sequelae associated with the disorder. We reported on a case of two-year-old Italian girl with MVA1 who shows severe neurologic impairment, microcephaly and epileptic seizures. Materials and methods Clinical data collection and genetic diagnosis of the patient were assessed. Mutational analysis covers the chromosomal microarray analysis, the gene methylation pattern studied using the methylation-specific multiplex ligation-dependent probe amplification, and the family-based Whole Exome Sequencing (WES). A literature research based on reported cases of MVA and premature chromatid separation was also included. Results Karyotyping has revealed 12% of mosaics in the patient who carries a novel variant in BUB1B gene (c.2679A > T, p.Arg893Ser) detected by WES. Thirty-one cases of MVA1 including the present report, and four prenatally diagnosed cases with MVA1 were selected and inspected. Conclusion Clinical and genetic findings reported in the girl strongly suggest a new MVA1 genotype–phenotype correlation and lead to a reappraisal of a severe syndrome. Diagnosis and in-depth follow-up provided worthwhile data. Supplementary Information The online version contains supplementary material available at 10.1007/s10072-022-06247-w.
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Affiliation(s)
- Piero Pavone
- Pediatric Clinic, Department of Clinical and Experimental Medicine, University Hospital A.U.O. "Policlinico-Vittorio Emanuele, Catania, Italy.
| | - Xena Giada Pappalardo
- National Council of Research, Institute for Biomedical Research and Innovation (IRIB), Unit of Catania, Catania, Italy
- Department of Biomedical and Biotechnological Sciences (BIOMETEC), University of Catania, Catania, Italy
| | - Naira Mustafa
- Department of Paediatrics, School of Clinical Medicine, University of Cambridge, Cambridge, UK
- Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Raffaele Falsaperla
- Pediatrics and Pediatric Emergency Department, University Hospital, A.U.O "Policlinico Vittorio Emanuele", Catania, Italy
| | - Simona Domenica Marino
- Pediatrics and Pediatric Emergency Department, University Hospital, A.U.O "Policlinico Vittorio Emanuele", Catania, Italy
| | - Giovanni Corsello
- Mother and Child Department, Operative Unit of Pediatrics and Neonatal Intensive Therapy, University of Palermo, Palermo, Italy
| | - Sebastiano Bianca
- Medical Genetics, Referral Centre for Rare Genetic Diseases, ARNAS Garibaldi, Catania, Italy
| | - Enrico Parano
- National Council of Research, Institute for Biomedical Research and Innovation (IRIB), Unit of Catania, Catania, Italy
| | - Martino Ruggieri
- Unit of Rare Diseases of the Nervous System in Childhood, Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, AOU "Policlinico," PO "G. Rodolico, Catania, Italy.
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Falsaperla R, Vitaliti G, Sciacca M, Tardino L, Marino SD, Marino S, Moscheo C, Meli M, Vitaliti MC, Barbagallo M, Di Stefano VA, Saporito MAN, Ruggieri M. Neonatal neurologic emergencies requiring access to paediatric emergency units: a retrospective observational study. Sci Rep 2022; 12:10273. [PMID: 35715441 PMCID: PMC9205415 DOI: 10.1038/s41598-022-13703-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 05/26/2022] [Indexed: 11/22/2022] Open
Abstract
Herein, authors present a retrospective, multi-center study to determine the number of accesses to Pediatric Emergency Unit (PEU) of patients within 28 days of life, admitted to (1) the Acute and Emergency Pediatric Unit, San Marco University Hospital, Catania, Italy; (2) Garibaldi Hospital for Emergency Care, Catania, Italy; (3) Cannizzaro Hospital for Emergency Care, Catania, Italy. We included neonates admitted for neurologic problems, from January 2015 to December 2020, to the 1—Acute and Emergency Access of the San Marco University Hospital, Catania, Italy [observation center 1 (OC1)]; 2—Garibaldi Hospital for Emergency Care, Catania, Italy (Observation Center 2—OC2); 3—Cannizzaro Hospital for Emergency Care, Catania, Italy (Observation Center 3—OC3). For each patient, we evaluated the severity of urgency, by studying the admission triage-coloured codes, the clinical data at admission and the discharge diagnosis. Neonates who had access to PEU were 812 in the OC1, 3720 in the OC2, and 748 in the OC3 respectively; 69 (8.4%), 138 (3.7%), and 55 (7.4%) was the proportion of neonatal accesses for neurological conditions. We observed that in the study period, the three hospitals had an important decrease of pediatric accesses to their PEU, but the proportion of neonates who had access to the OC1 for neurologic diseases, with respect to the total neonatal accesses, remained stable. We found that the most frequent neurologic disease for which newborns had access to PEU was Cyanosis, (46.1% of all neonatal accesses). Apnea was the second most frequent cause, with a number of 76 accesses (29%). In the literature there are numerous studies on the assessment of diseases that most frequently concern the pediatric patient in an emergency room, but there are very few references on neonatal accesses for urgent neurologic diseases. Therefore, appropriate training is required to avoid unnecessary tests without overlooking potentially serious conditions.
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Affiliation(s)
- Raffaele Falsaperla
- Neonatal Intensive Care Unit, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-San Marco", San Marco Hospital, University of Catania, Catania, Italy. .,Pediatrics and Pediatric Emergency Operative Unit, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-San Marco", San Marco Hospital, University of Catania, Catania, Italy.
| | - Giovanna Vitaliti
- Pediatrics Operative Unit, Department of Medical Sciences, Section of Pediatrics, University of Ferrara, Ferrara, Italy.
| | - Monica Sciacca
- Pediatrics and Pediatric Emergency Operative Unit, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-San Marco", San Marco Hospital, University of Catania, Catania, Italy
| | - Lucia Tardino
- Pediatrics and Pediatric Emergency Operative Unit, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-San Marco", San Marco Hospital, University of Catania, Catania, Italy
| | - Simona Domenica Marino
- Pediatrics and Pediatric Emergency Operative Unit, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-San Marco", San Marco Hospital, University of Catania, Catania, Italy
| | - Silvia Marino
- Pediatrics and Pediatric Emergency Operative Unit, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-San Marco", San Marco Hospital, University of Catania, Catania, Italy
| | - Carla Moscheo
- Pediatrics and Pediatric Emergency Operative Unit, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-San Marco", San Marco Hospital, University of Catania, Catania, Italy
| | - Mariaclaudia Meli
- Pediatrics and Pediatric Emergency Operative Unit, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-San Marco", San Marco Hospital, University of Catania, Catania, Italy
| | - Maria Concetta Vitaliti
- Pediatrics and Pediatric Emergency Operative Unit, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-San Marco", San Marco Hospital, University of Catania, Catania, Italy
| | - Massimo Barbagallo
- Department of Paediatrics, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specializzazione "Garibaldi", Catania, Italy
| | | | - Marco Andrea Nicola Saporito
- Neonatal Intensive Care Unit, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-San Marco", San Marco Hospital, University of Catania, Catania, Italy
| | - Martino Ruggieri
- Unit of Rare Diseases of the Nervous System in Childhood, Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, 95124, Catania, Italy
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11
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Pavone P, Pappalardo XG, Parano E, Falsaperla R, Marino SD, Fink JK, Ruggieri M. Fever-Associated Seizures or Epilepsy: An Overview of Old and Recent Literature Acquisitions. Front Pediatr 2022; 10:858945. [PMID: 35529330 PMCID: PMC9070101 DOI: 10.3389/fped.2022.858945] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/17/2022] [Indexed: 02/06/2023] Open
Abstract
In addition to central nervous system infections, seizures and fever may occur together in several neurological disorders. Formerly, based on the clinical features and prognostic evolution, the co-association of seizure and fever included classical febrile seizures (FS) divided into simple, complex, and prolonged FS (also called febrile status epilepticus). Later, this group of disorders has been progressively indicated, with a more inclusive term, as "fever-associated seizures or epilepsy" (FASE) that encompasses: (a) FS divided into simple, complex, and prolonged FS; (b) FS plus; (c) severe myoclonic epilepsy in infancy (Dravet syndrome); (d) genetic epilepsy with FS plus; and (e) febrile infection-related epilepsy syndrome (FIRES). Among the FASE disorders, simple FS, the most common and benign condition, is rarely associated with subsequent epileptic seizures. The correlation of FS with epilepsy and other neurological disorders is highly variable. The pathogenesis of FASE is unclear but immunological and genetic factors play a relevant role and the disorders belonging to the FASE group show to have an underlying common clinical, immunological, and genetic pathway. In this study, we have reviewed and analyzed the clinical data of each of the heterogeneous group of disorders belonging to FASE.
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Affiliation(s)
- Piero Pavone
- Unit of Clinical Pediatrics, AOU "Policlinico", PO "G. Rodolico", University of Catania, Catania, Italy
| | - Xena Giada Pappalardo
- Unit of Catania, National Council of Research, Institute for Research and Biomedical Innovation (IRIB), Catania, Italy.,Department of Biomedical and Biotechnological Sciences (BIOMETEC), University of Catania, Catania, Italy
| | - Enrico Parano
- Unit of Catania, National Council of Research, Institute for Research and Biomedical Innovation (IRIB), Catania, Italy
| | - Raffaele Falsaperla
- Unit of Pediatrics, Neonatology and Neonatal Intensive Care, and Pediatric Emergency, AOU "Policlinico", PO "San Marco", University of Catania, Catania, Italy
| | - Simona Domenica Marino
- Unit of Pediatrics, Neonatology and Neonatal Intensive Care, and Pediatric Emergency, AOU "Policlinico", PO "San Marco", University of Catania, Catania, Italy
| | - John Kane Fink
- Department of Neurology and Ann Arbor Veterans Affairs Medical Center, University of Michigan, Ann Arbor, MI, United States
| | - Martino Ruggieri
- Unit of Rare Diseases of the Nervous System in Childhood, Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, AOU "Policlinico", PO "G. Rodolico", Catania, Italy
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12
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Falsaperla R, Vitaliti G, Marino SD, Praticò AD, Mailo J, Spatuzza M, Cilio MR, Foti R, Ruggieri M. Graph theory in paediatric epilepsy: A systematic review. Dialogues in Clinical Neuroscience 2021; 23:3-13. [PMID: 35860177 PMCID: PMC9286734 DOI: 10.1080/19585969.2022.2043128] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Graph theoretical studies have been designed to investigate network topologies during life. Network science and graph theory methods may contribute to a better understanding of brain function, both normal and abnormal, throughout developmental stages. The degree to which childhood epilepsies exert a significant effect on brain network organisation and cognition remains unclear. The hypothesis suggests that the formation of abnormal networks associated with epileptogenesis early in life causes a disruption in normal brain network development and cognition, reflecting abnormalities in later life. Neurological diseases with onset during critical stages of brain maturation, including childhood epilepsy, may threaten this orderly neurodevelopmental process. According to the hypothesis that the formation of abnormal networks associated with epileptogenesis in early life causes a disruption in normal brain network development, it is then mandatory to perform a proper examination of children with new-onset epilepsy early in the disease course and a deep study of their brain network organisation over time. In regards, graph theoretical analysis could add more information. In order to facilitate further development of graph theory in childhood, we performed a systematic review to describe its application in functional dynamic connectivity using electroencephalographic (EEG) analysis, focussing on paediatric epilepsy.
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Affiliation(s)
- Raffaele Falsaperla
- Neonatal Intensive Care Unit, San Marco Hospital, University Hospital Policlinico “G. Rodolico-San Marco", Catania, Italy
- Unit of Pediatrics and Pediatric Emergency, University Hospital Policlinico “G. Rodolico-San Marco", Catania, Italy
| | - Giovanna Vitaliti
- Department of Medical Sciences, Unit of Pediatrics, University of Ferrara, Ferrara, Italy
| | - Simona Domenica Marino
- Unit of Pediatrics and Pediatric Emergency, University Hospital Policlinico “G. Rodolico-San Marco", Catania, Italy
| | - Andrea Domenico Praticò
- Unit of Rare Diseases of the Nervous System in Childhood, Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy
| | - Janette Mailo
- Division of Pediatric Neurology, University of Alberta, Stollery Children’s Hospital, Edmonton, Alberta, Canada
| | - Michela Spatuzza
- National Council of Research, Institute for Biomedical Research and Innovation (IRIB), Unit of Catania, Catania, Italy
| | - Maria Roberta Cilio
- Institute for Experimental and Clinical Research, Catholic University of Leuven, Brussels, Belgium
| | - Rosario Foti
- Department Chief of Rheumatology Unit, San Marco Hospital, University Hospital Policlinico “G. Rodolico-San Marco", Catania, Italy
| | - Martino Ruggieri
- Unit of Rare Diseases of the Nervous System in Childhood, Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy
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13
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Pavone P, Pappalardo XG, Ohazuruike UNN, Striano P, Parisi P, Corsello G, Marino SD, Ruggieri M, Parano E, Falsaperla R. Chromosome 15q BP4-BP5 Deletion in a Girl with Nocturnal Frontal Lobe Epilepsy, Migraine, Circumscribed Hypertrichosis, and Language Impairment. J Epilepsy Res 2020; 10:84-91. [PMID: 33659201 PMCID: PMC7903043 DOI: 10.14581/jer.20014] [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] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/06/2020] [Accepted: 11/25/2020] [Indexed: 01/01/2023] Open
Abstract
The 15q13.3 microdeletion (microdel15q13.3) syndrome (OMIM 612001) has been reported in healthy subjects as well as in individuals with a wide spectrum of clinical manifestations ranging from mild to severe neurological disorders, including developmental delay/intellectual disability, autism spectrum disorder, schizophrenia, epilepsy, behavioral problems and speech dysfunction. This study explored the link between this genomic rearrangement and nocturnal frontal lobe epilepsy (NFLE), which could improve the clinical interpretation. A clinical and genomic investigation was carried out on an 8-year-girl with a de novo deletion flanking the breakpoints (BPs) 4 and 5 of 15q13.3 detected by array comparative genomic hybridization analysis, affected by NFLE, migraine with aura, minor facial features, mild cognitive and language impairment, and circumscribed hypertrichosis. Literature survey of clinical studies was included. Nine years follow-up have displayed a benign course of the epileptic disorder with a progressive reduction and disappearance of the epileptic seizures, mild improvement of cognitive and language skills, partial cutaneous hypertrichosis regression, but stable ongoing of migraine episodes. A likely relationship between the BP4–BP5 deletion and NFLE with other symptoms presented by the girl is discussed together with a review of the literature on phenotypic features in microdel15q13.3.
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Affiliation(s)
- Piero Pavone
- Unit of Pediatrics and Pediatric Emergency, University Hospital "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Xena Giada Pappalardo
- Unit of Catania, Institute for Biomedical Research and Innovation (IRIB), National Council of Research, Catania, Italy.,Department of Biomedical and Biotechnological Sciences (BIOMETEC), University of Catania, Catania, Italy
| | | | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, IRCCS 'G. Gaslini' Institute, Genoa, Italy
| | - Pasquale Parisi
- Child Neurology, NESMOS Department, Faculty of Medicine & Psychology, "Sapienza" University, c/o Sant'Andrea Hospital, Rome, Italy
| | - Giovanni Corsello
- Department of Sciences for Health Promotion and Mother and Child Care "G. D'Alessandro", University of Palermo, Palermo, Italy
| | | | - Martino Ruggieri
- Unit of Pediatrics and Pediatric Emergency, University Hospital "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Enrico Parano
- Unit of Catania, Institute for Biomedical Research and Innovation (IRIB), National Council of Research, Catania, Italy
| | - Raffaele Falsaperla
- Unit of Neonatology University Hospital "Policlinico-Vittorio Emanuele", Catania, Italy
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Abstract
Since its first clinical description (on his son) by William James West (1793–1848) in 1841, and the definition of the classical triad of (1) infantile spasms; (2) hypsarrhythmia, and (3) developmental arrest or regression as “West syndrome”, new and relevant advances have been recorded in this uncommon disorder. New approaches include terminology of clinical spasms (e.g., infantile (IS) vs. epileptic spasms (ES)), variety of clinical and electroencephalographic (EEG) features (e.g., typical ictal phenomena without EEG abnormalities), burden of developmental delay, spectrum of associated genetic abnormalities, pathogenesis, treatment options, and related outcome and prognosis. Aside the classical manifestations, IS or ES may present with atypical electroclinical phenotypes (e.g., subtle spasms; modified hypsarrhythmia) and may have their onset outside infancy. An increasing number of genes, proteins, and signaling pathways play crucial roles in the pathogenesis. This condition is currently regarded as a spectrum of disorders: the so-called infantile spasm syndrome (ISs), in association with other causal factors, including structural, infectious, metabolic, syndromic, and immunologic events, all acting on a genetic predisposing background. Hormonal therapy and ketogenic diet are widely used also in combination with (classical and recent) pharmacological drugs. Biologically targeted and gene therapies are increasingly studied. The present narrative review searched in seven electronic databases (primary MeSH terms/keywords included West syndrome, infantile spasms and infantile spasms syndrome and were coupled to 25 secondary clinical, EEG, therapeutic, outcomes, and associated conditions terms) including MEDLINE, Embase, Cochrane Central, Web of Sciences, Pubmed, Scopus, and OMIM to highlight the past knowledge and more recent advances.
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Affiliation(s)
- Piero Pavone
- Unit of Clinical Pediatrics, AOU "Policlinico", PO "G. Rodolico", University of Catania, Catania, Italy
| | - Agata Polizzi
- Chair of Pediatrics, Department of Educational Sciences, University of Catania, Catania, Italy
| | - Simona Domenica Marino
- Unit of Pediatrics, Neonatology and Neonatal Intensive Care, and Pediatric Emergency, AOU "Policlinico", PO "San Marco", University of Catania, Catania, Italy
| | - Giovanni Corsello
- Unit of Pediatrics and Neonatal Intensive Therapy, Department of Promotion of Maternal and Infantile and Internal Medicine Health, and Specialist Excellence "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Raffaele Falsaperla
- Unit of Pediatrics and Neonatal Intensive Therapy, Department of Promotion of Maternal and Infantile and Internal Medicine Health, and Specialist Excellence "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Silvia Marino
- Unit of Pediatrics, Neonatology and Neonatal Intensive Care, and Pediatric Emergency, AOU "Policlinico", PO "San Marco", University of Catania, Catania, Italy
| | - Martino Ruggieri
- Unit of Rare Diseases of the Nervous System in Childhood, Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, AOU "Policlinico", PO "G. Rodolico", Via S. Sofia, 87, 95128, Catania, Italy.
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Pavone P, Pappalardo XG, Incorpora G, Falsaperla R, Marino SD, Corsello G, Parano E, Ruggieri M. Long-term follow-up and novel genotype-phenotype analysis of monozygotic twins with ATP1A3 mutation in Alternating Hemiplegia of Childhood-2. Eur J Med Genet 2020; 63:103957. [PMID: 32454213 DOI: 10.1016/j.ejmg.2020.103957] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 01/27/2020] [Accepted: 05/16/2020] [Indexed: 11/28/2022]
Abstract
Alternating Hemiplegia of Childhood (AHC) is a rare disorder characterized by frequent, transient attacks of hemiplegia involving either side of the body or both in association to several other disturbances including dystonic spells, abnormal ocular movements, autonomic manifestations, epileptic seizures and cognitive impairment. The clinical manifestations usually start before the age of 18 months. Two forms of the disorder known as AHC-1 (MIM#104290) and AHC-2 (MIM#614820) depends on mutations in ATP1A2 and ATP1A3 genes respectively, with over 75% of AHC caused by a mutation in the ATP1A3 gene. Herewith, we report serial clinical follow-up data of monozygotic (MZ) twin sisters, who presented in early life bath-induced dystonia, signs of acute encephalopathy at the age of 2 years, hemiplegic spells, and motor dysfunction after the age of 3 years, and in young/adult frequent episodes of headache with drastic reduction of paroxysmal motor attacks. The molecular analysis revealed a known pathogenic variant p.Asn773Ser (rs606231437) in ATP1A3 gene associated with an unusual and moderate AHC-2 phenotype, with mild cognitive impairment and lack of epilepsy. The aim of this study is to analyze the clinical phases of the MZ twins, and to investigate the novel genotype-phenotype correlation.
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Affiliation(s)
- Piero Pavone
- Pediatric Clinic, Department of Clinical and Experimental Medicine, University Hospital A.U.O. "Policlinico-Vittorio Emanuele", Catania, Italy; Pediatrics and Pediatric Emergency Department, University Hospital, A.U.O "Policlinico Vittorio Emanuele", Catania, Italy.
| | - Xena Giada Pappalardo
- National Council of Research, Institute for Biomedical Research and Innovation (IRIB), Unit of Catania, Italy; Department of Biomedical and Biotechnological Sciences (BIOMETEC), University of Catania, Italy
| | - Gemma Incorpora
- Pediatric Clinic, Department of Clinical and Experimental Medicine, University Hospital A.U.O. "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Raffaele Falsaperla
- Pediatrics and Pediatric Emergency Department, University Hospital, A.U.O "Policlinico Vittorio Emanuele", Catania, Italy
| | - Simona Domenica Marino
- Pediatrics and Pediatric Emergency Department, University Hospital, A.U.O "Policlinico Vittorio Emanuele", Catania, Italy
| | - Giovanni Corsello
- Mother and Child Health Department, Operative Unit of Pediatrics and Neonatal Intensive Therapy, University of Palermo, Palermo, Italy
| | - Enrico Parano
- National Council of Research, Institute for Biomedical Research and Innovation (IRIB), Unit of Catania, Italy
| | - Martino Ruggieri
- Pediatric Clinic, Department of Clinical and Experimental Medicine, University Hospital A.U.O. "Policlinico-Vittorio Emanuele", Catania, Italy
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Falsaperla R, Pappalardo XG, Romano C, Marino SD, Corsello G, Ruggieri M, Parano E, Pavone P. Intronic Variant in CNTNAP2 Gene in a Boy With Remarkable Conduct Disorder, Minor Facial Features, Mild Intellectual Disability, and Seizures. Front Pediatr 2020; 8:550. [PMID: 33042910 PMCID: PMC7518065 DOI: 10.3389/fped.2020.00550] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/30/2020] [Indexed: 12/02/2022] Open
Abstract
Introduction: Mutations in the contactin-associated protein-like 2 (CNTNAP2) gene (MIM#604569) encoding for CASPR2, a cell adhesion protein of the neurexin family, are known to be associated with autism, intellectual disability, and other neuropsychiatric disorders. A set of intronic deletions of CNTNAP2 gene has also been suggested to have a causative role in individuals with a wide phenotypic spectrum, including Pitt-Hopkins syndrome, cortical dysplasia-focal epilepsy syndrome, Tourette syndrome, language dysfunction, and abnormal behavioral manifestations. Case presentation: A 10-years-old boy was referred to the hospital with mild intellectual disability and language impairment. Moreover, the child exhibited minor facial features, epileptic seizures, and notable behavioral abnormalities including impulsivity, aggressivity, and hyperactivity suggestive of the diagnosis of disruptive, impulse-control and conduct disorder (CD). Array comparative genomic hybridization (CGH) revealed a copy number variant (CNV) deletion in the first intron of CNTNAP2 gene inherited from a healthy father. Conclusions: A comprehensive description of the phenotypic features of the child is provided, revealing a distinct and remarkable alteration of social behavior not previously reported in individuals affected by disorders related to CNTNAP2 gene disruptions. A possible causative link between the deletion of a non-coding regulatory region and the symptoms presented by the boy has been advanced.
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Affiliation(s)
- Raffaele Falsaperla
- Unit of Neonatology, University Hospital "Policlinico-Vittorio Emanuele, " Catania, Italy
| | - Xena Giada Pappalardo
- National Council of Research, Institute for Biomedical Research and Innovation (IRIB), Catania, Italy.,Department of Biomedical and Biotechnological Sciences (BIOMETEC), University of Catania, Catania, Italy
| | - Catia Romano
- Unit of Pediatrics and Pediatric Emergency, University Hospital "Policlinico-Vittorio Emanuele, " Catania, Italy
| | - Simona Domenica Marino
- Unit of Neonatology, University Hospital "Policlinico-Vittorio Emanuele, " Catania, Italy
| | - Giovanni Corsello
- Department of Sciences for Health Promotion and Mother and Child Care "G. D'Alessandro, " University of Palermo, Palermo, Italy
| | - Martino Ruggieri
- Unit of Pediatrics and Pediatric Emergency, University Hospital "Policlinico-Vittorio Emanuele, " Catania, Italy
| | - Enrico Parano
- National Council of Research, Institute for Biomedical Research and Innovation (IRIB), Catania, Italy
| | - Piero Pavone
- Unit of Pediatrics and Pediatric Emergency, University Hospital "Policlinico-Vittorio Emanuele, " Catania, Italy
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Pavone P, Corsello G, Cho SY, Pappalardo XG, Ruggieri M, Marino SD, Jin DK, Marino S, Falsaperla R. PRRT2 gene variant in a child with dysmorphic features, congenital microcephaly, and severe epileptic seizures: genotype-phenotype correlation? Ital J Pediatr 2019; 45:159. [PMID: 31801583 PMCID: PMC6894132 DOI: 10.1186/s13052-019-0755-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 11/25/2019] [Indexed: 12/22/2022] Open
Abstract
Background Mutations in Proline-rich Transmembrane Protein 2 (PRRT2) have been primarily associated with individuals presenting with infantile epilepsy, including benign familial infantile epilepsy, benign infantile epilepsy, and benign myoclonus of early infancy, and/or with dyskinetic paroxysms such as paroxysmal kinesigenic dyskinesia, paroxysmal non-kinesigenic dyskinesia, and exercise-induced dyskinesia. However, the clinical manifestations of this disorder vary widely. PRRT2 encodes a protein expressed in the central nervous system that is mainly localized in the pre-synaptic neurons and is involved in the modulation of synaptic neurotransmitter release. The anomalous function of this gene has been proposed to cause dysregulation of neuronal excitability and cerebral disorders. Case presentation We hereby report on a young child followed-up for three years who presents with a spectrum of clinical manifestations such as congenital microcephaly, dysmorphic features, severe intellectual disability, and drug-resistant epileptic encephalopathy in association with a synonymous variant in PRRT2 gene (c.501C > T; p.Thr167Ile) of unknown clinical significance variant (VUS) revealed by diagnostic exome sequencing. Conclusion Several hypotheses have been advanced on the specific role that PRRT2 gene mutations play to cause the clinical features of affected patients. To our knowledge, the severe phenotype seen in this case has never been reported in association with any clinically actionable variant, as the missense substitution detected in PRRT2 gene. Intriguingly, the same mutation was reported in the healthy father: the action of modifying factors in the affected child may be hypothesized. The report of similar observations could extend the spectrum of clinical manifestations linked to this mutation.
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Affiliation(s)
- Piero Pavone
- Department of Pediatrics, University-Hospital "Policlinico-Vittorio Emanuele", University of Catania, Via Santa Sofia 78, 95124, Catania, Italy.
| | | | - Sung Yoon Cho
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Xena Giada Pappalardo
- National Council of Research, CNR, Institute for Research and for Biomedicine Innovation (IRIB) unit of Catania, Catania, Italy
| | - Martino Ruggieri
- Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy
| | - Simona Domenica Marino
- Department of Pediatrics, University-Hospital "Policlinico-Vittorio Emanuele", University of Catania, Via Santa Sofia 78, 95124, Catania, Italy
| | - Dong Kyu Jin
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Silvia Marino
- Department of Pediatrics, University-Hospital "Policlinico-Vittorio Emanuele", University of Catania, Via Santa Sofia 78, 95124, Catania, Italy
| | - Raffaele Falsaperla
- Department of Pediatrics, University-Hospital "Policlinico-Vittorio Emanuele", University of Catania, Via Santa Sofia 78, 95124, Catania, Italy
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Falsaperla R, Marino SD, Aguglia MG, Cupitò G, Pisani F, Mailo J, Suppiej A. Developmental EEG hallmark or biological artifact? Glossokinetic artifact mimicking anterior slow dysrhythmia in two full term newborns. Neurophysiol Clin 2019; 49:377-380. [PMID: 31740127 DOI: 10.1016/j.neucli.2019.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 07/12/2019] [Accepted: 07/12/2019] [Indexed: 11/28/2022] Open
Abstract
The aim of this paper is to describe an uncommon physiological EEG artifact in newborns caused by tongue movements (TM), mimicking anterior slow dysrhythmia (ASD). The subjects are two full-term newborns (39 weeks gestational age (GA)), admitted to the Neonatal Intensive Care Unit for respiratory distress. Both underwent polygraphic video-EEG recording in order to better characterize tremor-like movements of all four limbs that appeared 48 hours after birth. Multichannel video-EEG polygraphy was performed using the 10-20 electrode montage modified for neonates. Ninety minutes of EEG was recorded for each subject, capturing different behavioral states. Background EEG activity was normal for both subjects. During active sleep (AS), synchronous and symmetric slow activity was recorded over bifrontal head regions. For subject 1, bursts of monomorphic 2Hz delta waves, with an amplitude between 50-100μV lasting two seconds, were recorded and identified as anterior slow dysrhythmia. For subject 2, polymorphic 1-2Hz delta waves, 50-100μV in amplitude and lasting for 20 seconds, were recorded only during suction. After thorough analysis of simultaneous digital video recording synchronized with the EEG trace, this activity was thought to be compatible with glossokinetic artifact. Interpretation of neonatal EEG can be challenging; the background activity is frequently intermixed with physiological artifacts, such as ocular, muscle and movement artifacts, complicating the interpretation. Even continuous video-recording might not make the diagnosis immediately obvious. Therefore, when a rhythmic monomorphic pattern without evolution in amplitude or frequency is seen, we suggest that tongue movement artifact should be considered.
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Affiliation(s)
- Raffaele Falsaperla
- Neonatal Intensive Care Unit, Santo Bambino Hospital, University Hospital "Policlinico-Vittorio Emanuele", via Tindaro 2, 95124 Catania, Italy
| | - Simona Domenica Marino
- Pediatric and Pediatric Emergency Department, University Hospital "Policlinico-Vittorio Emanuele", via Plebiscito 628, 95124 Catania, Italy.
| | - Maria Giovanna Aguglia
- Neonatal Intensive Care Unit, Santo Bambino Hospital, University Hospital "Policlinico-Vittorio Emanuele", via Tindaro 2, 95124 Catania, Italy
| | - Giulia Cupitò
- Pediatric and Pediatric Emergency Department, University Hospital "Policlinico-Vittorio Emanuele", via Plebiscito 628, 95124 Catania, Italy
| | - Francesco Pisani
- Child Neuropsychiatry Unit, Neuroscience Division, Medicine & Surgery Department, University of Parma, Parma, Italy
| | - Janette Mailo
- Division of Pediatric Neurology, University of Alberta, Edmonton, Alberta, Canada
| | - Agnese Suppiej
- Pediatric section, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
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Pavone P, Corsello G, Marino SD, Ruggieri M, Falsaperla R. 7q31.32 partial duplication: First report of a child with dysmorphism, autistic spectrum disorder, moderate intellectual disability and, epilepsy. Literature review. Epilepsy Res 2019; 158:106223. [PMID: 31707317 DOI: 10.1016/j.eplepsyres.2019.106223] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 09/10/2019] [Accepted: 10/19/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Duplication of long arm of chromosome 7(q) is uncommon. It may occur as "pure", isolated anomaly or in association with other mutations involving the same or other chromosomes. "Pure" chromosome 7q duplication has recently been classified by segment involved: the interstitial, proximal, or distal segment of the arm. Attempts to correlate genotype with phenotype in each group has yielded questionable results even though intellective disability and minor dysmorphic features of variable types are typically seen. MATERIAL AND METHODS In a young boy showing minor facial dysmorphism, language delay, autistic spectrum disorder, epileptic seizures, behavioral disturbances and irritability an array-CGH analysis was carried out. RESULTS Array-CGH analysis found in the proband a de novo variant of partial duplication of 7q31.32 (122.254.792-122.376.908). DISCUSSION A very few cases of partial 7q duplication have been reported thus far mainly presenting with clinical signs of dysmorphic features, large head, developmental delay, epileptic seizures and skeletal anomalies. To our knowledge, this is the first report of a case of a de novo variant of 7q31.32 duplication, showing dysmorphic anomalies and neurologic impairment including ASD and seizures. In the 7q31.32 region is located the gene CADPS2, which has been associated to autistic spectrum disorder and other neurologic disorders. In the child, a genotype-phenotype correlation may be hypothesized. Further similar reports may be useful to confirm this observation.
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Affiliation(s)
- Piero Pavone
- Department of Pediatrics, University Hospital. "Vittorio Emanuele-Policlinico" Catania, Italy.
| | - Giovanni Corsello
- Department of Maternal and Child Health, University of Palermo, Italy
| | - Simona Domenica Marino
- Pediatrics and Pediatric Emergency Complex Unity, University-Hospital "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Martino Ruggieri
- Unit of Rare Diseases of the Nervous System in childhood, Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, A.U.O. Vittorio Emanuele-Policlinico of Catania, Italy
| | - Raffaele Falsaperla
- Pediatrics and Pediatric Emergency Complex Unity, University-Hospital "Policlinico-Vittorio Emanuele", Catania, Italy
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Pavone P, Marino SD, Corsello G, Ruggieri M, Chiodo DC, Marino S, Falsaperla R. Cerebral White Matter Lesions and Dysmorphisms: Signs Suggestive of 6p25 Deletion Syndrome-Literature Review. J Pediatr Genet 2019; 8:205-211. [PMID: 31687258 DOI: 10.1055/s-0039-1694015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 06/20/2019] [Indexed: 02/08/2023]
Abstract
Deletion of the region including chromosome 6p25 has been defined as a syndrome, with more than 68 reported cases. Individuals affected by the syndrome exhibit variable findings, including developmental delay and intellectual disability, cardiac anomalies, dysmorphic features, and-less commonly-skeletal and renal malformations. Ocular and hearing abnormalities are the most notable presenting features. The region encompasses more than 15 genes, of which the FOX group is the most likely causal factor of the clinical manifestations. We report the case of a 2-year-old child with developmental delay, generalized hypotonia, facial dysmorphism, and anomalies involving malformations of the eyes, heart, teeth, and skeleton. The magnetic resonance imaging (MRI) of the child's brain displayed cerebral anomalies involving the white matter, perivascular spaces, and corpus callosum. Array-CGH (comparative genomic hybridization) analysis displayed a de novo partial deletion of the short arm of chromosome 6, extending 5.13 Mb from nt 407.231 to nt 5.541.179. In infancy, neuroradiologic findings of abnormalities in the cerebral white matter and other neurologic anomalies elsewhere in the brain, in association with dysmorphisms and malformations, are highly suggestive of the diagnosis of 6p25 deletion syndrome. When these anomalies are found, the syndrome must be included in the differential diagnosis of disorders affecting the cerebral white matter.
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Affiliation(s)
- Piero Pavone
- Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, Catania University, Catania, Italy
| | - Simona Domenica Marino
- General Pediatrics and Pediatric Acute and Emergency Unit, Policlinico-Vittorio-Emanuele University Hospital, University of Catania, Catania, Italy
| | - Giovanni Corsello
- Mother and Child Department, Operative Unit of Pediatrics and Neonatal Intensive Therapy, University of Palermo, Palermo, Italy
| | - Martino Ruggieri
- Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, Catania University, Catania, Italy
| | | | - Silvia Marino
- General Pediatrics and Pediatric Acute and Emergency Unit, Policlinico-Vittorio-Emanuele University Hospital, University of Catania, Catania, Italy
| | - Raffaele Falsaperla
- General Pediatrics and Pediatric Acute and Emergency Unit, Policlinico-Vittorio-Emanuele University Hospital, University of Catania, Catania, Italy
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Falsaperla R, Piattelli G, Marino S, Marino SD, Fontana A, Pavone P. Grisel's syndrome caused by Mycoplasma pneumoniae infection: a case report and review of the literature. Childs Nerv Syst 2019; 35:523-527. [PMID: 30209598 DOI: 10.1007/s00381-018-3970-z] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 09/04/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Grisel's syndrome is a non-traumatic subluxation of the atlantoaxial joints, which is caused by an inflammatory process involving the upper neck. Torticollis, neck pain, and reduced neck mobility are the main clinical signs of presentation. Predisposing factors are trauma, hyperlaxity of the transverse and alar ligaments of the atlantoaxial joints, and surgical interventions carried out in this area. Several viral and bacterial pathogens have been reported as causative events of Grisel's syndrome, including Epstein-Barr virus, Kawasaki disease, Streptococcus pyogenes, Staphylococcus aureus, and other infectious agents. Grisel's syndrome linked to Mycoplasma pneumoniae infection as the trigger has not previously been reported. Mycoplasma pneumoniae is a small prokaryotic microbe and a frequent etiologic factor of respiratory tract infections and, less frequently, of extrapulmonary body organs. The recognition of the Grisel's syndrome is based on clinical and neuroradiological investigations, and early diagnosis and specific treatment are crucial to the successful outcome of the disease. RESULTS We report the case of an 8-year-old girl with Grisel's syndrome caused by an upper respiratory tract infection due to Mycoplasma pneumoniae. Diagnostic suspicion and treatment of Grisel's syndrome were established quickly by anamnestic and clinical data and confirmed by radiological findings. The girl was immediately treated with specific antibiotic therapy and cervical immobilization, thus preventing the most dangerous complications of the disorder. CONCLUSION Mycoplasma pneumoniae, among the other infectious agents, may be cause of scute torticollis and Gresel's syndrome.
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Affiliation(s)
- Raffaele Falsaperla
- Pediatric Emergency Department, University Hospital "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Gianluca Piattelli
- Department of Neurosurgery, University Hospital "Giannina Gaslini", Genoa, Italy
| | - Silvia Marino
- Pediatric Emergency Department, University Hospital "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Simona Domenica Marino
- Pediatric Emergency Department, University Hospital "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Alessandra Fontana
- Department of Pediatrics, University Hospital "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Piero Pavone
- Department of Pediatrics, University Hospital "Policlinico-Vittorio Emanuele", Catania, Italy.
- Department of Pediatrics, AOU Policlinico-Vittorio Emanuele, University of Catania, Via S. Sofia 78, 95123, Catania, Italy.
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Marino S, Vitaliti G, Marino SD, Pavone P, Provvidenti S, Romano C, Falsaperla R. Pyridoxine Add-On Treatment for the Control of Behavioral Adverse Effects Induced by Levetiracetam in Children: A Case-Control Prospective Study. Ann Pharmacother 2018; 52:645-649. [PMID: 29442544 DOI: 10.1177/1060028018759637] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Few studies on adult and pediatric patients have shown pyridoxine efficacy as additional therapy for those receiving levetiracetam (LEV) to prevent and mitigate behavioral adverse effects (BAEs). OBJECTIVE The aim of our study was to analyze the safety and efficacy of pyridoxine supplementation in the prevention of LEV adverse effects, including suicidal ideation. METHODS This randomized, case-control trial included patients receiving LEV as monotherapy treatment. Patients were subdivided into 2 groups, according to whether they were treated with LEV only (group 1) or LEV with supplemental pyridoxine (group 2). RESULTS In both cohorts, the most frequent BAEs were irritability/aggression followed by depression and confusion. Those patients (92%) who initiated pyridoxine after 1 month of LEV treatment did not need to change or suspend LEV ( P < 0.001), and BAE improved after 9.06 ± 3.05 days of pyridoxine supplementation. None of the patients complained of symptoms of pyridoxine toxicity, and no new adverse effects of LEV off-label were reported. CONCLUSIONS In our study, we found pyridoxine to be safe and effective in controlling LEV-induced BAEs in children.
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Affiliation(s)
- Silvia Marino
- 1 University Hospital Policlinico-Vittorio Emanuele, Catania, Italy
| | | | | | - Piero Pavone
- 1 University Hospital Policlinico-Vittorio Emanuele, Catania, Italy
| | | | - Catia Romano
- 1 University Hospital Policlinico-Vittorio Emanuele, Catania, Italy
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Cucuzza ME, Marino SD, Schiavone L, Smilari P, Filosco F, Barone P. Diffuse alveolar haemorrage as initial presentation of systemic lupus erythematosus: a case report. Lupus 2018; 27:507-510. [DOI: 10.1177/0961203317713144] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Diffuse alveolar haemorrhage (DAH) is a rare life-threatening complication of systemic lupus erythematosus (SLE), associated with high mortality rates. It usually occurs in patients with an established diagnosis of SLE. It has been reported as the initial presentation of SLE in 11−20% of cases. It occurs most frequently in females. We describe the case of a child, aged 14 years, with fever, asthenia, haemoptysis, dyspnea, anaemia, increased inflammatory markers, positivity to ANA, nDNA, direct Coombs tests, anticardiolipin antibodies and complement factors consumption. Computed tomography (CTscan) of the chest showed bilateral pulmonary alveolar infiltrates. He also developed renal involvement with nephritis later in the course of the disease. He was started on the treatment approved by the Euro Lupus Protocol for critical patients. After starting Mycophenolate Mofetil the clinical and radiological features were improved as was the survival outcome.
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Affiliation(s)
- M E Cucuzza
- Department of Clinical and Experimental Medicine, University of Catania, Italy
| | - S D Marino
- Department of Clinical and Experimental Medicine, University of Catania, Italy
| | - L Schiavone
- Department of Clinical and Experimental Medicine, University of Catania, Italy
| | - P Smilari
- Department of Clinical and Experimental Medicine, University of Catania, Italy
| | - F Filosco
- Department of Clinical and Experimental Medicine, University of Catania, Italy
| | - P Barone
- Department of Clinical and Experimental Medicine, University of Catania, Italy
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Abstract
Aim of the study: To evaluate the electroclinical course and the correlation Electroencephalographic (EEG) pattern and epileptic seizures in an infant with Miller Dieker Syndrome (MDS) during the first year of life. Materials and Methods: MDS was diagnosed in the infant soon after birth and followed up from six months of life to one year, at the Department of Pediatrics, General Pediatric Operative Unit, Policlinico Vittorio Emanuele, University Hospital, XCatania, Italy, with clinical and serial EEG recording. Results: Aside from severe delay in the developmental milestone, the onset of the seizures was first noticed by the parents at the age of 4 months as brief slow tonic movements; at 6 months as tonic movements of the upper limbs with a slow rotations of the trunk, i.e. “subtle spams”; and at 7 months as typical “infantile spams” and tonic seizures. The EEG recording registered pattern of modified hypsarrhythmia (MH) correlated with “subtle spams” at the age of 6 months and at the age of 7 months the same EEG recording of MH associated to clinical expression of classical Infantile Spams (IS). Conclusions: In this infant, the EEG pattern and epileptic seizures were widely variable ranging clinically from brief anomalous movements to “subtle spams” and to typical infantile spams. At the same time, the EEG recording manifested first with MH and one month later with classical hypsarrhythmia. The EEG recording MH correlated first with clinical expression of subtle spams and the EEG remaining unchanged with the classical clinical expression of infantile spams.
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Affiliation(s)
- Raffaele Falsaperla
- Pediatric and Pediatric Emergency Department, University Hospital "Policlinico-Vittorio Emanuele," Catania, Italy
| | - Simona Domenica Marino
- Pediatric and Pediatric Emergency Department, University Hospital "Policlinico-Vittorio Emanuele," Catania, Italy
| | - Silvia Marino
- Pediatric and Pediatric Emergency Department, University Hospital "Policlinico-Vittorio Emanuele," Catania, Italy
| | - Piero Pavone
- Pediatric and Pediatric Emergency Department, University Hospital "Policlinico-Vittorio Emanuele," Catania, Italy
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