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Spagnoli C, Duca M, Pelliccia V, Lanzone J, Masnada S, Chiarello D, Barco TL, Dono F, Nucera B. Educational needs and career development of young epileptologists in Italy. Epilepsia Open 2024; 9:613-625. [PMID: 38386334 PMCID: PMC10984319 DOI: 10.1002/epi4.12888] [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: 08/16/2023] [Revised: 11/23/2023] [Accepted: 12/18/2023] [Indexed: 02/23/2024] Open
Abstract
OBJECTIVE The Education and Career Task Force of the Young Epilepsy Section-Italy focuses on educational and career development needs of young Italian epileptologists. Two surveys were developed (pre- and post COVID-19 pandemic) in order to identify the needs of members of the Lega Italiana Contro l'Epilessia under 40 years of age. METHODS The first was distributed during the 42nd National Congress (Rome, June 5-7, 2019); the second during the 45th National Congress (Padova, June 8-10, 2022) and subsequently by e-mail until July 9, 2022. Data from the 2019 survey were analyzed descriptively. Data from the 2022 survey were further analyzed with Pearson's chi-square test to establish if gender, field of clinical practice, and professional role were associated with different needs. RESULTS Sixty surveys were completed in 2019 and 69 in 2022. Attendance to courses and congresses as the preferred way to keep medical knowledge updated reduced between 2019 and 2022. The reason was different between trainees (mostly elevated costs) and early-career consultants (mostly organizational issues) (p = 0.005). The main needs for improvement also diverged: trainees indicated differential diagnosis and diagnostic approach to the first seizure while consultants indicated diagnostic approach to genetic epilepsies (p = 0.004); in the genetic field, priority needs were selection of genetic investigations for trainees versus genotype-phenotype correlations for consultants (p = 0.022). The field of practice (pediatric vs. adult) also impacted on the main needs for improvement that is, acquisition of expertise in neuroradiology and drug therapy for pediatric versus genetics for adult neurology trainees or consultants (p = 0.018); in the clinical area, differential diagnosis and approach to the first seizure versus status epilepticus (p = 0.027); in the genetic field, precision medicine versus genotype-phenotype correlations (p = 0.034). No differences were found based on gender. SIGNIFICANCE The surveys identified different needs based on professional role and discipline. PLAIN LANGUAGE SUMMARY The Education and Career Task Force of the Young Epilepsy Section-Italy (YES-I) launched two surveys among young Italian epileptologists. Our research shows that the educational and professional needs of young Italian epileptologists vary based on their job role and field of practice, but not on gender. Their preference for on-site congresses and courses reduced after the pandemic, and the main reason is linked to financial constraints for trainees and to organizational issues for consultants. The main expectation toward YES-I is to receive support for education and career development. Thus, we collected useful suggestions on how to organize our future YES-I activities.
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Affiliation(s)
- Carlotta Spagnoli
- Child Neuropsychiatry Unit, Pediatric DepartmentSanta Maria Nuova Hospital, Azienda USL‐IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - Maddalena Duca
- Child Neuropsychiatry UnitOspedale Civile di MacerataMacerataItaly
| | - Veronica Pelliccia
- "Claudio Munari" Epilepsy Surgery CentreAzienda Socio‐Sanitaria Territoriale Grande Ospedale Metropolitano NiguardaMilanItaly
| | - Jacopo Lanzone
- Neurorehabilitation Department of the Milano InstituteIstituti Clinici Scientifici Maugeri IRCCSMilanItaly
| | | | - Daniela Chiarello
- "Claudio Munari" Epilepsy Surgery CentreAzienda Socio‐Sanitaria Territoriale Grande Ospedale Metropolitano NiguardaMilanItaly
| | - Tommaso Lo Barco
- Child Neuropsychiatry Department, Epilepsy CenterC. Poma HospitalMantovaItaly
| | - Fedele Dono
- Department of Neuroscience, Imaging and Clinical Science"G. D'Annunzio" University of Chieti‐PescaraChietiItaly
| | - Bruna Nucera
- Department of NeurologyHospital of Merano (SABES‐ASDAA)MeranoItaly
- Paracelsus Medical UniversitySalzburgAustria
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Lo Barco T, Garcelon N, Neuraz A, Nabbout R. Natural history of rare diseases using natural language processing of narrative unstructured electronic health records: The example of Dravet syndrome. Epilepsia 2024; 65:350-361. [PMID: 38065926 DOI: 10.1111/epi.17855] [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: 07/04/2023] [Revised: 12/07/2023] [Accepted: 12/07/2023] [Indexed: 12/31/2023]
Abstract
OBJECTIVE The increasing implementation of electronic health records allows the use of advanced text-mining methods for establishing new patient phenotypes and stratification, and for revealing outcome correlations. In this study, we aimed to explore the electronic narrative clinical reports of a cohort of patients with Dravet syndrome (DS) longitudinally followed at our center, to identify the capacity of this methodology to retrace natural history of DS during the early years. METHODS We used a document-based clinical data warehouse employing natural language processing to recognize the phenotype concepts in the narrative medical reports. We included patients with DS who have a medical report produced before the age of 2 years and a follow-up after the age of 3 years ("DS cohort," 56 individuals). We selected two control populations, a "general control cohort" (275 individuals) and a "neurological control cohort" (281 individuals), with similar characteristics in terms of gender, number of reports, and age at last report. To find concepts specifically associated with DS, we performed a phenome-wide association study using Cox regression, comparing the reports of the three cohorts. We then performed a qualitative analysis of the surviving concepts based on their median age at first appearance. RESULTS A total of 76 concepts were prevalent in the reports of children with DS. Concepts appearing during the first 2 years were mostly related with the epilepsy features at the onset of DS (convulsive and prolonged seizures triggered by fever, often requiring in-hospital care). Subsequently, concepts related to new types of seizures and to drug resistance appeared. A series of non-seizure-related concepts emerged after the age of 2-3 years, referring to the nonseizure comorbidities classically associated with DS. SIGNIFICANCE The extraction of clinical terms by narrative reports of children with DS allows outlining the known natural history of this rare disease in early childhood. This original model of "longitudinal phenotyping" could be applied to other rare and very rare conditions with poor natural history description.
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Affiliation(s)
- Tommaso Lo Barco
- Department of Pediatric Neurology, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Reference Center for Rare Epilepsies, Member of European Reference Network EpiCARE, Université Paris Cité, Paris, France
| | - Nicolas Garcelon
- Data Science Platform, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche 1163, Imagine Institute, Université Paris Cité, Paris, France
| | - Antoine Neuraz
- Data Science Platform, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche 1163, Imagine Institute, Université Paris Cité, Paris, France
| | - Rima Nabbout
- Department of Pediatric Neurology, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Reference Center for Rare Epilepsies, Member of European Reference Network EpiCARE, Université Paris Cité, Paris, France
- Translational Research for Neurological Disorders, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche 1163, Imagine Institute, Université Paris Cité, Paris, France
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Kuchenbuch M, Lo Barco T, Chemaly N, Chiron C, Nabbout R. Fifteen years of real-world data on the use of vigabatrin in individuals with infantile epileptic spasms syndrome. Epilepsia 2024; 65:430-444. [PMID: 37872396 DOI: 10.1111/epi.17808] [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: 03/17/2023] [Revised: 10/14/2023] [Accepted: 10/19/2023] [Indexed: 10/25/2023]
Abstract
OBJECTIVE This study was undertaken to evaluate our treatment algorithm for infantile epileptic spasms syndrome (IESS) used between 2000 and 2018. We initiated vigabatrin (VGB), and steroids were added if the electroclinical response (spasms and electroencephalogram [EEG]) to VGB was not obtained or incomplete. METHODS Individuals with IESS treated with VGB were recruited from our hospital clinical data warehouse based on electronic health records (EHRs) generated since 2009 and containing relevant keywords. We confirmed the diagnosis of IESS. Clinical, EEG, imaging, and biological data were extracted from the EHRs. We analyzed factors associated with short-term response, time to response, relapse, time to relapse of spasms, and the presence of spasms at last follow-up. RESULTS We collected data from 198 individuals (female: 46.5%, IESS onset: 6 [4.5-10.3] months, follow-up: 4.6 [2.5-7.6] years, median [Q1-Q3]) including 129 (65.2%) with identifiable etiology. VGB was started 17 (5-57.5) days after IESS diagnosis. A total of 113 individuals were responders (57.1% of the cohort), 64 with VGB alone and 38 with VGB further combined with steroids (56.6% and 33.6% of responders, respectively). Among responders, 33 (29%) experienced relapses of spasms, mostly those with later onset of spasms (p = .002) and those who received VGB for <24 months after spasms cessation compared to a longer duration on VGB (45% vs. 12.8%, p = .003). At follow-up, 92 individuals were seizure-free (46.5% of the whole cohort), including 26 free of therapy (13.1%). One hundred twelve individuals (56.6%) were still receiving VGB, with a duration of 3.2 (1.75-5.7) years. SIGNIFICANCE Our sequential protocol introducing VGB then adding steroids is an effective alternative to a combined VGB-steroids approach in IESS. It avoids steroid-related adverse events, as well as those from VGB-steroid combination. According to our data, a period of 7 days seems sufficient to assess VGB response and enables the addition of steroids rapidly if needed. Continuing VGB for 2 years may balance the risk of relapse and treatment-induced adverse events.
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Affiliation(s)
- Mathieu Kuchenbuch
- Department of Pediatric Neurology, Reference Center for Rare Epilepsies, Hôpital Necker-Enfants Malades, member of ERN EpiCARE, Paris, France
- Laboratory of Translational Research for Neurological Disorders, INSERM MR1163, Imagine Institute, Paris, France
- Service de Pédiatrie, Reference Center for Rare Epilepsies, member of ERN EpiCARE, Université de Lorraine, CHRU-Nancy, Nancy, France
| | - Tommaso Lo Barco
- Department of Pediatric Neurology, Reference Center for Rare Epilepsies, Hôpital Necker-Enfants Malades, member of ERN EpiCARE, Paris, France
| | - Nicole Chemaly
- Department of Pediatric Neurology, Reference Center for Rare Epilepsies, Hôpital Necker-Enfants Malades, member of ERN EpiCARE, Paris, France
- Laboratory of Translational Research for Neurological Disorders, INSERM MR1163, Imagine Institute, Paris, France
| | - Catherine Chiron
- Department of Pediatric Neurology, Reference Center for Rare Epilepsies, Hôpital Necker-Enfants Malades, member of ERN EpiCARE, Paris, France
| | - Rima Nabbout
- Department of Pediatric Neurology, Reference Center for Rare Epilepsies, Hôpital Necker-Enfants Malades, member of ERN EpiCARE, Paris, France
- Laboratory of Translational Research for Neurological Disorders, INSERM MR1163, Imagine Institute, Paris, France
- Université de Paris Cité, Paris, France
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Chemaly N, Kuchenbuch M, Teng T, Marie E, D'Onofrio G, Lo Barco T, Brambilla I, Flege S, Hallet A, Nabbout R. A European pilot study in Dravet Syndrome to delineate what really matters for the patients and families. Epilepsia Open 2024; 9:388-396. [PMID: 34747137 PMCID: PMC10839355 DOI: 10.1002/epi4.12557] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 10/26/2021] [Accepted: 10/31/2021] [Indexed: 11/09/2022] Open
Abstract
We aimed to identify caregivers' opinions on the outcome measures that matter in clinical trials in individuals with Dravet syndrome (DS). We conducted a prospective European multicenter study based on an 11 closed questions survey developed by the French reference center for rare epilepsies and DS patients' advocacy groups. Items included questions on seizures and daily life outcomes that a clinical trial on a therapy for individuals with DS should target. Statistical analyses were performed to evaluate the impact of the country of residence and of the patients' age. The survey was answered by 153 caregivers (68%: France, 28%: Germany, and 24%: Italy) off individuals with DS. Individuals with DS included 86 males (mean age of 11.4 [interquartile: 7-20.4] years). Families ranked as important almost all the items proposed. However, items related to daily life had the highest rank in all three countries compared to items about seizures (P = 0.02). Increase in individuals' age was associated with a higher age at diagnosis (ρ = 0.26, P = 0.02), and a lower impact of seizure duration (ρ = -0.25, P = 0.005) and on the need of hospital referral (ρ = -0.26, P = 0.005). These data can help tailor patient-centered outcome measures in future clinical and real-life trials for DS.
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Affiliation(s)
- Nicole Chemaly
- Department of Pediatric NeurologyReference Centre for Rare EpilepsiesHôpital Necker‐Enfants MaladesAPHPMember of ERN EpiCAREParisFrance
- Laboratory of Translational Research for Neurological DisordersINSERM MR1163Imagine InstituteParisFrance
- Université de ParisParisFrance
| | - Mathieu Kuchenbuch
- Department of Pediatric NeurologyReference Centre for Rare EpilepsiesHôpital Necker‐Enfants MaladesAPHPMember of ERN EpiCAREParisFrance
- Laboratory of Translational Research for Neurological DisordersINSERM MR1163Imagine InstituteParisFrance
| | - Théo Teng
- Department of Pediatric NeurologyReference Centre for Rare EpilepsiesHôpital Necker‐Enfants MaladesAPHPMember of ERN EpiCAREParisFrance
| | | | - Gianluca D'Onofrio
- Department of Pediatric NeurologyReference Centre for Rare EpilepsiesHôpital Necker‐Enfants MaladesAPHPMember of ERN EpiCAREParisFrance
- Department of Women and Child HealthUniversity of PaduaPaduaItaly
| | - Tommaso Lo Barco
- Department of Pediatric NeurologyReference Centre for Rare EpilepsiesHôpital Necker‐Enfants MaladesAPHPMember of ERN EpiCAREParisFrance
- Child NeuropsychiatryDepartment of Surgical SciencesDentistry, Gynecology and PediatricsUniversity of VeronaVeronaItaly
| | | | | | | | - Rima Nabbout
- Department of Pediatric NeurologyReference Centre for Rare EpilepsiesHôpital Necker‐Enfants MaladesAPHPMember of ERN EpiCAREParisFrance
- Laboratory of Translational Research for Neurological DisordersINSERM MR1163Imagine InstituteParisFrance
- Université de ParisParisFrance
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Proietti J, Fiorini E, Cantalupo G, Fontana E, Lo Barco T, Bonin C, Bernardina BD, Darra F. Refractory tonic-myoclonic status epilepticus with catamenial recurrence in epilepsy with myoclonic atonic seizures: A case report. Heliyon 2024; 10:e24747. [PMID: 38304836 PMCID: PMC10831770 DOI: 10.1016/j.heliyon.2024.e24747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/08/2023] [Accepted: 01/12/2024] [Indexed: 02/03/2024] Open
Abstract
In epilepsy with myoclonic-atonic seizures (EMA), status epilepticus (SE) may occur during the onset phase, uncommonly in post-puberal patients. We report a post-puberal patient with EMA who presented SE with insidious onset and catamenial recurrence. She had a stormy epilepsy onset at 4 years, with tonic seizures, atypical absences, and myoclonic-atonic seizures, in the absence of SE. After the onset phase, sporadic nocturnal tonic seizures persisted and a mild intellectual disability appeared. At the age of 7, after gonadotropin-releasing hormone analog administration due to central precocious puberty, she presented with SE characterized by recurrent atypical absences, tonic seizures, and awareness impairment, which was successfully treated in 4 days. At 11 years, one week before menstruation, the patient presented with analogous SE that lasted 8 days. One week before the subsequent menstruation, she presented again with SE, initially characterized by atypical absences alternating with phases of awareness and motor impairment related to fast low-voltage EEG activity in the central regions; later, tonic and myoclonic seizures occurring even in the awake state increased, and the "atonic-akinetic status" related to fast EEG activity worsened. After conventional antiepileptic drugs had failed to control the seizures, a progestin was added, with subsequent gradual complete recovery.
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Affiliation(s)
- Jacopo Proietti
- UOC Neuropsichiatria Infantile, Dipartimento Materno-Infantile, Azienda Ospedaliero-Universitaria Integrata, Verona, Italy - Full member of ERN EpiCARE
- Innovation biomedicine Section, Department of Engineering for Innovation Medicine, University of Verona, Verona, Italy
- Center for Research on Epilepsies in Pediatric age (CREP), Verona, Italy
| | - Elena Fiorini
- UOC Neuropsichiatria Infantile, Dipartimento Materno-Infantile, Azienda Ospedaliero-Universitaria Integrata, Verona, Italy - Full member of ERN EpiCARE
- Center for Research on Epilepsies in Pediatric age (CREP), Verona, Italy
| | - Gaetano Cantalupo
- UOC Neuropsichiatria Infantile, Dipartimento Materno-Infantile, Azienda Ospedaliero-Universitaria Integrata, Verona, Italy - Full member of ERN EpiCARE
- Innovation biomedicine Section, Department of Engineering for Innovation Medicine, University of Verona, Verona, Italy
- Center for Research on Epilepsies in Pediatric age (CREP), Verona, Italy
| | - Elena Fontana
- UOC Neuropsichiatria Infantile, Dipartimento Materno-Infantile, Azienda Ospedaliero-Universitaria Integrata, Verona, Italy - Full member of ERN EpiCARE
- Center for Research on Epilepsies in Pediatric age (CREP), Verona, Italy
| | - Tommaso Lo Barco
- UOC Neuropsichiatria Infantile, Dipartimento Materno-Infantile, Azienda Ospedaliero-Universitaria Integrata, Verona, Italy - Full member of ERN EpiCARE
- Center for Research on Epilepsies in Pediatric age (CREP), Verona, Italy
| | - Cecilia Bonin
- U.O.C. Ostetricia e Ginecologia B, Dipartimento di Ostetricia e Ginecologia, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Francesca Darra
- UOC Neuropsichiatria Infantile, Dipartimento Materno-Infantile, Azienda Ospedaliero-Universitaria Integrata, Verona, Italy - Full member of ERN EpiCARE
- Innovation biomedicine Section, Department of Engineering for Innovation Medicine, University of Verona, Verona, Italy
- Center for Research on Epilepsies in Pediatric age (CREP), Verona, Italy
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Nucera B, Rinaldi F, Dono F, Evangelista G, Consoli S, Proietti J, Lanzone J, Lo Barco T, Tappatà M, Cossu A, Narducci F, Zaboli A, Cantalupo G, Brigo F. Let the EEG speak my language: Italian translation of Standardized Computer-based Organized Reporting of EEG (SCORE). Epileptic Disord 2023; 25:919-922. [PMID: 37597157 DOI: 10.1002/epd2.20151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 08/14/2023] [Indexed: 08/21/2023]
Affiliation(s)
- Bruna Nucera
- Department of Neurology, Hospital of Merano-Meran (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Merano-Meran, Italy
- Paracelsus Medical University, Salzburg, Austria
| | - Fabrizio Rinaldi
- Department of Neurology, Hospital of Merano-Meran (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Merano-Meran, Italy
- Paracelsus Medical University, Nuernberg, Germany
| | - Fedele Dono
- Department of Neuroscience, Imaging and Clinical Science, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Giacomo Evangelista
- Department of Neuroscience, Imaging and Clinical Science, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Stefano Consoli
- Department of Neuroscience, Imaging and Clinical Science, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Jacopo Proietti
- Child Neuropsychiatry Unit, Department of Surgical Sciences, Dentistry, Gynaecology and Pediatrics, University of Verona, Full Member of European Reference Network EpiCARE, Verona, Italy
- Center for Research on Epilepsy in Pediartic age (CREP) - Department of Surgery, Dentistry, Paediatrics and Gynecology, University of Verona, Verona, Italy
| | - Jacopo Lanzone
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Department of the Milano Institute, Milan, Italy
| | - Tommaso Lo Barco
- Child Neuropsychiatry Unit, Department of Mental Health and Pathological Addictions, Azienda USL di Parma, Parma, Italy
| | - Maria Tappatà
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Alberto Cossu
- Child Neuropsychiatry Unit, Department of Surgical Sciences, Dentistry, Gynaecology and Pediatrics, University of Verona, Full Member of European Reference Network EpiCARE, Verona, Italy
- Center for Research on Epilepsy in Pediartic age (CREP) - Department of Surgery, Dentistry, Paediatrics and Gynecology, University of Verona, Verona, Italy
| | - Flavia Narducci
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico, Rome, Italy
| | - Arian Zaboli
- Department of Emergency Medicine, Hospital of Merano-Meran (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Merano-Meran, Italy
- Innovation, Research and Teaching Service (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano-Bozen, Italy
| | - Gaetano Cantalupo
- Child Neuropsychiatry Unit, Department of Surgical Sciences, Dentistry, Gynaecology and Pediatrics, University of Verona, Full Member of European Reference Network EpiCARE, Verona, Italy
- Center for Research on Epilepsy in Pediartic age (CREP) - Department of Surgery, Dentistry, Paediatrics and Gynecology, University of Verona, Verona, Italy
- Innovation Biomedicine section, Department of Engineering for Innovation Medicine, University of Verona, Verona, Italy
| | - Francesco Brigo
- Department of Neurology, Hospital of Merano-Meran (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Merano-Meran, Italy
- Innovation, Research and Teaching Service (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano-Bozen, Italy
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Lo Barco T, Corona L, Solazzi R, Fiorini E, Galati G, Cossu A, Proietti J, Francione S, Dalla Bernardina B, Darra F, Cantalupo G. Gelastic seizures and "smiling spasms": A peculiar ictal pattern. Epileptic Disord 2023; 25:269-273. [PMID: 37194193 DOI: 10.1002/epd2.20012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 05/18/2023]
Affiliation(s)
- Tommaso Lo Barco
- Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynaecology and Pediatrics, University of Verona, Full Member of European Reference Network EpiCARE, Verona, Italy
- Center for Research on Epilepsies in Pediatric age (CREP), Verona, Italy
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Laura Corona
- Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynaecology and Pediatrics, University of Verona, Full Member of European Reference Network EpiCARE, Verona, Italy
| | - Roberta Solazzi
- Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynaecology and Pediatrics, University of Verona, Full Member of European Reference Network EpiCARE, Verona, Italy
- Department of Pediatric Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta, Full Member of European Reference Network EpiCARE, Milan, Italy
| | - Elena Fiorini
- Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynaecology and Pediatrics, University of Verona, Full Member of European Reference Network EpiCARE, Verona, Italy
| | - Giulia Galati
- Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynaecology and Pediatrics, University of Verona, Full Member of European Reference Network EpiCARE, Verona, Italy
| | - Alberto Cossu
- Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynaecology and Pediatrics, University of Verona, Full Member of European Reference Network EpiCARE, Verona, Italy
| | - Jacopo Proietti
- Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynaecology and Pediatrics, University of Verona, Full Member of European Reference Network EpiCARE, Verona, Italy
| | - Stefano Francione
- "Claudio Munari" Centre for Epilepsy Surgery, ASST GOM Niguarda, Full Member of European Reference Network EpiCARE, Milan, Italy
| | | | - Francesca Darra
- Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynaecology and Pediatrics, University of Verona, Full Member of European Reference Network EpiCARE, Verona, Italy
- Center for Research on Epilepsies in Pediatric age (CREP), Verona, Italy
| | - Gaetano Cantalupo
- Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynaecology and Pediatrics, University of Verona, Full Member of European Reference Network EpiCARE, Verona, Italy
- Center for Research on Epilepsies in Pediatric age (CREP), Verona, Italy
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Balestrini S, Doccini V, Giometto S, Lucenteforte E, De Masi S, Giarola E, Brambilla I, Pieroni F, Perulli M, Battaglia D, Specchio N, Ragona F, Granata T, Pellacani S, Ferrari A, Marini C, Matricardi S, Cesaroni E, Giordano L, Accorsi P, Sciruicchio V, Tinuper P, Messana T, Russo A, Pruna D, Nosadini M, De Giorgis V, Caputo D, Pellegrin S, Lo Barco T, Darra F, Dalla Bernardina B, Guerrini R. A registry for Dravet syndrome: the Italian experience. Epilepsia Open 2023. [PMID: 36938796 DOI: 10.1002/epi4.12730] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 03/11/2023] [Indexed: 03/21/2023] Open
Abstract
OBJECTIVES We describe the Residras registry, dedicated to Dravet syndrome (DS) and to other phenotypes related to SCN1A mutations, as a paradigm of registry for rare and complex epilepsies. Our primary objectives are to present the tools and framework of the integrative platform, the main characteristics emerging from the patient cohort included in the registry, with emphasis on demographic, clinical outcome, and mortality. METHODS Standardised data of enrolled paediatric and adult patients were collected in 24 Italian expert centres, and regularly updated at least on a yearly basis. Patients were prospectively enrolled, at registry starting, but historical retrospective data were also included. RESULTS At present, 281 individuals with DS and a confirmed SCN1A mutation are included. Most patients have data available on epilepsy (n=263) and their overall neurological condition (n=255), based on at least one follow-up update. Median age at first clinical assessment was 2 years (IQR 0-9) whilst at last follow-up was 11 years (IQR 5-18.5). During the seven year-activity of the registry, five patients died resulting in a mortality rate of 1.84 per 1000-person-years. When analysing clinical changes over the first 5-year follow-up, we observed a significant difference in cognitive function (P< 0.001), an increased prevalence of behavioural disorders including attention deficit (P< 0.001), a significant worsening of language (P= 0.001) and intellectual disability (P< 0.001). SIGNIFICANCE The Residras registry represents a large collection of standardised national data for the DS population. The registry platform relies on a shareable and interoperable framework which promotes multicentre high-quality data collection. In the future such integrated platform may represent an invaluable asset for easing access to cohorts of patients that may benefit from clinical trials with emerging novel therapies, for drug safety monitoring, and for delineating natural history. Its framework makes it improvable based on growing experience with its use and easily adaptable to other rare and complex epilepsy syndromes.
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Affiliation(s)
- Simona Balestrini
- Neuroscience Department, Meyer Children's Hospital IRCSS-University of Florence, Full Member of European Reference Network EpiCARE, Florence, Italy.,Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, and Chalfont Centre for Epilepsy, Buckinghamshire, UK
| | - Viola Doccini
- Neuroscience Department, Meyer Children's Hospital IRCSS-University of Florence, Full Member of European Reference Network EpiCARE, Florence, Italy
| | - Sabrina Giometto
- Unit of Medical Statistics, Department of Clinical and Experimental Medicine, University of Pisa, 56126, Pisa, Italy
| | - Ersilia Lucenteforte
- Unit of Medical Statistics, Department of Clinical and Experimental Medicine, University of Pisa, 56126, Pisa, Italy
| | | | - Elisa Giarola
- Research Center for Pediatric Epilepsies Verona, IT, Verona, Italy.,Dravet Italia Onlus, Italy; Rare Epilepsies Alliance, Italy; ERN EpiCare (Epag), Italy
| | - Isabella Brambilla
- Research Center for Pediatric Epilepsies Verona, IT, Verona, Italy.,Dravet Italia Onlus, Italy; Rare Epilepsies Alliance, Italy; ERN EpiCare (Epag), Italy
| | | | - Marco Perulli
- Pediatric Neuropsychiatry, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Gemelli, IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Domenica Battaglia
- Pediatric Neuropsychiatry, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Gemelli, IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Nicola Specchio
- Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Full Member of European Reference Network EpiCARE, Rome, Italy
| | - Francesca Ragona
- Department of Pediatric Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta, Full Member of European Reference Network EpiCARE, Milan, Italy
| | - Tiziana Granata
- Department of Pediatric Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta, Full Member of European Reference Network EpiCARE, Milan, Italy
| | - Simona Pellacani
- Neuroscience Department, Meyer Children's Hospital IRCSS-University of Florence, Full Member of European Reference Network EpiCARE, Florence, Italy
| | - Annarita Ferrari
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Calambrone, 56128, Pisa, Italy
| | - Carla Marini
- Department of Child Neuropsychiatry, Children's Hospital, Ancona, Italy
| | - Sara Matricardi
- Department of Child Neuropsychiatry, Children's Hospital, Ancona, Italy
| | | | - Lucio Giordano
- Paediatric Neurology and Psychiatry Unit, Spedali Civili Children's Hospital, University of Brescia, Brescia, Italy
| | - Patrizia Accorsi
- Paediatric Neurology and Psychiatry Unit, Spedali Civili Children's Hospital, University of Brescia, Brescia, Italy
| | | | - Paolo Tinuper
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Full Member of European Reference Network EpiCARE, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria dell'età pediatrica, Bologna, Italy
| | - Tullio Messana
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria dell'età pediatrica, Bologna, Italy
| | - Angelo Russo
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria dell'età pediatrica, Bologna, Italy
| | - Dario Pruna
- Child Neurology and Epileptology Unit, Paediatric Department, ARNAS Brotzu, Cagliari, Italy
| | - Margherita Nosadini
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Valentina De Giorgis
- Department of Child Neurology and Psychiatry, IRCSS Mondino Foundation, Pavia, Italy
| | - Davide Caputo
- Epilepsy Center, ASST Santi Paolo Carlo, Health Sciences Department University of Milan, Italy
| | - Serena Pellegrin
- Department of Pediatric Neurology, Bolzano Hospital, Bolzano, Italy
| | - Tommaso Lo Barco
- Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Francesca Darra
- Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Bernardo Dalla Bernardina
- Research Center for Pediatric Epilepsies Verona, IT, Verona, Italy.,Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Renzo Guerrini
- Neuroscience Department, Meyer Children's Hospital IRCSS-University of Florence, Full Member of European Reference Network EpiCARE, Florence, Italy
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Lo Barco T, Offredi F, Castino E, Proietti J, Cossu A, Fiorini E, Fontana E, Cantalupo G, Dalla Bernardina B, Darra F. Adaptive behaviour in adolescents and adults with Dravet syndrome. Dev Med Child Neurol 2022; 65:838-846. [PMID: 36316303 DOI: 10.1111/dmcn.15448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 10/01/2022] [Accepted: 10/06/2022] [Indexed: 11/26/2022]
Abstract
AIM To explore the feasibility of using an adaptive behaviour profile (ABP) assessment generated from a well-known measure-the Vineland Adaptive Behavior Scales, Second Edition (VABS-II)-as an instrument for outcome measures in adolescents and adults with Dravet syndrome. METHOD We administered the VABS-II to 35 adolescents and adults with Dravet syndrome (15 males; mean age 24 years, SD 8 years, range: 12-46 years) and collected epilepsy history and neurological features at the time of assessment. We conducted a cross-sectional analysis of VABS-II raw scores and performed cluster analysis to identify different subgroups. We then explored possible relationships between clinical and epilepsy features, ABPs, and age. RESULTS Most participants obtained the minimum standard scores in the various VABS-II subdomains, while the raw score analysis outlined interindividual and intraindividual differences among skills. We found two subpopulations: one with a 'lower' ABP and one with a 'higher' ABP, corresponding respectively to individuals in whom myoclonic seizures or generalized spike-and-wave activity were present ('complete phenotype') or absent ('incomplete phenotype') on electroencephalography. INTERPRETATION This study further delineates the natural history of Dravet syndrome. The assessment of an ABP through the VABS-II raw score analysis provides a means by which to illustrate profiles of adaptive behaviour in adolescents and adults with Dravet syndrome but shows limitations related to poor sensitivity in measuring fine clinical details. There is a need for new and more specific tools to monitor patients with developmental and epileptic encephalopathies.
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Affiliation(s)
- Tommaso Lo Barco
- Child Neuropsychiatry Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy.,Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy.,Research Center for Pediatric Epilepsies Verona, Verona, Italy
| | - Francesca Offredi
- Child Neuropsychiatry Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Eva Castino
- Child Neuropsychiatry Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Jacopo Proietti
- Child Neuropsychiatry Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy.,Research Center for Pediatric Epilepsies Verona, Verona, Italy
| | - Alberto Cossu
- Child Neuropsychiatry Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Elena Fiorini
- Child Neuropsychiatry Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Elena Fontana
- Child Neuropsychiatry Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Gaetano Cantalupo
- Child Neuropsychiatry Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy.,Research Center for Pediatric Epilepsies Verona, Verona, Italy
| | - Bernardo Dalla Bernardina
- Child Neuropsychiatry Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy.,Research Center for Pediatric Epilepsies Verona, Verona, Italy
| | - Francesca Darra
- Child Neuropsychiatry Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy.,Research Center for Pediatric Epilepsies Verona, Verona, Italy
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10
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Lo Barco T, De Gaetano L, Santangelo E, Bravi T, Proietti J, Cantalupo G, Brambilla I, Darra F. SYNGAP1-related developmental and epileptic encephalopathy: The impact on daily life. Epilepsy Behav 2022; 127:108500. [PMID: 34954508 DOI: 10.1016/j.yebeh.2021.108500] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 12/06/2021] [Accepted: 12/06/2021] [Indexed: 11/26/2022]
Abstract
SYNGAP1-developmental and epileptic encephalopathy (SYNGAP1-DEE) has been recently featured as a distinct genetic disease characterized by global psychomotor delay mainly involving language, moderate-to-severe cognitive impairment, autism spectrum disorder, and a generalized epilepsy with spontaneous and reflex seizures. The severity and variability of function impairment and the impact on patients' and caregivers' daily life are still poorly acknowledged. The SYNGAP1 Italian Family Association developed a survey, shared online with caregivers, exploring several issues, including: epilepsy outcome, comorbidities, daily-living skills, hospitalizations, rehabilitation treatments, economic burden, and COVID-19 pandemic impact. Caregivers of 13 children and adolescents participated in the survey. They most often show a fine and gross-motor impairment and a drug-resistant epilepsy with possibility to experience pluridaily absence seizures that may lead to periods of psychomotor regressions. Eating and sleep problems are reported in the majority. Most parents are concerned about language impairment, behavioral issues and lack of autonomy in daily-living activities. Specific neuropsychological evaluations for autism should be early considered in order to identify intervention strategies involving alternative communication strategies, which can positively affect behavior and quality of life. Rehabilitation treatment should aim to the acquisition and consolidation of personal autonomy.
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Affiliation(s)
- Tommaso Lo Barco
- Child Neuropsychiatry Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy; Research Center for Pediatric Epilepsies Verona, IT, Verona, Italy; PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy.
| | - Luciana De Gaetano
- Associazione Famiglie SYNGAP1, Italy; Faculty of Medicine and Surgery, University of Verona, Verona, Italy
| | - Elisabetta Santangelo
- Child Neuropsychiatry Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | | | - Jacopo Proietti
- Child Neuropsychiatry Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy; Research Center for Pediatric Epilepsies Verona, IT, Verona, Italy
| | - Gaetano Cantalupo
- Child Neuropsychiatry Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy; Research Center for Pediatric Epilepsies Verona, IT, Verona, Italy
| | - Isabella Brambilla
- Research Center for Pediatric Epilepsies Verona, IT, Verona, Italy; Dravet Italia Onlus, Italy; Rare Epilepsies Alliance, Italy; ERN EpiCare (Epag), Italy
| | - Francesca Darra
- Child Neuropsychiatry Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy; Research Center for Pediatric Epilepsies Verona, IT, Verona, Italy
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11
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Barco TL, Kuchenbuch M, Garcelon N, Neuraz A, Nabbout R. Improving early diagnosis of rare diseases using Natural Language Processing in unstructured medical records: an illustration from Dravet syndrome. Orphanet J Rare Dis 2021; 16:309. [PMID: 34256808 PMCID: PMC8278630 DOI: 10.1186/s13023-021-01936-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 01/13/2021] [Accepted: 06/27/2021] [Indexed: 12/01/2022] Open
Abstract
Background The growing use of Electronic Health Records (EHRs) is promoting the application of data mining in health-care. A promising use of big data in this field is to develop models to support early diagnosis and to establish natural history. Dravet Syndrome (DS) is a rare developmental and epileptic encephalopathy that commonly initiates in the first year of life with febrile seizures (FS). Age at diagnosis is often delayed after 2 years, as it is difficult to differentiate DS at onset from FS. We aimed to explore if some clinical terms (concepts) are significantly more used in the electronic narrative medical reports of individuals with DS before the age of 2 years compared to those of individuals with FS. These concepts would allow an earlier detection of patients with DS resulting in an earlier orientation toward expert centers that can provide early diagnosis and care. Methods Data were collected from the Necker Enfants Malades Hospital using a document-based data warehouse, Dr Warehouse, which employs Natural Language Processing, a computer technology consisting in processing written information. Using Unified Medical Language System Meta-thesaurus, phenotype concepts can be recognized in medical reports. We selected individuals with DS (DS Cohort) and individuals with FS (FS Cohort) with confirmed diagnosis after the age of 4 years. A phenome-wide analysis was performed evaluating the statistical associations between the phenotypes of DS and FS, based on concepts found in the reports produced before 2 years and using a series of logistic regressions. Results We found significative higher representation of concepts related to seizures’ phenotypes distinguishing DS from FS in the first phases, namely the major recurrence of complex febrile convulsions (long-lasting and/or with focal signs) and other seizure-types. Some typical early onset non-seizure concepts also emerged, in relation to neurodevelopment and gait disorders. Conclusions Narrative medical reports of individuals younger than 2 years with FS contain specific concepts linked to DS diagnosis, which can be automatically detected by software exploiting NLP. This approach could represent an innovative and sustainable methodology to decrease time of diagnosis of DS and could be transposed to other rare diseases.
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Affiliation(s)
- Tommaso Lo Barco
- Department of Pediatric Neurology, Necker-Enfants Malades Hospital, APHP, Centre de Référence Épilepsies Rares, Member of ERN EPICARE, Université de Paris, Paris, France.,Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Mathieu Kuchenbuch
- Department of Pediatric Neurology, Necker-Enfants Malades Hospital, APHP, Centre de Référence Épilepsies Rares, Member of ERN EPICARE, Université de Paris, Paris, France.,Imagine Institute, INSERM, UMR 1163, Université de Paris, 75015, Paris, France
| | - Nicolas Garcelon
- Imagine Institute, INSERM, UMR 1163, Université de Paris, 75015, Paris, France
| | - Antoine Neuraz
- Université de Paris, Paris, France.,INSERM, UMR1138, Centre de Recherche Des Cordeliers, Paris, France.,Department of Medical Informatics, University Hospital Necker-Enfants Malades, APHP, Paris, France
| | - Rima Nabbout
- Department of Pediatric Neurology, Necker-Enfants Malades Hospital, APHP, Centre de Référence Épilepsies Rares, Member of ERN EPICARE, Université de Paris, Paris, France. .,Imagine Institute, INSERM, UMR 1163, Université de Paris, 75015, Paris, France. .,Université de Paris, Paris, France.
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12
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Lo Barco T, Ghobert AL, Lucca F, Galati G, Proietti J, Cantalupo G. Reversible tremor in an infant with vitamin E deficiency and cystic fibrosis. Lancet 2021; 398:156. [PMID: 34246348 DOI: 10.1016/s0140-6736(21)01048-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/25/2021] [Accepted: 04/29/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Tommaso Lo Barco
- Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Verona, Italy; PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Anna Ludovica Ghobert
- Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Verona, Italy
| | - Francesca Lucca
- Cystic Fibrosis Centre of Verona, Azienda Ospedaliero Universitaria Integrata di Verona, Verona, Italy
| | - Giulia Galati
- Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Verona, Italy
| | - Jacopo Proietti
- Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Verona, Italy
| | - Gaetano Cantalupo
- Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Verona, Italy.
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13
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Darra F, Lo Barco T, Opri R, Parrini E, Bianchini C, Fiorini E, Simonati A, Dalla Bernardina B, Cantalupo G, Guerrini R. Migrating Focal Seizures and Myoclonic Status in ARV1-Related Encephalopathy. Neurol Genet 2021; 7:e593. [PMID: 34017911 PMCID: PMC8131096 DOI: 10.1212/nxg.0000000000000593] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 03/23/2021] [Indexed: 12/04/2022]
Abstract
Objective To report longitudinal clinical, EEG, and MRI findings in 2 sisters carrying compound heterozygous ARV1 mutations and exhibiting a peculiar form of developmental and epileptic encephalopathy (DEE). Neuropathologic features are also described in one of the sisters. Methods Clinical course description, video-EEG polygraphic recordings, brain MRI, skin and muscle biopsies, whole-exome sequencing (WES), and brain neuropathology. Results Since their first months of life, both girls exhibited severe axial hypotonia, visual inattention, dyskinetic movements, severe developmental delay, and slow background EEG activity. Intractable nonmotor seizures started in both at the eighth month of life, exhibiting the electroclinical characteristics of epilepsy of infancy with migrating focal seizures (EIMFS). In the second year of life, continuous epileptiform EEG activity of extremely high amplitude appeared in association with myoclonic status, leading to severely impaired alertness and responsiveness. Repeated brain MRI revealed progressive atrophic changes and severe hypomyelination. WES identified a compound heterozygous in the ARV1 gene [(p.Ser122Glnfs*7) and (p.Trp163*)] in one patient and was subsequently confirmed in the other. Both sisters died prematurely during respiratory infections. Postmortem neuropathologic examination of the brain, performed in one, revealed atrophic brain changes, mainly involving the cerebellum. Conclusions This report confirms that biallelic ARV1 mutations cause a severe form of DEE and adds epilepsy with migrating focal seizures and myoclonic status to the spectrum of epilepsy phenotypes. Considering the potential role of human ARV1 in glycosylphosphatidylinositol (GPI) anchor biosynthesis, this severe syndrome can be assigned to the group of inherited GPI deficiency disorders, with which it shares remarkably similar clinical and neuroimaging features. ARV1 should be considered in the genetic screening of individuals with EIMFS.
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Affiliation(s)
- Francesca Darra
- Child Neuropsychiatry Unit(F.D.), Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics University of Verona; Child Neuropsychiatry Unit(T.L.B.), Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics University of Verona; PhD Program in Clinical and Experimental Medicine (T.L.B.), University of Modena and Reggio Emilia; Pediatric Unit (R.O.), Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics University of Verona; Pediatric Neurology (E.P.), Neurogenetics and Neurobiology Unit and Laboratories, Meyer Children's Hospital, University of Florence; Pediatric Neurology (C.B.), Neurogenetics and Neurobiology Unit and Laboratories, Meyer Children's Hospital, University of Florence; Child Neuropsychiatry Unit (E.F.), Azienda Ospedaliera Universitaria Integrata di Verona; Neurology (Child Neurology and Neuropathology) (A.S.), Department of Neuroscience, Biomedicine and Movement, University of Verona; CREP (Research Center for Pediatric Epilepsies) (B.D.B.), Azienda Ospedaliera Universitaria Integrata di Verona; and Pediatric Neurology (R.G.), Neurogenetics and Neurobiology Unit and Laboratories, Meyer Children's Hospital, University of Florence, Italy
| | - Tommaso Lo Barco
- Child Neuropsychiatry Unit(F.D.), Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics University of Verona; Child Neuropsychiatry Unit(T.L.B.), Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics University of Verona; PhD Program in Clinical and Experimental Medicine (T.L.B.), University of Modena and Reggio Emilia; Pediatric Unit (R.O.), Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics University of Verona; Pediatric Neurology (E.P.), Neurogenetics and Neurobiology Unit and Laboratories, Meyer Children's Hospital, University of Florence; Pediatric Neurology (C.B.), Neurogenetics and Neurobiology Unit and Laboratories, Meyer Children's Hospital, University of Florence; Child Neuropsychiatry Unit (E.F.), Azienda Ospedaliera Universitaria Integrata di Verona; Neurology (Child Neurology and Neuropathology) (A.S.), Department of Neuroscience, Biomedicine and Movement, University of Verona; CREP (Research Center for Pediatric Epilepsies) (B.D.B.), Azienda Ospedaliera Universitaria Integrata di Verona; and Pediatric Neurology (R.G.), Neurogenetics and Neurobiology Unit and Laboratories, Meyer Children's Hospital, University of Florence, Italy
| | - Roberta Opri
- Child Neuropsychiatry Unit(F.D.), Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics University of Verona; Child Neuropsychiatry Unit(T.L.B.), Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics University of Verona; PhD Program in Clinical and Experimental Medicine (T.L.B.), University of Modena and Reggio Emilia; Pediatric Unit (R.O.), Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics University of Verona; Pediatric Neurology (E.P.), Neurogenetics and Neurobiology Unit and Laboratories, Meyer Children's Hospital, University of Florence; Pediatric Neurology (C.B.), Neurogenetics and Neurobiology Unit and Laboratories, Meyer Children's Hospital, University of Florence; Child Neuropsychiatry Unit (E.F.), Azienda Ospedaliera Universitaria Integrata di Verona; Neurology (Child Neurology and Neuropathology) (A.S.), Department of Neuroscience, Biomedicine and Movement, University of Verona; CREP (Research Center for Pediatric Epilepsies) (B.D.B.), Azienda Ospedaliera Universitaria Integrata di Verona; and Pediatric Neurology (R.G.), Neurogenetics and Neurobiology Unit and Laboratories, Meyer Children's Hospital, University of Florence, Italy
| | - Elena Parrini
- Child Neuropsychiatry Unit(F.D.), Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics University of Verona; Child Neuropsychiatry Unit(T.L.B.), Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics University of Verona; PhD Program in Clinical and Experimental Medicine (T.L.B.), University of Modena and Reggio Emilia; Pediatric Unit (R.O.), Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics University of Verona; Pediatric Neurology (E.P.), Neurogenetics and Neurobiology Unit and Laboratories, Meyer Children's Hospital, University of Florence; Pediatric Neurology (C.B.), Neurogenetics and Neurobiology Unit and Laboratories, Meyer Children's Hospital, University of Florence; Child Neuropsychiatry Unit (E.F.), Azienda Ospedaliera Universitaria Integrata di Verona; Neurology (Child Neurology and Neuropathology) (A.S.), Department of Neuroscience, Biomedicine and Movement, University of Verona; CREP (Research Center for Pediatric Epilepsies) (B.D.B.), Azienda Ospedaliera Universitaria Integrata di Verona; and Pediatric Neurology (R.G.), Neurogenetics and Neurobiology Unit and Laboratories, Meyer Children's Hospital, University of Florence, Italy
| | - Claudia Bianchini
- Child Neuropsychiatry Unit(F.D.), Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics University of Verona; Child Neuropsychiatry Unit(T.L.B.), Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics University of Verona; PhD Program in Clinical and Experimental Medicine (T.L.B.), University of Modena and Reggio Emilia; Pediatric Unit (R.O.), Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics University of Verona; Pediatric Neurology (E.P.), Neurogenetics and Neurobiology Unit and Laboratories, Meyer Children's Hospital, University of Florence; Pediatric Neurology (C.B.), Neurogenetics and Neurobiology Unit and Laboratories, Meyer Children's Hospital, University of Florence; Child Neuropsychiatry Unit (E.F.), Azienda Ospedaliera Universitaria Integrata di Verona; Neurology (Child Neurology and Neuropathology) (A.S.), Department of Neuroscience, Biomedicine and Movement, University of Verona; CREP (Research Center for Pediatric Epilepsies) (B.D.B.), Azienda Ospedaliera Universitaria Integrata di Verona; and Pediatric Neurology (R.G.), Neurogenetics and Neurobiology Unit and Laboratories, Meyer Children's Hospital, University of Florence, Italy
| | - Elena Fiorini
- Child Neuropsychiatry Unit(F.D.), Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics University of Verona; Child Neuropsychiatry Unit(T.L.B.), Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics University of Verona; PhD Program in Clinical and Experimental Medicine (T.L.B.), University of Modena and Reggio Emilia; Pediatric Unit (R.O.), Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics University of Verona; Pediatric Neurology (E.P.), Neurogenetics and Neurobiology Unit and Laboratories, Meyer Children's Hospital, University of Florence; Pediatric Neurology (C.B.), Neurogenetics and Neurobiology Unit and Laboratories, Meyer Children's Hospital, University of Florence; Child Neuropsychiatry Unit (E.F.), Azienda Ospedaliera Universitaria Integrata di Verona; Neurology (Child Neurology and Neuropathology) (A.S.), Department of Neuroscience, Biomedicine and Movement, University of Verona; CREP (Research Center for Pediatric Epilepsies) (B.D.B.), Azienda Ospedaliera Universitaria Integrata di Verona; and Pediatric Neurology (R.G.), Neurogenetics and Neurobiology Unit and Laboratories, Meyer Children's Hospital, University of Florence, Italy
| | - Alessandro Simonati
- Child Neuropsychiatry Unit(F.D.), Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics University of Verona; Child Neuropsychiatry Unit(T.L.B.), Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics University of Verona; PhD Program in Clinical and Experimental Medicine (T.L.B.), University of Modena and Reggio Emilia; Pediatric Unit (R.O.), Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics University of Verona; Pediatric Neurology (E.P.), Neurogenetics and Neurobiology Unit and Laboratories, Meyer Children's Hospital, University of Florence; Pediatric Neurology (C.B.), Neurogenetics and Neurobiology Unit and Laboratories, Meyer Children's Hospital, University of Florence; Child Neuropsychiatry Unit (E.F.), Azienda Ospedaliera Universitaria Integrata di Verona; Neurology (Child Neurology and Neuropathology) (A.S.), Department of Neuroscience, Biomedicine and Movement, University of Verona; CREP (Research Center for Pediatric Epilepsies) (B.D.B.), Azienda Ospedaliera Universitaria Integrata di Verona; and Pediatric Neurology (R.G.), Neurogenetics and Neurobiology Unit and Laboratories, Meyer Children's Hospital, University of Florence, Italy
| | - Bernardo Dalla Bernardina
- Child Neuropsychiatry Unit(F.D.), Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics University of Verona; Child Neuropsychiatry Unit(T.L.B.), Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics University of Verona; PhD Program in Clinical and Experimental Medicine (T.L.B.), University of Modena and Reggio Emilia; Pediatric Unit (R.O.), Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics University of Verona; Pediatric Neurology (E.P.), Neurogenetics and Neurobiology Unit and Laboratories, Meyer Children's Hospital, University of Florence; Pediatric Neurology (C.B.), Neurogenetics and Neurobiology Unit and Laboratories, Meyer Children's Hospital, University of Florence; Child Neuropsychiatry Unit (E.F.), Azienda Ospedaliera Universitaria Integrata di Verona; Neurology (Child Neurology and Neuropathology) (A.S.), Department of Neuroscience, Biomedicine and Movement, University of Verona; CREP (Research Center for Pediatric Epilepsies) (B.D.B.), Azienda Ospedaliera Universitaria Integrata di Verona; and Pediatric Neurology (R.G.), Neurogenetics and Neurobiology Unit and Laboratories, Meyer Children's Hospital, University of Florence, Italy
| | - Gaetano Cantalupo
- Child Neuropsychiatry Unit(F.D.), Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics University of Verona; Child Neuropsychiatry Unit(T.L.B.), Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics University of Verona; PhD Program in Clinical and Experimental Medicine (T.L.B.), University of Modena and Reggio Emilia; Pediatric Unit (R.O.), Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics University of Verona; Pediatric Neurology (E.P.), Neurogenetics and Neurobiology Unit and Laboratories, Meyer Children's Hospital, University of Florence; Pediatric Neurology (C.B.), Neurogenetics and Neurobiology Unit and Laboratories, Meyer Children's Hospital, University of Florence; Child Neuropsychiatry Unit (E.F.), Azienda Ospedaliera Universitaria Integrata di Verona; Neurology (Child Neurology and Neuropathology) (A.S.), Department of Neuroscience, Biomedicine and Movement, University of Verona; CREP (Research Center for Pediatric Epilepsies) (B.D.B.), Azienda Ospedaliera Universitaria Integrata di Verona; and Pediatric Neurology (R.G.), Neurogenetics and Neurobiology Unit and Laboratories, Meyer Children's Hospital, University of Florence, Italy
| | - Renzo Guerrini
- Child Neuropsychiatry Unit(F.D.), Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics University of Verona; Child Neuropsychiatry Unit(T.L.B.), Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics University of Verona; PhD Program in Clinical and Experimental Medicine (T.L.B.), University of Modena and Reggio Emilia; Pediatric Unit (R.O.), Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics University of Verona; Pediatric Neurology (E.P.), Neurogenetics and Neurobiology Unit and Laboratories, Meyer Children's Hospital, University of Florence; Pediatric Neurology (C.B.), Neurogenetics and Neurobiology Unit and Laboratories, Meyer Children's Hospital, University of Florence; Child Neuropsychiatry Unit (E.F.), Azienda Ospedaliera Universitaria Integrata di Verona; Neurology (Child Neurology and Neuropathology) (A.S.), Department of Neuroscience, Biomedicine and Movement, University of Verona; CREP (Research Center for Pediatric Epilepsies) (B.D.B.), Azienda Ospedaliera Universitaria Integrata di Verona; and Pediatric Neurology (R.G.), Neurogenetics and Neurobiology Unit and Laboratories, Meyer Children's Hospital, University of Florence, Italy
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14
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Lo Barco T, Kaminska A, Solazzi R, Cancés C, Barcia G, Chemaly N, Fontana E, Desguerre I, Canafoglia L, Hachon Le Camus C, Losito E, Villard L, Eisermann M, Dalla Bernardina B, Villeneuve N, Nabbout R. SYNGAP1-DEE: A visual sensitive epilepsy. Clin Neurophysiol 2021; 132:841-850. [PMID: 33639450 DOI: 10.1016/j.clinph.2021.01.014] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 01/05/2021] [Accepted: 01/24/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To further delineate the electroclinical features of individuals with SYNGAP1 pathogenic variants. METHODS Participants with pathogenic SYNGAP1 variants and available video-electroencephalogram (EEG) recordings were recruited within five European epilepsy reference centers. We obtained molecular and clinical data, analyzed EEG recordings and archived video-EEGs of seizures and detailed characteristics of interictal and ictal EEG patterns for every patient. RESULTS We recruited 15 previously unreported patients and analyzed 72 EEGs. Two distinct EEG patterns emerged, both triggered by eye closure. Pattern 1 (14/15 individuals) consisted of rhythmic posterior/diffuse delta waves appearing with eye-closure and persisting until eye opening (strongly suggestive of fixation-off sensitivity). Pattern 2 (9/15 individuals) consisted of diffuse polyspike-and-wave discharges triggered by eye closure (eye-closure sensitivity). Both patterns presented in 8/15. Including archived video-EEG clips of seizures from 9/15 patients, we analyzed 254 seizures. Of 224 seizures experienced while awake, 161 (72%) occurred at or following eye closure. In 119/161, pattern 1 preceded an atypical absence, myoclonic seizure or myoclonic absence; in 42/161, pattern 2 was associated with eyelid myoclonia, absences and myoclonic or atonic seizures. CONCLUSIONS Fixation-off and eye closure were the main triggers for seizures in this SYNGAP1 cohort. SIGNIFICANCE Combining these clinical and electroencephalographic features could help guide genetic diagnosis.
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Affiliation(s)
- Tommaso Lo Barco
- Reference Centre for Rare Epilepsies, Department of Pediatric Neurology, Necker Enfants Malades Hospital, Imagine Institute, Paris Descartes University, Paris, France; Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Italy; PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Italy.
| | - Anna Kaminska
- Department of Clinical Neurophysiology, Necker-Enfants-Malades Hospital, AP-HP, Paris, France
| | - Roberta Solazzi
- Department of Pediatric Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Claude Cancés
- Department of Pediatric Neurology, Toulouse Children Hospital, Toulouse University Hospital, Toulouse, France
| | - Giulia Barcia
- Fédération de Génétique Médicale, Hôpital Necker-Enfants Malades, Paris, France
| | - Nicole Chemaly
- Reference Centre for Rare Epilepsies, Department of Pediatric Neurology, Necker Enfants Malades Hospital, Imagine Institute, Paris Descartes University, Paris, France; Department of Paediatric Neurology, Necker-Enfants Malades Hospital, University of Paris, AP-HP, Paris, France
| | - Elena Fontana
- Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Italy; Research Center for Pediatric Epilepsies Verona, Verona, Italy
| | - Isabelle Desguerre
- Department of Paediatric Neurology, Necker-Enfants Malades Hospital, University of Paris, AP-HP, Paris, France
| | - Laura Canafoglia
- Neurophysiopathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Caroline Hachon Le Camus
- Department of Pediatric Neurology, Toulouse Children Hospital, Toulouse University Hospital, Toulouse, France
| | - Emma Losito
- Reference Centre for Rare Epilepsies, Department of Pediatric Neurology, Necker Enfants Malades Hospital, Imagine Institute, Paris Descartes University, Paris, France
| | - Laurent Villard
- Pediatric Neurology Department, Timone Children Hospital, Reference Center for Rare Epilepsies, APHM, Marseille, France
| | - Monika Eisermann
- Department of Clinical Neurophysiology, Necker-Enfants-Malades Hospital, AP-HP, Paris, France
| | | | - Nathalie Villeneuve
- Pediatric Neurology Department, Timone Children Hospital, Reference Center for Rare Epilepsies, APHM, Marseille, France
| | - Rima Nabbout
- Reference Centre for Rare Epilepsies, Department of Pediatric Neurology, Necker Enfants Malades Hospital, Imagine Institute, Paris Descartes University, Paris, France; Department of Paediatric Neurology, Necker-Enfants Malades Hospital, University of Paris, AP-HP, Paris, France.
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15
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Cossu A, Lo Barco T, Darra F, Fontana E, Fiorini E, Marangone M, Biban P, Dalla Bernardina B, Cantalupo G. Remote Teamwork Management of NORSE During the COVID-19 Lockdown. Neurol Clin Pract 2020; 11:e170-e173. [PMID: 33842087 DOI: 10.1212/cpj.0000000000001027] [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: 08/17/2020] [Accepted: 10/30/2020] [Indexed: 11/15/2022]
Abstract
New-onset refractory status epilepticus (NORSE) is rare condition, and sharing knowledge is vital in its management, based on strict collaboration between multiple specialists, continuous EEG (c-EEG) monitoring, and prompt therapy modification. The coronavirus disease 2019 (COVID-19) pandemic challenged many of these established practices because of "social distancing" measures, making it necessary to work around physical restrictions. We report a case of a 10-year-old with NORSE admitted in a pediatric intensive-care unit and monitored with c-EEG and amplitude-integrated EEG. The monitoring interface was livestreamed using videoconference web-based platforms allowing remote viewing. Multiple daily web meetings took place between team members, where real-time therapy response was evaluated and confronted with medium-term trends in the epileptic activity, dictating further treatment and diagnostic steps. In addition to the known use of telemedicine in chronic conditions, we report how its use can be exploited to treat urgent conditions such as NORSE. By taking advantage of new tools and virtual environments, we were able to share treatment and diagnostic decisions and guarantee real-time therapy adjustments and a coherent course in treatment despite restrictions necessary for the COVID-19 pandemic. The constant specialist monitoring and the coherent and on-time communication of the patient's condition relieved the family stress, usually complained in these situations.
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Affiliation(s)
- Alberto Cossu
- Child Neuropsychiatry (FD, TLB, FD, GC), Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona; Clinical and Experimental Medicine PhD Program (TLB), University of Modena and Reggio Emilia; Child Neuropsychiatry Unit (FD, E. Fontana, E. Fiorini, MM, GC), and Pediatric Intensive Care Unit (PB), University-Hospital of Verona; and Center for Research on Epilepsies in Pediatric Age (CREP) (BDB), Verona, Italy
| | - Tommaso Lo Barco
- Child Neuropsychiatry (FD, TLB, FD, GC), Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona; Clinical and Experimental Medicine PhD Program (TLB), University of Modena and Reggio Emilia; Child Neuropsychiatry Unit (FD, E. Fontana, E. Fiorini, MM, GC), and Pediatric Intensive Care Unit (PB), University-Hospital of Verona; and Center for Research on Epilepsies in Pediatric Age (CREP) (BDB), Verona, Italy
| | - Francesca Darra
- Child Neuropsychiatry (FD, TLB, FD, GC), Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona; Clinical and Experimental Medicine PhD Program (TLB), University of Modena and Reggio Emilia; Child Neuropsychiatry Unit (FD, E. Fontana, E. Fiorini, MM, GC), and Pediatric Intensive Care Unit (PB), University-Hospital of Verona; and Center for Research on Epilepsies in Pediatric Age (CREP) (BDB), Verona, Italy
| | - Elena Fontana
- Child Neuropsychiatry (FD, TLB, FD, GC), Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona; Clinical and Experimental Medicine PhD Program (TLB), University of Modena and Reggio Emilia; Child Neuropsychiatry Unit (FD, E. Fontana, E. Fiorini, MM, GC), and Pediatric Intensive Care Unit (PB), University-Hospital of Verona; and Center for Research on Epilepsies in Pediatric Age (CREP) (BDB), Verona, Italy
| | - Elena Fiorini
- Child Neuropsychiatry (FD, TLB, FD, GC), Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona; Clinical and Experimental Medicine PhD Program (TLB), University of Modena and Reggio Emilia; Child Neuropsychiatry Unit (FD, E. Fontana, E. Fiorini, MM, GC), and Pediatric Intensive Care Unit (PB), University-Hospital of Verona; and Center for Research on Epilepsies in Pediatric Age (CREP) (BDB), Verona, Italy
| | - Martina Marangone
- Child Neuropsychiatry (FD, TLB, FD, GC), Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona; Clinical and Experimental Medicine PhD Program (TLB), University of Modena and Reggio Emilia; Child Neuropsychiatry Unit (FD, E. Fontana, E. Fiorini, MM, GC), and Pediatric Intensive Care Unit (PB), University-Hospital of Verona; and Center for Research on Epilepsies in Pediatric Age (CREP) (BDB), Verona, Italy
| | - Paolo Biban
- Child Neuropsychiatry (FD, TLB, FD, GC), Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona; Clinical and Experimental Medicine PhD Program (TLB), University of Modena and Reggio Emilia; Child Neuropsychiatry Unit (FD, E. Fontana, E. Fiorini, MM, GC), and Pediatric Intensive Care Unit (PB), University-Hospital of Verona; and Center for Research on Epilepsies in Pediatric Age (CREP) (BDB), Verona, Italy
| | - Bernardo Dalla Bernardina
- Child Neuropsychiatry (FD, TLB, FD, GC), Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona; Clinical and Experimental Medicine PhD Program (TLB), University of Modena and Reggio Emilia; Child Neuropsychiatry Unit (FD, E. Fontana, E. Fiorini, MM, GC), and Pediatric Intensive Care Unit (PB), University-Hospital of Verona; and Center for Research on Epilepsies in Pediatric Age (CREP) (BDB), Verona, Italy
| | - Gaetano Cantalupo
- Child Neuropsychiatry (FD, TLB, FD, GC), Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona; Clinical and Experimental Medicine PhD Program (TLB), University of Modena and Reggio Emilia; Child Neuropsychiatry Unit (FD, E. Fontana, E. Fiorini, MM, GC), and Pediatric Intensive Care Unit (PB), University-Hospital of Verona; and Center for Research on Epilepsies in Pediatric Age (CREP) (BDB), Verona, Italy
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16
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Lo Barco T, Osanni E, Bordugo A, Rodella G, Iascone M, Tenconi R, Barone R, Dalla Bernardina B, Cantalupo G. Epilepsy and movement disorders in CDG: Report on the oldest-known MOGS-CDG patient. Am J Med Genet A 2020; 185:219-222. [PMID: 33058492 DOI: 10.1002/ajmg.a.61916] [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: 04/24/2020] [Revised: 08/16/2020] [Accepted: 09/26/2020] [Indexed: 12/18/2022]
Abstract
Congenital glycosylation disorders (CDG) are inherited metabolic diseases due to defective glycoprotein and glycolipid glycan assembly and attachment. MOGS-CDG is a rare disorder with seven patients from five families reported worldwide. We report on a 19-year-old girl with MOGS-CDG. At birth she presented facial dysmorphism, marked hypotonia, and drug-resistant tonic seizures. In the following months, her motility was strongly limited by dystonia, with forced posture of the head and of both hands. She showed a peculiar hyperkinetic movement disorder with a rhythmic and repetitive pattern repeatedly documented on EEG-polygraphy recordings. Brain MRI showed progressive cortical and subcortical atrophy. Epileptic spasms appeared in first months and ceased by the age of 7 years, while tonic seizures were still present at last assessment (19 years). We report the oldest-known MOGS-CDG patient and broaden the neurological phenotype of this CDG.
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Affiliation(s)
- Tommaso Lo Barco
- Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy.,PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Elisa Osanni
- Child Neuropsychiatry, Epilepsy and Clinical Neurophysiology Unit, IRCCS "E. Medea", Conegliano, Treviso, Italy
| | - Andrea Bordugo
- Pediatrics Unit, Department of Pediatrics, Regional Center for Newborn Screening, Diagnosis and Treatment of Inherited Metabolic Diseases and Congenital Endocrine Diseases, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Giulia Rodella
- Pediatrics Unit, Department of Pediatrics, Regional Center for Newborn Screening, Diagnosis and Treatment of Inherited Metabolic Diseases and Congenital Endocrine Diseases, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Maria Iascone
- Laboratorio di Genetica Medica, ASST Papa Giovanni XXIII, Piazza OMS, Bergamo, Italy
| | - Romano Tenconi
- Genetica Clinica, Dipartimento di Pediatria, Università di Padova, Padova, Italy
| | - Rita Barone
- Child Neurology and Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | | | - Gaetano Cantalupo
- Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
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17
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Lo Barco T, Chemaly N, Teng T, Darra F, Nabbout R. Head circumferences of patients with Dravet syndrome show growth slowdown. Epilepsy Behav 2020; 111:107157. [PMID: 32702652 DOI: 10.1016/j.yebeh.2020.107157] [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: 03/29/2020] [Revised: 05/03/2020] [Accepted: 05/04/2020] [Indexed: 11/24/2022]
Abstract
The measurement of head circumference (HC) represents a useful and reliable tool to monitor brain growth. Many genetic conditions are associated with an abnormal pattern of head growth, but no specific pattern has been described in Dravet Syndrome (DS). To investigate the head growth trajectories in a pediatric population with DS, a retrospective analysis of medical records of patients with DS was performed in 2 epilepsy centers. Quantitative data were compared with z-score growth curve of standard population, and an independent samples t-test was performed using 6-month ranges. A total of 137 subjects aged less than 18 years were included, with a total of 529 HC values and a mean of 3.9 measures per patient. From birth until 24 months of life, HC values were almost equally distributed around the mean trajectory of the reference population from each side of the curve. This trend line deflects from the mean curve after 24 months showing a head growth slowdown reaching a statistical significance (p < .05) from 48 months for males and 60 for females. Future prospective studies are needed to assess factors that can impact head growth and explore possible phenotype-genotype correlation with HC.
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Affiliation(s)
- Tommaso Lo Barco
- Reference Centre for Rare Epilepsies, Department of Pediatric Neurology, Necker Enfants Malades Hospital, Paris Descartes University, Paris, France; Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Italy
| | - Nicole Chemaly
- Reference Centre for Rare Epilepsies, Department of Pediatric Neurology, Necker Enfants Malades Hospital, Paris Descartes University, Paris, France
| | - Theo Teng
- Reference Centre for Rare Epilepsies, Department of Pediatric Neurology, Necker Enfants Malades Hospital, Paris Descartes University, Paris, France
| | - Francesca Darra
- Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Italy
| | - Rima Nabbout
- Reference Centre for Rare Epilepsies, Department of Pediatric Neurology, Necker Enfants Malades Hospital, Paris Descartes University, Paris, France; Inserm U1163, Imagine institute, Paris, France.
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