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Thiel M, Bamborschke D, Janzarik WG, Assmann B, Zittel S, Patzer S, Auhuber A, Opp J, Matzker E, Bevot A, Seeger J, van Baalen A, Stüve B, Brockmann K, Cirak S, Koy A. Genotype-phenotype correlation and treatment effects in young patients with GNAO1-associated disorders. J Neurol Neurosurg Psychiatry 2023; 94:806-815. [PMID: 37225406 DOI: 10.1136/jnnp-2022-330261] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 05/03/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Patients carrying pathogenic variants in GNAO1 often present with early-onset central hypotonia and global developmental delay, with or without epilepsy. As the disorder progresses, a complex hypertonic and hyperkinetic movement disorder is a common phenotype. A genotype-phenotype correlation has not yet been described and there are no evidence-based therapeutic recommendations. METHODS To improve understanding of the clinical course and pathophysiology of this ultra-rare disorder, we built up a registry for GNAO1 patients in Germany. In this retrospective, multicentre cohort study, we collected detailed clinical data, treatment effects and genetic data for 25 affected patients. RESULTS The main clinical features were symptom onset within the first months of life, with central hypotonia or seizures. Within the first year of life, nearly all patients developed a movement disorder comprising dystonia (84%) and choreoathetosis (52%). Twelve (48%) patients suffered life-threatening hyperkinetic crises. Fifteen (60%) patients had epilepsy with poor treatment response. Two patients showed an atypical phenotype and seven novel pathogenic variants in GNAO1 were identified. Nine (38%) patients were treated with bilateral deep brain stimulation of the globus pallidus internus. Deep brain stimulation reduced hyperkinetic symptoms and prevented further hyperkinetic crises. The in silico prediction programmes did not predict the phenotype by the genotype. CONCLUSION The broad clinical spectrum and genetic findings expand the phenotypical spectrum of GNAO1-associated disorder and therefore disprove the assumption that there are only two main phenotypes. No specific overall genotype-phenotype correlation was identified. We highlight deep brain stimulation as a useful treatment option in this disorder.
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Affiliation(s)
- Moritz Thiel
- Department of Pediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Daniel Bamborschke
- Pediatric Neurology, University of Bonn, Faculty of Medicine, Bonn, Germany
| | - Wibke G Janzarik
- Pediatric Neurology and Muscle Disorders, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Birgit Assmann
- Department of General Pediatrics, Pediatric Neurology, Metabolic Diseases, Gastroenterology and Nephrology, University Hospital Heidelberg, Heidelberg, Germany
| | - Simone Zittel
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Steffi Patzer
- Department of Pediatrics, Krankenhaus St. Elisabeth und St. Barbara, Halle (Saale), Germany
| | - Andrea Auhuber
- Sozialpädiatrisches Zentrum, Celle General Hospital, Celle, Germany
| | - Joachim Opp
- Sozialpädiatrisches Zentrum, Evangelisches Krankenhaus Oberhausen, Oberhausen, Germany
| | - Eva Matzker
- Pediatric Neurology, Carl-Thiem Hospital Cottbus, Cottbus, Germany
| | - Andrea Bevot
- Pediatric Neurology and Developmental Medicine, Eberhard Karls University Tübingen, Faculty of Medicine, Tübingen, Germany
| | - Juergen Seeger
- Sozialpädiatrisches Zentrum Frankfurt Mitte, Frankfurt, Germany
| | - Andreas van Baalen
- Department of Neuropediatrics, University Medical Center Schleswig-Holstein, Kiel University (CAU), Kiel, Germany
| | - Burkhard Stüve
- Pediatric Neurology, DRK-Kinderklinik Siegen gGmbH, Siegen, Germany
| | - Knut Brockmann
- Division of Pediatric Neurology, Department of Paediatrics and Adolescent Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Sebahattin Cirak
- Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
| | - Anne Koy
- Center for Rare Diseases, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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2
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Döring JH, Saffari A, Bast T, Brockmann K, Ehrhardt L, Fazeli W, Janzarik WG, Klabunde-Cherwon A, Kluger G, Muhle H, Pendziwiat M, Møller RS, Platzer K, Santos JL, Schröter J, Hoffmann GF, Kölker S, Syrbe S. Efficacy, Tolerability, and Retention of Antiseizure Medications in PRRT2-Associated Infantile Epilepsy. Neurol Genet 2022; 8:e200020. [PMID: 36187725 PMCID: PMC9520344 DOI: 10.1212/nxg.0000000000200020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/29/2022] [Indexed: 11/15/2022]
Abstract
Background and Objectives Pathogenic variants in PRRT2, encoding for the proline-rich transmembrane protein 2, were identified as the main cause of self-limiting sporadic and familial infantile epilepsy. Reported data on treatment response to antiseizure medications (ASMs) in defined monogenic epilepsies are limited. The aim of this study was to evaluate the treatment response of ASMs in children with monogenic PRRT2-associated infantile epilepsy. Methods A multicenter, retrospective, cross-sectional cohort study was conducted according to the Strengthening the Reporting of Observational Studies in Epidemiology criteria. Inclusion criteria were occurrence of infantile seizures and genetic diagnosis of likely pathogenic/pathogenic PRRT2 variants. Results Treatment response data from 52 individuals with PRRT2-associated infantile epilepsy with a total of 79 treatments (defined as each use of an ASM in an individual) were analyzed. Ninety-six percent (50/52) of all individuals received ASMs. Levetiracetam (LEV), oxcarbazepine (OXC), valproate (VPA), and phenobarbital (PB) were most frequently administered. Sodium channel blockers were used in 22 individuals and resulted in seizure freedom in all but 1 child, who showed a reduction of more than 50% in seizure frequency. By contrast, treatment with LEV was associated with worsening of seizure activity in 2/25 (8%) treatments and no effect in 10/25 (40%) of treatments. LEV was rated significantly less effective also compared with VPA and PB. The retention rate for LEV was significantly lower compared with all aforementioned ASMs. No severe adverse events were reported, and no discontinuation of treatment was reported because of side effects. Discussion In conclusion, a favorable effect of most ASMs, especially sodium channel blockers such as carbamezepine and OXC, was observed, whereas the efficacy and the retention rate of LEV was lower in PRRT2-associated childhood epilepsy. Tolerability in these young children was good for all ASMs reported in the cohort. Classification of Evidence This study provides Class IV evidence that in individuals with PRRT2-associated infantile epilepsy, sodium channel blockers are associated with reduced seizure frequency but levetiracetam is not.
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Janzarik WG, Krägeloh-Mann I, Langer T, van Buiren M, Schaefer HE, Gerner P. Spasmodic Abdominal Pain and Other Gastrointestinal Symptoms in Pontocerebellar Hypoplasia Type 2. Neuropediatrics 2021; 52:495-498. [PMID: 34255333 DOI: 10.1055/s-0041-1730445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Pontocerebellar hypoplasia type 2 (PCH2) is a rare neurodevelopmental disease with a high disease burden. Besides neurological symptoms, somatic symptoms, such as gastroesophageal reflux (GERD) and failure to thrive, are major contributors to this burden. METHODS We report three patients with genetically confirmed PCH2A and significant gastrointestinal (GI) symptoms. RESULTS Apart from impaired swallowing and GERD, which are frequently reported in patients with PCH2, all three patients suffered from episodes of spasmodic abdominal pain and restlessness. In one severely affected patient, lack of intestinal alkaline phosphatase (IAP) is demonstrated. CONCLUSION GI symptoms are common in PCH2. We draw attention to episodes of spasmodic abdominal pain seriously, aggravating the condition of the patients, especially their movement disorder, and discuss the role of IAP.
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Affiliation(s)
- Wibke G Janzarik
- Department of Neuropediatrics and Muscle Disorders, Center for Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ingeborg Krägeloh-Mann
- Department of Pediatric and Developmental Neurology, University Children's Hospital, Tübingen, Germany
| | - Thorsten Langer
- Department of Neuropediatrics and Muscle Disorders, Center for Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Miriam van Buiren
- Department of Pediatric Hematology and Oncology, Center for Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Hans E Schaefer
- Department of Pathology, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Patrick Gerner
- Department of Pediatrics and Adolescent Medicine, Center for Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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4
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Dzinovic I, Škorvánek M, Necpál J, Boesch S, Švantnerová J, Wagner M, Havránková P, Pavelekova P, Haň V, Janzarik WG, Berweck S, Diebold I, Kuster A, Jech R, Winkelmann J, Zech M. Dystonia as a prominent presenting feature in developmental and epileptic encephalopathies: A case series. Parkinsonism Relat Disord 2021; 90:73-78. [PMID: 34399161 DOI: 10.1016/j.parkreldis.2021.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/03/2021] [Accepted: 08/06/2021] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Although there has been increasing recognition of the occurrence of non-epileptic involuntary movements in developmental and epileptic encephalopathies (DEEs), the spectrum of dystonic presentations associated with these conditions remains poorly described. We sought to expand the catalogue of dystonia-predominant phenotypes in monogenic DEEs, building on the recently introduced concept of an epilepsy-movement disorder spectrum. METHODS Cases were identified from a whole-exome-sequenced cohort of 45 pediatric index patients with complex dystonia (67% sequenced as parent-child trios). Review of molecular findings in DEE-associated genes was performed. For five individuals with identified DEE-causing variants, detailed information about presenting phenotypic features and the natural history of disease was obtained. RESULTS De-novo pathogenic and likely pathogenic missense variants in GABRA1, GABBR2, GNAO1, and FOXG1 gave rise to infantile-onset persistent and paroxysmal dystonic manifestations, beginning in the limb or truncal musculature and progressing gradually to a generalized state. Coexisting, less prominent movement-disorder symptoms were observed and included myoclonic, ballistic, and stereotypic abnormal movements as well as choreoathetosis. Dystonia dominated over epileptic neurodevelopmental comorbidities in all four subjects and represented the primary indication for molecular genetic analysis. We also report the unusual case of an adult female patient with dystonia, tremor, and mild learning disability who was found to harbor a pathogenic frameshift variant in MECP2. CONCLUSIONS Dystonia can be a leading clinical manifestation in different DEEs. A monogenic basis of disease should be considered on the association of dystonia and developmental delay-epilepsy presentations, justifying a molecular screening for variants in DEE-associated genes.
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Affiliation(s)
- Ivana Dzinovic
- Institute of Neurogenomics, Helmholtz Zentrum München, Munich, Germany
| | - Matej Škorvánek
- Department of Neurology, P.J. Safarik University, Kosice, Slovak Republic; Department of Neurology, University Hospital of L. Pasteur, Kosice, Slovak Republic
| | - Ján Necpál
- Department of Neurology, Zvolen Hospital, Slovakia
| | - Sylvia Boesch
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Jana Švantnerová
- Second Department of Neurology, Faculty of Medicine, Comenius University, University Hospital Bratislava, Bratislava, Slovakia
| | - Matias Wagner
- Institute of Neurogenomics, Helmholtz Zentrum München, Munich, Germany; Technical University of Munich, Munich, Germany; School of Medicine, Institute of Human Genetics
| | - Petra Havránková
- Department of Neurology, Charles University, 1st Faculty of Medicine and General University Hospital in Prague, Prague, Czech Republic
| | - Petra Pavelekova
- Department of Neurology, P.J. Safarik University, Kosice, Slovak Republic; Department of Neurology, University Hospital of L. Pasteur, Kosice, Slovak Republic
| | - Vladimír Haň
- Department of Neurology, P.J. Safarik University, Kosice, Slovak Republic; Department of Neurology, University Hospital of L. Pasteur, Kosice, Slovak Republic
| | - Wibke G Janzarik
- Department of Neuropediatrics and Muscle Disorders, University Medical Center, Faculty of Medicine, University of Freiburg, Germany
| | - Steffen Berweck
- Ludwig Maximilian University of Munich, Munich, Germany; Hospital for Neuropediatrics and Neurological Rehabilitation, Centre of Epilepsy for Children and Adolescents, Schoen Klinik Vogtareuth, Vogtareuth, Germany
| | - Isabel Diebold
- MGZ - Medical Genetics Center Munich, Munich, Germany; Department of Pediatrics, Technical University of Munich School of Medicine, Munich, Germany
| | - Alice Kuster
- Inborn Errors of Metabolism, Pediatric Intensive Care Unit, University Hospital of Nantes, Nantes, France
| | - Robert Jech
- Department of Neurology, Charles University, 1st Faculty of Medicine and General University Hospital in Prague, Prague, Czech Republic
| | - Juliane Winkelmann
- Institute of Neurogenomics, Helmholtz Zentrum München, Munich, Germany; Technical University of Munich, Munich, Germany; School of Medicine, Institute of Human Genetics; Lehrstuhl für Neurogenetik, Technische Universität München, Munich, Germany; Munich Cluster for Systems Neurology, SyNergy, Munich, Germany
| | - Michael Zech
- Institute of Neurogenomics, Helmholtz Zentrum München, Munich, Germany; Technical University of Munich, Munich, Germany; School of Medicine, Institute of Human Genetics.
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5
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Zech M, Jech R, Boesch S, Škorvánek M, Necpál J, Švantnerová J, Wagner M, Sadr-Nabavi A, Distelmaier F, Krenn M, Serranová T, Rektorová I, Havránková P, Mosejová A, Příhodová I, Šarláková J, Kulcsarová K, Ulmanová O, Bechyně K, Ostrozovičová M, Haň V, Ventosa JR, Brunet T, Berutti R, Shariati M, Shoeibi A, Schneider SA, Kuster A, Baumann M, Weise D, Wilbert F, Janzarik WG, Eckenweiler M, Mall V, Haslinger B, Berweck S, Winkelmann J, Oexle K. Scoring Algorithm-Based Genomic Testing in Dystonia: A Prospective Validation Study. Mov Disord 2021; 36:1959-1964. [PMID: 33949708 DOI: 10.1002/mds.28614] [Citation(s) in RCA: 6] [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: 11/06/2020] [Revised: 02/22/2021] [Accepted: 03/26/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Despite the established value of genomic testing strategies, practice guidelines for their use do not exist in many indications. OBJECTIVES We sought to validate a recently introduced scoring algorithm for dystonia, predicting the diagnostic utility of whole-exome sequencing (WES) based on individual phenotypic aspects (age-at-onset, body distribution, presenting comorbidity). METHODS We prospectively enrolled a set of 209 dystonia-affected families and obtained summary scores (0-5 points) according to the algorithm. Singleton (N = 146), duo (N = 11), and trio (N = 52) WES data were generated to identify genetic diagnoses. RESULTS Diagnostic yield was highest (51%) among individuals with a summary score of 5, corresponding to a manifestation of early-onset segmental or generalized dystonia with coexisting non-movement disorder-related neurological symptoms. Sensitivity and specificity at the previously suggested threshold for implementation of WES (3 points) was 96% and 52%, with area under the curve of 0.81. CONCLUSIONS The algorithm is a useful predictive tool and could be integrated into dystonia routine diagnostic protocols. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson Movement Disorder Society.
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Affiliation(s)
- Michael Zech
- Institute of Neurogenomics, Helmholtz Zentrum München, Munich, Germany.,Institute of Human Genetics, Technical University of Munich, Munich, Germany
| | - Robert Jech
- Department of Neurology, Charles University, 1st Faculty of Medicine and General University Hospital in Prague, Prague, Czech Republic
| | - Sylvia Boesch
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Matej Škorvánek
- Department of Neurology, P.J. Safarik University, Kosice, Slovak Republic.,Department of Neurology, University Hospital of L. Pasteur, Kosice, Slovak Republic
| | - Ján Necpál
- Department of Neurology, Zvolen Hospital, Zvolen, Slovakia
| | - Jana Švantnerová
- Second Department of Neurology, Faculty of Medicine, Comenius University, University Hospital Bratislava, Bratislava, Slovakia
| | - Matias Wagner
- Institute of Neurogenomics, Helmholtz Zentrum München, Munich, Germany.,Institute of Human Genetics, Technical University of Munich, Munich, Germany
| | - Ariane Sadr-Nabavi
- Department of Medical Genetics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Neurology, Faculty of Medicine, Mashhad University of Medical Sciences, Qaem Medical Center, Mashhad, Iran.,Academic Center for Education, Culture and Research (ACECR)-Khorasan Razavi, Mashhad, Iran
| | - Felix Distelmaier
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Martin Krenn
- Institute of Human Genetics, Technical University of Munich, Munich, Germany.,Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Tereza Serranová
- Department of Neurology, Charles University, 1st Faculty of Medicine and General University Hospital in Prague, Prague, Czech Republic
| | - Irena Rektorová
- First Department of Neurology, Faculty of Medicine, St. Anne's University Hospital and CEITEC, Masaryk University, Brno, Czech Republic
| | - Petra Havránková
- Department of Neurology, Charles University, 1st Faculty of Medicine and General University Hospital in Prague, Prague, Czech Republic
| | - Alexandra Mosejová
- Department of Neurology, P.J. Safarik University, Kosice, Slovak Republic.,Department of Neurology, University Hospital of L. Pasteur, Kosice, Slovak Republic
| | - Iva Příhodová
- Department of Neurology, Charles University, 1st Faculty of Medicine and General University Hospital in Prague, Prague, Czech Republic
| | - Jana Šarláková
- Department of Neurology, University Hospital, Hradec Kralove, Czech Republic
| | - Kristína Kulcsarová
- Department of Neurology, P.J. Safarik University, Kosice, Slovak Republic.,Department of Neurology, University Hospital of L. Pasteur, Kosice, Slovak Republic
| | - Olga Ulmanová
- Department of Neurology, Charles University, 1st Faculty of Medicine and General University Hospital in Prague, Prague, Czech Republic
| | | | - Miriam Ostrozovičová
- Department of Neurology, P.J. Safarik University, Kosice, Slovak Republic.,Department of Neurology, University Hospital of L. Pasteur, Kosice, Slovak Republic
| | - Vladimír Haň
- Department of Neurology, P.J. Safarik University, Kosice, Slovak Republic.,Department of Neurology, University Hospital of L. Pasteur, Kosice, Slovak Republic
| | - Joaquim Ribeiro Ventosa
- Department of Neurology, P.J. Safarik University, Kosice, Slovak Republic.,Department of Neurology, University Hospital of L. Pasteur, Kosice, Slovak Republic
| | - Theresa Brunet
- Institute of Human Genetics, Technical University of Munich, Munich, Germany
| | - Riccardo Berutti
- Institute of Human Genetics, Technical University of Munich, Munich, Germany
| | - Mohammad Shariati
- Department of Neurology, Faculty of Medicine, Mashhad University of Medical Sciences, Qaem Medical Center, Mashhad, Iran.,Academic Center for Education, Culture and Research (ACECR)-Khorasan Razavi, Mashhad, Iran
| | - Ali Shoeibi
- Department of Neurology, Faculty of Medicine, Mashhad University of Medical Sciences, Qaem Medical Center, Mashhad, Iran
| | | | - Alice Kuster
- Inborn Errors of Metabolism, Pediatric Intensive Care Unit, University Hospital of Nantes, Nantes, France
| | - Matthias Baumann
- Department of Pediatrics, Medical University Innsbruck, Innsbruck, Austria
| | - David Weise
- Klinik für Neurologie, Asklepios Fachklinikum Stadtroda, Stadtroda, Germany
| | - Friederike Wilbert
- Department of Neuropediatrics and Muscle Disorders, University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Wibke G Janzarik
- Department of Neuropediatrics and Muscle Disorders, University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Matthias Eckenweiler
- Department of Neuropediatrics and Muscle Disorders, University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Volker Mall
- Lehrstuhl für Sozialpädiatrie, Technische Universität München, Munich, Germany.,kbo-Kinderzentrum München, Munich, Germany
| | - Bernhard Haslinger
- Klinik und Poliklinik für Neurologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Steffen Berweck
- Ludwig Maximilian University of Munich, Munich, Germany.,Hospital for Neuropediatrics and Neurological Rehabilitation, Centre of Epilepsy for Children and Adolescents, Schoen Klinik Vogtareuth, Vogtareuth, Germany
| | - Juliane Winkelmann
- Institute of Neurogenomics, Helmholtz Zentrum München, Munich, Germany.,Institute of Human Genetics, Technical University of Munich, Munich, Germany.,Lehrstuhl für Neurogenetik, Technische Universität München, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Konrad Oexle
- Institute of Neurogenomics, Helmholtz Zentrum München, Munich, Germany.,Institute of Human Genetics, Technical University of Munich, Munich, Germany
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6
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Janzarik WG, Sander M, Rößler J, Sommerlade L, Allignol A, Reinhard M. Cerebral Autoregulation and Neurovascular Coupling after Craniospinal Irradiation in Long-Term Survivors of Malignant Pediatric Brain Tumors of the Posterior Fossa. Neuropediatrics 2021; 52:12-18. [PMID: 33065751 DOI: 10.1055/s-0040-1709452] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Long-term survivors of craniospinal irradiation have an increased risk for stroke which increases with radiation dose and follow-up time. Radiotherapy induces structural changes of the cerebral vasculature, affecting both, large, and small vessels. It is unknown how these structural changes affect functional mechanisms of cerebral blood flow regulation such as cerebral autoregulation and neurovascular coupling. METHODS Using the transcranial Doppler, we compared dynamic cerebral autoregulation and neurovascular coupling of 12 patients after long-term survival of craniospinal irradiation due to a malignant pediatric brain tumor of the posterior fossa and 12 age- and sex-matched healthy patients. Mean arterial blood pressure and cerebral blood flow velocities in the middle and posterior cerebral artery were recorded at rest during normal breathing to assess cerebral autoregulation (transfer function parameters phase and gain, as well as the correlation coefficient indices Mx, Sx, and Dx), and during 10 cycles of a visual task to assess neurovascular coupling (parameters time delay, natural frequency, gain, attenuation, and rate time). RESULTS Parameters of cerebral autoregulation showed a consistent trend toward reduced cerebral autoregulation in patients that did not reach statistical significance. Neurovascular coupling was not altered after craniospinal irradiation. CONCLUSION In this pilot study, we demonstrated a trend toward reduced cerebral autoregulation, and no alteration of neurovascular coupling after irradiation in long-term survivors of malignant pediatric brain tumors of the posterior fossa.
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Affiliation(s)
- Wibke G Janzarik
- Department of Neuropediatrics and Muscle Disorders, Center for Pediatrics, University Medical Center Freiburg, University of Freiburg, Germany
| | - Milena Sander
- Department of Neuropediatrics and Muscle Disorders, Center for Pediatrics, University Medical Center Freiburg, University of Freiburg, Germany
| | - Jochen Rößler
- Department of Pediatric Hematology and Oncology, Center for Pediatrics, University Medical Center Freiburg, University of Freiburg, Germany.,Division of Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Linda Sommerlade
- Institute for Complex Systems and Mathematical Biology, King's College, University of Aberdeen, Aberdeen, United Kingdom
| | | | - Matthias Reinhard
- Department of Neurology and Clinical Neurophysiology, Medical Center Esslingen, Academic Teaching Hospital of the University of Tübingen, Germany.,Department of Neurology and Neurophysiology, University Medical Center Freiburg, University of Freiburg, Germany
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7
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Minthe A, Janzarik WG, Lachner-Piza D, Reinacher P, Schulze-Bonhage A, Dümpelmann M, Jacobs J. Stable high frequency background EEG activity distinguishes epileptic from healthy brain regions. Brain Commun 2020; 2:fcaa107. [PMID: 32954347 PMCID: PMC7475693 DOI: 10.1093/braincomms/fcaa107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 05/06/2020] [Accepted: 05/15/2020] [Indexed: 11/24/2022] Open
Abstract
High-frequency oscillations are markers of epileptic tissue. Recently, different patterns of EEG background activity were described from which high-frequency oscillations occur: high-frequency oscillations with continuously oscillating background were found to be primarily physiological, those from quiet background were linked to epileptic tissue. It is unclear, whether these interactions remain stable over several days and during different sleep-wake stages. High-frequency oscillation patterns (oscillatory vs. quiet background) were analysed in 23 patients implanted with depth and subdural grid electrodes. Pattern scoring was performed on every channel in 10 s intervals in three separate day- and night-time EEG segments. An entropy value, measuring variability of patterns per channel, was calculated. A low entropy value indicated a stable occurrence of the same pattern in one channel, whereas a high value indicated pattern instability. Differences in pattern distribution and entropy were analysed for 143 280 10 s intervals with allocated patterns from inside and outside the seizure onset zone, different electrode types and brain regions. We found a strong association between high-frequency oscillations out of quiet background activity, and channels of the seizure onset zone (35.2% inside versus 9.7% outside the seizure onset zone, P < 0.001), no association was found for high-frequency oscillations from continuous oscillatory background (P = 0.563). The type of background activity remained stable over the same brain region over several days and was independent of sleep stage and recording technique. Stability of background activity was significantly higher in channels of the seizure onset zone (entropy mean value 0.56 ± 0.39 versus 0.64 ± 0.41; P < 0.001). This was especially true for the presumed epileptic high-frequency oscillations out of quiet background (0.57 ± 0.39 inside versus 0.72 ± 0.37 outside the seizure onset zone; P < 0.001). In contrast, presumed physiological high-frequency oscillations from continuous oscillatory backgrounds were significantly more stable outside the seizure onset zone (0.72 ± 0.45 versus 0.48 ± 0.53; P < 0.001). The overall low entropy values suggest that interactions between high-frequency oscillations and background activity are a stable phenomenon specific to the function of brain regions. High-frequency oscillations occurring from a quiet background are strongly linked to the seizure onset zone whereas high-frequency oscillations from an oscillatory background are not. Pattern stability suggests distinct underlying mechanisms. Analysing short time segments of high-frequency oscillations and background activity could help distinguishing epileptic from physiologically active brain regions.
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Affiliation(s)
- Annika Minthe
- Department of Neuropediatrics and Muscular Diseases, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Wibke G Janzarik
- Department of Neuropediatrics and Muscular Diseases, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Daniel Lachner-Piza
- Department of Neurosurgery, Epilepsy Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Peter Reinacher
- Division of Stereotactic and Functional Neurosurgery, Department of Neurosurgery, Clinic for Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Andreas Schulze-Bonhage
- Department of Neurosurgery, Epilepsy Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Matthias Dümpelmann
- Department of Neurosurgery, Epilepsy Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Julia Jacobs
- Department of Neuropediatrics and Muscular Diseases, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.,Department of Neurosurgery, Epilepsy Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
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Leidner V, Markfeld-Erol F, Wuttke M, Kunze M, Jacobs J, Janzarik WG. Maternal blood pressure levels prepartum correlate with neonatal birth weight in preeclampsia. J Perinat Med 2019; 47:894-896. [PMID: 31494641 DOI: 10.1515/jpm-2019-0267] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 07/26/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Viola Leidner
- Department of Neuropediatrics and Muscular Diseases, Center of Pediatrics and Adolescent Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | - Filiz Markfeld-Erol
- Department of Obstetrics and Gynecology, Medical Center, University of Freiburg, Freiburg, Germany
| | - Matthias Wuttke
- Division of Genetic Epidemiology, Institute for Medical Biometry and Statistics, Medical Center, University of Freiburg, Freiburg, Germany
| | - Mirjam Kunze
- Department of Obstetrics and Gynecology, Medical Center, University of Freiburg, Freiburg, Germany
| | - Julia Jacobs
- Department of Neuropediatrics and Muscular Diseases, Center of Pediatrics and Adolescent Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | - Wibke G Janzarik
- Department of Neuropediatrics and Muscular Diseases, Center of Pediatrics and Adolescent Medicine, Medical Center, University of Freiburg, Freiburg, Germany
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9
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Janzarik WG, Jacob J, Katagis E, Markfeld-Erol F, Sommerlade L, Wuttke M, Reinhard M. Preeclampsia postpartum: Impairment of cerebral autoregulation and reversible cerebral hyperperfusion. Pregnancy Hypertens 2019; 17:121-126. [DOI: 10.1016/j.preghy.2019.05.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 05/26/2019] [Accepted: 05/29/2019] [Indexed: 11/28/2022]
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10
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Janzarik WG, Gerber AK, Markfeld-Erol F, Sommerlade L, Allignol A, Reinhard M. No long-term impairment of cerebral autoregulation after preeclampsia. Pregnancy Hypertens 2018; 13:171-173. [DOI: 10.1016/j.preghy.2018.06.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 04/19/2018] [Accepted: 06/10/2018] [Indexed: 10/14/2022]
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11
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Pschibul A, Janzarik WG, Franck P, Hufnagel M, Beck C, Korinthenberg R. Cystic Encephalomalacia following Vasculopathy and Vasospasm of Proximal Intracranial Arteries Due to Pneumococcal Meningitis in a Infant. Neuropediatrics 2018. [PMID: 29523004 DOI: 10.1055/s-0038-1635075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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] [Indexed: 10/17/2022]
Abstract
Despite the availability of modern antibiotics, pneumococcal meningitis in both children and adults remains a severe disease-one known to frequently cause grave complications and residual disability. Although the appearance of arterial vasospasms in bacterial meningitis systematically has been investigated and reported on for adult patients, such research is lacking when it comes to infants. We report on a 4-week-old infant who, 6 days after onset of pneumococcal meningitis, suffered severe neurological deterioration with treatment-resistant seizures and coma. Generalized cortical and subcortical edema developed in conjunction with diminished cerebral blood flow, as depicted in magnetic resonance angiography and serial Doppler-sonographic examinations. The ischemia resulted in extensive cystic encephalomalacia. We propose that the degree of variation in cerebral blood flow in the acute phase was the result of an extensive arterial vasculopathy involving vasospasms. Awareness of this complication and prospective serial Doppler-sonographic examinations may improve our understanding of the connection between brain edema and vasculopathy. At present, however, no effective treatment appears available.
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Affiliation(s)
- Alexander Pschibul
- Department of Neuropediatrics and Muscle Disorders, University of Freiburg, Freiburg, Germany
| | - Wibke G Janzarik
- Department of Neuropediatrics and Muscle Disorders, University of Freiburg, Freiburg, Germany
| | - Peter Franck
- Department of Neuropediatrics and Muscle Disorders, University of Freiburg, Freiburg, Germany.,Department of Neurology and Neuroscience, University of Freiburg, Freiburg, Germany
| | - Markus Hufnagel
- Department of General Pediatrics, Adolescent Medicine and Neonatology, University of Freiburg, Freiburg, Germany
| | - Christopher Beck
- Department of Neuroradiology, University of Freiburg, Freiburg, Germany
| | - Rudolf Korinthenberg
- Department of Neuropediatrics and Muscle Disorders, University of Freiburg, Freiburg, Germany
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12
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Janzarik WG, Ehmann R, Ehlers E, Allignol A, Mayer S, Gabriel B, Weiller C, Prömpeler H, Reinhard M. Neurovascular coupling in pregnancy and the risk of preeclampsia. Stroke 2014; 45:2792-4. [PMID: 25034711 DOI: 10.1161/strokeaha.114.006272] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE This study investigated whether a short testing of neurovascular coupling during midterm pregnancy could identify women at risk for subsequent preeclampsia. METHODS Transcranial Doppler sonography of the posterior cerebral artery during a brief visual stimulation was analyzed in 68 women at midterm pregnancy, the primary clinical end point was preeclampsia. RESULTS Women with bilateral notching of the uterine arteries showed an exaggerated visually evoked blood flow increase and longer time-to-peak. Neurovascular coupling was not significantly associated with the occurrence of preeclampsia. CONCLUSIONS Neurovascular coupling was altered in women with impaired uteroplacentar vasoregulation but not a significant predictor of preeclampsia.
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Affiliation(s)
- Wibke G Janzarik
- From the Departments of Neurology (W.G.J., R.E., E.E., C.W., M.R.), Pediatrics and Adolescent Medicine (W.G.J.), and Obstetrics and Gynecology (S.M., B.G., H.P.), University of Freiburg, Freiburg, Germany; and Department of Statistics, University of Ulm, Ulm, Germany (A.A.)
| | - Renata Ehmann
- From the Departments of Neurology (W.G.J., R.E., E.E., C.W., M.R.), Pediatrics and Adolescent Medicine (W.G.J.), and Obstetrics and Gynecology (S.M., B.G., H.P.), University of Freiburg, Freiburg, Germany; and Department of Statistics, University of Ulm, Ulm, Germany (A.A.)
| | - Elena Ehlers
- From the Departments of Neurology (W.G.J., R.E., E.E., C.W., M.R.), Pediatrics and Adolescent Medicine (W.G.J.), and Obstetrics and Gynecology (S.M., B.G., H.P.), University of Freiburg, Freiburg, Germany; and Department of Statistics, University of Ulm, Ulm, Germany (A.A.)
| | - Arthur Allignol
- From the Departments of Neurology (W.G.J., R.E., E.E., C.W., M.R.), Pediatrics and Adolescent Medicine (W.G.J.), and Obstetrics and Gynecology (S.M., B.G., H.P.), University of Freiburg, Freiburg, Germany; and Department of Statistics, University of Ulm, Ulm, Germany (A.A.)
| | - Sebastian Mayer
- From the Departments of Neurology (W.G.J., R.E., E.E., C.W., M.R.), Pediatrics and Adolescent Medicine (W.G.J.), and Obstetrics and Gynecology (S.M., B.G., H.P.), University of Freiburg, Freiburg, Germany; and Department of Statistics, University of Ulm, Ulm, Germany (A.A.)
| | - Boris Gabriel
- From the Departments of Neurology (W.G.J., R.E., E.E., C.W., M.R.), Pediatrics and Adolescent Medicine (W.G.J.), and Obstetrics and Gynecology (S.M., B.G., H.P.), University of Freiburg, Freiburg, Germany; and Department of Statistics, University of Ulm, Ulm, Germany (A.A.)
| | - Cornelius Weiller
- From the Departments of Neurology (W.G.J., R.E., E.E., C.W., M.R.), Pediatrics and Adolescent Medicine (W.G.J.), and Obstetrics and Gynecology (S.M., B.G., H.P.), University of Freiburg, Freiburg, Germany; and Department of Statistics, University of Ulm, Ulm, Germany (A.A.)
| | - Heinrich Prömpeler
- From the Departments of Neurology (W.G.J., R.E., E.E., C.W., M.R.), Pediatrics and Adolescent Medicine (W.G.J.), and Obstetrics and Gynecology (S.M., B.G., H.P.), University of Freiburg, Freiburg, Germany; and Department of Statistics, University of Ulm, Ulm, Germany (A.A.)
| | - Matthias Reinhard
- From the Departments of Neurology (W.G.J., R.E., E.E., C.W., M.R.), Pediatrics and Adolescent Medicine (W.G.J.), and Obstetrics and Gynecology (S.M., B.G., H.P.), University of Freiburg, Freiburg, Germany; and Department of Statistics, University of Ulm, Ulm, Germany (A.A.).
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13
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Janzarik WG, Ehlers E, Ehmann R, Gerds TA, Schork J, Mayer S, Gabriel B, Weiller C, Prömpeler H, Reinhard M. Dynamic Cerebral Autoregulation in Pregnancy and the Risk of Preeclampsia. Hypertension 2014; 63:161-6. [DOI: 10.1161/hypertensionaha.113.01667] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Preeclampsia may affect severely the cerebral circulation leading to impairment of cerebral autoregulation, edema, and ischemia. It is not known whether impaired autoregulation occurs before the clinical onset of preeclampsia, and whether this can predict the occurrence of preeclampsia. Seventy-two women at 25 to 28 weeks of gestation were studied. Control values were derived from 26 nonpregnant women. Dynamic properties of cerebral autoregulation (DCA) were measured in the middle and posterior cerebral artery using transcranial Doppler and transfer function analysis (phase and gain) of respiratory-induced 0.1 Hz hemodynamic oscillations. Uterine artery ultrasound was performed to search for a notch sign as an early marker of general endothelial dysfunction. All women were followed up until 6 weeks after delivery for the occurrence of preeclampsia. The autoregulation parameter gain did not differ between pregnant and nonpregnant women. Phase was slightly but significantly higher in pregnant women, indicating better DCA. Women with a notch sign did not show altered DCA. A history of preeclampsia during a previous pregnancy was associated with lower phase in middle cerebral artery and posterior cerebral artery (
P
<0.05 each). During follow-up, 9 women developed preeclampsia. None of the DCA parameters were associated with the occurrence of preeclampsia. In conclusion, DCA is well preserved during late midterm pregnancy, even in women with disturbed uterine blood flow. Yet, pregnant women with preeclampsia in a previous pregnancy seem to have poorer DCA. Although limited in statistical power, this study does not support DCA as a strong early risk marker of preeclampsia.
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Affiliation(s)
- Wibke G. Janzarik
- From the Department of Neurology, Neurocenter (W.G.J., E.E., R.E., J.S., C.W., M.R.), Department of Pediatrics and Adolescent Medicine (W.G.J.), Department of Cardiology, Heart Center (E.E.), and Department of Obstetrics and Gynecology (S.M., B.G., H.P.), University of Freiburg, Freiburg, Germany; and Department of Public Health, University of Copenhagen, Copenhagen, Denmark (T.A.G.)
| | - Elena Ehlers
- From the Department of Neurology, Neurocenter (W.G.J., E.E., R.E., J.S., C.W., M.R.), Department of Pediatrics and Adolescent Medicine (W.G.J.), Department of Cardiology, Heart Center (E.E.), and Department of Obstetrics and Gynecology (S.M., B.G., H.P.), University of Freiburg, Freiburg, Germany; and Department of Public Health, University of Copenhagen, Copenhagen, Denmark (T.A.G.)
| | - Renata Ehmann
- From the Department of Neurology, Neurocenter (W.G.J., E.E., R.E., J.S., C.W., M.R.), Department of Pediatrics and Adolescent Medicine (W.G.J.), Department of Cardiology, Heart Center (E.E.), and Department of Obstetrics and Gynecology (S.M., B.G., H.P.), University of Freiburg, Freiburg, Germany; and Department of Public Health, University of Copenhagen, Copenhagen, Denmark (T.A.G.)
| | - Thomas A. Gerds
- From the Department of Neurology, Neurocenter (W.G.J., E.E., R.E., J.S., C.W., M.R.), Department of Pediatrics and Adolescent Medicine (W.G.J.), Department of Cardiology, Heart Center (E.E.), and Department of Obstetrics and Gynecology (S.M., B.G., H.P.), University of Freiburg, Freiburg, Germany; and Department of Public Health, University of Copenhagen, Copenhagen, Denmark (T.A.G.)
| | - Joscha Schork
- From the Department of Neurology, Neurocenter (W.G.J., E.E., R.E., J.S., C.W., M.R.), Department of Pediatrics and Adolescent Medicine (W.G.J.), Department of Cardiology, Heart Center (E.E.), and Department of Obstetrics and Gynecology (S.M., B.G., H.P.), University of Freiburg, Freiburg, Germany; and Department of Public Health, University of Copenhagen, Copenhagen, Denmark (T.A.G.)
| | - Sebastian Mayer
- From the Department of Neurology, Neurocenter (W.G.J., E.E., R.E., J.S., C.W., M.R.), Department of Pediatrics and Adolescent Medicine (W.G.J.), Department of Cardiology, Heart Center (E.E.), and Department of Obstetrics and Gynecology (S.M., B.G., H.P.), University of Freiburg, Freiburg, Germany; and Department of Public Health, University of Copenhagen, Copenhagen, Denmark (T.A.G.)
| | - Boris Gabriel
- From the Department of Neurology, Neurocenter (W.G.J., E.E., R.E., J.S., C.W., M.R.), Department of Pediatrics and Adolescent Medicine (W.G.J.), Department of Cardiology, Heart Center (E.E.), and Department of Obstetrics and Gynecology (S.M., B.G., H.P.), University of Freiburg, Freiburg, Germany; and Department of Public Health, University of Copenhagen, Copenhagen, Denmark (T.A.G.)
| | - Cornelius Weiller
- From the Department of Neurology, Neurocenter (W.G.J., E.E., R.E., J.S., C.W., M.R.), Department of Pediatrics and Adolescent Medicine (W.G.J.), Department of Cardiology, Heart Center (E.E.), and Department of Obstetrics and Gynecology (S.M., B.G., H.P.), University of Freiburg, Freiburg, Germany; and Department of Public Health, University of Copenhagen, Copenhagen, Denmark (T.A.G.)
| | - Heinrich Prömpeler
- From the Department of Neurology, Neurocenter (W.G.J., E.E., R.E., J.S., C.W., M.R.), Department of Pediatrics and Adolescent Medicine (W.G.J.), Department of Cardiology, Heart Center (E.E.), and Department of Obstetrics and Gynecology (S.M., B.G., H.P.), University of Freiburg, Freiburg, Germany; and Department of Public Health, University of Copenhagen, Copenhagen, Denmark (T.A.G.)
| | - Matthias Reinhard
- From the Department of Neurology, Neurocenter (W.G.J., E.E., R.E., J.S., C.W., M.R.), Department of Pediatrics and Adolescent Medicine (W.G.J.), Department of Cardiology, Heart Center (E.E.), and Department of Obstetrics and Gynecology (S.M., B.G., H.P.), University of Freiburg, Freiburg, Germany; and Department of Public Health, University of Copenhagen, Copenhagen, Denmark (T.A.G.)
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14
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Jung NH, Janzarik WG, Delvendahl I, Münchau A, Biscaldi M, Mainberger F, Bäumer T, Rauh R, Mall V. Impaired induction of long-term potentiation-like plasticity in patients with high-functioning autism and Asperger syndrome. Dev Med Child Neurol 2013; 55:83-9. [PMID: 23157428 DOI: 10.1111/dmcn.12012] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM We aimed to investigate the induction of long-term potentiation (LTP)-like plasticity by paired associative stimulation (PAS) in patients with high-functioning autism and Asperger syndrome (HFA/AS). METHOD PAS with an interstimulus interval between electrical and transcranial magnetic stimulation of 25 ms (PAS(25)) was performed in patients with HFA/AS (n=9; eight males, one female; mean age 17 y 11 mo, SD 4 y 5 mo) and in typically developing age-matched volunteers (n=9; five males, four females; mean age 22 y 4 mo, SD 5 y 2 mo). The amplitude of motor-evoked potentials was measured before PAS(25), immediately after stimulation, and 30 minutes and 60 minutes later. A PAS protocol adapted to individual N20 latency (PAS(N20+2)) was performed in six additional patients with HFA/AS. Short-interval intracortical inhibition was measured using paired-pulse stimulation. RESULTS In contrast to the typically developing participants, the patients with HFA/AS did not show a significant increase in motor-evoked potentials after PAS(25). This finding could also be demonstrated after adaptation for N20 latency. Short-interval intracortical inhibition of patients with HFA/AS was normal compared with the comparison group and did not correlate with PAS effect. INTERPRETATION Our results show a significant impairment of LTP-like plasticity induced by PAS in individuals with HFA/AS compared with typically developing participants. This finding is in accordance with results from animal studies as well as human studies. Impaired LTP-like plasticity in patients with HFA/AS points towards reduced excitatory synaptic connectivity and deficits in sensory-motor integration in these patients.
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Affiliation(s)
- Nikolai H Jung
- Department of Paediatrics, Technical University Munich, Munich, Germany
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15
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Cin H, Meyer C, Herr R, Janzarik WG, Lambert S, Jones DTW, Jacob K, Benner A, Witt H, Remke M, Bender S, Falkenstein F, Van Anh TN, Olbrich H, Deimling AV, Pekrun A, Kulozik AE, Gnekow A, Scheurlen W, Witt O, Omran H, Jabado N, Collins VP, Brummer T, Marschalek R, Lichter P, Korshunov A, Pfister SM. FAM131B-BRAF Fusion Gene Resulting From 7q34 Deletion Leads to MAPK Pathway Activation in Pilocytic Astrocytoma. Klin Padiatr 2011. [DOI: 10.1055/s-0031-1292584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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16
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Cin H, Meyer C, Herr R, Janzarik WG, Lambert S, Jones DTW, Jacob K, Benner A, Witt H, Remke M, Bender S, Falkenstein F, Van Anh TN, Olbrich H, von Deimling A, Pekrun A, Kulozik AE, Gnekow A, Scheurlen W, Witt O, Omran H, Jabado N, Collins VP, Brummer T, Marschalek R, Lichter P, Korshunov A, Pfister SM. Oncogenic FAM131B-BRAF fusion resulting from 7q34 deletion comprises an alternative mechanism of MAPK pathway activation in pilocytic astrocytoma. Acta Neuropathol 2011; 121:763-74. [PMID: 21424530 DOI: 10.1007/s00401-011-0817-z] [Citation(s) in RCA: 176] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Revised: 02/18/2011] [Accepted: 02/19/2011] [Indexed: 01/01/2023]
Abstract
Activation of the MAPK signaling pathway has been shown to be a unifying molecular feature in pilocytic astrocytoma (PA). Genetically, tandem duplications at chromosome 7q34 resulting in KIAA1549-BRAF fusion genes constitute the most common mechanism identified to date. To elucidate alternative mechanisms of aberrant MAPK activation in PA, we screened 125 primary tumors for RAF fusion genes and mutations in KRAS, NRAS, HRAS, PTPN11, BRAF and RAF1. Using microarray-based comparative genomic hybridization (aCGH), we identified in three cases an interstitial deletion of ~2.5 Mb as a novel recurrent mechanism forming BRAF gene fusions with FAM131B, a currently uncharacterized gene on chromosome 7q34. This deletion removes the BRAF N-terminal inhibitory domains, giving a constitutively active BRAF kinase. Functional characterization of the novel FAM131B-BRAF fusion demonstrated constitutive MEK phosphorylation potential and transforming activity in vitro. In addition, our study confirmed previously reported BRAF and RAF1 fusion variants in 72% (90/125) of PA. Mutations in BRAF (8/125), KRAS (2/125) and NF1 (4/125) and the rare RAF1 gene fusions (2/125) were mutually exclusive with BRAF rearrangements, with the exception of two cases in our series that concomitantly harbored more than one hit in the MAPK pathway. In summary, our findings further underline the fundamental role of RAF kinase fusion products as a tumor-specific marker and an ideally suited drug target for PA.
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Affiliation(s)
- Huriye Cin
- Division of Molecular Genetics, German Cancer Research Center, Heidelberg, Germany
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17
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Cin H, Meyer C, Herr R, Janzarik WG, Lambert S, Jones DTW, Jacob K, Witt H, Remke M, Bender S, Scheurlen W, Witt O, Omran H, Jabado N, Collins VP, Brummer T, Marschalek R, Lichter P, Korshunov A, Pfister SM. FAM131B-BRAF Fusion Gene Resulting From 7q34 Deletion Leads to MAPK Pathway Activation in Pilocytic Astrocytoma. Klin Padiatr 2011. [DOI: 10.1055/s-0031-1277077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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18
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Cin H, Meyer C, Herr R, Janzarik WG, Lambert S, Jones DTW, Benner A, Witt H, Remke M, Bender S, Falkenstein F, Anh TNV, Olbrich H, von Deimling A, Kulozik AE, Gnekow A, Scheurlen W, Witt O, Omran H, Collins VP, Brummer T, Marschalek R, Lichter P, Korshunov A, Pfister SM. Abstract 4699: Oncogenic fusion genes resulting from 7q34 deletions constitute a novel mechanism of MAPK pathway activation in pilocytic astrocytoma. Cancer Res 2011. [DOI: 10.1158/1538-7445.am2011-4699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Pilocytic astrocytoma (PA) is the most common brain tumor in children. Underlying genetic driver aberrations can currently be determined for 75-80% of cases. In particular, we and others have recently shown that tandem duplication at 7q34, resulting in BRAF fusion genes and constitutive activation of the MAPK signaling pathway, is a hallmark genetic lesion in PA development. Alternative mechanisms of MAPK activation include BRAF and KRAS point mutations, RAF1 fusions, and Neurofibromatosis-associated NF1 mutations.
In order to examine more precisely the spectrum of alterations in PA, we screened 79 tumor samples for RAF fusion genes and mutations in KRAS, NRAS, PTPN11, BRAF and RAF1. We used multiplex and long-distance inverse (LDI) PCR to identify BRAF and RAF1 fusion genes and direct sequencing for detailed breakpoint mapping.
Strikingly, LDI-PCR revealed a novel BRAF fusion gene with an uncharacterized gene, FAM131B, as a partner. Array-based comparative genomic hybridization (aCGH), revealed an interstitial deletion of ∼2.5 Mb as a novel mechanism forming the FAM131B-BRAF fusion. As with the more common duplication, this deletion removes the N-terminal auto-inhibitory domain of BRAF kinase, resulting in constitutive kinase activity. Functional characterization of the novel fusion gene demonstrated constitutive MEK phosphorylation potential and transforming activity in NIH 3T3 cells. The same fusion gene was also identified in one PA in an additional series from Cambridge, UK (n=7, with no previously identified alteration). Furthermore, we have detected a larger deletion at 7q in one additional case from our series, in which the alternative fusion partner is currently being identified.
Overall, gene fusions targeting RAF kinases were identified in 68% (54/79) of PA. Detailed analysis of genomic DNA mapped 96% (52/54) of the breakpoints to the same breakpoint cluster region in intron 8 of the BRAF gene. Moreover, we identified the first non-intronic breakpoint in exon 8 of BRAF and two novel SRGAP3-RAF1 fusion variants. BRAF, KRAS or NF1 mutations were observed as alternative mechanisms of MAPK activation in 9 tumors in which no RAF duplication was detected, as well as in two cases in our series which concomitantly harbored two or even three hits in the MAPK pathway.
In summary, we have identified a novel, recurrent BRAF fusion gene resulting in MAPK pathway activation in PA caused by a genomic deletion rather than amplification at 7q34, suggesting the possibility of further undiscovered fusion variants targeting RAF genes in this and other tumor types. Being a hallmark of PA tumorigenesis, these RAF fusion genes are expected to have clinical utility as both a specific marker for PA and a tumor-specific therapeutic target, which offers promise for applying novel treatment strategies in the near future.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 4699. doi:10.1158/1538-7445.AM2011-4699
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Affiliation(s)
- Huriye Cin
- 1German Cancer Research Center, Heidelberg, Germany
| | - Claus Meyer
- 2Institute of Pharmaceutical Biology, Diagnostic Center of Acute Leukemia (DCAL), Goethe-University, Frankfurt, Germany
| | - Ricarda Herr
- 3Centre for Biological Systems Analysis (ZBSA), Centre for Biological Signalling Studies BIOSS and Faculty of Biology, Albert-Ludwigs-University Freiburg, Germany
| | | | - Sally Lambert
- 5Division of Molecular Histopathology, Department of Pathology, University of Cambridge, United Kingdom
| | | | - Axel Benner
- 6Division of Biostatistics, German Cancer Research Center, Heidelberg, Germany
| | - Hendrik Witt
- 1German Cancer Research Center, Heidelberg, Germany
| | - Marc Remke
- 1German Cancer Research Center, Heidelberg, Germany
| | | | | | - Ton Nu Van Anh
- 8Department of Pediatric Neurology and Muscle Disorders, University Hospital Freiburg, Germany
| | - Heike Olbrich
- 8Department of Pediatric Neurology and Muscle Disorders, University Hospital Freiburg, Germany
| | | | - Andreas E. Kulozik
- 10Department of Pediatric Oncology, Hematology and Immunology, University Hospital Heidelberg, Germany
| | - Astrid Gnekow
- 7Department of Pediatrics, Klinikum Augsburg, Germany
| | | | - Olaf Witt
- 10Department of Pediatric Oncology, Hematology and Immunology, University Hospital Heidelberg, Germany
| | - Heymut Omran
- 12Clinic and Polyclinic for Pediatrics, Department of General Pediatrics, University Hospital Muenster, Germany
| | - V Peter Collins
- 5Division of Molecular Histopathology, Department of Pathology, University of Cambridge, United Kingdom
| | - Tilman Brummer
- 3Centre for Biological Systems Analysis (ZBSA), Centre for Biological Signalling Studies BIOSS and Faculty of Biology, Albert-Ludwigs-University Freiburg, Germany
| | - Rolf Marschalek
- 2Institute of Pharmaceutical Biology, Diagnostic Center of Acute Leukemia (DCAL), Goethe-University, Frankfurt, Germany
| | | | - Andrey Korshunov
- 9Department of Neuropathology, University Hospital Heidelberg, Germany
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Janzarik WG, Müller K, Lübbert M, Spreer J, Trippel M, Uhlig I, Weiller C, Rauer S. Occurrence of a germinoma 22 years after resection of a mature cerebral teratoma. J Neurooncol 2008; 88:217-9. [PMID: 18320141 DOI: 10.1007/s11060-008-9554-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2007] [Accepted: 02/18/2008] [Indexed: 10/22/2022]
Abstract
We present the rare case of a 31-year-old man who developed a germinoma 22 years after resection of a mature teratoma of the pineal region. The initial stereotactic biopsy showed a granulomatous inflammation, but no malignant cells. The correct diagnosis could only be confirmed in a second cerebral biopsy, allowing for proper treatment with radiation therapy. The need to consider metachronous germinoma in this setting is discussed.
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Affiliation(s)
- Wibke G Janzarik
- Department of Neurology, Neurocenter, University of Freiburg, Freiburg, Germany.
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Pfister S, Janzarik WG, Remke M, Ernst A, Werft W, Becker N, Toedt G, Wittmann A, Kratz C, Olbrich H, Ahmadi R, Thieme B, Joos S, Radlwimmer B, Kulozik A, Pietsch T, Herold-Mende C, Gnekow A, Reifenberger G, Korshunov A, Scheurlen W, Omran H, Lichter P. BRAF gene duplication constitutes a mechanism of MAPK pathway activation in low-grade astrocytomas. J Clin Invest 2008; 118:1739-49. [PMID: 18398503 DOI: 10.1172/jci33656] [Citation(s) in RCA: 392] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2007] [Accepted: 02/13/2008] [Indexed: 12/30/2022] Open
Abstract
The molecular pathogenesis of pediatric astrocytomas is still poorly understood. To further understand the genetic abnormalities associated with these tumors, we performed a genome-wide analysis of DNA copy number aberrations in pediatric low-grade astrocytomas by using array-based comparative genomic hybridization. Duplication of the BRAF protooncogene was the most frequent genomic aberration, and tumors with BRAF duplication showed significantly increased mRNA levels of BRAF and a downstream target, CCND1, as compared with tumors without duplication. Furthermore, denaturing HPLC showed that activating BRAF mutations were detected in some of the tumors without BRAF duplication. Similarly, a marked proportion of low-grade astrocytomas from adult patients also had BRAF duplication. Both the stable silencing of BRAF through shRNA lentiviral transduction and pharmacological inhibition of MEK1/2, the immediate downstream phosphorylation target of BRAF, blocked the proliferation and arrested the growth of cultured tumor cells derived from low-grade gliomas. Our findings implicate aberrant activation of the MAPK pathway due to gene duplication or mutation of BRAF as a molecular mechanism of pathogenesis in low-grade astrocytomas and suggest inhibition of the MAPK pathway as a potential treatment.
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Affiliation(s)
- Stefan Pfister
- Division Molecular Genetics, German Cancer Research Center (DKFZ), Heidelberg, Germany
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Janzarik WG, Ringleb PA, Reinhard M, Rauer S. Response to Letter by Menon and Norris. Stroke 2007. [DOI: 10.1161/strokeaha.106.480202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Peter A. Ringleb
- Department of Neurology, Ruprecht-Karls University of Heidelberg, Heidelberg, Germany
| | | | - Sebastian Rauer
- Department of Neurology, University of Freiburg, Freiburg, Germany
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Janzarik WG, Kratz CP, Loges NT, Olbrich H, Klein C, Schäfer T, Scheurlen W, Roggendorf W, Weiller C, Niemeyer C, Korinthenberg R, Pfister S, Omran H. Further evidence for a somatic KRAS mutation in a pilocytic astrocytoma. Neuropediatrics 2007; 38:61-3. [PMID: 17712732 DOI: 10.1055/s-2007-984451] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Astrocytomas are the most common brain tumors of childhood. However, knowledge of the molecular etiology of astrocytomas WHO grade I and II is limited. Germline mutations in the Ras-guanosine triphosphatase-activating protein, neurofibromin, in individuals with neurofibromatosis type I predispose to pilocytic astrocytomas. This association suggests that constitutive activation of the Ras signaling pathway plays a fundamental role in astrocytoma development. We screened 25 WHO I and II astrocytomas for mutations of PTPN11, NRAS, KRAS, and HRAS genes and identified the somatic G12A KRAS mutation in one pilocytic astrocytoma. These data suggest that Ras is rarely mutated in these tumors. Analyzed astrocytomas without mutations in Ras or neurofibromin may harbor mutations in other proteins of this pathway leading to hyperactive Ras signaling.
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Affiliation(s)
- W G Janzarik
- Department of Neurology, University Hospital Freiburg, Freiburg, Germany
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Tritschler E, Janzarik WG, Kiesel H, Fauser S, Rauer S. D-Laktat Azidose als Ursache episodischer Enzephalopathie. Akt Neurol 2007. [DOI: 10.1055/s-2007-987696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Janzarik WG, Olbrich H, Pfister S, Gnekow A, Pietsch T, Roggendorf W, Scheurlen W, Kratz C, Omran H. Nachweis von BRAF-Mutationen in niedriggradigen Astrozytomen. Akt Neurol 2007. [DOI: 10.1055/s-2007-987521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
BACKGROUND AND PURPOSE Spontaneous vasospasms of the submandibular internal carotid arteries are rarely observed. They are a highly dynamic process, recur frequently, and can be detected by serial ultrasound examinations. SUMMARY OF CASES We present 2 cases of recurrent extracranial vasospasms of the internal carotid artery as a cause of stroke. In both cases, arterial dissection was initially suspected, but no intramural hematoma was detected on magnetic resonance imaging. Duplex sonography demonstrated recurrent high-grade stenoses of both internal carotid arteries that resolved spontaneously within hours to days. The vasospasms were treated with calcium antagonists and in 1 patient with oral corticoids. CONCLUSIONS Extracranial vasospasms as a cause of stroke might be underestimated. Vasospasms of the internal carotid arteries should be considered in patients with recurring ischemic events in the absence of any other explanation. Antiphlogistic treatment in combination with calcium antagonists might be effective to reduce the frequency of vasospasms.
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Affiliation(s)
- Wibke G Janzarik
- Department of Neurology, University of Freiburg, Neurocenter, Breisacher Strasse 64, 79106 Freiburg, Germany.
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