1
|
Specchio N, Trivisano M, Lenge M, Ferretti A, Mei D, Parrini E, Napolitano A, Rossi-Espagnet C, Talenti G, Longo D, Proietti J, Ragona F, Freri E, Solazzi R, Granata T, Darra F, Bernardina BD, Vigevano F, Guerrini R. CDKL5 deficiency disorder: progressive brain atrophy may be part of the syndrome. Cereb Cortex 2023; 33:9709-9717. [PMID: 37429835 PMCID: PMC10472491 DOI: 10.1093/cercor/bhad235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/17/2023] [Accepted: 06/19/2023] [Indexed: 07/12/2023] Open
Abstract
The clinical phenotype of Cyclin-Dependent Kinase-Like 5 (CDKL5) deficiency disorder (CDD) has been delineated but neuroimaging features have not been systematically analyzed. We studied brain magnetic resonance imaging (MRI) scans in a cohort of CDD patients and reviewed age at seizure onset, seizure semiology, head circumference. Thirty-five brain MRI from 22 unrelated patients were included. The median age at study entry was 13.4 years. In 14/22 patients (85.7%), MRI in the first year of life was unremarkable in all but two. In 11/22, we performed MRI after 24 months of age (range 2.5-23 years). In 8 out of 11 (72.7%), MRI showed supratentorial atrophy and in six cerebellar atrophy. Quantitative analysis detected volumetric reduction of the whole brain (-17.7%, P-value = 0.014), including both white matter (-25.7%, P-value = 0.005) and cortical gray matter (-9.1%, P-value = 0.098), with a reduction of surface area (-18.0%, P-value = 0.032), mainly involving the temporal regions, correlated with the head circumference (ρ = 0.79, P-value = 0.109). Both the qualitative structural assessment and the quantitative analysis detected brain volume reduction involving the gray and white matter. These neuroimaging findings may be related to either progressive changes due to CDD pathogenesis, or to the extreme severity of epilepsy, or both. Larger prospective studies are needed to clarify the bases for the structural changes we observed.
Collapse
Affiliation(s)
- Nicola Specchio
- Clinical and Experimental Neurology, Bambino Gesù Children’s Hospital IRCCS, Rome 00165, Italy
| | - Marina Trivisano
- Clinical and Experimental Neurology, Bambino Gesù Children’s Hospital IRCCS, Rome 00165, Italy
| | - Matteo Lenge
- Neuroscience Department, Meyer Children's Hospital IRCCS, Florence, 50139, Italy
| | - Alessandro Ferretti
- Clinical and Experimental Neurology, Bambino Gesù Children’s Hospital IRCCS, Rome 00165, Italy
| | - Davide Mei
- Neuroscience Department, Meyer Children's Hospital IRCCS, Florence, 50139, Italy
| | - Elena Parrini
- Neuroscience Department, Meyer Children's Hospital IRCCS, Florence, 50139, Italy
| | - Antonio Napolitano
- Medical Physics Unit, Enterprise Risk Management, Bambino Gesù Children's Hospital, IRCCS, Rome 00165, Italy
| | - Camilla Rossi-Espagnet
- Functional and Interventional Neuroimaging Unit, Bambino Gesù Children's Hospital, IRCCS, Rome 00165, Italy
| | - Giacomo Talenti
- Neuroradiology Unit, Neuroradiology Unit, Azienda Ospedale-Università di Padova, Padova 35128, Italy
| | - Daniela Longo
- Functional and Interventional Neuroimaging Unit, Bambino Gesù Children's Hospital, IRCCS, Rome 00165, Italy
| | - Jacopo Proietti
- Child Neuropsychiatry Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona 37121, Italy
| | - Francesca Ragona
- Department of Pediatric Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano 20133, Italy
| | - Elena Freri
- Department of Pediatric Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano 20133, Italy
| | - Roberta Solazzi
- Department of Pediatric Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano 20133, Italy
| | - Tiziana Granata
- Department of Pediatric Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano 20133, Italy
| | - Francesca Darra
- Child Neuropsychiatry Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona 37121, Italy
| | - Bernardo Dalla Bernardina
- Child Neuropsychiatry Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona 37121, Italy
| | - Federico Vigevano
- Research Area on Neurology and Neurorehabilitation, Bambino Gesù Children’s Hospital IRCCS, Rome 00050, Italy
| | - Renzo Guerrini
- Neuroscience Department, Meyer Children's Hospital IRCCS, Florence, 50139, Italy
| |
Collapse
|