1
|
Iai Y, Kashiwagi M, Tanabe T, Oba C, Nomura S, Ashida A. Rhabdomyolysis during ACTH therapy for west syndrome. Pediatr Int 2023; 65:e15583. [PMID: 37551657 DOI: 10.1111/ped.15583] [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: 02/19/2023] [Revised: 04/01/2023] [Accepted: 04/21/2023] [Indexed: 08/09/2023]
Affiliation(s)
- Yuki Iai
- Department of Pediatrics, Hirakata City Hospital, Osaka, Japan
| | | | - Takuya Tanabe
- Department of Child Neurology, Tanabe Children's Clinic, Osaka, Japan
| | - Chizu Oba
- Department of Pediatrics, Hirakata City Hospital, Osaka, Japan
| | - Shouhei Nomura
- Department of Pediatrics, Hirakata City Hospital, Osaka, Japan
| | - Akira Ashida
- Department of Pediatrics, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
| |
Collapse
|
2
|
Kanai S, Oguri M, Okanishi T, Miyamoto Y, Maeda M, Yazaki K, Matsuura R, Tozawa T, Sakuma S, Chiyonobu T, Hamano SI, Maegaki Y. Quantitative pretreatment EEG predicts efficacy of ACTH therapy in infantile epileptic spasms syndrome. Clin Neurophysiol 2022; 144:83-90. [PMID: 36327598 DOI: 10.1016/j.clinph.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/13/2022] [Accepted: 10/04/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE This study aimed to determine the correlation between outcomes following adrenocorticotrophic hormone (ACTH) therapy and measurements of relative power spectrum (rPS), weighted phase lag index (wPLI), and graph theoretical analysis on pretreatment electroencephalography (EEG) in infants with non-lesional infantile epileptic spasms syndrome (IESS). METHODS Twenty-eight patients with non-lesional IESS were enrolled. Outcomes were classified based on seizure recurrence following ACTH therapy: seizure-free (F, n = 21) and seizure-recurrence (R, n = 7) groups. The rPS, wPLI, clustering coefficient, and betweenness centrality were calculated on pretreatment EEG and were statistically analyzed to determine the correlation with outcomes following ACTH therapy. RESULTS The rPS value was significantly higher in the delta frequency band in group R than in group F (p < 0.001). The wPLI values were significantly higher in the delta, theta, and alpha frequency bands in group R than in group F (p = 0.007, <0.001, and <0.001, respectively). The clustering coefficient in the delta frequency band was significantly lower in group R than in group F (p < 0.001). CONCLUSIONS Our findings demonstrate the significant differences in power and functional connectivity between outcome groups. SIGNIFICANCE This study may contribute to an early prediction of ACTH therapy outcomes and thus help in the development of appropriate treatment strategies.
Collapse
Affiliation(s)
- Sotaro Kanai
- Division of Child Neurology, Institute of Neurological Sciences, Faculty of Medicine, Tottori University, 86 Nishi-cho, Yonago 683-8503, Japan.
| | - Masayoshi Oguri
- Department of Medical Technology, Kagawa Prefectural University of Health Sciences, 281-1 Mure-cho, Takamatsu 761-0123, Japan
| | - Tohru Okanishi
- Division of Child Neurology, Institute of Neurological Sciences, Faculty of Medicine, Tottori University, 86 Nishi-cho, Yonago 683-8503, Japan
| | - Yosuke Miyamoto
- Department of Pediatrics, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Masanori Maeda
- Department of Pediatrics, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8509, Japan
| | - Kotaro Yazaki
- Department of Pediatrics, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Ryuki Matsuura
- Division of Neurology, Saitama Children's Medical Center, 1-2 Shintoshin, Chuo-ku. Saitama 330-8777, Japan
| | - Takenori Tozawa
- Department of Pediatrics, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Satoru Sakuma
- Department of Pediatrics, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Tomohiro Chiyonobu
- Department of Pediatrics, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Shin-Ichiro Hamano
- Division of Neurology, Saitama Children's Medical Center, 1-2 Shintoshin, Chuo-ku. Saitama 330-8777, Japan
| | - Yoshihiro Maegaki
- Division of Child Neurology, Institute of Neurological Sciences, Faculty of Medicine, Tottori University, 86 Nishi-cho, Yonago 683-8503, Japan
| |
Collapse
|
3
|
Takeda K, Miyamoto Y, Yamamoto H, Iwasaki T, Sumitomo N, Takeshita E, Ishii A, Hirose S, Shimizu N. Mutation in the STXBP1 Gene Associated with Early Onset West Syndrome: A Case Report and Literature Review. Pediatr Rep 2022; 14:386-95. [PMID: 36278550 DOI: 10.3390/pediatric14040046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/05/2022] [Accepted: 09/13/2022] [Indexed: 11/17/2022] Open
Abstract
Syntaxin-binding protein1 (STXBP1) is a member of the Sec1/Munc18-1 protein family, which comprises important regulators of the secretory and synaptic vesicle fusion machinery underlying hormonal and neuronal transmission, respectively. STXBP1 pathogenic variants are associated with multiple neurological disorders. Herein, we present the case of a Japanese girl with a mutation in the STXBP1 gene, who was born at 40 weeks without neonatal asphyxia. At 15 days old, she developed epilepsy and generalized seizures. Around 88 days old, she presented with a series of nodding spasms, with the seizure frequency gradually increasing. Interictal EEG indicated hypsarrhythmia and she presented with developmental regression. At 1.5 years old, genetic testing was performed and mutational analysis revealed an STXBP1 gene mutation (c.875G > A: p.Arg292His). Accordingly, she was diagnosed with developmental and epileptic encephalopathy, presenting West syndrome’s clinical characteristics caused by the STXBP1 gene mutation. Although drug treatment has reduced the frequency of epileptic seizures, her development has remained regressive. The relationship between the location and type of genetic abnormality and the phenotype remains unclear. Future studies should investigate the genotype−phenotype correlation and the underlying pathophysiology to elucidate the causal relationships among the multiple phenotype-determining factors.
Collapse
|
4
|
Hagiwara S, Shiohama T, Ogi T, Ichikawa T, Hamada H. Subtle infantile spasms presenting as hyperirritability in CK syndrome. Pediatr Int 2022; 64:e15335. [PMID: 36331250 DOI: 10.1111/ped.15335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 07/28/2022] [Accepted: 08/16/2022] [Indexed: 01/05/2023]
Affiliation(s)
- Sho Hagiwara
- Department of Pediatrics, Chiba University Hospital, Chiba, Japan
| | - Tadashi Shiohama
- Department of Pediatrics, Chiba University Hospital, Chiba, Japan
| | - Tomoo Ogi
- Research Institute of Environmental Medicine (RIeM), Nagoya University, Nagoya, Japan
| | - Tomohiko Ichikawa
- Division of Clinical Genetics, Chiba University Hospital, Chiba, Japan
| | - Hiromichi Hamada
- Department of Pediatrics, Chiba University Hospital, Chiba, Japan
| |
Collapse
|
5
|
Ueda Y, Fujishige S, Goto T, Kimura S, Namatame N, Narugami M, Nakakubo S, Nakajima M, Egawa K, Kaneko N, Nakayama K, Hishimura N, Yamaguchi T, Nakamura A, Shiraishi H. Adrenal function during long-term ACTH therapy for patients with developmental and epileptic encephalopathy. Epilepsia Open 2021; 7:194-200. [PMID: 34862857 PMCID: PMC8886065 DOI: 10.1002/epi4.12566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/09/2021] [Accepted: 12/02/2021] [Indexed: 11/18/2022] Open
Abstract
Some patients with developmental and epileptic encephalopathy (DEE) respond to adrenocorticotropic hormone (ACTH) therapy but relapse soon after. While long‐term ACTH therapy (LT‐ACTH) has been attempted for these patients, no previous studies have carefully assessed adrenal function during LT‐ACTH. We evaluated the effectiveness of LT‐ACTH, as well as adverse effects (AE), including their adrenal function in three DEE patients. Patients underwent a corticotropin‐releasing hormone (CRH) stimulation test during LT‐ACTH, and those with peak serum cortisol below 15 μg/dL were considered to be at high risk of adrenal insufficiency (AI). Two of three responded, and their life‐threatening seizures with postgeneralized electroencephalogram (EEG) suppression decreased. Although no individuals had serious AE, CRH stimulation test revealed relatively weak responses, without reaching normal cortisol peak level (18 μg/dL). Hydrocortisone replacement during stress was prepared in a case with lower cortisol peak than our cutoff level. LT‐ACTH could be a promising treatment option for cases of DEE that relapse soon after effective ACTH treatment. The longer duration and larger cumulative dosage in LT‐ACTH than in conventional ACTH could increase the relative risk of AI. Careful evaluation with pediatric endocrinologists, including hormonal stimulation tests, might be useful for continuing this treatment safely.
Collapse
Affiliation(s)
- Yuki Ueda
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Shuta Fujishige
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Takeru Goto
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Shuhei Kimura
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Noriko Namatame
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Masashi Narugami
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Sachiko Nakakubo
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Midori Nakajima
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Kiyoshi Egawa
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Naoya Kaneko
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Kanako Nakayama
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Nozomi Hishimura
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Takeshi Yamaguchi
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Akie Nakamura
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Hideaki Shiraishi
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| |
Collapse
|
6
|
Xu L, Chen D, Zhao C, Jiang L, Mao S, Song C, Gao F. Decreased abundance of Akkermansia after adrenocorticotropic hormone therapy in patients with West syndrome. BMC Microbiol 2021; 21:126. [PMID: 33892634 PMCID: PMC8063292 DOI: 10.1186/s12866-021-02189-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 04/11/2021] [Indexed: 12/12/2022] Open
Abstract
Background Infants suffer from a severe epileptic encephalopathy known as West syndrome (WS). Treatment with adrenocorticotropic hormone (ACTH) indicates the involvement of the gut-brain axis in WS. Several pieces of evidence show the communication of the gut microbiota (GM) with the brain via the hypothalamic–pituitary–adrenal axis (HPA axis) and blood cytokines. This study aimed at (1) determining the GM diversity in infants having WS and (2) comparing the results of infants having WS with those of the healthy infants and also in the patients with WS before and after the ACTH therapy. Results In this study, 29 infants with WS and 29 healthy infants aged 3–13 months were recruited. Fecal samples were collected, and DNA was extracted and sequenced on the Illumina MiSeq platform. Kruskal-Wallis rank-sum test was used to analyze the between-group differences in the Chao1 index, Shannon index, and the abundances of GM at different taxonomy levels. R software was used to plot the graphs. The top five dominant GM genera between patients with WS and healthy infants showed no significant differences. However, the relative abundance of genus Akkermansia was observed to be significantly (P = 0.011) higher in the BT group than in the HC group and AT group. After 2 weeks of ACTH therapy, the relative abundance of Akkermansia significantly (P = 0.003) decreased. Conclusion The relative abundance of Akkermansia was observed to be significantly higher in patients with WS than that in healthy infants. However, the relationship between Akkermansia and WS pathogenesis needs to be clarified in further studies.
Collapse
Affiliation(s)
- Lu Xu
- Department of Neurology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310003, Zhejiang, China
| | - Dandan Chen
- Department of Neurology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310003, Zhejiang, China
| | - Congying Zhao
- Department of Neurology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310003, Zhejiang, China
| | - Lihua Jiang
- Department of Neurology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310003, Zhejiang, China
| | - Shanshan Mao
- Department of Neurology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310003, Zhejiang, China
| | - Chao Song
- Department of Neurology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310003, Zhejiang, China
| | - Feng Gao
- Department of Neurology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310003, Zhejiang, China.
| |
Collapse
|
7
|
Russo A, Gobbi G, Pini A, Møller RS, Rubboli G. Encephalopathy related to status epilepticus during sleep due to a de novo KCNA1 variant in the Kv-specific Pro-Val-Pro motif: phenotypic description and remarkable electroclinical response to ACTH. Epileptic Disord 2020; 22:802-6. [PMID: 33355533 DOI: 10.1684/epd.2020.1222] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Although the classic phenotype of episodic ataxia type 1 (EA1) caused by variants in KCNA1 includes episodic ataxia and myokymia, further genotype-phenotype correlations are difficult to establish due to highly heterogeneous clinical presentations associated with KCNA1 pathogenic variants. De novo variants in the paralogous Pro-Val-Pro motif (PVP) of KCNA2, an essential region for channel gating, have been reported to be associated with severe epilepsy phenotypes, including developmental and epileptic encephalopathies (DEE). Here, we describe the first patient with a DEE who developed an encephalopathy related to status epilepticus during sleep (ESES) and cerebellar signs, harbouring a variant in the Kv-specific PVP motif of the KCNA1 gene. Interestingly, he showed a remarkable long-term electroclinical response to IM ACTH therapy. This report extends the range of phenotypes associated with KCNA1 variants to include that of ESES, and suggests that ACTH therapy is likely to have a positive effect in patients with these variants.
Collapse
|
8
|
FAYYAZI A, ESLAMIAN R, KHAJEH A, DEHGHANI M. Comparison of the Effect of High and Low Doses of Adrenocorticotropic Hormone (ACTH) in the Management of Infantile Spasms. Iran J Child Neurol 2020; 14:17-25. [PMID: 32256621 PMCID: PMC7085132] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 12/20/2018] [Accepted: 04/15/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Infantile spasms can have irrecoverable adverse effects on a child's brain. Adrenocorticotropic hormone (ACTH) is the most common first-line medication for the treatment of infantile spasms. However, the suitable dose and duration of treatment continue to be debated among specialists. Since high doses of ACTH, which are commonly used, can produce more side effects, lower doses are preferred. The aim of this study was to determine the effect and extent of complications caused by high and low doses of ACTH in children with infantile spasms. MATERIALS & METHODS This clinical trial was performed on 32 infants with infantile spasms, aged 1.5-18 months. The subjects were divided into high- and low-dose ACTH groups. Treatment continued for two months. The therapeutic effects and complications were then compared over 18 months. RESULTS The results indicated no significant difference between the groups in terms of the short-term prognosis of convulsions, final prognosis of patients with spasm relapse, EEG changes after treatment, and post-treatment development of hypertension. On the other hand, there was a significant difference in the frequency distribution of restlessness intensity and becoming Cushingoid, which were more frequent in the high-dose group. CONCLUSION The results indicated that high- and low-dose ACTH are equally effective in controlling spasms, yet the low dose causes fewer side effects.
Collapse
Affiliation(s)
- Afshin FAYYAZI
- Department of Pediatrics Neurology, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Reihane ESLAMIAN
- Department of Pediatrics Neurology, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ali KHAJEH
- Department of Pediatrics Neurology, Children and Adolescents Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran.
| | - Maryam DEHGHANI
- Instructor of Pediatrics Nursing, Nahavand School of Allied Medical Sciences, Hamadan University of Medical Sciences, Hamadan, Iran.
| |
Collapse
|
9
|
Hatanaka M, Shimakawa S, Okumura A, Natsume J, Fukui M, Nomura S, Kashiwagi M, Tamai H. The efficacy of adrenocorticotropic hormone in a girl with anti-N-methyl-D-aspartate receptor encephalitis. Brain Dev 2018; 40:247-250. [PMID: 29122401 DOI: 10.1016/j.braindev.2017.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 08/15/2017] [Accepted: 10/12/2017] [Indexed: 01/24/2023]
Abstract
BACKGROUND Immunomodulatory therapy has shown some therapeutic benefits in patients with anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis. In this report, we describe the use of adrenocorticotropic hormone (ACTH) immunotherapy with good outcome in a patient with anti-NMDAR encephalitis. SUBJECT AND METHODS A 4-year-old girl developed convulsions in her right arm and leg without impaired consciousness. These convulsions occurred frequently in clusters of 10-20 events of 10-20 s duration. She was admitted to our hospital on the 6th day following her initial series of convulsions. Flaccid paralysis of the right hand and leg was also found. Interictal electroencephalography showed high-amplitude slow waves. No abnormal findings were shown on MRI. 99mTc-ECD brain SPECT on the 14th day showed hyperperfusion in the left hemisphere, including the left basal ganglia. The convulsions ceased following the oral administration of valproic acid on the 10th day; however, paralysis associated with choreic dyskinesia of the right arm and leg remained. ACTH immunotherapy was then performed on the 15th day. We identified the presence of N-methyl-D-aspartate receptor antibody in CSF samples taken on the 6th day. After ACTH therapy, the patient fully recovered from the paralysis associated with choreic dyskinesia of the right arm and leg. She has not had a relapse and has not required medication for over a year. CONCLUSION ACTH immunotherapy may be a useful treatment option for patients with anti-NMDAR encephalitis, although further evaluation is required.
Collapse
Affiliation(s)
- Mari Hatanaka
- Department of Pediatrics, Osaka Medical College, Osaka, Japan
| | | | - Akihisa Okumura
- Department of Pediatrics, Aichi Medical University, Aichi, Japan
| | - Jun Natsume
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Miho Fukui
- Department of Pediatrics, Osaka Medical College, Osaka, Japan
| | - Shohei Nomura
- Department of Pediatrics, Hirakata Municipal Hospital, Osaka, Japan
| | | | - Hiroshi Tamai
- Department of Pediatrics, Osaka Medical College, Osaka, Japan
| |
Collapse
|
10
|
Numoto S, Kurahashi H, Azuma Y, Numaguchi A, Nakahara K, Tainaka T, Takasu M, Yamakawa K, Nago N, Muto T, Kitagawa Y, Okumura A. Fournier's gangrene during ACTH therapy. Brain Dev 2017; 39:435-438. [PMID: 28007393 DOI: 10.1016/j.braindev.2016.11.012] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 11/22/2016] [Accepted: 11/28/2016] [Indexed: 11/28/2022]
Abstract
Fournier's gangrene is an infectious necrotizing fasciitis of the perineal, genital, or perianal regions and is uncommon in children. Adrenocorticotropic hormone (ACTH) is effective for the treatment of infantile spasms; however, suppression of immune function is one of the major adverse effects of this approach. We encountered a 2-month-old boy with infantile spasms that had been treated with ACTH and had developed complicating Fournier's gangrene. Strangulation of a right inguinal hernia was observed after ACTH treatment. Although surgical repair was successful and no intestinal injuries were detected, swelling and discoloration of the right scrotum developed in association with pyrexia and a severe inflammatory response. A scrotal incision revealed pus with a putrid smell. The patient was subsequently diagnosed with Fournier's gangrene complicated by septic shock and disseminated intravascular coagulation. Extensive debridement and intensive care was performed. Enterobactor aerogenes, methicillin-resistant Staphylococcus aureus, and Enterococcus faecalis were isolated from the pus. Meropenem, teicoplanin, and clindamycin were administered to control the bacterial infection. The patient was discharged from the intensive care unit without any obvious neurological sequelae. Suppression of immune function associated with ACTH therapy may have been related to the development of Fournier's gangrene in this case.
Collapse
Affiliation(s)
- Shingo Numoto
- Department of Pediatrics, Aichi Medical University, Japan.
| | | | - Yoshiteru Azuma
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Japan
| | - Atsushi Numaguchi
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Japan; Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Japan
| | - Kozaburo Nakahara
- Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Japan
| | - Takahisa Tainaka
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Japan
| | | | | | - Nozomi Nago
- Department of Pediatrics, Aichi Medical University, Japan
| | - Taichiro Muto
- Department of Pediatrics, Aichi Medical University, Japan
| | | | | |
Collapse
|
11
|
Kimizu T, Takahashi Y, Oboshi T, Horino A, Koike T, Yoshitomi S, Mori T, Yamaguchi T, Ikeda H, Okamoto N, Nakashima M, Saitsu H, Kato M, Matsumoto N, Imai K. A case of early onset epileptic encephalopathy with de novo mutation in SLC35A2: Clinical features and treatment for epilepsy. Brain Dev 2017; 39:256-260. [PMID: 27743886 DOI: 10.1016/j.braindev.2016.09.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 09/24/2016] [Accepted: 09/26/2016] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Mutations of SLC35A2 that encodes Golgi-localized Uridine diphosphate (UDP)-galactose transporter at Xp11.23 lead to congenital disorders of glycosylation (CDG). Although patients with CDG generally have diverse systemic symptoms, patients with a SLC35A2 mutation manifest predominantly disorders of the central nervous system (CNS). CASE REPORT A female infant aged 12months was referred to our center because of intractable seizures. The patient was born with birth weight of 3228g after 40weeks of unremarkable gestation. At the age of 2months, she had partial seizures evolving to epileptic spasms. Her electroencephalogram showed hypsarrhythmia. Her seizures were refractory to antiepileptic drugs. At referral to our center at 12months, she had developmental delay (no head control), widely spaced inverted nipples, external strabismus, and bilateral heterochromia of irises. Blood examinations were normal. Brain magnetic resonance imaging findings included cerebral and cerebellar atrophy, thinning of the corpus callosum, and arachnoid pouch. Whole-exome sequencing detected a de novo frameshift mutation c.950delG (p.Gly317Alafs*32) at exon 4 in SLC35A2. Seizures subsided after the second adrenocorticotropic hormones (ACTH) therapy at 18months. At the age of 36months, although she had intellectual disability with no meaningful words, she was seizure-free and was able to sit without support and showed smiling face a lot. CONCLUSION This report reviewed the clinical features of patients with a SLC35A2 mutation. ACTH therapy may be effective for refractory epilepsy in these patients.
Collapse
Affiliation(s)
- Tomokazu Kimizu
- Department of Pediatrics, National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, NHO, Japan.
| | - Yukitoshi Takahashi
- Department of Pediatrics, National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, NHO, Japan
| | - Taikan Oboshi
- Department of Pediatrics, National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, NHO, Japan
| | - Asako Horino
- Department of Pediatrics, National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, NHO, Japan
| | - Takayoshi Koike
- Department of Pediatrics, National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, NHO, Japan
| | - Shinsaku Yoshitomi
- Department of Pediatrics, National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, NHO, Japan
| | - Tatsuo Mori
- Department of Pediatrics, National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, NHO, Japan; Department of Pediatrics, Graduate School of Medical Sciences Tokushima University, Japan
| | - Tokito Yamaguchi
- Department of Pediatrics, National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, NHO, Japan
| | - Hiroko Ikeda
- Department of Pediatrics, National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, NHO, Japan
| | - Nobuhiko Okamoto
- Department of Clinical Genetics, Osaka Medical Center and Research Institute for Maternal and Child Health, Japan
| | - Mitsuko Nakashima
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Japan
| | - Hirotomo Saitsu
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Japan
| | - Mitsuhiro Kato
- Department of Pediatrics, Showa University School of Medicine, Japan
| | - Naomichi Matsumoto
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Japan
| | - Katsumi Imai
- Department of Pediatrics, National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, NHO, Japan
| |
Collapse
|
12
|
Hayashi Y, Yoshinaga H, Akiyama T, Endoh F, Ohtsuka Y, Kobayashi K. Predictive factors for relapse of epileptic spasms after adrenocorticotropic hormone therapy in West syndrome. Brain Dev 2016; 38:32-9. [PMID: 26547521 DOI: 10.1016/j.braindev.2015.05.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [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: 12/09/2014] [Revised: 05/08/2015] [Accepted: 05/25/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE To investigate whether serial electroencephalographic (EEG) findings can predict relapse of epileptic spasms after synthetic adrenocorticotropic hormone (ACTH) therapy in patients with West syndrome (WS). SUBJECTS AND METHODS Thirty-nine WS patients (8 cryptogenic and 31 symptomatic) were included in this study. These patients received ACTH therapy for the first time and were regularly followed up for more than three years at our hospital. Sixteen patients (41.0%) showed seizure relapse (relapse group) and 23 patients (59.0%) did not show relapse (non-relapse group). We used survival analysis to investigate the influence of etiology and presence of epileptic discharges after the ACTH therapy on seizure outcome. RESULTS Immediately after the ACTH therapy, etiology was associated with seizure outcome (p=0.003). In the early stage (1 month after the ACTH therapy), only the presence of epileptic discharges (p=0.001) had a significant association with seizure outcome, regardless of etiology. Because all relapsed patients were in the symptomatic group, we performed the same statistical analysis on symptomatic WS patient data only. We found that the group with no epileptic discharges on EEG showed a significantly higher seizure-free rate than those with epileptic discharges in the early stage (p=0.0091). CONCLUSION This study demonstrated that serial EEG findings after ACTH therapy are significantly related to relapse of epileptic spasms.
Collapse
Affiliation(s)
- Yumiko Hayashi
- Department of Child Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
| | - Harumi Yoshinaga
- Department of Child Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan; Department of Child Neurology, Okayama University Hospital, Okayama, Japan
| | - Tomoyuki Akiyama
- Department of Child Neurology, Okayama University Hospital, Okayama, Japan
| | - Fumika Endoh
- Department of Child Neurology, Okayama University Hospital, Okayama, Japan
| | - Yoko Ohtsuka
- Department of Child Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Katsuhiro Kobayashi
- Department of Child Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan; Department of Child Neurology, Okayama University Hospital, Okayama, Japan
| |
Collapse
|