Clinical variability of CMS-EA (congenital myasthenic syndrome with episodic apnea) due to identical CHAT mutations in two infants

Congenital myasthenic syndromes (CMS) result from mutations in various synapse-associated genes. Mutations in the choline acetyltransferase (CHAT) gene cause a presynaptic CMS associated with episodic apnea (CMS-EA). We present two unrelated Croatian children affected by CMS-EA. Beside other clinical findings characteristic for CMS, both patients manifested intermittent apneas since early infancy. Whereas the course of disease is mild in the female patient (patient 2), the male patient (patient 1) experienced recurrent and severe episodes of apnea despite adequate treatment with AChE-inhibitors and shows a global developmental delay with delayed myelination and signs of hypoxic-ischemic injury in brain imaging. Interestingly, sequencing of the CHAT gene revealed identical, compound heterozygous mutations S694C and T354M in both children. These findings are in line with a remarkable clinical heterogeneity observed in patients with CHAT mutations and emphasize the potential role of apneic crises for the development of secondary hypoxic brain damage and psychomotor retardation.

Teachers' opinions about capabilities and behavior of children with epilepsy

The purpose of this study was to investigate primary school teachers' opinions or knowledge about children with epilepsy. Two hundred and sixteen teachers were involved. The results reveal that teachers do not have an accurate conception of the capabilities of children with epilepsy and that those beliefs differ from teacher to teacher. Nearly half of the teachers believe that children with epilepsy differ from healthy children in their behavior. The majority of teachers (60%) receive information on the child's disease not from the parents, but from other sources. One-third of teachers do not feel confident in their work in children with epilepsy. A great majority (91.2%) of teachers desire additional information and education about epilepsy. Primary school teachers who work with children with epilepsy have inconsistent knowledge of the capabilities and behavior of, and an inadequate way of working with, children with epilepsy. Therefore, they are eager to get more information on epilepsy. It is the duty of the medical team to offer teachers the necessary information, so that the approach to work with, and life quality of children with epilepsy can be improved. Our results are concordant with similar studies performed in various countries within the last 30 years. It is proved that epilepsy as a disease has a very similar social effect on the affected person with no regard for cultural or social background, implying that the stigma of epilepsy is still a very powerful factor in the formation of general opinions about the disease.