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Jaspersen SL, Bruns DA, Candee MS, Battaglia A, Carey JC, Fishler KP. Seizures in trisomy 18: Prevalence, description, and treatment. Am J Med Genet A 2023; 191:1026-1037. [PMID: 36601988 DOI: 10.1002/ajmg.a.63113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 01/06/2023]
Abstract
Changes in medical intervention over the last decade have improved outcomes for individuals with trisomy 18, the second most common human aneuploidy syndrome at birth. As children with trisomy 18 live longer, a shared concern of medical experts and parents is the occurrence and treatment of seizures. Previously published surveillance guidelines for this condition have not addressed seizure management. Using parent-reported data collected as part of the Tracking Rare Incidence Syndromes project, we report on the prevalence, course, and management of seizures in individuals with trisomy 18. Twenty-eight percent (52/186) of individuals diagnosed with trisomy 18 in our retrospective cohort experienced generalized, focal, or mixed seizures at some point in their lifetime. For many individuals, seizures were effectively managed by broad-spectrum anti-seizure medications. Correlation analysis showed that focal and generalized seizures were more likely to occur in individuals who had previously experienced infantile spasms or central apnea. Electroencephalogram testing should be considered as part of a standard screening approach in individuals with trisomy 18 to enable early diagnosis and treatment of seizures. An international registry that incorporates parent-reported and clinical data for patients with trisomy 18 may facilitate ongoing research and recruitment into clinical trials for seizure management.
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Affiliation(s)
- Sue L Jaspersen
- Genetic Counseling Program, Department of Medical Sciences, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Deborah A Bruns
- Special Education Program, School of Education, Southern Illinois University Carbondale, Carbondale, Illinois, USA
| | - Meghan S Candee
- Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Agatino Battaglia
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy
| | - John C Carey
- Division of Medical Genetics, Department of Pediatrics, University of Utah Health, Salt Lake City, Utah, USA
| | - Kristen P Fishler
- Munroe-Meyer Institute for Genetics and Rehabilitation, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Nevado J, Ho KS, Zollino M, Blanco R, Cobaleda C, Golzio C, Beaudry‐Bellefeuille I, Berrocoso S, Limeres J, Barrúz P, Serrano‐Martín C, Cafiero C, Málaga I, Marangi G, Campos‐Sánchez E, Moriyón‐Iglesias T, Márquez S, Markham L, Twede H, Lortz A, Olson L, Sheng X, Weng C, Wassman ER, Newcomb T, Wassman ER, Carey JC, Battaglia A, López‐Granados E, Douglas D, Lapunzina P. International meeting on Wolf‐Hirschhorn syndrome: Update on the nosology and new insights on the pathogenic mechanisms for seizures and growth delay. Am J Med Genet A 2019; 182:257-267. [DOI: 10.1002/ajmg.a.61406] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 10/23/2019] [Indexed: 01/17/2023]
Affiliation(s)
- Julián Nevado
- Medical and Molecular Genetics Institute (INGEMM) La Paz University Hospital, IdiPAZ Madrid Spain
- Basic Research Center in the Rare Diseases Network (CIBERER) Madrid Spain
| | - Karen S. Ho
- Lineagen, Inc. Salt Lake City Utah
- University of Utah School of Medicine Utah
- Hopeful Science, Inc. Salt Lake City Utah
| | - Marcella Zollino
- Institute of Genomic Medicine Catholic University, A. Gemelli Foundation Rome Italy
| | - Raquel Blanco
- Hospital Universitario Central de Asturias Oviedo Spain
| | - César Cobaleda
- Centro de Biología Molecular “Severo Ochoa,” CSIC/UAM Madrid Spain
| | | | | | - Sarah Berrocoso
- Neuro‐e‐Motion Research Team—University of Deusto Bilbao Spain
| | - Jacobo Limeres
- Facultad de Medicina y Odontología Universidad de Santiago de Compostela Santiago Galicia Spain
| | - Pilar Barrúz
- Medical and Molecular Genetics Institute (INGEMM) La Paz University Hospital, IdiPAZ Madrid Spain
| | - Candela Serrano‐Martín
- Facultad de Medicina y Odontología Universidad de Santiago de Compostela Santiago Galicia Spain
| | - Concetta Cafiero
- Institute of Genomic Medicine Catholic University, A. Gemelli Foundation Rome Italy
| | | | - Giuseppe Marangi
- Institute of Genomic Medicine Catholic University, A. Gemelli Foundation Rome Italy
| | | | | | | | | | | | | | | | | | - Cindy Weng
- University of Utah School of Medicine Utah
| | | | | | | | | | - Agatino Battaglia
- Department of Developmental Neuroscience IRCCS Stella Maris Foundation Pisa Italy
| | | | - Damien Douglas
- Wolf‐Hirschhorn Syndrome Trust of the UK and Ireland, Dublin UK
| | - Pablo Lapunzina
- Medical and Molecular Genetics Institute (INGEMM) La Paz University Hospital, IdiPAZ Madrid Spain
- Basic Research Center in the Rare Diseases Network (CIBERER) Madrid Spain
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Ho KS, Markham LM, Twede H, Lortz A, Olson LM, Sheng X, Weng C, Wassman ER, Newcomb T, Wassman ER, Carey JC, Battaglia A. A survey of antiepileptic drug responses identifies drugs with potential efficacy for seizure control in Wolf-Hirschhorn syndrome. Epilepsy Behav 2018; 81:55-61. [PMID: 29477837 DOI: 10.1016/j.yebeh.2017.12.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 12/11/2017] [Accepted: 12/11/2017] [Indexed: 12/19/2022]
Abstract
Seizures are present in over 90% of infants and children with Wolf-Hirschhorn syndrome (WHS). When present, they significantly affect quality of life. The goal of this study was to use caregiver reports to describe the comparative efficacies of commonly used antiepileptic medications in a large population of individuals with WHS. A web-based, confidential caregiver survey was developed to capture seizure semiology and a chronologic record of seizure treatments as well as responses to each treatment. Adverse events for each drug were also cataloged. We received 141 complete survey responses (47% response rate) describing the seizures of individuals ranging in age from 4months to 61years (90 females: 51 males). Using the Early Childhood Epilepsy Severity Scale (E-Chess), WHS-associated seizures are demonstrably severe regardless of deletion size. The best-performing antiepileptic drugs (AEDs) for controlling seizures in this cohort were broad spectrum drugs clobazam, levetiracetam, and lamotrigine; whereas, the three commonly used carboxamide class drugs: carbamazepine, phenytoin, and oxcarbazepine, were reported to have little effect on, or even exacerbate, seizures. The carboxamide class drugs, along with phenobarbital and topiramate, were also associated with the highest rate of intolerance due to cooccurrence of adverse events. Levetiracetam, clobazam, and clonazepam demonstrated higher tolerability and comparatively less severe adverse events (Wilcoxon rank sum comparison between performance of levetiracetam and carboxamide class drugs gives a p<0.0001 after multiple comparison adjustment). This is the largest survey to date assessing WHS seizures. This study design is susceptible to possible bias, as the data are largely drawn from caregiver report and investigators had limited access to medical records. Despite this, our data suggest that the genetic etiology of seizures, together with an accurate electroclinical delineation, are important components of drug selection, even in contiguous gene syndromes which may have complex seizure etiologies.
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Affiliation(s)
- Karen S Ho
- Lineagen, Inc., 2677 Parleys Way, Salt Lake City, UT 84109, United States; Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, United States.
| | - Leah M Markham
- Lineagen, Inc., 2677 Parleys Way, Salt Lake City, UT 84109, United States.
| | - Hope Twede
- Lineagen, Inc., 2677 Parleys Way, Salt Lake City, UT 84109, United States.
| | - Amanda Lortz
- 4p- Support Group, 1495 Forest Brooke Way, #262, Delaware, OH 43015, United States.
| | - Lenora M Olson
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, United States.
| | - Xiaoming Sheng
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, United States.
| | - Cindy Weng
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, United States.
| | | | - Tara Newcomb
- Department of Neurology, University of Utah School of Medicine, 175 N Medical Dr, Salt Lake City, UT 84132, United States.
| | - E Robert Wassman
- Lineagen, Inc., 2677 Parleys Way, Salt Lake City, UT 84109, United States.
| | - John C Carey
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, United States.
| | - Agatino Battaglia
- Stella Maris Clinical Research Institute for Child and Adolescent Neuropsychiatry, Pisa, Italy.
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Lee IC, Hong SY. Treatment of intractable seizure in Wolf-Hirschhorn syndrome with bromide. Brain Dev 2017; 39:633. [PMID: 28377151 DOI: 10.1016/j.braindev.2017.03.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 03/14/2017] [Accepted: 03/15/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Inn-Chi Lee
- Department of Pediatrics, Chung Shan Medical University Hospital and Institute of Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Syuan-Yu Hong
- Division of Pediatrics Neurology, Children's Hospital of China Medical University, 2 Yuh-Der Road, Taichung 404, Taiwan.
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Ho KS, Wassman ER. A case for cannabidiol in Wolf-Hirschhorn syndrome seizure management. Am J Med Genet A 2016; 173:324-326. [PMID: 28102593 PMCID: PMC6585685 DOI: 10.1002/ajmg.a.37979] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 08/29/2016] [Indexed: 12/14/2022]
Abstract
Complex, and sometimes intractable, seizures affect the quality of life and cognitive development of over 90% of individuals with Wolf-Hirschhorn syndrome (WHS). Fine resolution genotype-phenotype mapping of the WHS locus recently identified a candidate gene whose probable function has led to insights into a mechanism connecting WHS seizures with those of Dravet syndrome, a distinct condition caused by mutations in SCN1A and SCN1B. In addition to this possible molecular mechanistic connection, these disorders' seizures share a strikingly similar constellation of features, including clinical presentation, seizure types, early age of onset, EEG pattern, and responses to specific anti-epileptic drugs. Based in part on these similarities, we suggest that a highly successful Phase III clinical trial of a formulation of cannabidiol for Dravet syndrome seizures may be directly translatable into possible benefits for WHS individuals with challenging seizure patterns. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Karen S Ho
- Lineagen, Inc., Salt Lake City, Utah.,Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, Utah
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