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Özsoy Ö, Cinleti T, Günay Ç, Sarıkaya Uzan G, Giray Bozkaya Ö, Çağlayan AO, Hız Kurul S, Yiş U. Genetic, serological and clinical evaluation of childhood myasthenia syndromes- single center subgroup analysis experience in Turkey. Acta Neurol Belg 2023; 123:2325-2335. [PMID: 37656362 DOI: 10.1007/s13760-023-02370-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 08/21/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Congenital myasthenic syndrome is a disease that occurs due to several types such as mutations in different pre-synaptic, synaptic, post-synaptic proteins and, glycosylation defects associated with congenital myopathy. Juvenile myasthenia gravis is an autoimmune condition usually caused by antibodies targeting the acetylcholine receptor. AIMS Our objective is to conduct an analysis on the subgroup traits exhibited by patients who have been diagnosed with congenital myasthenic syndrome and juvenile myasthenia gravis, with a focus on their long-term monitoring and management. METHODS This study was conducted on children diagnosed with myasthenia gravis, who were under the care of Dokuz Eylul University's Department of Pediatric Neurology for a period of ten years. RESULTS A total of 22 (12 congenital myasthenic syndrome, 10 juvenile myasthenia gravis) patients were identified. Defects in the acetylcholine receptor (6/12) were the most common type in the congenital myasthenic syndrome group. Basal-lamina-related defects (5/12) were the second most prevalent. One patient had a GFPT1 gene mutation (1/12). Patients with ocular myasthenia gravis (n = 6) exhibited milder symptoms. In the generalized myasthenia gravis group (n = 4), specifically in postpubertal girls, a more severe clinical progression was observed, leading to the implementation of more aggressive treatment strategies. CONCLUSION This study highlights that clinical recognition of congenital myasthenic syndrome and knowledge of related genes will aid the rapid diagnosis and treatment of these rare neuromuscular disorders. Findings in the juvenile myasthenia gravis group demonstrate the impact of pubertal development and the need for timely and appropriate active therapy, including thymectomy, to improve prognosis.
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Affiliation(s)
- Özlem Özsoy
- Department of Pediatric Neurology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey.
| | - Tayfun Cinleti
- Department of Pediatric Genetics, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Çağatay Günay
- Department of Pediatric Neurology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Gamze Sarıkaya Uzan
- Department of Pediatric Neurology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Özlem Giray Bozkaya
- Department of Pediatric Genetics, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Ahmet Okay Çağlayan
- Department of Medical Genetics, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
- Department of Molecular Medicine, Institute of Health Sciences, Dokuz Eylül University, İzmir, Turkey
| | - Semra Hız Kurul
- Department of Pediatric Neurology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
- İzmir Biomedicine and Genome Center, Dokuz Eylül University Health Campus, İzmir, Turkey
- İzmir International Biomedicine and Genome Institute, Dokuz Eylül University, İzmir, Turkey
| | - Uluç Yiş
- Department of Pediatric Neurology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
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Yildiz EP, Kilic MA, Yalcin EU, Kurekci F, Avci R, Hacıfazlıoğlu NE, Ceylaner S, Gezdirici A, Çalışkan M. Genetic and clinical evaluation of congenital myasthenic syndromes with long-term follow-up: experience of a tertiary center in Turkey. Acta Neurol Belg 2023; 123:1841-1847. [PMID: 36094697 DOI: 10.1007/s13760-022-02090-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 09/01/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Congenital myasthenic syndromes (CMS) are a heterogeneous group of genetic disorders affecting the safety factor which required for neuromuscular transmission. Here we reported our experience in children with CMS. METHODS We retrospectively collected the data of 18 patients with CMS who were examined in our outpatient clinic between January 2021 and January 2022. The diagnosis of CMS was based on the presence of clinical symptoms such as abnormal fatigability and weakness, absence of autoantibodies against acetylcholine receptor and muscle-specific kinase, electromyographic evidence of neuromuscular junction defect, molecular genetic confirmation, and response to treatment. RESULTS The most common mutations were in the acetylcholine receptor (CHRNE) gene (8/18) and choline acetyltransferase (ChAT) (2/18) gene. Despite targeted gene sequencing and whole exome sequencing (WES) were underwent, we couldn't detect a genetic mutation in three out of patients. The most commonly determined initial finding was eyelid ptosis, followed by fatigable weakness, and respiratory insufficiency. Although the most commonly used drug was pyridostigmine, we have experienced that caution should be exercised as it may worsen some types of CMS. DISCUSSION We reported in detail the phenotypic features of very rare gene mutations associated with CMS and our experience in the treatment of this disease. Although CMS are rare genetic disorder, the prognosis can be very promising with appropriate treatment in most CMS subtypes.
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Affiliation(s)
- Edibe Pembegul Yildiz
- Department of Pediatric Neurology, Istanbul Medical Faculty, Istanbul, Turkey.
- Istanbul University Institute of Child Health, Istanbul, Turkey.
- Istanbul University Medical School. Millet Cd, 34000, Fatih-Istanbul, Turkey.
| | - Mehmet Akif Kilic
- Department of Pediatric Neurology, Istanbul Medical Faculty, Istanbul, Turkey
| | - Emek Uyur Yalcin
- Department of Pediatric Neurology, Zeynep Kamil Maternity and Children's Diseases Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Fulya Kurekci
- Department of Pediatric Neurology, Istanbul Medical Faculty, Istanbul, Turkey
| | - Ridvan Avci
- Department of Pediatric Neurology, Istanbul Medical Faculty, Istanbul, Turkey
| | - Nilüfer Eldeş Hacıfazlıoğlu
- Department of Pediatric Neurology, Zeynep Kamil Maternity and Children's Diseases Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | | | - Alper Gezdirici
- Department of Medical Genetics, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Mine Çalışkan
- Department of Pediatric Neurology, Istanbul Medical Faculty, Istanbul, Turkey
- Istanbul University Institute of Child Health, Istanbul, Turkey
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Eshaghian T, Rabbani B, Badv RS, Mikaeeli S, Gharib B, Iyadurai S, Mahdieh N. COLQ-related congenital myasthenic syndrome: An integrative view. Neurogenetics 2023; 24:189-200. [PMID: 37231228 DOI: 10.1007/s10048-023-00719-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/15/2023] [Indexed: 05/27/2023]
Abstract
Congenital myasthenic syndromes are inherited disorders caused by mutation in components of the neuromuscular junction and manifest early in life. Mutations in COLQ gene result in congenital myasthenic syndrome. Here, we present the analysis of data from 209 patients from 195 unrelated families highlighting genotype-phenotype correlation. In addition, we describe a COLQ homozygous variant a new patient and discuss it utilizing the Phyre2 and I-TASSER programs. Clinical, molecular genetics, imaging (MRI), and electrodiagnostic (EEG, EMG/NCS) evaluations were performed. Our data showed 89 pathogenic/likely pathogenic variants including 35 missenses, 21 indels, 14 nonsense, 14 splicing, and 5 large deletions variants. Eight common variants were responsible for 48.46% of those. Weakness in proximal muscles, hypotonia, and generalized weakness were detected in all individuals tested. Apart from the weakness, extensive clinical heterogeneity was noted among patients with COLQ-related patients based on their genotypes-those with variants affecting the splice site exhibited more severe clinical features while those with missense variants displayed milder phenotypes, suggesting the role of differential splice variants in multiple functions within the muscle. Analyses and descriptions of these COLQ variants may be helpful in clinical trial readiness and potential development of novel therapies in the setting of established structure-function relationships.
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Affiliation(s)
- Tina Eshaghian
- Growth and Development Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahareh Rabbani
- Growth and Development Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Shervin Badv
- Growth and Development Research, Tehran University of Medical Sciences, Tehran, Iran
- Children's Hospital Center, Pediatric Center of Excellence, Tehran University of Medical Center, Tehran, Iran
| | - Sahar Mikaeeli
- Growth and Development Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Behdad Gharib
- Children's Hospital Center, Pediatric Center of Excellence, Tehran University of Medical Center, Tehran, Iran
| | - Stanley Iyadurai
- Johns Hopkins All Children's Hospital, Division of Neurology, 601 5th Street S, St. Petersburg, FL, 33701, USA
| | - Nejat Mahdieh
- Growth and Development Research, Tehran University of Medical Sciences, Tehran, Iran.
- Cardiogenetic Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Niayesh-Vali asr Intersection, Tehran, Iran.
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Shao S, Shi G, Bi FF, Huang K. Pharmacological Treatments for Congenital Myasthenic Syndromes Caused by COLQ Mutations. Curr Neuropharmacol 2023; 21:1594-1605. [PMID: 36703579 PMCID: PMC10472815 DOI: 10.2174/1570159x21666230126145652] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 09/30/2022] [Accepted: 11/18/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Congenital myasthenic syndromes (CMS) refer to a series of inherited disorders caused by defects in various proteins. Mutation in the collagen-like tail subunit of asymmetric acetylcholinesterase (COLQ) is the second-most common cause of CMS. However, data on pharmacological treatments are limited. OBJECTIVE In this study, we reviewed related reports to determine the most appropriate pharmacological strategy for CMS caused by COLQ mutations. A literature review and meta-analysis were also performed. PubMed, MEDLINE, Web of Science, and Cochrane Library databases were searched to identify studies published in English before July 22, 2022. RESULTS A total of 42 studies including 164 patients with CMS due to 72 different COLQ mutations were selected for evaluation. Most studies were case reports, and none were randomized clinical trials. Our meta-analysis revealed evidence that β-adrenergic agonists, including salbutamol and ephedrine, can be used as first-line pharmacological treatments for CMS patients with COLQ mutations, as 98.7% of patients (74/75) treated with β-adrenergic agonists showed positive effects. In addition, AChEIs should be avoided in CMS patients with COLQ mutations, as 90.5% (105/116) of patients treated with AChEIs showed either no or negative effects. CONCLUSION (1) β-adrenergic agonist therapy is the first pharmacological strategy for treating CMS with COLQ mutations. (2) AChEIs should be avoided in patients with CMS with COLQ mutations.
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Affiliation(s)
- Shuai Shao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
- Xiangya School of Medicine, Central South University, Changsha, Hunan province, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Guanzhong Shi
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
- Xiangya School of Medicine, Central South University, Changsha, Hunan province, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Fang-Fang Bi
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Kun Huang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
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Öztürk S, Güleç A, Erdoğan M, Demir M, Canpolat M, Gümüş H, Çağlayan AO, Dündar M, Per H. Congenital Myasthenic Syndromes in Turkey: Clinical and Molecular Characterization of 16 Cases With Three Novel Mutations. Pediatr Neurol 2022; 136:43-49. [PMID: 36099689 DOI: 10.1016/j.pediatrneurol.2022.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/23/2022] [Accepted: 08/09/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Congenital myasthenic syndromes (CMS) are composed of numerous hereditary disorders involving genetic mutations in proteins essential to the integrity of neuromuscular transmission. The symptoms of CMS vary according to the age at onset of symptoms, and the type and severity of muscle weakness. Effective treatment and genetic counseling depend upon the underlying pathogenic molecular mechanism and subtype of CMS. METHODS A retrospective and cross-sectional study was performed with 16 patients with a genetically confirmed diagnosis of CMS to share our experience with clinical symptoms, demographic data, genetic variants, and treatments applied. RESULTS Sixteen patients with a specific CMS genetic diagnosis (three novel mutations) were identified, including CHRNE (n = 7), DOK7 (n = 2), AGRN (n = 2), RAPSN (n = 1), CHRNA1 (n = 1), CHRNB1 (n = 1), CHAT (n = 1), and SCN4A (n = 1). Age at onset of symptoms ranged from the neonatal period to 12 years. Genetic diagnosis was confirmed between the ages of three months and 17 years. A significant delay was determined between the onset of symptoms and genetic diagnosis of the disease. CONCLUSIONS This study highlights the importance of genetic testing in CMS. Due to the rarity of CMS, more cases will be recognized and reported as the use of laboratory and genetic testing accelerates. We hope that our experience will grow and contribute further to the literature as clinical follow-up and treatment increase.
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Affiliation(s)
- Selcan Öztürk
- Fellow in Pediatric Neurology, Faculty of Medicine, Division of Pediatric Neurology, Department of Pediatrics, Erciyes University, Kayseri, Turkey
| | - Ayten Güleç
- Fellow in Pediatric Neurology, Faculty of Medicine, Division of Pediatric Neurology, Department of Pediatrics, Erciyes University, Kayseri, Turkey
| | - Murat Erdoğan
- Medical Doctor, Department of Medical Genetics, Kayseri State Hospital, Kayseri, Turkey
| | - Mikail Demir
- Medical Doctor, Faculty of Medicine, Department of Medical Genetics, Erciyes University, Kayseri, Turkey
| | - Mehmet Canpolat
- Professor of Pediatrics, Faculty of Medicine, Division of Pediatric Neurology, Department of Pediatrics, Erciyes University, Kayseri, Turkey
| | - Hakan Gümüş
- Professor of Pediatrics, Faculty of Medicine, Division of Pediatric Neurology, Department of Pediatrics, Erciyes University, Kayseri, Turkey
| | - Ahmet Okay Çağlayan
- Professor of Genetics, Faculty of Medicine, Department of Genetics, Dokuz Eylül University, Izmir, Turkey
| | - Munis Dündar
- Professor of Genetics, Faculty of Medicine, Department of Genetics, Erciyes University, Kayseri, Turkey
| | - Hüseyin Per
- Professor of Pediatrics, Faculty of Medicine, Division of Pediatric Neurology, Department of Pediatrics, Erciyes University, Kayseri, Turkey.
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El Kadiri Y, Ratbi I, Sefiani A, Lyahyai J. Novel copy number variation of COLQ gene in a Moroccan patient with congenital myasthenic syndrome: a case report and review of the literature. BMC Neurol 2022; 22:292. [PMID: 35932018 PMCID: PMC9354381 DOI: 10.1186/s12883-022-02822-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 07/29/2022] [Indexed: 11/11/2022] Open
Abstract
Background Congenital myasthenic syndromes (CMSs) are rare genetic diseases due to abnormalities of the neuromuscular junction leading to permanent or transient muscle fatigability and weakness. To date, 32 genes were found to be involved in CMSs with autosomal dominant and/or recessive inheritance patterns. CMS with acetylcholinesterase deficiency, in particular, was determined to be due to biallelic mutations of COLQ gene with early-onset clinical signs. Here, we report clinical features and novel molecular findings of COLQ-related CMS in a Moroccan patient with a review of the literature for this rare form. Case presentation In this study, we report the case of a 28-month-old Moroccan female patient with hypotonia, associated to axial muscle weakness, global motor delay, bilateral ptosis, unilateral partial visual field deficiency with normal ocular motility, and fatigable muscle weakness. Clinical exome sequencing revealed a novel homozygous deletion of exon 13 in COLQ gene, NM_005677.4(COLQ):c.(814+1_815-1)_(954+1_955-1) del p.(Gly272Aspfs*11). This finding was subsequently confirmed by quantitative real-time PCR (qPCR) in the proband and her parents. In silico analysis of protein-protein interaction network by STRING tool revealed that 12 proteins are highly associated to COLQ with an elevated confidence score. Treatment with Salbutamol resulted in clear benefits and recovery. Conclusions This clinical observation illustrates the important place of next-generation sequencing in the precise molecular diagnosis of heterogeneous forms of CMS, the appropriate management and targeted treatment, and genetic counseling of families, with a better characterization of the mutational profile of this rare disease in the Moroccan population.
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Affiliation(s)
- Youssef El Kadiri
- Research Team in Genomics and Molecular Epidemiology of Genetic Diseases, Genomics Center of Human Pathologies, Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, 10 100 Rabat, Morocco. .,Department of Medical Genetics, National Institute of Health, BP 769-Agdal, 10 090, Rabat, Morocco.
| | - Ilham Ratbi
- Research Team in Genomics and Molecular Epidemiology of Genetic Diseases, Genomics Center of Human Pathologies, Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, 10 100 Rabat, Morocco
| | - Abdelaziz Sefiani
- Research Team in Genomics and Molecular Epidemiology of Genetic Diseases, Genomics Center of Human Pathologies, Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, 10 100 Rabat, Morocco.,Department of Medical Genetics, National Institute of Health, BP 769-Agdal, 10 090, Rabat, Morocco
| | - Jaber Lyahyai
- Research Team in Genomics and Molecular Epidemiology of Genetic Diseases, Genomics Center of Human Pathologies, Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, 10 100 Rabat, Morocco
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Khaoula R, Cerino M, Da Silva N, Delague V, Nahili H, Kriouile Y, Gorokhova S, Bartoli M, Saïle R, Barakat A, Krahn M. First characterization of congenital myasthenic syndrome type 5 in North Africa. Mol Biol Rep 2021; 48:6999-7006. [PMID: 34553317 DOI: 10.1007/s11033-021-06530-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/29/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Congenital myasthenic syndromes (CMS) are associated with defects in the structure and the function of neuromuscular junctions. These rare disorders can result from mutations in the collagenic tail of endplate acetylcholinesterase (COLQ) essentially associated with autosomal recessive inheritance. With the lowered cost of genetic testing and increased access to next-generation sequencing, many mutations have been reported to date. METHODS AND RESULTS In this study we identified the first COLQ homozygous mutation c.1193T>A in the North African population. This study outlines the genetic and phenotypic features of a CMS patient in a Moroccan family. It also describes a novel COLQ missense mutation associated with CMS-5. CONCLUSION COLQ mutations are probably underdiagnosed in these North African populations, this is an issue as CMS-5 may be treated with ephedrine, and albuterol. Indeed, patients can seriously benefit and even recover after the treatment that should be planned according to genetic tests and clinical findings.
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Affiliation(s)
- Rochdi Khaoula
- Laboratory of Biology and Health, URAC 34, Faculty of Sciences Ben M'Sik, Hassan II University, Casablanca, Morocco. .,Laboratory of Genomics and Human Genetics, Institut Pasteur du Maroc, Casablanca, Morocco.
| | - Mathieu Cerino
- Inserm, U1251-MMG, Marseille Medical Genetics, Aix-Marseille Université, Marseille, France.,Département de Génétique Médicale, APHM, Hôpital Timone Enfants, Marseille, France.,APHM, Hôpital de la Conception, Laboratoire de Biochimie, Marseille, France
| | - Nathalie Da Silva
- Faculté des Sciences Médicales et Paramédicales, Marseille Medical Genetics, Aix Marseille Université, INSERM, Marseille, France
| | - Valerie Delague
- INSERM, MMG, UMR 1251, Aix Marseille University, Marseille, France
| | - Halima Nahili
- Laboratory of Genomics and Human Genetics, Institut Pasteur du Maroc, Casablanca, Morocco
| | - Yamna Kriouile
- Unit of Neuropediatrics and Neurometabolism, Pediatric Department 2, Rabat Children's Hospital, and Faculty of Medicine and Pharmacy of Rabat, University Mohammed V of Rabat, Rabat, Morocco
| | - Svetlana Gorokhova
- Département de Génétique Médicale, APHM, Hôpital Timone Enfants, Marseille, France.,Inserm, U1251-MMG, Marseille Medical Genetics, Aix-Marseille Université, Marseille, France
| | - Marc Bartoli
- Inserm, U1251-MMG, Marseille Medical Genetics, Aix-Marseille Université, Marseille, France
| | - Rachid Saïle
- Laboratory of Biology and Health, URAC 34, Faculty of Sciences Ben M'Sik, Hassan II University, Casablanca, Morocco
| | - Abdelhamid Barakat
- Laboratory of Genomics and Human Genetics, Institut Pasteur du Maroc, Casablanca, Morocco
| | - Martin Krahn
- Département de Génétique Médicale, APHM, Hôpital Timone Enfants, Marseille, France.,Inserm, U1251-MMG, Marseille Medical Genetics, Aix-Marseille Université, Marseille, France
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Kim HG, Lee JS, Kim KW, Kang HC, Kim SH. Effects of Salbutamol in Collagen like Tail Subunit of Asymmetric Acetylcholinesterase-Related Congenital Myasthenic Syndrome: A First Korean Case. ANNALS OF CHILD NEUROLOGY 2021. [DOI: 10.26815/acn.2020.00171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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