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Elamin M, Lemtiri-Chlieh F, Robinson TM, Levine ES. Dysfunctional sodium channel kinetics as a novel epilepsy mechanism in chromosome 15q11-q13 duplication syndrome. Epilepsia 2023; 64:2515-2527. [PMID: 37329181 PMCID: PMC10529833 DOI: 10.1111/epi.17687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/14/2023] [Accepted: 06/14/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE Duplication of the maternal chromosome 15q11.2-q13.1 region causes Dup15q syndrome, a highly penetrant neurodevelopmental disorder characterized by severe autism and refractory seizures. Although UBE3A, the gene encoding the ubiquitin ligase E3A, is thought to be the main driver of disease phenotypes, the cellular and molecular mechanisms that contribute to the development of the syndrome are yet to be determined. We previously established the necessity of UBE3A overexpression for the development of cellular phenotypes in human Dup15q neurons, including increased action potential firing and increased inward current density, which prompted us to further investigate sodium channel kinetics. METHODS We used a Dup15q patient-derived induced pluripotent stem cell line that was CRISPR-edited to remove the supernumerary chromosome and create an isogenic control line. We performed whole cell patch clamp electrophysiology on Dup15q and corrected control neurons at two time points of in vitro development. RESULTS Compared to corrected neurons, Dup15q neurons showed increased sodium current density and a depolarizing shift in steady-state inactivation. Moreover, onset of slow inactivation was delayed, and a faster recovery from both fast and slow inactivation processes was observed in Dup15q neurons. A fraction of sodium current in Dup15q neurons (~15%) appeared to be resistant to slow inactivation. Not unexpectedly, a higher fraction of persistent sodium current was also observed in Dup15q neurons. These phenotypes were modulated by the anticonvulsant drug rufinamide. SIGNIFICANCE Sodium channels play a crucial role in the generation of action potentials, and sodium channelopathies have been uncovered in multiple forms of epilepsy. For the first time, our work identifies in Dup15q neurons dysfunctional inactivation kinetics, which have been previously linked to multiple forms of epilepsy. Our work can also guide therapeutic approaches to epileptic seizures in Dup15q patients and emphasize the role of drugs that modulate inactivation kinetics, such as rufinamide.
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Affiliation(s)
- Marwa Elamin
- Department of Neuroscience, School of Medicine, University of Connecticut, Farmington, Connecticut, USA
| | - Fouad Lemtiri-Chlieh
- Department of Neuroscience, School of Medicine, University of Connecticut, Farmington, Connecticut, USA
| | - Tiwanna M Robinson
- Department of Neuroscience, School of Medicine, University of Connecticut, Farmington, Connecticut, USA
| | - Eric S Levine
- Department of Neuroscience, School of Medicine, University of Connecticut, Farmington, Connecticut, USA
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Dangles MT, Malan V, Dumas G, Romana S, Raoul O, Coste-Zeitoun D, Soufflet C, Vignolo-Diard P, Bahi-Buisson N, Barnérias C, Chemaly N, Desguerre I, Gitiaux C, Hully M, Bourgeois M, Guimier A, Rio M, Munnich A, Nabbout R, Kaminska A, Eisermann M. Electro-clinical features in epileptic children with chromosome 15q duplication syndrome. Clin Neurophysiol 2021; 132:1126-1137. [PMID: 33773177 DOI: 10.1016/j.clinph.2021.02.010] [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: 12/08/2020] [Revised: 02/03/2021] [Accepted: 02/22/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We aimed to describe epilepsy and EEG patterns related to vigilance states and age, in chromosome15-long-arm-duplication-syndrome (dup15q) children with epilepsy, in both duplication types: interstitial (intdup15) and isodicentric (idic15). METHODS Clinical data and 70 EEGs of 12 patients (5 intdup15, 7 idic15), followed from 4.5 m.o to 17y4m (median follow-up 8y3m), were retrospectively reviewed. EEGs were analyzed visually and using power spectrum analysis. RESULTS Seventy video-EEGs were analyzed (1-16 per patient, median 6), follow-up lasting up to 8y10m (median 4y2m): 25 EEGs in intdup15 (8 m.o to 12y.o, median 4y6m) and 45 EEGs in idic15 (7 m.o to 12 y.o, median 15 m). Epilepsy: 6 West syndrome (WS) (2intdup15, 4idic15); 4 Lennox-Gastaut syndromes (LGS) (1 intdup15, 3 idic15), 2 evolving from WS; focal epilepsy (3 intdup15). In idic15, WS displayed additional myoclonic seizures (3), atypical (4) or no hypsarrhythmia (2) and posterior predominant spike and polyspike bursts (4). Beta-band rapid-rhythms (RR): present in 11 patients, power decreased during non-REM-sleep, localization shifted from diffuse to anterior, peak frequency increased with age. CONCLUSION WS with peculiar electro-clinical features and LGS, along with beta-band RR decreasing in non-REM-sleep and shifting from diffuse to anterior localization with age are recognizable features pointing towards dup15q diagnosis in children with autism spectrum disorder and developmental delay. SIGNIFICANCE This study describes electroclinical features in both interstitial and isodicentric duplications of chromosome 15q, in epileptic children, including some recent extensions regarding sleep features; and illustrates how the temporo-spatial organization of beta oscillations can be of significant help in directing towards dup15q diagnosis hypothesis.
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Affiliation(s)
- M-T Dangles
- Department of Clinical Neurophysiology, Necker-Enfants-Malades Hospital, Assistance Publique -Hôpitaux de Paris, Paris, France; Centre de Référence des Epilepsies Rares CRéER, Department of Pediatric Neurology, Necker-Enfants-Malades Hospital, Assistance Publique -Hôpitaux de Paris, Paris, France; Department of Pediatric Neurology, Necker-Enfants-Malades Hospital, Assistance Publique -Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France.
| | - V Malan
- Université de Paris, Paris, France; Department of Cytogenetics, Necker-Enfants-Malades Hospital, Assistance Publique -Hôpitaux de Paris, Paris, France
| | - G Dumas
- Department of Clinical Neurophysiology, Necker-Enfants-Malades Hospital, Assistance Publique -Hôpitaux de Paris, Paris, France; Human Genetics and Cognitive Functions, Institut Pasteur, UMR3571 CNRS, Université de Paris, Paris, France; Department of Psychiatry, Université de Montreal, CHU Sainte-Justine Hospital, Montreal, QC, Canada
| | - S Romana
- Université de Paris, Paris, France; Department of Cytogenetics, Necker-Enfants-Malades Hospital, Assistance Publique -Hôpitaux de Paris, Paris, France
| | - O Raoul
- Department of Cytogenetics, Necker-Enfants-Malades Hospital, Assistance Publique -Hôpitaux de Paris, Paris, France
| | - D Coste-Zeitoun
- Department of Clinical Neurophysiology, Necker-Enfants-Malades Hospital, Assistance Publique -Hôpitaux de Paris, Paris, France; Centre de Référence des Epilepsies Rares CRéER, Department of Pediatric Neurology, Necker-Enfants-Malades Hospital, Assistance Publique -Hôpitaux de Paris, Paris, France
| | - C Soufflet
- Department of Clinical Neurophysiology, Necker-Enfants-Malades Hospital, Assistance Publique -Hôpitaux de Paris, Paris, France
| | - P Vignolo-Diard
- Department of Clinical Neurophysiology, Necker-Enfants-Malades Hospital, Assistance Publique -Hôpitaux de Paris, Paris, France
| | - N Bahi-Buisson
- Department of Pediatric Neurology, Necker-Enfants-Malades Hospital, Assistance Publique -Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France
| | - C Barnérias
- Department of Pediatric Neurology, Necker-Enfants-Malades Hospital, Assistance Publique -Hôpitaux de Paris, Paris, France
| | - N Chemaly
- Centre de Référence des Epilepsies Rares CRéER, Department of Pediatric Neurology, Necker-Enfants-Malades Hospital, Assistance Publique -Hôpitaux de Paris, Paris, France; Department of Pediatric Neurology, Necker-Enfants-Malades Hospital, Assistance Publique -Hôpitaux de Paris, Paris, France
| | - I Desguerre
- Department of Pediatric Neurology, Necker-Enfants-Malades Hospital, Assistance Publique -Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France
| | - C Gitiaux
- Department of Clinical Neurophysiology, Necker-Enfants-Malades Hospital, Assistance Publique -Hôpitaux de Paris, Paris, France; Department of Pediatric Neurology, Necker-Enfants-Malades Hospital, Assistance Publique -Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France
| | - M Hully
- Department of Pediatric Neurology, Necker-Enfants-Malades Hospital, Assistance Publique -Hôpitaux de Paris, Paris, France
| | - M Bourgeois
- Department of Pediatric Neurosurgery, Necker-Enfants-Malades Hospital, Assistance Publique -Hôpitaux de Paris, Paris, France
| | - A Guimier
- Department of Genetics, Necker-Enfants Malades Hospital, Assistance Publique -Hôpitaux de Paris, Paris, France
| | - M Rio
- Department of Genetics, Necker-Enfants Malades Hospital, Assistance Publique -Hôpitaux de Paris, Paris, France
| | - A Munnich
- Université de Paris, Paris, France; Department of Genetics, Necker-Enfants Malades Hospital, Assistance Publique -Hôpitaux de Paris, Paris, France
| | - R Nabbout
- Centre de Référence des Epilepsies Rares CRéER, Department of Pediatric Neurology, Necker-Enfants-Malades Hospital, Assistance Publique -Hôpitaux de Paris, Paris, France; Department of Pediatric Neurology, Necker-Enfants-Malades Hospital, Assistance Publique -Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France
| | - A Kaminska
- Department of Clinical Neurophysiology, Necker-Enfants-Malades Hospital, Assistance Publique -Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France
| | - M Eisermann
- Department of Clinical Neurophysiology, Necker-Enfants-Malades Hospital, Assistance Publique -Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France
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Beghi E, Giussani G, Bianchi E, Randazzo G, Sarcona V, Elia M, Striano P, Verrotti A, Ferretti A, Rebessi E, Specchio N, Bonanni P. A validation study of the clinical diagnosis of Dup15q syndrome: Which symptoms matter most? Seizure 2019; 74:26-30. [PMID: 31805494 DOI: 10.1016/j.seizure.2019.11.010] [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: 09/05/2019] [Revised: 11/20/2019] [Accepted: 11/22/2019] [Indexed: 10/25/2022] Open
Abstract
PURPOSE Dup15q syndrome is a rare genetic disease with a fairly nonspecific phenotype, clinical heterogeneity, and a wide spectrum of severity. However, no formal characterization has been attempted to select clusters of symptoms, signs and instrumental tests, to be used in the differential diagnosis with other neurodevelopmental disorders. Thus, our purpose was to identify symptoms, signs and instrumental findings, singly or in various combinations, favoring the early diagnosis of the Dup15q syndrome and the indication for genetic testing. METHODS 25 patients with Dup15q syndrome and 25 age and sex matched controls with other neurodevelopmental disorders were the study population. Patients' history, clinical and instrumental assessment were examined by five expert child neurologists blind to the genetic diagnosis. Each rater was asked to make the diagnosis in three subsequent steps: 1. Revision of the medical records; 2. Examination of the videorecorded clinical findings; 3. Assessment of the instrumental tests. Inter-rater agreement was measured with the Kendall's coefficient of concordance) and the Kappa statistic. Sensitivity, specificity and predictive values for symptoms, signs and instrumental findings, singly or in various combinations, were measured. RESULTS The Kendall's coefficient for the diagnosis of Dup15q syndrome was 0.43 at step 1 was 0.43, at step 2 was 0.42, at step 3. Patients with past feeding difficulties, hypotonia during the neonatal period, and epilepsy had >80 % probability of having the Dup15q syndrome. CONCLUSION Feeding difficulties, hypotonia and epilepsy, though unspecific, can be used as signals of Dup15q syndrome and focused search of genetic abnormalities.
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Affiliation(s)
- E Beghi
- Laboratory of Neurological Disorders, Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy.
| | - G Giussani
- Laboratory of Neurological Disorders, Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - E Bianchi
- Laboratory of Neurological Disorders, Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - G Randazzo
- Scientific IRCCS E. Medea, San Vito al Tagliamento, Pordenone, Italy
| | - V Sarcona
- Scientific Institute, IRCCS E. Medea, Epilepsy and Clinical Neurophysiology Unit, Conegliano, Treviso, Italy
| | - M Elia
- Oasi Research Institute - IRCCS, Troina, Italy
| | - P Striano
- Pediatric Neurology and Muscular Diseases Unit, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, "G. Gaslini" Institute, Genova, Italy
| | - A Verrotti
- Department of Pediatrics, University of L'Aquila, Italy
| | - A Ferretti
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Roma, Italy
| | - E Rebessi
- Pediatric Neurology Unit and Epilepsy Center, Department of Neuroscience, "Fatebenefratelli e Oftalmico'' Hospital, Milano, Italy
| | - N Specchio
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Roma, Italy
| | - P Bonanni
- Scientific Institute, IRCCS E. Medea, Epilepsy and Clinical Neurophysiology Unit, Conegliano, Treviso, Italy
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Possible Phenotypic Consequences of Structural Differences in Idic(15) in a Small Cohort of Patients. Int J Mol Sci 2019; 20:ijms20194935. [PMID: 31590400 PMCID: PMC6801911 DOI: 10.3390/ijms20194935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 09/27/2019] [Accepted: 10/03/2019] [Indexed: 01/04/2023] Open
Abstract
Among human supernumerary marker chromosomes, the occurrence of isodicentric form of 15 origin is relatively well known due to its high frequency, both in terms of gene content and associated clinical symptoms. The associated epilepsy and autism are typically more severe than in cases with interstitial 15q duplication, despite copy number gain of approximately the same genomic region. Other mechanisms besides segmental aneuploidy and epigenetic changes may also cause this difference. Among the factors influencing the expression of members of the GABAA gene cluster, the imprinting effect and copy number differences has been debated. Limited numbers of studies investigate factors influencing the interaction of GABAA cluster homologues. Five isodicentric (15) patients are reported with heterogeneous symptoms, and structural differences of their isodicentric chromosomes based on array comparative genomic hybridization results. Relations between the structure and the heterogeneous clinical picture are discussed, raising the possibility that the structure of the isodicentric (15), which has an asymmetric breakpoint and consequently a lower copy number segment, would be the basis of the imbalance of the GABAA homologues. Studies of trans interaction and regulation of GABAA cluster homologues are needed to resolve this issue, considering copy number differences within the isodicentric chromosome 15.
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Matricardi S, Darra F, Spalice A, Basti C, Fontana E, Dalla Bernardina B, Elia M, Giordano L, Accorsi P, Cusmai R, De Liso P, Romeo A, Ragona F, Granata T, Concolino D, Carotenuto M, Pavone P, Pruna D, Striano P, Savasta S, Verrotti A. Electroclinical findings and long-term outcomes in epileptic patients with inv dup (15). Acta Neurol Scand 2018; 137:575-581. [PMID: 29363096 DOI: 10.1111/ane.12902] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To define the electroclinical phenotype and long-term outcomes in a cohort of patients with inv dup (15) syndrome. MATERIAL AND METHODS The electroclinical data of 45 patients (25 males) affected by inv dup (15) and seizures were retrospectively analysed, and long-term follow-up of epilepsy was evaluated. RESULTS Epilepsy onset was marked by generalized seizures in 53% of patients, epileptic spasms in 51%, focal seizures in 26%, atypical absences in 11% and epileptic falls in 9%. The epileptic syndromes defined were: generalized epilepsy (26.7%), focal epilepsy (22.3%), epileptic encephalopathy with epileptic spasms as the only seizure type (17.7%) and Lennox-Gastaut syndrome (33.3%). Drug-resistant epilepsy was detected in 55.5% of patients. There was a significant higher prevalence of seizure-free patients in those with seizure onset after the age of 5 years and with focal epilepsy, with respect to those with earlier epilepsy onset because most of these later developed an epileptic encephalopathy (69.2% vs 34.4%; P = .03), usually Lennox-Gastaut Syndrome in type. In fact, among patients with early-onset epilepsy, those presenting with epileptic spasms as the only seizure type associated with classical hypsarrhythmia achieved seizure freedom (P < .001) compared to patients with spasms and other seizure types associated with modified hypsarrhythmia. CONCLUSIONS Epilepsy in inv dup (15) leads to a more severe burden of disease. Frequently, these patients show drug resistance, in particular when epilepsy onset is before the age of five and features epileptic encephalopathy.
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Affiliation(s)
- S. Matricardi
- Department of Neuropsychiatry; Children's Hospital “G.Salesi”; Ospedali Riuniti; Ancona Italy
| | - F. Darra
- Department of Life and Reproduction Sciences; University of Verona; Verona Italy
| | - A. Spalice
- Department of Pediatrics; Division of Child Neurology; Sapienza, University of Rome; Rome Italy
| | - C. Basti
- Department of Pediatrics; University of L'Aquila; L'Aquila Italy
| | - E. Fontana
- Department of Life and Reproduction Sciences; University of Verona; Verona Italy
| | - B. Dalla Bernardina
- Department of Life and Reproduction Sciences; University of Verona; Verona Italy
| | - M. Elia
- Unit of Neurology and Clinical Neurophysiopathology; Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS); Troina (EN) Italy
| | - L. Giordano
- Department of Child and Adolescent Neuropsychiatry; Ospedali Civili; Brescia Italy
| | - P. Accorsi
- Department of Child and Adolescent Neuropsychiatry; Ospedali Civili; Brescia Italy
| | - R. Cusmai
- Child Neurology Unit; Department of Neuroscience and Neurorehabilitation; “Bambino Gesù” Children's Hospital; IRCCS; Rome Italy
| | - P. De Liso
- Child Neurology Unit; Department of Neuroscience and Neurorehabilitation; “Bambino Gesù” Children's Hospital; IRCCS; Rome Italy
| | - A. Romeo
- Department of Neuroscience; Pediatric Neurology Unit and Epilepsy Center; “Fatebenefratelli e Oftalmico” Hospital; Milan Italy
| | - F. Ragona
- Department of Pediatric Neuroscience; Foundation I.R.C.C.S. Neurological Institute ‘‘C. Besta’’; Milan Italy
| | - T. Granata
- Department of Pediatric Neuroscience; Foundation I.R.C.C.S. Neurological Institute ‘‘C. Besta’’; Milan Italy
| | - D. Concolino
- Department of Medical and Surgical Sciences; Pediatric Unit; Magna Graecia University; Catanzaro Italy
| | - M. Carotenuto
- Department of Mental Health, Physical and Preventive Medicine; Clinic of Child and Adolescent Neuropsychiatry; Università degli Studi della Campania “Luigi Vanvitelli”; Naples Italy
| | - P. Pavone
- General and Emergency Paediatrics Operative Unit; Policlinico-Vittorio Emanuele University Hospital; University of Catania; Catania Italy
| | - D. Pruna
- Epilepsy Unit; A. Cao Hospital; Cagliari Italy
| | - P. Striano
- Pediatric Neurology and Muscular Diseases Unit; Department of Neurosciences, Rehabilitation, Opthalmology, Genetics and Maternal and Child Health; G. Gaslini Institute; University of Genova; Genova Italy
| | - S. Savasta
- Department of Pediatrics; University of Pavia; Pavia Italy
| | - A. Verrotti
- Department of Pediatrics; University of L'Aquila; L'Aquila Italy
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Verrotti A, Sertorio F, Matricardi S, Ferrara P, Striano P. Electroclinical features of epilepsy in patients with InvDup(15). Seizure 2017; 47:87-91. [PMID: 28343008 DOI: 10.1016/j.seizure.2017.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 03/07/2017] [Accepted: 03/08/2017] [Indexed: 01/14/2023] Open
Abstract
PURPOSE InvDup(15) syndrome is one of the most common chromosomal abnormalities associated with epilepsy. Here we review the seizure types described in InvDup(15) patients and the main electroclinical, therapeutic, and prognostic aspects of the syndrome. METHODS A literature search of PubMed, MEDLINE, and EMBASE was performed to identify papers examining InvDup(15) syndrome and epilepsy. RESULTS About 65% of the InvDup(15) patients described in the literature had multiple seizure types with a predominance (40.4%) of tonic-clonic seizures. Age at seizure onset was before 10 years in more than half of them. Patients suffered from a variety of EEG abnormalities, generalized spike activity being the most frequent. Brain MRI was unremarkable in the majority of patients. Treatment was with several anticonvulsant drugs used as mono- or polytherapy. Valproic acid was the most common treatment against generalized seizures and was often effective, although drug resistance was a major concern in a large number of cases. Finally, more than 30% of the children suffered from infantile spasms, and status epilepticus was described in nearly 20% of patients, occasionally resulting in death. CONCLUSION Seizures are very common in InvDup(15) patients, who suffer from a variety of seizure types. Information about EEG and brain MRI findings, seizure treatment, and prognosis is often poor. The overall prognosis is fair. Prospective studies of larger samples are needed, to gain further insights into the natural history of InvDup(15) syndrome.
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Affiliation(s)
- Alberto Verrotti
- Department of Pediatrics, University of L'Aquila, L'Aquila, Italy.
| | | | - Sara Matricardi
- Department of Pediatrics, University of Chieti, Chieti, Italy.
| | - Pietro Ferrara
- Institute of Pediatrics, Catholic University, Roma, Italy.
| | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, G. Gaslini Institute, Genova, Italy.
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Arkilo D, Devinsky O, Mudigoudar B, Boronat S, Jennesson M, Sassower K, Vaou OE, Lerner JT, Jeste SS, Luchsinger K, Thibert R. Electroencephalographic patterns during sleep in children with chromosome 15q11.2-13.1 duplications (Dup15q). Epilepsy Behav 2016; 57:133-136. [PMID: 26949155 DOI: 10.1016/j.yebeh.2016.02.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 02/05/2016] [Accepted: 02/06/2016] [Indexed: 11/25/2022]
Abstract
Our objective was to define the EEG features during sleep of children with neurodevelopmental disorders due to copy number gains of 15q11-q13 (Dup15q). We retrospectively reviewed continuous EEG recordings of 42 children with Dup15q (mean age: eight years, 32 with idic15), and data collected included background activity, interictal epileptiform discharges, sleep organization, and ictal activity. Three patterns were recognized: Pattern 1: Alpha–delta sleep was noted in 14 children (33%), not associated with any clinical changes. Pattern 2: Electrical status epilepticus in sleep was noted in 15 children (35%), all diagnosed with treatmentresistant epilepsy. Thirteen of the 15 children had clinical seizures. Pattern 3: Frequent bursts of high amplitude bifrontal predominant, paroxysmal fast activity (12–15 Hz) during non-REM sleep was noted in 15 children (35%). All 15 children had treatment-resistant epilepsy. This is the first report of electroencephalographic patterns during sleep of children with Dup15q reporting alpha-delta rhythms, CSWS, and high amplitude fast frequencies. Alpha-delta rhythms are described in children with dysautonomia and/or mood disorders and CSWS in children with developmental regression. The significance of these findings in cognitive function and epilepsy for the children in our cohort needs to be determined with follow-up studies.
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Affiliation(s)
- Dimitrios Arkilo
- Minnesota Epilepsy Group, PA-Children's Hospitals and Clinics of Minnesota, 225 Smith Ave. N, St. 201, St. Paul, MN 55102, USA.
| | - Orrin Devinsky
- Department of Neurology, NYU Langone Medical Center, New York University, 240 East 38th Street, 20th floor, New York, NY 10016, USA.
| | - Basanagoud Mudigoudar
- Comprehensive Epilepsy Program and Neuroscience Center, Le Bonheur Children's Hospital, 848 Adams Ave., Memphis, TN 38103, USA.
| | - Susana Boronat
- Department of Pediatric Neurology, Vall d'Hebron Hospital, Universitat Autonoma de Barcelona, P. de la Vall d'Hebron, 119-129, 08035 Barcelona, Spain.
| | - Melanie Jennesson
- Department of Pediatric Neurology, American Memorial Hospital, CHU Reims, 47 Rue Cognacq-Jay, 51100 Reims, France.
| | - Kenneth Sassower
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 15 Parkman St., # 835, Boston, MA 02114, USA.
| | - Okeanis Eleni Vaou
- Noran Neurological Clinic, 2828 Chicago Ave. S, #200, Minneapolis, MN 55407, USA.
| | - Jason T Lerner
- Department of Pediatrics, Mattel Children's Hospital at UCLA, 757 Westwood Plaza, Los Angeles, CA 90095, USA.
| | - Shafali Spurling Jeste
- Department of Neurology, UCLA Center for Autism Research and Treatment, 710 Westwood Plaza, Los Angeles, CA 90095, USA.
| | | | - Ronald Thibert
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 15 Parkman St., # 835, Boston, MA 02114, USA.
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Conant KD, Finucane B, Cleary N, Martin A, Muss C, Delany M, Murphy EK, Rabe O, Luchsinger K, Spence SJ, Schanen C, Devinsky O, Cook EH, LaSalle J, Reiter LT, Thibert RL. A survey of seizures and current treatments in 15q duplication syndrome. Epilepsia 2014; 55:396-402. [PMID: 24502430 DOI: 10.1111/epi.12530] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2013] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Seizures are common in individuals with duplications of chromosome 15q11.2-q13 (Dup15q). The goal of this study was to examine the phenotypes and treatments of seizures in Dup15q in a large population. METHODS A detailed electronic survey was conducted through the Dup15q Alliance containing comprehensive questions regarding seizures and their treatments in Dup15q. RESULTS There were 95 responses from Dup15q families. For the 83 with idic(15), 63% were reported to have seizures, of which 81% had multiple seizure types and 42% had infantile spasms. Other common seizure types were tonic-clonic, atonic, myoclonic, and focal. Only 3 of 12 individuals with int dup(15) had seizures. Broad spectrum antiepileptic drugs (AEDs) were the most effective medications, but carbamazepine and oxcarbazepine were also effective, although typical benzodiazepines were relatively ineffective. There was a 24% response rate (>90% seizure reduction) to the first AED tried. For those with infantile spasms, adrenocorticotropic hormone (ACTH) was more effective than vigabatrin. SIGNIFICANCE This is the largest study assessing seizures in Duplication 15q syndrome, but because this was a questionnaire-based study with a low return rate, it is susceptible to bias. Seizures are common in idic(15) and typically difficult to control, often presenting with infantile spasms and progressing to a Lennox-Gastaut-type syndrome. Seizures in those with int dup(15) are less common, with a frequency similar to the general autism population. In addition to broad spectrum AED, medications such as carbamazepine and oxcarbazepine are also relatively effective in controlling seizures in this population, suggesting a possible multifocal etiology, which may also explain the high rate of infantile spasms. Our small sample suggests a relative lack of efficacy of vigabatrin and other γ-aminobutyric acid (GABA)ergic medications, such as typical benzodiazepines, which may be attributable to abnormal GABAergic transmission resulting from the duplication of a cluster of GABAβ3 receptor genes in the 15q11.2-13 region.
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Affiliation(s)
- Kerry D Conant
- Pediatric Epilepsy Program, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
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Kleefstra T, de Leeuw N, Wolf R, Nillesen WM, Schobers G, Mieloo H, Willemsen M, Perrotta CS, Poddighe PJ, Feenstra I, Draaisma J, van Ravenswaaij-Arts CM. Phenotypic spectrum of 20 novel patients with molecularly defined supernumerary marker chromosomes 15 and a review of the literature. Am J Med Genet A 2010; 152A:2221-9. [DOI: 10.1002/ajmg.a.33529] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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