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Ziniel SI, Mackie A, Saldaris J, Leonard H, Jacoby P, Marsh ED, Suter B, Pestana-Knight E, Olson HE, Price D, Weisenberg J, Rajaraman R, VanderVeen G, Benke TA, Downs J, Demarest S. The development, content and response process validation of a caregiver-reported severity measure for CDKL5 deficiency disorder. Epilepsy Res 2023; 197:107231. [PMID: 37751639 PMCID: PMC10760432 DOI: 10.1016/j.eplepsyres.2023.107231] [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: 04/28/2023] [Accepted: 09/18/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND CDKL5 Deficiency Disorder (CDD) is a severe X-linked developmental and epileptic encephalopathy. Existing developmental outcome measures have floor effects and cannot capture incremental changes in symptoms. We modified the caregiver portion of a CDD clinical severity assessment (CCSA) and assessed content and response-process validity. METHODS We conducted cognitive interviews with 15 parent caregivers of 1-39-year-old children with CDD. Caregivers discussed their understanding and concerns regarding appropriateness of both questions and answer options. Item wording and questionnaire structure were adjusted iteratively to ensure questions were understood as intended. RESULTS The CCSA was refined during three rounds of cognitive interviews into two measures: (1) the CDD Developmental Questionnaire - Caregiver (CDQ-Caregiver) focused on developmental skills, and (2) the CDD Clinical Severity Assessment - Caregiver (CCSA-Caregiver) focused on symptom severity. Branching logic was used to ensure questions were age and skill appropriate. Initial pilot data (n = 11) suggested no floor effects. CONCLUSIONS This study modified the caregiver portion of the initial CCSA and provided evidence for its content and response process validity.
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Affiliation(s)
- Sonja I Ziniel
- University of Colorado School of Medicine Department of Pediatrics, Section of Pediatric Hospital Medicine, 13123 East 16th Avenue, Box 302, Aurora, CO, United States; Children's Hospital Colorado Precision Medicine Institute, 13123 East 16th Avenue, Box 155, Aurora, CO 80045 United States
| | - Alexandra Mackie
- University of Colorado School of Medicine Department of Pediatrics, Section of Neurology, 13123 East 16th Avenue, Box 155, Aurora, CO 80045, United States
| | - Jacinta Saldaris
- University of Western Australia Centre for Child Health Research, Telethon Kids Institute, PO Box 855, West Perth, Western Australia 6872, Australia
| | - Helen Leonard
- University of Western Australia Centre for Child Health Research, Telethon Kids Institute, PO Box 855, West Perth, Western Australia 6872, Australia
| | - Peter Jacoby
- University of Western Australia Centre for Child Health Research, Telethon Kids Institute, PO Box 855, West Perth, Western Australia 6872, Australia
| | - Eric D Marsh
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, United States
| | - Bernhard Suter
- Baylor College of Medicine and Texas Children's Hospital, 6701 Fannin St MWT, Suite 1250, Houston, TX 77030, United States
| | - Elia Pestana-Knight
- Cleveland Clinic Neurological Institute, Epilepsy Center, S10-024 9500 Euclid Ave, Cleveland, OH 44195, United States
| | - Heather E Olson
- Boston Children's Hospital Department of Neurology Division of Epilepsy and Clinical Neurophysiology and Epilepsy Genetics Program, 300 Longwood Ave, Boston, MA, United States
| | - Dana Price
- NYU Langone Comprehensive Epilepsy Center, 223 East 34th Street, New York, NY 10016, United States
| | - Judith Weisenberg
- Washington University School of Medicine Department of Neurology, Division of Pediatric Neurology, 660 South Euclid Ave Campus Box 8111, St. Louis, MO 63110 United States
| | - Rajsekar Rajaraman
- David Geffen School of Medicine and UCLA Mattel Children's Hospital Division of Pediatric Neurology, 10833 Le Conte Ave 22-474 MDCC, Los Angeles, CA 90095 United States
| | - Gina VanderVeen
- Children's Hospital Colorado Precision Medicine Institute, 13123 East 16th Avenue, Box 155, Aurora, CO 80045 United States; University of Colorado School of Medicine Department of Pediatrics, Section of Neurology, 13123 East 16th Avenue, Box 155, Aurora, CO 80045, United States
| | - Tim A Benke
- Children's Hospital Colorado Precision Medicine Institute, 13123 East 16th Avenue, Box 155, Aurora, CO 80045 United States; University of Colorado School of Medicine Department of Pediatrics, Section of Neurology, 13123 East 16th Avenue, Box 155, Aurora, CO 80045, United States
| | - Jenny Downs
- University of Western Australia Centre for Child Health Research, Telethon Kids Institute, PO Box 855, West Perth, Western Australia 6872, Australia; Curtin University, Curtin School of Allied Health, GPO Box U1987, Perth, Western Australia 6845, Australia
| | - Scott Demarest
- Children's Hospital Colorado Precision Medicine Institute, 13123 East 16th Avenue, Box 155, Aurora, CO 80045 United States; University of Colorado School of Medicine Department of Pediatrics, Section of Neurology, 13123 East 16th Avenue, Box 155, Aurora, CO 80045, United States.
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2
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Viglione A, Mazziotti R, Pizzorusso T. From pupil to the brain: New insights for studying cortical plasticity through pupillometry. Front Neural Circuits 2023; 17:1151847. [PMID: 37063384 PMCID: PMC10102476 DOI: 10.3389/fncir.2023.1151847] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 03/08/2023] [Indexed: 04/03/2023] Open
Abstract
Pupil size variations have been associated with changes in brain activity patterns related with specific cognitive factors, such as arousal, attention, and mental effort. The locus coeruleus (LC), a key hub in the noradrenergic system of the brain, is considered to be a key regulator of cognitive control on pupil size, with changes in pupil diameter corresponding to the release of norepinephrine (NE). Advances in eye-tracking technology and open-source software have facilitated accurate pupil size measurement in various experimental settings, leading to increased interest in using pupillometry to track the nervous system activation state and as a potential biomarker for brain disorders. This review explores pupillometry as a non-invasive and fully translational tool for studying cortical plasticity starting from recent literature suggesting that pupillometry could be a promising technique for estimating the degree of residual plasticity in human subjects. Given that NE is known to be a critical mediator of cortical plasticity and arousal, the review includes data revealing the importance of the LC-NE system in modulating brain plasticity and pupil size. Finally, we will review data suggesting that pupillometry could provide a quantitative and complementary measure of cortical plasticity also in pre-clinical studies.
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Affiliation(s)
- Aurelia Viglione
- BIO@SNS Lab, Scuola Normale Superiore, Pisa, Italy
- *Correspondence: Aurelia Viglione,
| | | | - Tommaso Pizzorusso
- BIO@SNS Lab, Scuola Normale Superiore, Pisa, Italy
- Institute of Neuroscience, National Research Council, Pisa, Italy
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3
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Darra F, Monchelato M, Loos M, Juanes M, Bernardina BD, Valenzuela GR, Gallo A, Caraballo R. CDKL5-associated developmental and epileptic encephalopathy: A long-term, longitudinal electroclinical study of 22 cases. Epilepsy Res 2023; 190:107098. [PMID: 36739728 DOI: 10.1016/j.eplepsyres.2023.107098] [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: 09/05/2022] [Revised: 01/02/2023] [Accepted: 01/23/2023] [Indexed: 01/26/2023]
Abstract
OBJECTIVE The study was conducted to analyze the possible diagnostic value of the electroclinical semiology of the epileptic seizures. METHODS We evaluated the medical records of 17 females and 5 males with CDKL5 deficiency disorder (CDD) considering the long-term evolution, including the polygraphic video-EEG recordings. RESULTS We recognized three disease phases. We found that the seizure semiology was already recognizable in the first phase of the syndrome. In the short-term evolution, all patients had focal motor and 12/21 hypermotor seizures. Both epileptic spasms and myoclonic seizures were already present in more than half of the cases in the first 2 months after onset. In the second phase, the intermediate period, the polymorphic pattern was maintained, but in eight patients the electroclinical pattern of epileptic encephalopathy with hypsarrhythmia appeared. In the long-term period, the seizure polymorphism continued but myoclonic and epileptic spasms diminished. Tonic seizures appeared in the last 2 phases. Progressively, with the aggravation of seizures and paroxysmal EEG abnormalities impairment of the neurocognitive status was observed. Severe behavioral disturbances were seen in eight and autistic-like features in 14. CONCLUSION CDD is a true developmental and epileptic encephalopathy with a specific etiology characterized by the early appearance of epileptic seizures that quickly become polymorphic and drug resistant in infants that are most often female and already have neurological impairment. Polygraphic video-EEG recordings are important to recognize ictal events of the association of hypermotor seizures, epileptic spasms in clusters, and massive myoclonic jerks, already present at onset.
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Affiliation(s)
- Francesca Darra
- Unit of Child Neuropsychiatry, Azienda Ospedaliera Universitaria Integrata, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Manuela Monchelato
- Unit of Child Neuropsychiatry, Azienda Ospedaliera Universitaria Integrata, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Mariana Loos
- Department of Neurology, Hospital de Padiatría J.P. Garrahan, Buenos Aires, Argentina
| | - Matias Juanes
- Genomics Laboratory, Hospital de Padiatría J.P. Garrahan, Buenos Aires, Argentina
| | - Bernardo Dalla Bernardina
- Unit of Child Neuropsychiatry, Azienda Ospedaliera Universitaria Integrata, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Adolfo Gallo
- Department of Neurology, Hospital de Padiatría J.P. Garrahan, Buenos Aires, Argentina
| | - Roberto Caraballo
- Department of Neurology, Hospital de Padiatría J.P. Garrahan, Buenos Aires, Argentina.
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4
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Viglione A, Sagona G, Carrara F, Amato G, Totaro V, Lupori L, Putignano E, Pizzorusso T, Mazziotti R. Behavioral impulsivity is associated with pupillary alterations and hyperactivity in CDKL5 mutant mice. Hum Mol Genet 2022; 31:4107-4120. [PMID: 35861639 DOI: 10.1093/hmg/ddac164] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 06/24/2022] [Accepted: 07/12/2022] [Indexed: 11/14/2022] Open
Abstract
Cyclin-dependent kinase-like 5 (Cdkl5) deficiency disorder (CDD) is a severe neurodevelopmental condition caused by mutations in the X-linked Cdkl5 gene. CDD is characterized by early-onset seizures in the first month of life, intellectual disability, motor and social impairment. No effective treatment is currently available and medical management is only symptomatic and supportive. Recently, mouse models of Cdkl5 disorder have demonstrated that mice lacking Cdkl5 exhibit autism-like phenotypes, hyperactivity and dysregulations of the arousal system, suggesting the possibility to use these features as translational biomarkers. In this study, we tested Cdkl5 male and female mutant mice in an appetitive operant conditioning chamber to assess cognitive and motor abilities, and performed pupillometry to assess the integrity of the arousal system. Then, we evaluated the performance of artificial intelligence models to classify the genotype of the animals from the behavioral and physiological phenotype. The behavioral results show that CDD mice display impulsivity, together with low levels of cognitive flexibility and perseverative behaviors. We assessed arousal levels by simultaneously recording pupil size and locomotor activity. Pupillometry reveals in CDD mice a smaller pupil size and an impaired response to unexpected stimuli associated with hyperlocomotion, demonstrating a global defect in arousal modulation. Finally, machine learning reveals that both behavioral and pupillometry parameters can be considered good predictors of CDD. Since early diagnosis is essential to evaluate treatment outcomes and pupillary measures can be performed easily, we proposed the monitoring of pupil size as a promising biomarker for CDD.
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Affiliation(s)
- Aurelia Viglione
- BIO@SNS Lab, Scuola Normale Superiore, via Moruzzi 1, 56124 Pisa, Italy
| | - Giulia Sagona
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, viale del Tirreno 331, 56128 Pisa, Italy
| | - Fabio Carrara
- ISTI-Istituto di Scienza e Tecnologia dell'Informazione, National Research Council, via Moruzzi 1, 56124 Pisa, Italy
| | - Giuseppe Amato
- ISTI-Istituto di Scienza e Tecnologia dell'Informazione, National Research Council, via Moruzzi 1, 56124 Pisa, Italy
| | - Valentino Totaro
- BIO@SNS Lab, Scuola Normale Superiore, via Moruzzi 1, 56124 Pisa, Italy
| | - Leonardo Lupori
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, viale del Tirreno 331, 56128 Pisa, Italy
| | - Elena Putignano
- Institute of Neuroscience, National Research Council, via Moruzzi 1, 56124 Pisa, Italy
| | - Tommaso Pizzorusso
- BIO@SNS Lab, Scuola Normale Superiore, via Moruzzi 1, 56124 Pisa, Italy.,Institute of Neuroscience, National Research Council, via Moruzzi 1, 56124 Pisa, Italy
| | - Raffaele Mazziotti
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, viale del Tirreno 331, 56128 Pisa, Italy
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Zhang J, Ma J, Chang X, Wu P, Li S, Wu Y. Efficacy of ketogenic diet in CDKL5-related epilepsy: a single arm meta-analysis. Orphanet J Rare Dis 2022; 17:385. [DOI: 10.1186/s13023-022-02492-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 08/15/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Drug-resistant epilepsy is one of the most important features of cyclin-dependent kinase-like 5 (CDKL5) deficiency disorder. The ketogenic diet (KD) may be effective for patients with CDKL5-related epilepsy, but there is little high-quality evidence to confirm the efficacy. This meta-analysis investigated the efficacy and safety of KD in CDKL5-related epilepsy.
Methods
The PubMed, Embase, Web of Science, Cochrane Library, WanFang, CNKI and VIP databases were searched for relevant studies published up to January 1, 2022. Two reviewers independently screened the literature according to inclusion and exclusion criteria and evaluated the bias risk of the included studies. Meta-analysis was performed using Review Manager 5.3 software.
Results
A total of 12 retrospective studies involving 193 patients met the inclusion criteria. Meta-analysis revealed that the definite responder rate to KD in the treatment of CDKL5-related epilepsy was 18.0% [95% CI (0.07, 0.67)], with no statistical heterogeneity among studies (I2 = 0%, P = 0.45). The clinical responder rate was 50.5% [95% CI (0.75, 1.39)], and there was no statistical heterogeneity among all studies (I2 = 46%, P = 0.05). Subgroup analysis showed that there was no significant difference in the clinical responder rate between the two groups with seizure onset age before and after 1 month (P = 0.14). Only one study mentioned adverse reactions, and the incidence of adverse reactions was 78.3% (18/23). Constipation and vomiting were the main manifestations, implying a high incidence of gastrointestinal adverse reactions.
Conclusions
The definite responder rate to KD in CDKL5-related epilepsy was 18%, and the gastrointestinal adverse reactions were probably common in these patients. All the studies included in the meta-analysis were retrospective, and most of them had small sample sizes. Additional high-quality studies are needed to confirm the efficacy and tolerance of KD in CDKL5-related epilepsy.
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6
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Wang J, Zhang J, Yang Y, Gao K, Wu Y, Zhang Y, Jiang Y. Efficacy of Ketogenic Diet for Infantile Spasms in Chinese Patients With or Without Monogenic Etiology. Front Pediatr 2022; 10:842666. [PMID: 35372146 PMCID: PMC8969902 DOI: 10.3389/fped.2022.842666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 02/11/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the efficacy of the ketogenic diet (KD) for infantile spasms (IS) in patients with and without different causative genetic mutations. METHODS We retrospectively evaluated the data of 119 infants with IS who underwent whole-exome sequencing (WES) before KD treatment. The KD efficacy was analyzed at the 16th week after initiation. Patients showing ≥ 50% seizure reduction from baseline and/or the disappeared hypsarrhythmia were considered as the responders. Chi-squared tests or two-sided Fisher's exact tests were performed for categorical data and Mann-Whitney U-tests for non-parametric and continuous data. RESULTS The responder rate to KD in 119 patients was 47.90%. Six different causative monogenic mutations were identified in 32 (26.89%) patients with IS, including CDKL5 (n = 8), ALG13 (n = 3), KCNT1 (n = 8), SLC35A2 (n = 5), PCDH19 (n = 4), and STXBP1 (n = 4). Patients with CDKL5 mutations showed a significantly better response to KD (87.50%) than patients without CDKL5 mutations (p = 0.03). Seven of eight patients with CDKL5 mutations were responders, including five mutations located in functional motifs, and two mutations in the catalytic domain. CONCLUSION KD therapy was effective in infants with IS. Patients with CDKL5 mutations might have a better response to KD treatment.
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Affiliation(s)
- Jun Wang
- Department of Pediatrics, Peking University First Hospital, Beijing, China.,Department of Neurology, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China
| | - Jie Zhang
- Department of Pediatrics, Peking University First Hospital, Beijing, China.,Beijing Key Laboratory of Molecular Diagnosis and Study on Pediatric Genetic Diseases, Beijing, China.,Children Epilepsy Center, Peking University First Hospital, Beijing, China
| | - Ying Yang
- Department of Pediatrics, Peking University First Hospital, Beijing, China.,Beijing Key Laboratory of Molecular Diagnosis and Study on Pediatric Genetic Diseases, Beijing, China
| | - Kai Gao
- Department of Pediatrics, Peking University First Hospital, Beijing, China.,Beijing Key Laboratory of Molecular Diagnosis and Study on Pediatric Genetic Diseases, Beijing, China
| | - Ye Wu
- Department of Pediatrics, Peking University First Hospital, Beijing, China.,Beijing Key Laboratory of Molecular Diagnosis and Study on Pediatric Genetic Diseases, Beijing, China.,Children Epilepsy Center, Peking University First Hospital, Beijing, China
| | - Yuehua Zhang
- Department of Pediatrics, Peking University First Hospital, Beijing, China.,Beijing Key Laboratory of Molecular Diagnosis and Study on Pediatric Genetic Diseases, Beijing, China
| | - Yuwu Jiang
- Department of Pediatrics, Peking University First Hospital, Beijing, China.,Beijing Key Laboratory of Molecular Diagnosis and Study on Pediatric Genetic Diseases, Beijing, China.,Children Epilepsy Center, Peking University First Hospital, Beijing, China.,Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing, China
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7
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Brock D, Fidell A, Thomas J, Juarez-Colunga E, Benke TA, Demarest S. Cerebral Visual Impairment in CDKL5 Deficiency Disorder Correlates With Developmental Achievement. J Child Neurol 2021; 36:974-980. [PMID: 34547934 PMCID: PMC9853471 DOI: 10.1177/08830738211019284] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Cyclin-dependent kinase-like 5 (CDKL5) deficiency disorder is a rare neurodevelopmental disorder characterized by infantile-onset refractory epilepsy, profound developmental delays, and cerebral visual impairment. Although there is evidence that the presence of cerebral visual impairment in CDKL5 deficiency disorder is common, the potential impact of cerebral visual impairment severity on developmental attainment has not been explored directly. Focusing on a cohort of 46 children with CDKL5 deficiency disorder, examination features indicative of cerebral visual impairment were quantified and compared to developmental achievement. The derived cerebral visual impairment severity score was inversely correlated with developmental attainment, bolstering the supposition that cerebral visual impairment severity may provide a useful early biomarker of disease severity and prognosis. This study demonstrates the utility of a cerebral visual impairment score to better capture the range of cerebral visual impairment severity in the CDKL5 deficiency disorder population and further elucidates the interaction between cerebral visual impairment and developmental outcomes.
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Affiliation(s)
- Dylan Brock
- Children’s Hospital Colorado, Department of Child Neurology, Anschutz Medical Campus, Aurora, CO, USA,University of Colorado Denver School of Medicine, Anschutz Medical Campus, Anschutz Medical Campus, Aurora, CO, USA
| | - Andrea Fidell
- Children’s Hospital Colorado, Department of Child Neurology, Anschutz Medical Campus, Aurora, CO, USA,University of Colorado Denver School of Medicine, Anschutz Medical Campus, Anschutz Medical Campus, Aurora, CO, USA
| | - Jacob Thomas
- University of Colorado Denver School of Medicine, Anschutz Medical Campus, Anschutz Medical Campus, Aurora, CO, USA
| | - Elizabeth Juarez-Colunga
- University of Colorado Denver School of Medicine, Anschutz Medical Campus, Anschutz Medical Campus, Aurora, CO, USA
| | - Tim A. Benke
- Children’s Hospital Colorado, Department of Child Neurology, Anschutz Medical Campus, Aurora, CO, USA,University of Colorado Denver School of Medicine, Anschutz Medical Campus, Anschutz Medical Campus, Aurora, CO, USA
| | - Scott Demarest
- Children’s Hospital Colorado, Department of Child Neurology, Anschutz Medical Campus, Aurora, CO, USA,University of Colorado Denver School of Medicine, Anschutz Medical Campus, Anschutz Medical Campus, Aurora, CO, USA
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8
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Siri B, Varesio C, Freri E, Darra F, Gana S, Mei D, Porta F, Fontana E, Galati G, Solazzi R, Niceta M, Veggiotti P, Alfei E. CDKL5 deficiency disorder in males: Five new variants and review of the literature. Eur J Paediatr Neurol 2021; 33:9-20. [PMID: 33989939 DOI: 10.1016/j.ejpn.2021.04.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 04/18/2021] [Accepted: 04/24/2021] [Indexed: 11/30/2022]
Abstract
The X-linked Cyclin-Dependent Kinase-Like 5 (CDKL5) gene encodes a serine-threonine kinase highly expressed in the developing brain. Loss of function of CDKL5 is pointed out to underlie the CDKL5 Deficiency Disorder (CDD), an X-linked dominant disease characterized by early-onset epileptic encephalopathy and developmental delay, usually affecting females more than males. To the best to our knowledge, only 45 males with CDD have been reported so far. Type and position of CDKL5 variants with different impact on the protein are reported to influence the clinical presentation. X-chromosome inactivation occurring in females and post-zygotic mosaicism in males are also believed to contribute to this variability. Based on these issues, genotype-phenotype correlations are still challenging. Here, we describe clinical features of five additional affected males with unreported CDKL5 variants, expanding the molecular spectrum of the disorder. We also reviewed the clinical profile of the previously reported 45 males with molecularly confirmed CDD. Severe developmental delay, cortical visual impairment, and early-onset refractory epilepsy characterize the CDD picture in males. By assessing the molecular spectrum, we confirm that germ-line truncating CDKL5 variants, equally distributed across the coding sequence, are the most recurrent mutations in CDD, and cause the worsen phenotype. While recurrence and relevance of missense substitutions within C-terminal remain still debated, disease-causing missense changes affecting the N-terminal catalytic domain correlate to a severe clinical phenotype. Finally, our data provide evidence that post-zygotic CDKL5 mosaicism may result in milder phenotypes and, at least in a subset of subjects, in variable response to antiepileptic treatments.
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Affiliation(s)
- Barbara Siri
- Department of Paediatrics, Ospedale Infantile Regina Margherita, University of Torino, Italy; Division of Metabolism, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - Costanza Varesio
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Italy.
| | - Elena Freri
- Department of Paediatric Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Francesca Darra
- Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynecology and Paediatrics, University of Verona, AOUI Verona, Verona, Italy
| | - Simone Gana
- Medical Genetics Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Davide Mei
- Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, Children's Hospital A. Meyer-University of Florence, Italy
| | - Francesco Porta
- Department of Paediatrics, AOU Città della Salute e della Scienza di Torino, University of Torino, Italy
| | - Elena Fontana
- Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynecology and Paediatrics, University of Verona, AOUI Verona, Verona, Italy
| | - Giulia Galati
- Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynecology and Paediatrics, University of Verona, AOUI Verona, Verona, Italy
| | - Roberta Solazzi
- Department of Paediatric Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Marcello Niceta
- Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - Pierangelo Veggiotti
- L. Sacco Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy; Paediatric Neurology Unit V. Buzzi Children's Hospital Milan, Italy
| | - Enrico Alfei
- Paediatric Neurology Unit V. Buzzi Children's Hospital Milan, Italy
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9
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Ciccia LM, Scalia B, Venti V, Pizzo F, Pappalardo MG, La Mendola FMC, Falsaperla R, Praticò AD. CDKL5 Gene: Beyond Rett Syndrome. JOURNAL OF PEDIATRIC NEUROLOGY 2021. [DOI: 10.1055/s-0041-1727141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Abstract
CDKL5 is a gene located in the X-chromosome (Xp22) encoding a serine/threonine kinase involved in various signaling pathways, implicated in cell proliferation, axon development, dendrite growth, synapse formation, and maintenance. Mutations occurring in this gene have been associated with drug-resistant early-onset epilepsy, with multiple seizures type, and deep cognitive and motor development delay with poor or absent speech, ataxic gait or inability to walk, hand stereotypies and in a few cases decrement of head growth. Many aspects remain unclear about the CDKL5 deficiency disorders, research will be fundamental to better understand the pathogenesis of neurological damage and consequently developed more targeted and profitable therapies, as there is not, at the present, a gene-based treatment and the seizures are in most of the cases drug resistant. In this article, we summarize the actual knowledge about CDKL5 gene function and mostly the consequence given by its dysfunction, also examining the possible therapeutic approaches.
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Affiliation(s)
- Lina Maria Ciccia
- Pediatrics Postgraduate Residency Program, Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Bruna Scalia
- Pediatrics Postgraduate Residency Program, Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Valeria Venti
- Pediatrics Postgraduate Residency Program, Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Francesco Pizzo
- Pediatrics Postgraduate Residency Program, Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Maria Grazia Pappalardo
- Pediatrics Postgraduate Residency Program, Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | | | - Raffaele Falsaperla
- Unit of Pediatrics and Pediatric Emergency, University Hospital “Policlinico Rodolico-San Marco,” Catania, Italy
- Unit of Neonatal Intensive Care and Neonatology, University Hospital “Policlinico Rodolico-San Marco,” Catania, Italy
| | - Andrea D. Praticò
- Unit of Rare Diseases of the Nervous System in Childhood, Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy
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10
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Kobayashi Y, Tohyama J, Takahashi Y, Goto T, Haginoya K, Inoue T, Kubota M, Fujita H, Honda R, Ito M, Kishimoto K, Nakamura K, Sakai Y, Takanashi JI, Tanaka M, Tanda K, Tominaga K, Yoshioka S, Kato M, Nakashima M, Saitsu H, Matsumoto N. Clinical manifestations and epilepsy treatment in Japanese patients with pathogenic CDKL5 variants. Brain Dev 2021; 43:505-514. [PMID: 33436160 DOI: 10.1016/j.braindev.2020.12.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 11/12/2020] [Accepted: 12/15/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Patients with pathogenic cyclin-dependent kinase-like-5 gene (CDKL5) variants are designated CDKL5 deficiency disorder (CDD). This study aimed to delineate the clinical characteristics of Japanese patients with CDD and elucidate possible appropriate treatments. METHODS We recruited patients with pathogenic or likely pathogenic CDKL5 variants from a cohort of approximately 1,100 Japanese patients with developmental and epileptic encephalopathies, who underwent genetic analysis. We retrospectively reviewed clinical, electroencephalogram, neuroimaging, and genetic information. RESULTS We identified 29 patients (21 females, eight males). All patients showed severe developmental delay, especially in males. Involuntary movements were observed in 15 patients. No antiepileptic drugs (AEDs) achieved seizure freedom by monotherapy. AEDs achieving ≥ 50% reduction in seizure frequency were sodium valproate in two patients, vigabatrin in one, and lamotrigine in one. Seizure aggravation was observed during the use of lamotrigine, potassium bromide, and levetiracetam. Adrenocorticotrophic hormone (ACTH) was the most effective treatment. The ketogenic diet (KD), corpus callosotomy and vagus nerve stimulation did not improve seizure frequency in most patients, but KD was remarkably effective in one. The degree of brain atrophy on magnetic resonance imaging (MRI) reflected disease severity. Compared with females, males had lower levels of attained motor development and more severe cerebral atrophy on MRI. CONCLUSION Our patients showed more severe global developmental delay than those in previous studies and had intractable epilepsy, likely because previous studies had lower numbers of males. Further studies are needed to investigate appropriate therapy for CDD, such as AED polytherapy or combination treatment involving ACTH, KD, and AEDs.
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Affiliation(s)
- Yu Kobayashi
- Department of Child Neurology, NHO Nishiniigata Chuo Hospital, Niigata, Japan.
| | - Jun Tohyama
- Department of Child Neurology, NHO Nishiniigata Chuo Hospital, Niigata, Japan
| | - Yukitoshi Takahashi
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan
| | - Tomohide Goto
- Division of Neurology, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Kazuhiro Haginoya
- Department of Pediatric Neurology, Miyagi Children's Hospital, Sendai, Japan
| | - Takeshi Inoue
- Department of Pediatric Neurology, Osaka City General Hospital, Osaka, Japan
| | - Masaya Kubota
- Division of Neurology, National Center for Child Health and Development, Tokyo, Japan
| | - Hiroshi Fujita
- Department of Pediatrics, NHO Aomori Hospital, Aomori, Japan
| | - Ryoko Honda
- Department of Pediatrics, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Masahiro Ito
- Department of Pediatrics, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Kanako Kishimoto
- Department of Pediatrics, Osaka Hospital, Japan Community Healthcare Organization (JCHO), Osaka, Japan
| | - Kazuyuki Nakamura
- Department of Pediatrics, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Yasunari Sakai
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Jun-Ichi Takanashi
- Department of Pediatrics, Tokyo Women's Medical University Yachiyo Medical Center, Yachiyo, Japan
| | - Manabu Tanaka
- Division of General Pediatrics, Saitama Children's Medical Center, Saitama, Japan
| | - Koichi Tanda
- Department of Pediatrics, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Koji Tominaga
- Department of Pediatrics, Graduate School of Medicine, Osaka University, Suita, Japan
| | | | - Mitsuhiro Kato
- Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan
| | - Mitsuko Nakashima
- Department of Biochemistry, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hirotomo Saitsu
- Department of Biochemistry, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Naomichi Matsumoto
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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11
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Tang Y, Wang ZI, Sarwar S, Choi JY, Wang S, Zhang X, Parikh S, Moosa AN, Pestana-Knight E. Brain morphological abnormalities in children with cyclin-dependent kinase-like 5 deficiency disorder. Eur J Paediatr Neurol 2021; 31:46-53. [PMID: 33621819 PMCID: PMC8026562 DOI: 10.1016/j.ejpn.2021.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 02/03/2021] [Accepted: 02/09/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND To quantitatively evaluate the brain MRI morphological abnormalities in patients with cyclin-dependent kinase-like 5 deficiency disorder (CDD) on a group level and longitudinally. METHODS We performed surface-based MRI analysis on high-resolution T1-weighted images on three CDD patients scanned at age of three years, and compared with 12 age- and gender-matched healthy controls. We further examined the longitudinal morphological changes in one patient with a follow-up of 5 years. RESULTS CDD patients presented significant reductions in total intracranial volume, total gray matter (GM) volume and subcortical GM volume compared to controls. For subcortical regions, significant GM volume reductions were seen in the brain stem, bilateral thalamus, bilateral hippocampus, bilateral cerebellum and left amygdala. Although GM volume of cortical mantle did not show statistical differences overall, significant reduction was detected in bilateral parietal, left occipital and right temporal lobes. Cortical thickness exhibited significant decreases in bilateral occipital, parietal and temporal lobes, while surface area did not show any significant differences. Longitudinal follow-up in one patient revealed a monotonic downward trend of relative volume in the majority of brain regions. The relative surface area appeared to gain age-related growth, whereas the relative cortical thickness exhibited a striking progressive decline over time. CONCLUSIONS Quantitative morphology analysis in children with CDD showed global volume loss in the cortex and more notably in the subcortical gray matter, with a progressive trend along with the disease course. Cortical thickness is a more sensitive measure to disclose cortical atrophy and disease progression than surface area.
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Affiliation(s)
- Yingying Tang
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, China; Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA
| | | | - Shaheera Sarwar
- Northeast Ohio Medical University, Rootstown, OH, USA; Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA
| | - Joon Yul Choi
- Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA
| | - Shan Wang
- Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA
| | | | - Sumit Parikh
- Center for Pediatric Neuroscience, Cleveland Clinic, Cleveland, OH, USA
| | - Ahsan N Moosa
- Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA
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12
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Carli S, Chaabane L, Butti C, De Palma C, Aimar P, Salio C, Vignoli A, Giustetto M, Landsberger N, Frasca A. In vivo magnetic resonance spectroscopy in the brain of Cdkl5 null mice reveals a metabolic profile indicative of mitochondrial dysfunctions. J Neurochem 2021; 157:1253-1269. [PMID: 33448385 DOI: 10.1111/jnc.15300] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 10/24/2020] [Accepted: 01/07/2021] [Indexed: 12/12/2022]
Abstract
Mutations in the X-linked CDKL5 gene cause CDKL5 deficiency disorder (CDD), a severe neurodevelopmental condition mainly characterized by infantile epileptic encephalopathy, intellectual disability, and autistic features. The molecular mechanisms underlying the clinical symptoms remain largely unknown and the identification of reliable biomarkers in animal models will certainly contribute to increase our comprehension of CDD as well as to assess the efficacy of therapeutic strategies. Here, we used different Magnetic Resonance (MR) methods to disclose structural, functional, or metabolic signatures of Cdkl5 deficiency in the brain of adult mice. We found that loss of Cdkl5 does not cause cerebral atrophy but affects distinct brain areas, particularly the hippocampus. By in vivo proton-MR spectroscopy (MRS), we revealed in the Cdkl5 null brain a metabolic dysregulation indicative of mitochondrial dysfunctions. Accordingly, we unveiled a significant reduction in ATP levels and a decrease in the expression of complex IV of mitochondrial electron transport chain. Conversely, the number of mitochondria appeared preserved. Importantly, we reported a significant defect in the activation of one of the major regulators of cellular energy balance, the adenosine monophosphate-activated protein kinase (AMPK), that might contribute to the observed metabolic impairment and become an interesting therapeutic target for future preclinical trials. In conclusion, MRS revealed in the Cdkl5 null brain the presence of a metabolic dysregulation suggestive of a mitochondrial dysfunction that permitted to foster our comprehension of Cdkl5 deficiency and brought our interest towards targeting mitochondria as therapeutic strategy for CDD.
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Affiliation(s)
- Sara Carli
- Neuroscience Division, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Linda Chaabane
- Institute of Experimental Neurology (INSPE) and Experimental Imaging Center (CIS), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Clarissa Butti
- Neuroscience Division, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Molecular Nociception Group, Wolfson Institute for Biomedical Research (WIBR), University College London, London, UK
| | - Clara De Palma
- Department of Medical Biotechnology and Translational Medicine, University of Milan, Segrate (Milan), Italy
| | - Patrizia Aimar
- Department of Veterinary Sciences, University of Turin, Grugliasco, Italy
| | - Chiara Salio
- Department of Veterinary Sciences, University of Turin, Grugliasco, Italy
| | - Aglaia Vignoli
- Epilepsy Center-Child Neuropsychiatric Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Maurizio Giustetto
- Department of Neuroscience, University of Turin, Turin, Italy.,National Institute of Neuroscience-Italy, Turin, Italy
| | - Nicoletta Landsberger
- Neuroscience Division, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Department of Medical Biotechnology and Translational Medicine, University of Milan, Segrate (Milan), Italy
| | - Angelisa Frasca
- Department of Medical Biotechnology and Translational Medicine, University of Milan, Segrate (Milan), Italy
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13
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von Stülpnagel C, van Baalen A, Borggraefe I, Eschermann K, Hartlieb T, Kiwull L, Pringsheim M, Wolff M, Kudernatsch M, Wiegand G, Striano P, Kluger G. Network for Therapy in Rare Epilepsies (NETRE): Lessons From the Past 15 Years. Front Neurol 2021; 11:622510. [PMID: 33519703 PMCID: PMC7840830 DOI: 10.3389/fneur.2020.622510] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 12/14/2020] [Indexed: 01/14/2023] Open
Abstract
Background: In 2005, Network for Therapy in Rare Epilepsies (NETRE)-was initiated in order to share treatment experiences among clinicians in patients with rare epilepsies. Here we describe the structure of the rapidly growing NETRE and summarize some of the findings of the last 15 years. Methodology/Structure of NETRE: NETRE is organized in distinct groups (currently >270). Starting point is always a patient with a rare epilepsy/ epileptic disorder. This creates a new group, and next, a medical coordinator is appointed. The exchange of experiences is established using a data entry form, which the coordinator sends to colleagues. The primary aim is to exchange experiences (retrospectively, anonymously, MRI results also non-anonymously) of the epilepsy treatment as well as on clinical presentation and comorbidities NETRE is neither financed nor sponsored. Results: Some of the relevant results: (1) first description of FIRES as a new epilepsy syndrome and its further investigation, (2) in SCN2A, the assignment to gain- vs. loss-of-function mutations has a major impact on clinical decisions to use or avoid treatment with sodium channel blockers, (3) the important aspect of avoiding overtreatment in CDKL5 patients, due to loss of effects of anticonvulsants after 12 months, (4) pathognomonic MRI findings in FOXG1 patients, (5) the first description of pathognomonic chewing-induced seizures in SYNGAP1 patients, and the therapeutic effect of statins as anticonvulsant in these patients, (6) the phenomenon of another reflex epilepsy-bathing epilepsy associated with a SYN1 mutation. Of special interest is also a NETRE group following twins with genetic and/or structural epilepsies [including vanishing-twin-syndrome and twin-twin-transfusion syndrome) [= "Early Neuroimpaired Twin Entity" (ENITE)]. Discussion and Perspective: NETRE enables clinicians to quickly exchange information on therapeutic experiences in rare diseases with colleagues at an international level. For both parents and clinicians/scientist this international exchange is both reassuring and helpful. In collaboration with other groups, personalized therapeutic approaches are sought, but the present limitations of currently available therapies are also highlighted. Presently, the PATRE Project (PATient based phenotyping and evaluation of therapy for Rare Epilepsies) is commencing, in which information on therapies will be obtained directly from patients and their caregivers.
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Affiliation(s)
- Celina von Stülpnagel
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics and Epilepsy Center, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
- Institute for Transition, Rehabilitation and Palliation, Paracelsus Medical University, Salzburg, Austria
| | - Andreas van Baalen
- Clinic for Child and Adolescent Medicine II, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Ingo Borggraefe
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics and Epilepsy Center, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Kirsten Eschermann
- Institute for Transition, Rehabilitation and Palliation, Paracelsus Medical University, Salzburg, Austria
| | - Till Hartlieb
- Institute for Transition, Rehabilitation and Palliation, Paracelsus Medical University, Salzburg, Austria
- Center for Pediatric Neurology, Neurorehabilitation and Epileptology, Schoen Klinik Vogtareuth, Vogtareuth, Germany
| | - Lorenz Kiwull
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics and Epilepsy Center, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
- Institute for Transition, Rehabilitation and Palliation, Paracelsus Medical University, Salzburg, Austria
- Institute of Social Pediatrics and Adolescent Medicine, Ludwig-Maximilian-University, Munich, Germany
| | - Milka Pringsheim
- Institute for Transition, Rehabilitation and Palliation, Paracelsus Medical University, Salzburg, Austria
- Center for Pediatric Neurology, Neurorehabilitation and Epileptology, Schoen Klinik Vogtareuth, Vogtareuth, Germany
| | - Markus Wolff
- Department of Pediatric Neurology, Vivantes Hospital Neukölln, Berlin, Germany
| | - Manfred Kudernatsch
- Institute for Transition, Rehabilitation and Palliation, Paracelsus Medical University, Salzburg, Austria
- Clinic for Neurosurgery, Schön Klinik Vogtareuth, Vogtareuth, Germany
| | - Gert Wiegand
- Clinic for Child and Adolescent Medicine II, University Hospital Schleswig-Holstein, Kiel, Germany
- Neuropediatrics Section of the Department of Pediatrics, Asklepios Clinic Hamburg Nord-Heidberg, Hamburg, Germany
| | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, Istituto die Ricovero e Cura a Carattere Scientifico Istituto Giannina Gaslini, Genova, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Gerhard Kluger
- Institute for Transition, Rehabilitation and Palliation, Paracelsus Medical University, Salzburg, Austria
- Center for Pediatric Neurology, Neurorehabilitation and Epileptology, Schoen Klinik Vogtareuth, Vogtareuth, Germany
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14
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Karunakaran S, Menon RN, Nair SS, Santhakumar S, Nair M, Sundaram S. Clinical and Genetic Profile of Autism Spectrum Disorder-Epilepsy (ASD-E) Phenotype: Two Sides of the Same Coin! Clin EEG Neurosci 2020; 51:390-398. [PMID: 32114799 DOI: 10.1177/1550059420909673] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The clinical phenotype of autism spectrum disorder and epilepsy (ASD-E) is a common neurological presentation in various genetic disorders, irrespective of the underlying pathophysiological mechanisms. Here we describe the demographic and clinical profiles, coexistent neurological conditions, type of seizures, epilepsy syndrome, and EEG findings in 11 patients with ASD-E phenotype with proven genetic etiology. The commonest genetic abnormality noted was CDKL5 mutation (3), MECP2 mutation (2), and 1p36 deletion (2). The median age of onset of clinical seizures was 6 months (range, 10 days to 11 years). The most common seizure type was focal onset seizures with impaired awareness, observed in 7 (63.6%) patients followed by epileptic spasms in 4 (30.8%), generalized tonic-clonic and atonic seizures in 3 (27.3%) patients each and tonic seizures in 2 (18.2%) patients and myoclonic seizures in 1 (9.1%) patient. Focal and multifocal interictal epileptiform abnormalities were seen in 6 (54.6%) and 5 (45.5%) patients, respectively. Epileptic encephalopathy and focal epilepsy were seen in 7 (63.6%) and 4 (36.4%) patients, respectively. The diagnostic yield of genetic testing was 44% (11 of 25 patients) and when variants of unknown significance and metabolic defects were included, the yield increased to 60% (15 of 25 patients). We conclude that in patients with ASD-E phenotype with an underlying genetic basis, the clinical seizure type, epilepsy syndrome, and EEG patterns are variable. Next-generation exome sequencing and chromosomal microarray need to be considered in clinical practice as part of evaluation of children with ASD-E phenotype.
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Affiliation(s)
- Sudhakar Karunakaran
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Ramshekhar N Menon
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Sruthi S Nair
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - S Santhakumar
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Muralidharan Nair
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Soumya Sundaram
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
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15
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Lupori L, Sagona G, Fuchs C, Mazziotti R, Stefanov A, Putignano E, Napoli D, Strettoi E, Ciani E, Pizzorusso T. Site-specific abnormalities in the visual system of a mouse model of CDKL5 deficiency disorder. Hum Mol Genet 2020; 28:2851-2861. [PMID: 31108505 PMCID: PMC6736061 DOI: 10.1093/hmg/ddz102] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 05/10/2019] [Accepted: 05/13/2019] [Indexed: 12/12/2022] Open
Abstract
CDKL5 deficiency disorder (CDD) is a neurodevelopmental disorder characterized by a severe global developmental delay and early-onset seizures. Notably, patients show distinctive visual abnormalities often clinically diagnosed as cortical visual impairment. However, the involvement of cerebral cortical dysfunctions in the origin of the symptoms is poorly understood. CDD mouse models also display visual deficits, and cortical visual responses can be used as a robust biomarker in CDKL5 mutant mice. A deeper understanding of the circuits underlying the described visual deficits is essential for directing preclinical research and translational approaches. Here, we addressed this question in two ways: first, we performed an in-depth morphological analysis of the visual pathway, from the retina to the primary visual cortex (V1), of CDKL5 null mice. We found that the lack of CDKL5 produced no alteration in the organization of retinal circuits. Conversely, CDKL5 mutants showed reduced density and altered morphology of spines and decreased excitatory synapse marker PSD95 in the dorsal lateral geniculate nucleus and in V1. An increase in the inhibitory marker VGAT was selectively present in V1. Second, using a conditional CDKL5 knockout model, we showed that selective cortical deletion of CDKL5 from excitatory cells is sufficient to produce abnormalities of visual cortical responses, demonstrating that the normal function of cortical circuits is dependent on CDKL5. Intriguingly, these deficits were associated with morphological alterations of V1 excitatory and inhibitory synaptic contacts. In summary, this work proposes cortical circuit structure and function as a critically important target for studying CDD.
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Affiliation(s)
- Leonardo Lupori
- BIO@SNS Laboratory, Scuola Normale Superiore, Via Moruzzi 1, Pisa 56124, Italy.,Institute of Neuroscience, National Research Council, Via Moruzzi 1, Pisa 56124, Italy
| | - Giulia Sagona
- Institute of Neuroscience, National Research Council, Via Moruzzi 1, Pisa 56124, Italy.,Department of Neuroscience, Psychology, Drug Research and Child Health NEUROFARBA University of Florence, Area San Salvi-Pad. 26, Florence 50135, Italy.,Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa 56128, Italy
| | - Claudia Fuchs
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna 40126, Italy
| | - Raffaele Mazziotti
- Institute of Neuroscience, National Research Council, Via Moruzzi 1, Pisa 56124, Italy.,Department of Neuroscience, Psychology, Drug Research and Child Health NEUROFARBA University of Florence, Area San Salvi-Pad. 26, Florence 50135, Italy
| | - Antonia Stefanov
- Institute of Neuroscience, National Research Council, Via Moruzzi 1, Pisa 56124, Italy
| | - Elena Putignano
- Institute of Neuroscience, National Research Council, Via Moruzzi 1, Pisa 56124, Italy
| | - Debora Napoli
- BIO@SNS Laboratory, Scuola Normale Superiore, Via Moruzzi 1, Pisa 56124, Italy.,Institute of Neuroscience, National Research Council, Via Moruzzi 1, Pisa 56124, Italy
| | - Enrica Strettoi
- Institute of Neuroscience, National Research Council, Via Moruzzi 1, Pisa 56124, Italy
| | - Elisabetta Ciani
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna 40126, Italy
| | - Tommaso Pizzorusso
- BIO@SNS Laboratory, Scuola Normale Superiore, Via Moruzzi 1, Pisa 56124, Italy.,Institute of Neuroscience, National Research Council, Via Moruzzi 1, Pisa 56124, Italy.,Department of Neuroscience, Psychology, Drug Research and Child Health NEUROFARBA University of Florence, Area San Salvi-Pad. 26, Florence 50135, Italy
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16
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Fuchs C, Gennaccaro L, Ren E, Galvani G, Trazzi S, Medici G, Loi M, Conway E, Devinsky O, Rimondini R, Ciani E. Pharmacotherapy with sertraline rescues brain development and behavior in a mouse model of CDKL5 deficiency disorder. Neuropharmacology 2019; 167:107746. [PMID: 31469994 DOI: 10.1016/j.neuropharm.2019.107746] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 07/27/2019] [Accepted: 08/21/2019] [Indexed: 12/15/2022]
Abstract
Mutations in the X-linked cyclin-dependent kinase-like 5 (CDKL5) gene cause a severe neurodevelopmental disorder, CDKL5 deficiency disorder (CDD). CDKL5 is fundamental for correct brain development and function, but the molecular mechanisms underlying aberrant neurologic dysfunction in CDD are incompletely understood. Here we show a dysregulation of hippocampal and cortical serotonergic (5-HT) receptor expression in heterozygous Cdkl5 knockout (KO) female mice, suggesting that impaired 5-HT neurotransmission contributes to CDD. We demonstrate that targeting impaired 5-HT signaling via the selective serotonin reuptake inhibitor (SSRI) sertraline rescues CDD-related neurodevelopmental and behavioral defects in heterozygous Cdkl5 KO female mice. In particular, chronic treatment with sertraline normalized locomotion, stereotypic and autistic-like features, and spatial memory in Cdkl5 KO mice. These positive behavioral effects were accompanied by restored neuronal survival, dendritic development and synaptic connectivity. At a molecular level, sertraline increased brain-derived neurotrophic factor (BDNF) expression and restored abnormal phosphorylation levels of tyrosine kinase B (TrkB) and its downstream target the extracellular signal-regulated kinase (ERK1/2). Since sertraline is an FDA-approved drug with an extensive safety and tolerability data package, even for children, our findings suggest that sertraline may improve neurodevelopment in children with CDD. This article is part of the special issue entitled 'Serotonin Research: Crossing Scales and Boundaries'.
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Affiliation(s)
- Claudia Fuchs
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy.
| | - Laura Gennaccaro
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Elisa Ren
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Giuseppe Galvani
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Stefania Trazzi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Giorgio Medici
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Manuela Loi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Erin Conway
- Department of Neurology, NYU Langone Health, New York, USA
| | - Orrin Devinsky
- Department of Neurology, NYU Langone Health, New York, USA
| | - Roberto Rimondini
- Department of Medical and Clinical Sciences, University of Bologna, Italy
| | - Elisabetta Ciani
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy.
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17
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Demarest S, Pestana-Knight EM, Olson HE, Downs J, Marsh ED, Kaufmann WE, Partridge CA, Leonard H, Gwadry-Sridhar F, Frame KE, Cross JH, Chin RFM, Parikh S, Panzer A, Weisenberg J, Utley K, Jaksha A, Amin S, Khwaja O, Devinsky O, Neul JL, Percy AK, Benke TA. Severity Assessment in CDKL5 Deficiency Disorder. Pediatr Neurol 2019; 97:38-42. [PMID: 31147226 PMCID: PMC6659999 DOI: 10.1016/j.pediatrneurol.2019.03.017] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 03/18/2019] [Accepted: 03/19/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Pathologic mutations in cyclin-dependent kinase-like 5 cause CDKL5 deficiency disorder, a genetic syndrome associated with severe epilepsy and cognitive, motor, visual, and autonomic disturbances. This disorder is a relatively common genetic cause of early-life epilepsy. A specific severity assessment is lacking, required to monitor the clinical course and needed to define the natural history and for clinical trial readiness. METHODS A severity assessment was developed based on clinical and research experience from the International Foundation for CDKL5 Research Centers of Excellence consortium and the National Institutes of Health Rett and Rett-Related Disorders Natural History Study consortium. An initial draft severity assessment was presented and reviewed at the annual CDKL5 Forum meeting (Boston, 2017). Subsequently it was iterated through four cycles of a modified Delphi process by a group of clinicians, researchers, industry, patient advisory groups, and parents familiar with this disorder until consensus was achieved. The revised version of the severity assessment was presented for review, comment, and piloting to families at the International Foundation for CDKL5 Research-sponsored family meeting (Colorado, 2018). Final revisions were based on this additional input. RESULTS The final severity assessment comprised 51 items that comprehensively describe domains of epilepsy; motor; cognition, behavior, vision, and speech; and autonomic functions. Parental ratings of therapy effectiveness and child and family functioning are also included. CONCLUSIONS A severity assessment was rapidly developed with input from multiple stakeholders. Refinement through ongoing validation is required for future clinical trials. The consensus methods employed for the development of severity assessment may be applicable to similar rare disorders.
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Affiliation(s)
- Scott Demarest
- Children's Hospital Colorado and University of Colorado School of Medicine Aurora, Colorado; Department of Pediatrics, Aurora, Colorado
| | - Elia M Pestana-Knight
- Cleveland Clinic, Neurological Institute Cleveland, Ohio; Epilepsy Center, Cleveland, Ohio
| | - Heather E Olson
- Department of Neurology, Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital Boston, Massachusetts
| | - Jenny Downs
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia; School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Eric D Marsh
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Walter E Kaufmann
- M.I.N.D. Institute, Department of Neurology, University of California Davis Health System, Sacramento, California; Department of Human Genetics, Emory University School of Medicine, Atlanta, Georgia
| | | | - Helen Leonard
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Femida Gwadry-Sridhar
- Department of Computer Science, University of Western Ontario and Pulse Infoframe, London, Ontario, Canada
| | | | - J Helen Cross
- UCL Great Ormond Street Institute of Child Health & NIHR GOSH BRC, London, UK
| | - Richard F M Chin
- University of Edinburgh and Royal Hospital for Sick Children, Edinburgh, UK
| | | | | | - Judith Weisenberg
- Neurology, Division of Pediatric Neurology, Epilepsy Section, Washington University School of Medicine, St. Louis Children's Hospital, St Louis, Missouri
| | - Karen Utley
- International Foundation for CDKL5 Research, Wadwsorth, Ohio
| | - Amanda Jaksha
- International Foundation for CDKL5 Research, Wadwsorth, Ohio
| | | | - Omar Khwaja
- Roche Innovation Center Basel, Roche Pharmaceutical Research and Early Development NORD, Basel, Switzerland
| | - Orrin Devinsky
- Department of Neurology, New York University, New York, New York
| | - Jeffery L Neul
- Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Tennessee
| | - Alan K Percy
- University of Alabama at Birmingham, Pediatrics, Neurology, Neurobiology, Genetics, and Psychology, Birmingham, Alabama
| | - Tim A Benke
- Children's Hospital Colorado and University of Colorado School of Medicine Aurora, Colorado; Department of Pediatrics, Aurora, Colorado; Department of Pharmacology, Aurora, Colorado; Department of Neurology, Aurora, Colorado; Department of Otolaryngology, Aurora, Colorado.
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18
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Demarest ST, Olson HE, Moss A, Pestana-Knight E, Zhang X, Parikh S, Swanson LC, Riley KD, Bazin GA, Angione K, Niestroj LM, Lal D, Juarez-Colunga E, Benke TA. CDKL5 deficiency disorder: Relationship between genotype, epilepsy, cortical visual impairment, and development. Epilepsia 2019; 60:1733-1742. [PMID: 31313283 PMCID: PMC7098045 DOI: 10.1111/epi.16285] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 06/20/2019] [Accepted: 06/20/2019] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The cyclin-dependent kinase like 5 (CDKL5) gene is a known cause of early onset developmental and epileptic encephalopathy, also known as CDKL5 deficiency disorder (CDD). We sought to (1) provide a description of seizure types in patients with CDD, (2) provide an assessment of the frequency of seizure-free periods and cortical visual impairment (CVI), (3) correlate these features with genotype and gender, and (4) correlate these features with developmental milestones. METHODS This is a cohort study of patients with CDD. Phenotypic features were explored and correlated with gene variant grouping and gender. A developmental score was created based on achieving seven primary milestones. Phenotypic variables were correlated with the developmental score to explore markers of better developmental outcomes. Multivariate linear regression was used to account for age at last visit. RESULTS Ninety-two patients with CDD were seen during the enrollment period. Eighteen were male (19%); median age at last visit was 5 years (interquartile range = 2.0-11.0). Eighty-one percent of patients developed epileptic spasms, but only 47% of those also had hypsarrhythmia. Previously described hypermotor-tonic-spasms sequence was seen in only 24% of patients, but 56% of patients had seizures with multiple phases (often tonic and spasms). Forty-three percent of patients experienced a seizure-free period ranging from 1 to >12 months, but only 6% were still seizure-free at the last visit. CVI was present in 75% of all CDD patients. None of these features was associated with genotype group or gender. CVI was correlated with reduced milestone achievement after adjusting for age at last visit and a history of hypsarrhythmia. SIGNIFICANCE The most common seizure types in CDD are epileptic spasms (often without hypsarrhythmia) and tonic seizures that may cluster together. CVI is a common feature in CDD and is correlated with achieving fewer milestones.
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Affiliation(s)
- Scott T Demarest
- Children's Hospital Colorado, Aurora, Colorado
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, Aurora, Colorado
- University of Colorado School of Medicine, Aurora, Colorado
- Department of Pediatrics, Colorado School of Public Health, Aurora, Colorado
- Department of Neurology, Colorado School of Public Health, Aurora, Colorado
| | - Heather E Olson
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Boston, Massachusetts
| | - Angela Moss
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, Aurora, Colorado
| | - Elia Pestana-Knight
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
- Department of Neurology, Lerner Research Institute, Cleveland, Ohio
- Genomic Medicine Institute, Lerner Research Institute, Cleveland, Ohio
| | - Xiaoming Zhang
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
- Department of Neurology, Lerner Research Institute, Cleveland, Ohio
- Genomic Medicine Institute, Lerner Research Institute, Cleveland, Ohio
| | - Sumit Parikh
- Genomic Medicine Institute, Lerner Research Institute, Cleveland, Ohio
- Department of Neurogenetics, Lerner Research Institute, Cleveland, Ohio
| | - Lindsay C Swanson
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Boston, Massachusetts
| | - Katherine D Riley
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Boston, Massachusetts
| | - Grace A Bazin
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Boston, Massachusetts
| | - Katie Angione
- Children's Hospital Colorado, Aurora, Colorado
- University of Colorado School of Medicine, Aurora, Colorado
| | | | - Dennis Lal
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
- Genomic Medicine Institute, Lerner Research Institute, Cleveland, Ohio
- Cologne Center for Genomics, University of Cologne, Cologne, Germany
- Cleveland Clinic Children's, Cleveland, Ohio
- Stanley Center for Psychiatric Research, Cambridge, Massachusetts
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, Massachusetts
| | - Elizabeth Juarez-Colunga
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, Aurora, Colorado
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado
| | - Tim A Benke
- Children's Hospital Colorado, Aurora, Colorado
- University of Colorado School of Medicine, Aurora, Colorado
- Department of Pediatrics, Colorado School of Public Health, Aurora, Colorado
- Department of Neurology, Colorado School of Public Health, Aurora, Colorado
- Department of Pharmacology, Colorado School of Public Health, Aurora, Colorado
- Department of Otolaryngology, Colorado School of Public Health, Aurora, Colorado
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19
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Koo CM, Kim SH, Kim HD, Lee JS, Choi JR, Lee ST, Kang HC. Clinical Features and Treatment Efficacy in CDKL5 Mutation-Related Epileptic Encephalopathy in the Infant. ANNALS OF CHILD NEUROLOGY 2019. [DOI: 10.26815/acn.2019.00052] [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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20
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Ren E, Roncacé V, Trazzi S, Fuchs C, Medici G, Gennaccaro L, Loi M, Galvani G, Ye K, Rimondini R, Aicardi G, Ciani E. Functional and Structural Impairments in the Perirhinal Cortex of a Mouse Model of CDKL5 Deficiency Disorder Are Rescued by a TrkB Agonist. Front Cell Neurosci 2019; 13:169. [PMID: 31114483 PMCID: PMC6503158 DOI: 10.3389/fncel.2019.00169] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 04/09/2019] [Indexed: 11/24/2022] Open
Abstract
Cyclin-dependent kinase-like 5 (CDKL5) deficiency disorder (CDD) is a severe X-linked neurodevelopmental encephalopathy caused by mutations in the CDKL5 gene and characterized by early-onset epilepsy and intellectual and motor impairments. No cure is currently available for CDD patients, as limited knowledge of the pathology has hindered the development of therapeutics. Cdkl5 knockout (KO) mouse models, recently created to investigate the role of CDKL5 in the etiology of CDD, recapitulate various features of the disorder. Previous studies have shown alterations in synaptic plasticity and dendritic pattern in the cerebral cortex and in the hippocampus, but the knowledge of the molecular substrates underlying these alterations is still limited. Here, we have examined for the first time synaptic function and plasticity, dendritic morphology, and signal transduction pathways in the perirhinal cortex (PRC) of this mouse model. Being interconnected with a wide range of cortical and subcortical structures and involved in various cognitive processes, PRC provides a very interesting framework for examining how CDKL5 mutation leads to deficits at the synapse, circuit, and behavioral level. We found that long-term potentiation (LTP) was impaired, and that the TrkB/PLCγ1 pathway could be mechanistically involved in this alteration. PRC neurons in mutant mice showed a reduction in dendritic length, dendritic branches, PSD-95-positive puncta, GluA2-AMPA receptor levels, and spine density and maturation. These functional and structural deficits were associated with impairment in visual recognition memory. Interestingly, an in vivo treatment with a TrkB agonist (the 7,8-DHF prodrug R13) to trigger the TrkB/PLCγ1 pathway rescued defective LTP, dendritic pattern, PSD-95 and GluA2-AMPA receptor levels, and restored visual recognition memory in Cdkl5 KO mice. Present findings demonstrate a critical role of TrkB signaling in the synaptic development alterations due to CDKL5 mutation, and suggest the possibility of TrkB-targeted pharmacological interventions.
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Affiliation(s)
- Elisa Ren
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Vincenzo Roncacé
- Department for Life Quality Studies, University of Bologna, Bologna, Italy
| | - Stefania Trazzi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Claudia Fuchs
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Giorgio Medici
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Laura Gennaccaro
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Manuela Loi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Giuseppe Galvani
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Keqiang Ye
- School of Medicine, Emory University, Atlanta, GA, United States
| | - Roberto Rimondini
- Department of Biomedical and Clinical Sciences, University of Bologna, Bologna, Italy
| | - Giorgio Aicardi
- Department for Life Quality Studies, University of Bologna, Bologna, Italy.,Interdepartmental Center "Luigi Galvani" for Integrated Studies of Bioinformatics, Biophysics and Biocomplexity, University of Bologna, Bologna, Italy
| | - Elisabetta Ciani
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
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21
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Trazzi S, De Franceschi M, Fuchs C, Bastianini S, Viggiano R, Lupori L, Mazziotti R, Medici G, Lo Martire V, Ren E, Rimondini R, Zoccoli G, Bartesaghi R, Pizzorusso T, Ciani E. CDKL5 protein substitution therapy rescues neurological phenotypes of a mouse model of CDKL5 disorder. Hum Mol Genet 2019; 27:1572-1592. [PMID: 29474534 DOI: 10.1093/hmg/ddy064] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Accepted: 02/17/2018] [Indexed: 11/13/2022] Open
Abstract
Cyclin-dependent kinase like-5 (CDKL5) disorder is a rare neurodevelopmental disease caused by mutations in the CDKL5 gene. The consequent misexpression of the CDKL5 protein in the nervous system leads to a severe phenotype characterized by intellectual disability, motor impairment, visual deficits and early-onset epilepsy. No therapy is available for CDKL5 disorder. It has been reported that a protein transduction domain (TAT) is able to deliver macromolecules into cells and even into the brain when fused to a given protein. We demonstrate that TAT-CDKL5 fusion protein is efficiently internalized by target cells and retains CDKL5 activity. Intracerebroventricular infusion of TAT-CDKL5 restored hippocampal development, hippocampus-dependent memory and breathing pattern in Cdkl5-null mice. Notably, systemically administered TAT-CDKL5 protein passed the blood-brain-barrier, reached the CNS, and rescued various neuroanatomical and behavioral defects, including breathing pattern and visual responses. Our results suggest that CDKL5 protein therapy may be an effective clinical tool for the treatment of CDKL5 disorder.
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Affiliation(s)
- Stefania Trazzi
- 1Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy
| | - Marianna De Franceschi
- 1Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy
| | - Claudia Fuchs
- 1Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy
| | - Stefano Bastianini
- 1Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy
| | - Rocchina Viggiano
- 1Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy
| | - Leonardo Lupori
- BIO@SNS lab, Scuola Normale Superiore di Pisa, 56125 Pisa, Italy
| | | | - Giorgio Medici
- 1Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy
| | - Viviana Lo Martire
- 1Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy
| | - Elisa Ren
- 1Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy
| | - Roberto Rimondini
- Department of Medical and Clinical Sciences, University of Bologna, 40126 Bologna, Italy
| | - Giovanna Zoccoli
- 1Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy
| | - Renata Bartesaghi
- 1Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy
| | - Tommaso Pizzorusso
- BIO@SNS lab, Scuola Normale Superiore di Pisa, 56125 Pisa, Italy.,NEUROFARBA Department, University of Florence, 50139 Florence, Italy.,Institute of Neuroscience, CNR, 56125 Pisa, Italy
| | - Elisabetta Ciani
- 1Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy
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22
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Dale T, Downs J, Olson H, Bergin AM, Smith S, Leonard H. Cannabis for refractory epilepsy in children: A review focusing on CDKL5 Deficiency Disorder. Epilepsy Res 2019; 151:31-39. [PMID: 30771550 DOI: 10.1016/j.eplepsyres.2019.02.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 01/15/2019] [Accepted: 02/03/2019] [Indexed: 12/20/2022]
Abstract
Severe paediatric epilepsies such as CDKL5 Deficiency Disorder (CDD) are extremely debilitating, largely due to the early-onset and refractory nature of the seizures. Existing treatment options are often ineffective and associated with a host of adverse effects, causing those that are affected to seek alternative treatments. Cannabis based products have attracted significant attention over recent years, primarily driven by reports of miraculous cures and a renewed public preference for 'natural' therapies, thus placing intense pressure on health professionals and the government for regulatory change. This study provides a comprehensive overview of the potential role for cannabis in the treatment of CDD. Key areas discussed include the history, mechanism of action, efficacy and safety of cannabis based preparations as well as the burden related to CDD. The evidence supports the use of cannabinoids, especially cannabidiol, in similar forms of refractory epilepsy including Dravet and Lennox-Gastaut syndromes. Evidence for cannabinoids specifically in CDD is limited but growing, with multiple anecdotal reports and an open-label trial showing cannabidiol to be associated with a significant reduction in seizure activity. This review provides the first comprehensive overview of the potential role for cannabis based preparations in the treatment of CDD and provides justification for further clinical and observational research.
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Affiliation(s)
- Tristan Dale
- UWA Medical School, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia(1); Telethon Kids Institute, University of Western Australia, Perth, WA, Australia(2).
| | - Jenny Downs
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia(2); School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia(3).
| | - Heather Olson
- Department of Neurology, Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, Boston, MA, USA(4).
| | - Ann Marie Bergin
- Department of Neurology, Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, Boston, MA, USA(4).
| | - Stephanie Smith
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia(2).
| | - Helen Leonard
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia(2).
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23
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Guzel O, Uysal U, Arslan N. Efficacy and tolerability of olive oil-based ketogenic diet in children with drug-resistant epilepsy: A single center experience from Turkey. Eur J Paediatr Neurol 2019; 23:143-151. [PMID: 30497921 DOI: 10.1016/j.ejpn.2018.11.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 10/20/2018] [Accepted: 11/13/2018] [Indexed: 11/15/2022]
Abstract
PURPOSE Ketogenic diet (KD) is an effective non-pharmacological treatment for drug-resistant epilepsy. The aim of this study was to investigate the efficacy, tolerability and complications of olive oil-based KD in epileptic children. METHOD In this single-center, prospective study, patients were followed up at 1, 3, 6 and 12 months after KD initiation. Initially, blood ketone levels were measured daily, and as needed thereafter to maintain the levels between 4 and 5 mmol/L. Patient demographics, seizure frequency, serum biochemistry, abdominal ultrasonography and adverse effects were recorded. Efficacy of KD was defined as ≥50% seizure reduction. RESULTS A total of 389 patients with drug-resistant epilepsy receiving KD from 2012 to 2016 were included. One hundred patients (25.7%) stopped the diet for different reasons in the first year, and 369, 314, 225 and 160 patients have been receiving KD treatment for 1, 3, 6 and 12 months, respectively. At 1, 3, 6 and 12th months, 65.8% (243/369), 74.7% (235/314), 70.6% (159/225) and 83.1% (133/160) of the patients were responders, respectively. None of the children had an increased seizure-frequency. Hyperlipidemia (50.8%), selenium deficiency (26.9%), constipation (26.2%), sleep disturbances (20.0%), nephrolithiasis (3.0%), hyperuricemia (3.0) and hepatic side effects (2.6%) were the most common complications of KD. Previous adrenocorticotropic hormone (ACTH) use due to epileptic encephalopathy and presence of constipation at baseline or during KD treatment were found the predictors of treatment efficacy. CONCLUSION KD is an effective and well-tolerated treatment option for patients with drug-resistant epilepsy. Previous history of ACTH use and constipation during KD treatment are important factors that affect the efficacy of KD treatment.
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Affiliation(s)
- Orkide Guzel
- Behçet Uz Children Hospital, Division of Pediatric Neurology, Izmir, Turkey; Mediterranean Ketogenic Diet Center, Izmir, Turkey
| | - Utku Uysal
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Nur Arslan
- Dokuz Eylul University, Division of Pediatric Metabolism and Nutrition, Izmir, Turkey.
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24
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Rout AK, Mishra J, Dehury B, Maharana J, Acharya V, Karna SK, Parida PK, Behera BK, Das BK. Structural bioinformatics insights into ATP binding mechanism in zebrafish (Danio rerio) cyclin-dependent kinase-like 5 (zCDKL5) protein. J Cell Biochem 2018; 120:9437-9447. [PMID: 30569538 DOI: 10.1002/jcb.28219] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 11/15/2018] [Indexed: 11/06/2022]
Abstract
In mammalian systems, the conserved cyclin-dependent protein kinases (CDKs) control the process of cell division and curb the transcription mechanism in response to diverse signaling events that are essential for the catalytic activity. In zebrafish, zCDKL5 portrays differential expression profiling in several tissues and presumed to play a vital role in the neuronal development. In this present study, the sequence-structure relationship and mode of ATP binding in zCDKL5 was unveiled through theoretical modeling, molecular docking, and MD simulations. Like human CDKs, the modeled zCDKL5 was found to be bipartite in nature, where, ATP binds to the central cavity of the catalytic domain through a strong network of H-bonding, electrostatic, and hydrophobic interactions. MD simulation portrayed that conserved residues, viz, Ile10, Gly11, Glu12, Val18, Val64, Glu81, Cys143, and Asp144 were indispensable for tight anchoring of ATP and contribute to the stability of the zCDKL5-ATP complex. MM/PBSA binding free energy analysis displayed that van der Waal energy (ΔG vwd ) and Electrostatic energy (ΔG ele ) were the major contributors towards the overall binding free energy. Thus, the comparative structural bioinformatics approach has shed new insights into the dynamics and ATP binding mechanism of zCDKL5. The results from the study will help to undertake further research on the role of phosphorylated CDKL5 in the onset of neurodevelopmental disorders caused by mutations in higher eukaryotic systems.
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Affiliation(s)
- Ajaya Kumar Rout
- Biotechnology Laboratory, ICAR-Central Inland Fisheries Research Institute, Kolkata, West Bengal, India
| | - Jagruti Mishra
- Department of Bioinformatics, Orissa University of Agriculture and Technology, Bhubaneswar, Odisha, India
| | - Budheswar Dehury
- Biomedical Informatics Centre, ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India.,Department of Chemistry, Technical University of Denmark, Denmark
| | - Jitendra Maharana
- Department of Bioinformatics, Orissa University of Agriculture and Technology, Bhubaneswar, Odisha, India
| | - Varsha Acharya
- Department of Bioinformatics, Orissa University of Agriculture and Technology, Bhubaneswar, Odisha, India
| | - Subodha Kumar Karna
- Biotechnology Laboratory, ICAR-Central Inland Fisheries Research Institute, Kolkata, West Bengal, India
| | - Pranaya Kumar Parida
- Biotechnology Laboratory, ICAR-Central Inland Fisheries Research Institute, Kolkata, West Bengal, India
| | - Bijay Kumar Behera
- Biotechnology Laboratory, ICAR-Central Inland Fisheries Research Institute, Kolkata, West Bengal, India
| | - Basanta Kumar Das
- Biotechnology Laboratory, ICAR-Central Inland Fisheries Research Institute, Kolkata, West Bengal, India
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25
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From molecules to medicines: the dawn of targeted therapies for genetic epilepsies. Nat Rev Neurol 2018; 14:735-745. [DOI: 10.1038/s41582-018-0099-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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26
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Lim Z, Wong K, Downs J, Bebbington K, Demarest S, Leonard H. Vagus nerve stimulation for the treatment of refractory epilepsy in the CDKL5 Deficiency Disorder. Epilepsy Res 2018; 146:36-40. [DOI: 10.1016/j.eplepsyres.2018.07.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 07/17/2018] [Accepted: 07/22/2018] [Indexed: 12/24/2022]
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27
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Mazziotti R, Lupori L, Sagona G, Gennaro M, Della Sala G, Putignano E, Pizzorusso T. Searching for biomarkers of CDKL5 disorder: early-onset visual impairment in CDKL5 mutant mice. Hum Mol Genet 2017; 26:2290-2298. [PMID: 28369421 PMCID: PMC5458338 DOI: 10.1093/hmg/ddx119] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 03/25/2017] [Indexed: 01/03/2023] Open
Abstract
CDKL5 disorder is a neurodevelopmental disorder still without a cure. Murine models of CDKL5 disorder have been recently generated raising the possibility of preclinical testing of treatments. However, unbiased, quantitative biomarkers of high translational value to monitor brain function are still missing. Moreover, the analysis of treatment is hindered by the challenge of repeatedly and non-invasively testing neuronal function. We analyzed the development of visual responses in a mouse model of CDKL5 disorder to introduce visually evoked responses as a quantitative method to assess cortical circuit function. Cortical visual responses were assessed in CDKL5 null male mice, heterozygous females, and their respective control wild-type littermates by repeated transcranial optical imaging from P27 until P32. No difference between wild-type and mutant mice was present at P25-P26 whereas defective responses appeared from P27-P28 both in heterozygous and homozygous CDKL5 mutant mice. These results were confirmed by visually evoked potentials (VEPs) recorded from the visual cortex of a different cohort. The previously imaged mice were also analyzed at P60-80 using VEPs, revealing a persistent reduction of response amplitude, reduced visual acuity and defective contrast function. The level of adult impairment was significantly correlated with the reduction in visual responses observed during development. Support vector machine showed that multi-dimensional visual assessment can be used to automatically classify mutant and wt mice with high reliability. Thus, monitoring visual responses represents a promising biomarker for preclinical and clinical studies on CDKL5 disorder.
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Affiliation(s)
- Raffaele Mazziotti
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Area San Salvi - Pad. 26, 50135 Florence, Italy
| | - Leonardo Lupori
- BIO@SNS Lab, Scuola Normale Superiore via Moruzzi, 1?56124 Pisa, Italy
| | - Giulia Sagona
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Area San Salvi - Pad. 26, 50135 Florence, Italy
| | - Mariangela Gennaro
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Area San Salvi - Pad. 26, 50135 Florence, Italy.,Institute of Neuroscience, National Research Council, via Moruzzi, 1 56124 Pisa, Italy
| | - Grazia Della Sala
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Area San Salvi - Pad. 26, 50135 Florence, Italy.,Institute of Neuroscience, National Research Council, via Moruzzi, 1 56124 Pisa, Italy
| | - Elena Putignano
- Institute of Neuroscience, National Research Council, via Moruzzi, 1?56124 Pisa, Italy
| | - Tommaso Pizzorusso
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Area San Salvi - Pad. 26, 50135 Florence, Italy.,BIO@SNS Lab, Scuola Normale Superiore via Moruzzi, 1 56124 Pisa, Italy.,Institute of Neuroscience, National Research Council, via Moruzzi, 1 56124 Pisa, Italy
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28
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Lim Z, Wong K, Olson HE, Bergin AM, Downs J, Leonard H. Use of the ketogenic diet to manage refractory epilepsy in CDKL5 disorder: Experience of >100 patients. Epilepsia 2017; 58:1415-1422. [PMID: 28605011 DOI: 10.1111/epi.13813] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2017] [Indexed: 12/30/2022]
Affiliation(s)
- Zhan Lim
- Telethon Kids Institute; University of Western Australia; West Perth Western Australia Australia
| | - Kingsley Wong
- Telethon Kids Institute; University of Western Australia; West Perth Western Australia Australia
| | - Heather E. Olson
- Division of Epilepsy and Clinical Neurophysiology; Department of Neurology; Boston Children's Hospital; Boston Massachusetts U.S.A
| | - Ann M. Bergin
- Division of Epilepsy and Clinical Neurophysiology; Department of Neurology; Boston Children's Hospital; Boston Massachusetts U.S.A
| | - Jenny Downs
- Telethon Kids Institute; University of Western Australia; West Perth Western Australia Australia
- School of Physiotherapy and Exercise Science; Curtin University; Perth Western Australia Australia
| | - Helen Leonard
- Telethon Kids Institute; University of Western Australia; West Perth Western Australia Australia
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Baba S, Sugawara Y, Moriyama K, Inaji M, Maehara T, Yamamoto T, Morio T. Amelioration of intractable epilepsy by adjunct vagus nerve stimulation therapy in a girl with a CDKL5 mutation. Brain Dev 2017; 39:341-344. [PMID: 27823948 DOI: 10.1016/j.braindev.2016.10.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 09/26/2016] [Accepted: 10/17/2016] [Indexed: 11/24/2022]
Abstract
We report the case of on an 8-year-old girl with a cyclin-dependent kinase-like 5 mutation and who underwent vagus nerve stimulation (VNS) therapy for 2years. She had developed epilepsy at the age of 6months and had severe developmental delays. Initially, she had tonic and tonic-clonic seizures; however, around the age of 5years, she also developed epileptic spasms. These seizures were never completely controlled by conventional medical treatments. At the age of 7, after VNS initiation, her seizure frequency markedly reduced, and abnormal electrical activities on her electroencephalography tests strikingly decreased. Moreover, using questionnaires, we confirmed an improvement in her quality of life in the fields of alertness and activity. Although the efficacy of VNS therapy for patients with intractable epilepsy associated with a genetic anomaly has not been fully established, adjunctive VNS therapy may widen the scope of treatment choices available to these patients.
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Affiliation(s)
- Shimpei Baba
- Department of Pediatrics, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan.
| | - Yuji Sugawara
- Department of Pediatrics, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan
| | - Kengo Moriyama
- Department of Pediatrics, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan
| | - Motoki Inaji
- Department of Neurosurgery, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan
| | - Taketoshi Maehara
- Department of Neurosurgery, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan
| | - Toshiyuki Yamamoto
- Tokyo Women's Medical University Institute for Integrated Medical Sciences, Shinjuku, Tokyo, Japan
| | - Tomohiro Morio
- Department of Pediatrics, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan
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Characterisation of Cdkl5 transcript isoforms in rat. Gene 2017; 603:21-26. [DOI: 10.1016/j.gene.2016.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 11/16/2016] [Accepted: 12/02/2016] [Indexed: 11/21/2022]
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Pizzo R, Gurgone A, Castroflorio E, Amendola E, Gross C, Sassoè-Pognetto M, Giustetto M. Lack of Cdkl5 Disrupts the Organization of Excitatory and Inhibitory Synapses and Parvalbumin Interneurons in the Primary Visual Cortex. Front Cell Neurosci 2016; 10:261. [PMID: 27965538 PMCID: PMC5124713 DOI: 10.3389/fncel.2016.00261] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 10/26/2016] [Indexed: 01/31/2023] Open
Abstract
Cyclin-dependent kinase-like 5 (CDKL5) mutations are found in severe neurodevelopmental disorders, including the Hanefeld variant of Rett syndrome (RTT; CDKL5 disorder). CDKL5 loss-of-function murine models recapitulate pathological signs of the human disease, such as visual attention deficits and reduced visual acuity. Here we investigated the cellular and synaptic substrates of visual defects by studying the organization of the primary visual cortex (V1) of Cdkl5−/y mice. We found a severe reduction of c-Fos expression in V1 of Cdkl5−/y mutants, suggesting circuit hypoactivity. Glutamatergic presynaptic structures were increased, but postsynaptic PSD-95 and Homer were significantly downregulated in CDKL5 mutants. Interneurons expressing parvalbumin, but not other types of interneuron, had a higher density in mutant V1, and were hyperconnected with pyramidal neurons. Finally, the developmental trajectory of pavalbumin-containing cells was also affected in Cdkl5−/y mice, as revealed by fainter appearance perineuronal nets at the closure of the critical period (CP). The present data reveal an overall disruption of V1 cellular and synaptic organization that may cause a shift in the excitation/inhibition balance likely to underlie the visual deficits characteristic of CDKL5 disorder. Moreover, ablation of CDKL5 is likely to tamper with the mechanisms underlying experience-dependent refinement of cortical circuits during the CP of development.
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Affiliation(s)
- Riccardo Pizzo
- Department of Neuroscience, University of Turin Turin, Italy
| | - Antonia Gurgone
- Department of Neuroscience, University of Turin Turin, Italy
| | | | - Elena Amendola
- Molecular Medicine and Medical Biotechnologies, University of Naples "Federico II" Napoli, Italy
| | - Cornelius Gross
- Mouse Biology Unit, European Molecular Biology Laboratory (EMBL) Monterotondo, Italy
| | - Marco Sassoè-Pognetto
- Department of Neuroscience, University of TurinTurin, Italy; National Institute of Neuroscience-ItalyTurin, Italy
| | - Maurizio Giustetto
- Department of Neuroscience, University of TurinTurin, Italy; National Institute of Neuroscience-ItalyTurin, Italy
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A novel CDKL5 mutation in a Japanese patient with atypical Rett syndrome. Clin Chim Acta 2016; 459:132-136. [DOI: 10.1016/j.cca.2016.06.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 05/26/2016] [Accepted: 06/02/2016] [Indexed: 12/22/2022]
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Characterisation of CDKL5 Transcript Isoforms in Human and Mouse. PLoS One 2016; 11:e0157758. [PMID: 27315173 PMCID: PMC4912119 DOI: 10.1371/journal.pone.0157758] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 06/03/2016] [Indexed: 12/21/2022] Open
Abstract
Mutations in the X-linked Cyclin-Dependent Kinase-Like 5 gene (CDKL5) cause early onset infantile spasms and subsequent severe developmental delay in affected children. Deleterious mutations have been reported to occur throughout the CDKL5 coding region. Several studies point to a complex CDKL5 gene structure in terms of exon usage and transcript expression. Improvements in molecular diagnosis and more extensive research into the neurobiology of CDKL5 and pathophysiology of CDKL5 disorders necessitate an updated analysis of the gene. In this study, we have analysed human and mouse CDKL5 transcript patterns both bioinformatically and experimentally. We have characterised the predominant brain isoform of CDKL5, a 9.7 kb transcript comprised of 18 exons with a large 6.6 kb 3’-untranslated region (UTR), which we name hCDKL5_1. In addition we describe new exonic regions and a range of novel splice and UTR isoforms. This has enabled the description of an updated gene model in both species and a standardised nomenclature system for CDKL5 transcripts. Profiling revealed tissue- and brain development stage-specific differences in expression between transcript isoforms. These findings provide an essential backdrop for the diagnosis of CDKL5-related disorders, for investigations into the basic biology of this gene and its protein products, and for the rational design of gene-based and molecular therapies for these disorders.
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Hagebeuk EEO, Marcelis CL, Alders M, Kaspers A, de Weerd AW. Two Siblings With a CDKL5 Mutation: Genotype and Phenotype Evaluation. J Child Neurol 2015; 30:1515-9. [PMID: 25762588 DOI: 10.1177/0883073815573317] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 01/20/2015] [Indexed: 01/24/2023]
Abstract
This is the second report of a family with a recurrence of a CDKL5 mutation (c. 283-3_290del) in 2 sisters. Both parents tested negative for the mutation in all tissues, but germline mosaicism is likely. Clinically CDKL5 patients resemble those with Rett syndrome, caused by a MECP2 mutation, who experience a regression, after an initial normal development. Even though both siblings showed a typical CDKL5 phenotype, their presentation is different. From birth, the oldest daughter had a severe developmental delay, feeding problems, and hypotonia and experienced daily refractory seizures. The youngest daughter appeared to be normal until age 3 months. At that age seizures started, deterioration and regression became evident, and an epileptic encephalopathy developed. This report of familial recurrence, with suspected germline mosaicism in a healthy parent, has important consequences for genetic counseling. Although it is not possible to predict an exact recurrence risk, it is likely to be increased.
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Affiliation(s)
- Eveline E O Hagebeuk
- Department of Pediatric Neurology, Stichting Epilepsie Instellingen Nederland, Zwolle, Netherlands
| | - Carlo L Marcelis
- Department of Genetics, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Mariëlle Alders
- Department of Clinical Genetics, Academic Medical Center, Amsterdam, Netherlands
| | - Ageeth Kaspers
- Department of Pediatrics, Medical Spectrum Twente, Enschede, Netherlands
| | - Al W de Weerd
- Sleepcenter of Stichting Epilepsie Instellingen Nederland (SEIN), Zwolle, Netherlands
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Agarwal J, Deepika G, Razak A, Nagesh NK, Aihole JS, Babu MN, Jagadisan B, Biswal N, Kamate M, Detroja M, Gazali ZA, Singal AK, Jain VG, Gulati R. Macroamylasemia: A benign cause for high serum amylase. Indian Pediatr 2015; 52:533. [DOI: 10.1007/s13312-015-0672-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Wong VCN, Kwong AKY. CDKL5 variant in a boy with infantile epileptic encephalopathy: case report. Brain Dev 2015; 37:446-8. [PMID: 25085838 DOI: 10.1016/j.braindev.2014.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 07/02/2014] [Accepted: 07/06/2014] [Indexed: 01/05/2023]
Abstract
UNLABELLED A Chinese boy presented at 18 months with intractable epilepsy, developmental delay and autistic features. He had multiple seizure types, including absence, myoclonic seizures, limb spasm and tonic seizures. His seizures were finally controlled at 3 years of age with clonazepam and a short course of chloral hydrate incidentally given for his insomnia. Subsequently, he had improvement in his communication skills. RESULT A novel hemizygous missense variant (c.1649G>A; p.R550Q) in exon 12 of CDKL5 gene was detected for him, his asymptomatic mother and elder sister. His phenotype is less severe than other male cases. CONCLUSION We recommend screening CDKL5 for boys with pharmarco-resistant epilepsy and a trial of benzodiazepines for Infantile Epileptic Encephalopathy (IEE).
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Affiliation(s)
- Virginia Chun-Nei Wong
- Division of Paediatric Neurology/Developmental Behavioural Paediatrics/NeuroHabilitation, Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region.
| | - Anna Ka-Yee Kwong
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
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Bosch DGM, Boonstra FN, Willemsen MAAP, Cremers FPM, de Vries BBA. Low vision due to cerebral visual impairment: differentiating between acquired and genetic causes. BMC Ophthalmol 2014; 14:59. [PMID: 24886270 PMCID: PMC4021540 DOI: 10.1186/1471-2415-14-59] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 04/28/2014] [Indexed: 11/21/2022] Open
Abstract
Background To gain more insight into genetic causes of cerebral visual impairment (CVI) in children and to compare ophthalmological findings between genetic and acquired forms of CVI. Methods The clinical data of 309 individuals (mainly children) with CVI, and a visual acuity ≤0.3 were analyzed for etiology and ocular variables. A differentiation was made between acquired and genetic causes. However, in persons with West syndrome or hydrocephalus, it might be impossible to unravel whether CVI is caused by the seizure disorder or increased intracranial pressure or by the underlying disorder (that in itself can be acquired or genetic). In two subgroups, individuals with ‘purely’ acquired CVI and with ‘purely’ genetic CVI, the ocular variables (such as strabismus, pale optic disc and visual field defects) were compared. Results It was possible to identify a putative cause for CVI in 60% (184/309) of the cohort. In the remaining 40% the etiology could not be determined. A ‘purely’ acquired cause was identified in 80 of the patients (26%). West syndrome and/or hydrocephalus was identified in 21 patients (7%), and in 17 patients (6%) both an acquired cause and West and/or hydrocephalus was present. In 66 patients (21%) a genetic diagnosis was obtained, of which 38 (12%) had other possible risk factor (acquired, preterm birth, West syndrome or hydrocephalus), making differentiation between acquired and genetic not possible. In the remaining 28 patients (9%) a ‘purely’ genetic cause was identified. CVI was identified for the first time in several genetic syndromes, such as ATR-X, Mowat-Wilson, and Pitt Hopkins syndrome. In the subgroup with ‘purely’ acquired causes (N = 80) strabismus (88% versus 64%), pale optic discs (65% versus 27%) and visual field defects (72% versus 30%) could be observed more frequent than in the subgroup with ‘purely’ genetic disorders (N = 28). Conclusions We conclude that CVI can be part of a genetic syndrome and that abnormal ocular findings are present more frequently in acquired forms of CVI.
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Affiliation(s)
| | | | | | | | - Bert B A de Vries
- Department of Human Genetics, Radboud University Medical Center, P,O, Box 9101, Nijmegen, HB 6500, The Netherlands.
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Abstract
Mutations in CDKL5 and ARX are known causes of early-onset epilepsy and severe developmental delay in males and females. Although numerous males with ARX mutations associated with various phenotypes have been reported in the literature, the majority of CDKL5 mutations have been identified in females with a phenotype characterized by early-onset epilepsy, severe global developmental delay, absent speech, and stereotypic hand movements. To date, only 10 males with CDKL5 mutations have been reported. Our retrospective study reports on the clinical, neuroimaging, and molecular findings of 18 males with early-onset epilepsy caused by either CDKL5 or ARX mutations. These 18 patients include eight new males with CDKL5 mutations and 10 with ARX mutations identified through sequence analysis of 266 and 346 males, respectively, at our molecular diagnostic laboratory. Our large dataset therefore expands on the number of reported males with CDKL5 mutations and highlights that aberrations of CDKL5 and ARX combined are an important consideration in the genetic forms of early-onset epilepsy in boys.
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Loss of CDKL5 disrupts kinome profile and event-related potentials leading to autistic-like phenotypes in mice. Proc Natl Acad Sci U S A 2012; 109:21516-21. [PMID: 23236174 DOI: 10.1073/pnas.1216988110] [Citation(s) in RCA: 142] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Mutations in the X-linked cyclin-dependent kinase-like 5 (CDKL5) gene have been identified in neurodevelopmental disorders including atypical Rett syndrome (RTT), autism spectrum disorders (ASDs), and early infantile epileptic encephalopathy. The biological function of CDKL5 and its role in the etiology of these disorders, however, remain unclear. Here we report the development of a unique knockout mouse model of CDKL5-related disorders and demonstrate that mice lacking CDKL5 show autistic-like deficits in social interaction, as well as impairments in motor control and fear memory. Neurophysiological recordings reveal alterations in event-related potentials (ERPs) similar to those observed in RTT and ASDs. Moreover, kinome profiling uncovers disruption of multiple signal transduction pathways, including the AKT-mammalian target of rapamycin (mTOR) cascade, upon Cdkl5 loss-of-function. These data demonstrate that CDKL5 regulates signal transduction pathways and mediates autistic-like phenotypes and together establish a causal role for Cdkl5 loss-of-function in neurodevelopmental disorders.
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Paine SML, Munot P, Carmichael J, Das K, Weber MA, Prabhakar P, Jacques TS. The neuropathological consequences ofCDKL5mutation. Neuropathol Appl Neurobiol 2012; 38:744-7. [DOI: 10.1111/j.1365-2990.2012.01292.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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What we know and would like to know about CDKL5 and its involvement in epileptic encephalopathy. Neural Plast 2012; 2012:728267. [PMID: 22779007 PMCID: PMC3385648 DOI: 10.1155/2012/728267] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Accepted: 04/06/2012] [Indexed: 12/11/2022] Open
Abstract
In the last few years, the X-linked serine/threonine kinase cyclin-dependent kinase-like 5 (CDKL5) has been associated with early-onset epileptic encephalopathies characterized by the manifestation of intractable epilepsy within the first weeks of life, severe developmental delay, profound hypotonia, and often the presence of some Rett-syndrome-like features. The association of CDKL5 with neurodevelopmental disorders and its high expression levels in the maturing brain underscore the importance of this kinase for proper brain development. However, our present knowledge of CDKL5 functions is still rather limited. The picture that emerges from the molecular and cellular studies suggests that CDKL5 functions are important for regulating both neuronal morphology through cytoplasmic signaling pathways and activity-dependent gene expression in the nuclear compartment. This paper surveys the current state of CDKL5 research with emphasis on the clinical symptoms associated with mutations in CDKL5, the different mechanisms regulating its functions, and the connected molecular pathways. Finally, based on the available data we speculate that CDKL5 might play a role in neuronal plasticity and we adduce and discuss some possible arguments supporting this hypothesis.
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Millichap JG. Epileptic Encephalopathies, CDKL5 Mutations, and Infantile Spasms. Pediatr Neurol Briefs 2012. [DOI: 10.15844/pedneurbriefs-26-2-3] [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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