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What is the role of next generation sequencing in status epilepticus? Epilepsy Behav 2019; 101:106373. [PMID: 31300382 DOI: 10.1016/j.yebeh.2019.06.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 06/11/2019] [Indexed: 02/01/2023]
Abstract
Status epilepticus is a life-threatening medical condition which requires immediate diagnosis and treatment. In children, it may be a recurrent manifestation in the context of heterogeneous severe developmental genetic encephalopathies, as well as the first neurological manifestation. Mutations in several genes have been consistently associated with status epilepticus despite none of them can be considered as 'pure' Mendelian status epilepticus gene. Most genetic conditions featuring status epilepticus can be assigned to specific phenotypic subgroups, including cortical dysplasias, inborn errors of metabolism, mitochondrial diseases, or epileptic encephalopathies and childhood syndromes. Next generation sequencing (NGS) has increased the number of genes associated with, and improved the turnaround time for molecular diagnosis of, status epilepticus, allowing more timely and rationale management choices for specific conditions. Next generation sequencing might become part of the standard of care in the near future for a large subset of patients with status epilepticus, especially in early life. At present, trios whole exome sequencing, with a first analysis of point and copy number variants of an in silico panel containing 'status epilepticus' genes might represent best choice as it would allow a rapid screening. This article is part of the Special Issue "Proceedings of the 7th London-Innsbruck Colloquium on Status Epilepticus and Acute Seizures".
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DiStefano C, Wilson RB, Hyde C, Cook EH, Thibert RL, Reiter LT, Vogel-Farley V, Hipp J, Jeste S. Behavioral characterization of dup15q syndrome: Toward meaningful endpoints for clinical trials. Am J Med Genet A 2019; 182:71-84. [PMID: 31654560 DOI: 10.1002/ajmg.a.61385] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 07/01/2019] [Accepted: 09/26/2019] [Indexed: 12/16/2022]
Abstract
Duplication of 15q11.2-q13.1 (dup15q syndrome) is one of the most common copy number variations associated with autism spectrum disorders (ASD) and intellectual disability (ID). As with many neurogenetic conditions, accurate behavioral assessment is challenging due to the level of impairment and heterogeneity across individuals. Large-scale phenotyping studies are necessary to inform future clinical trials in this and similar ID syndromes. This study assessed developmental and behavioral characteristics in a large cohort of children with dup15q syndrome, and examined differences based on genetic subtype and epilepsy status. Participants included 62 children (2.5-18 years). Across individuals, there was a wide range of abilities. Although adaptive behavior was strongly associated with cognitive ability, adaptive abilities were higher than cognitive scores. Measures of ASD symptoms were associated with cognitive ability, while parent report of challenging behavior was not. Both genetic subtype and epilepsy were related to degree of impairment across cognitive, language, motor, and adaptive domains. Children with isodicentric duplications and epilepsy showed the greatest impairment, while children with interstitial duplications showed the least. On average, participants with epilepsy experienced seizures over 53% of their lives, and half of children with epilepsy had infantile spasms. Parents of children with isodicentric duplications reported more concerns regarding challenging behaviors. Future trials in ID syndromes should employ a flexible set of assessments, allowing each participant to receive assessments that capture their skills. Multiple sources of information should be considered, and the impact of language and cognitive ability should be taken into consideration when interpreting results.
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Affiliation(s)
- Charlotte DiStefano
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California
| | - Rujuta B Wilson
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California
| | - Carly Hyde
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California
| | - Edwin H Cook
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois
| | - Ronald L Thibert
- Department of Neurology, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Lawrence T Reiter
- Department of Neurology, Pediatrics, Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis, Tennessee
| | | | - Joerg Hipp
- Roche Pharma Research and Early Development, Neuroscience, Ophthalmology and Rare Diseases, Roche Innovation Center, Basel, Switzerland
| | - Shafali Jeste
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California
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Possible Phenotypic Consequences of Structural Differences in Idic(15) in a Small Cohort of Patients. Int J Mol Sci 2019; 20:ijms20194935. [PMID: 31590400 PMCID: PMC6801911 DOI: 10.3390/ijms20194935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 09/27/2019] [Accepted: 10/03/2019] [Indexed: 01/04/2023] Open
Abstract
Among human supernumerary marker chromosomes, the occurrence of isodicentric form of 15 origin is relatively well known due to its high frequency, both in terms of gene content and associated clinical symptoms. The associated epilepsy and autism are typically more severe than in cases with interstitial 15q duplication, despite copy number gain of approximately the same genomic region. Other mechanisms besides segmental aneuploidy and epigenetic changes may also cause this difference. Among the factors influencing the expression of members of the GABAA gene cluster, the imprinting effect and copy number differences has been debated. Limited numbers of studies investigate factors influencing the interaction of GABAA cluster homologues. Five isodicentric (15) patients are reported with heterogeneous symptoms, and structural differences of their isodicentric chromosomes based on array comparative genomic hybridization results. Relations between the structure and the heterogeneous clinical picture are discussed, raising the possibility that the structure of the isodicentric (15), which has an asymmetric breakpoint and consequently a lower copy number segment, would be the basis of the imbalance of the GABAA homologues. Studies of trans interaction and regulation of GABAA cluster homologues are needed to resolve this issue, considering copy number differences within the isodicentric chromosome 15.
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Bernardo P, Del Gaudio L, Madia F, Riccio MP, Marino M, Santoro C, Caccavale C, Striano S, Bravaccio C, Coppola A. High-functioning autism spectrum disorder with fluent speech and late-onset epilepsy: an unusual presentation of Inv-Dup (15) syndrome. Neurocase 2019; 25:62-65. [PMID: 30991884 DOI: 10.1080/13554794.2019.1602144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Many neuropsychiatric phenotypes have been reported in association with rearrangements in the 15q11-q13 region. Clinical presentations can include hypotonia, developmental delay, severe/moderate intellectual disabilities, poor expressive language, difficult to treat epilepsy, and autism spectrum disorders. Here we report an additional case of a girl with inversion duplication on chromosome 15 (Inv-Dup 15) showing a peculiar and milder clinical phenotype, including atypical high-functioning autism disorder, late onset and drug-responsive epilepsy, and a relatively good language development . This report suggests that a diagnosis of Inv-Dup (15) can be suspected during more benign atypical condition with a better outcome than usually reported.
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Affiliation(s)
- Pia Bernardo
- a Department of Translational Medical Sciences, Child Neuropsychiatry , "Federico II" University of Naples , Naples , Italy.,b Department of Pediatric Neurosciences, Neuropsychiatry Unit , Santobono-Pausilipon Children's Hospital , Naples , Italy
| | - Luigi Del Gaudio
- c Department of Neuroscience, Reproductive and Odontostomatological Sciences, Epilepsy Centre , "Federico II" University of Naples , Naples , Italy
| | - Francesca Madia
- d Pediatric Neurology and Muscular Diseases Unit, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health , University of Genoa, "G. Gaslini" Institute , Genoa , Italy
| | - Maria Pia Riccio
- a Department of Translational Medical Sciences, Child Neuropsychiatry , "Federico II" University of Naples , Naples , Italy
| | - Maria Marino
- a Department of Translational Medical Sciences, Child Neuropsychiatry , "Federico II" University of Naples , Naples , Italy
| | - Claudia Santoro
- e Regional Referral Center for Neurofibromatosis, Department of Woman, Child, General and Specialistic Surgery , "Luigi Vanvitelli" University of Naples , Napoli , Italy
| | - Carmela Caccavale
- c Department of Neuroscience, Reproductive and Odontostomatological Sciences, Epilepsy Centre , "Federico II" University of Naples , Naples , Italy
| | - Salvatore Striano
- c Department of Neuroscience, Reproductive and Odontostomatological Sciences, Epilepsy Centre , "Federico II" University of Naples , Naples , Italy
| | - Carmela Bravaccio
- a Department of Translational Medical Sciences, Child Neuropsychiatry , "Federico II" University of Naples , Naples , Italy
| | - Antonietta Coppola
- c Department of Neuroscience, Reproductive and Odontostomatological Sciences, Epilepsy Centre , "Federico II" University of Naples , Naples , Italy
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[A clinical and genetic analysis of a child with supernumerary marker chromosome 15-caused mental retardation, intractable epilepsy, and central precocious puberty]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2018; 20. [PMID: 30111475 PMCID: PMC7389750 DOI: 10.7499/j.issn.1008-8830.2018.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Supernumerary marker chromosome 15 is a rare chromosome abnormality. This paper reports the clinical diagnosis and treatment, as well as genetic defects, of a child with supernumerary marker chromosome 15. The patient was a 9.5-year-old girl who had mental and motor retardation since infancy, breast development at the age of 7 years, and seizures at the age of 8.5 years. Seizures occurred with various features and could not be controlled by a variety of antiepileptic drugs. No abnormalities were found by brain magnetic resonance imaging. Electroencephalogram showed frequent epileptiform discharges. G-banding karyotype analysis, fluorescence in situ hybridization, methylation-specific multiplex ligation-dependent probe amplification, and array comparative genomic hybridization identified a de novo 15q duplication in the patient. The maternal copy number increased in the 15q11-13 region. The form of genome rearrangement was 47,XX,+inv dup(15)(pter to q13:q13 to pter). The increased copy number in the 15q11-13 region is closely related to mental retardation, intractable epilepsy, and central precocious puberty. High-resolution karyotype analysis is recommended for children with unexplained mental retardation and epilepsy.
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Matricardi S, Darra F, Spalice A, Basti C, Fontana E, Dalla Bernardina B, Elia M, Giordano L, Accorsi P, Cusmai R, De Liso P, Romeo A, Ragona F, Granata T, Concolino D, Carotenuto M, Pavone P, Pruna D, Striano P, Savasta S, Verrotti A. Electroclinical findings and long-term outcomes in epileptic patients with inv dup (15). Acta Neurol Scand 2018; 137:575-581. [PMID: 29363096 DOI: 10.1111/ane.12902] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To define the electroclinical phenotype and long-term outcomes in a cohort of patients with inv dup (15) syndrome. MATERIAL AND METHODS The electroclinical data of 45 patients (25 males) affected by inv dup (15) and seizures were retrospectively analysed, and long-term follow-up of epilepsy was evaluated. RESULTS Epilepsy onset was marked by generalized seizures in 53% of patients, epileptic spasms in 51%, focal seizures in 26%, atypical absences in 11% and epileptic falls in 9%. The epileptic syndromes defined were: generalized epilepsy (26.7%), focal epilepsy (22.3%), epileptic encephalopathy with epileptic spasms as the only seizure type (17.7%) and Lennox-Gastaut syndrome (33.3%). Drug-resistant epilepsy was detected in 55.5% of patients. There was a significant higher prevalence of seizure-free patients in those with seizure onset after the age of 5 years and with focal epilepsy, with respect to those with earlier epilepsy onset because most of these later developed an epileptic encephalopathy (69.2% vs 34.4%; P = .03), usually Lennox-Gastaut Syndrome in type. In fact, among patients with early-onset epilepsy, those presenting with epileptic spasms as the only seizure type associated with classical hypsarrhythmia achieved seizure freedom (P < .001) compared to patients with spasms and other seizure types associated with modified hypsarrhythmia. CONCLUSIONS Epilepsy in inv dup (15) leads to a more severe burden of disease. Frequently, these patients show drug resistance, in particular when epilepsy onset is before the age of five and features epileptic encephalopathy.
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Affiliation(s)
- S. Matricardi
- Department of Neuropsychiatry; Children's Hospital “G.Salesi”; Ospedali Riuniti; Ancona Italy
| | - F. Darra
- Department of Life and Reproduction Sciences; University of Verona; Verona Italy
| | - A. Spalice
- Department of Pediatrics; Division of Child Neurology; Sapienza, University of Rome; Rome Italy
| | - C. Basti
- Department of Pediatrics; University of L'Aquila; L'Aquila Italy
| | - E. Fontana
- Department of Life and Reproduction Sciences; University of Verona; Verona Italy
| | - B. Dalla Bernardina
- Department of Life and Reproduction Sciences; University of Verona; Verona Italy
| | - M. Elia
- Unit of Neurology and Clinical Neurophysiopathology; Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS); Troina (EN) Italy
| | - L. Giordano
- Department of Child and Adolescent Neuropsychiatry; Ospedali Civili; Brescia Italy
| | - P. Accorsi
- Department of Child and Adolescent Neuropsychiatry; Ospedali Civili; Brescia Italy
| | - R. Cusmai
- Child Neurology Unit; Department of Neuroscience and Neurorehabilitation; “Bambino Gesù” Children's Hospital; IRCCS; Rome Italy
| | - P. De Liso
- Child Neurology Unit; Department of Neuroscience and Neurorehabilitation; “Bambino Gesù” Children's Hospital; IRCCS; Rome Italy
| | - A. Romeo
- Department of Neuroscience; Pediatric Neurology Unit and Epilepsy Center; “Fatebenefratelli e Oftalmico” Hospital; Milan Italy
| | - F. Ragona
- Department of Pediatric Neuroscience; Foundation I.R.C.C.S. Neurological Institute ‘‘C. Besta’’; Milan Italy
| | - T. Granata
- Department of Pediatric Neuroscience; Foundation I.R.C.C.S. Neurological Institute ‘‘C. Besta’’; Milan Italy
| | - D. Concolino
- Department of Medical and Surgical Sciences; Pediatric Unit; Magna Graecia University; Catanzaro Italy
| | - M. Carotenuto
- Department of Mental Health, Physical and Preventive Medicine; Clinic of Child and Adolescent Neuropsychiatry; Università degli Studi della Campania “Luigi Vanvitelli”; Naples Italy
| | - P. Pavone
- General and Emergency Paediatrics Operative Unit; Policlinico-Vittorio Emanuele University Hospital; University of Catania; Catania Italy
| | - D. Pruna
- Epilepsy Unit; A. Cao Hospital; Cagliari Italy
| | - P. Striano
- Pediatric Neurology and Muscular Diseases Unit; Department of Neurosciences, Rehabilitation, Opthalmology, Genetics and Maternal and Child Health; G. Gaslini Institute; University of Genova; Genova Italy
| | - S. Savasta
- Department of Pediatrics; University of Pavia; Pavia Italy
| | - A. Verrotti
- Department of Pediatrics; University of L'Aquila; L'Aquila Italy
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