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Ng ACH, Chahine M, Scantlebury MH, Appendino JP. Channelopathies in epilepsy: an overview of clinical presentations, pathogenic mechanisms, and therapeutic insights. J Neurol 2024; 271:3063-3094. [PMID: 38607431 DOI: 10.1007/s00415-024-12352-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 03/24/2024] [Accepted: 03/25/2024] [Indexed: 04/13/2024]
Abstract
Pathogenic variants in genes encoding ion channels are causal for various pediatric and adult neurological conditions. In particular, several epilepsy syndromes have been identified to be caused by specific channelopathies. These encompass a spectrum from self-limited epilepsies to developmental and epileptic encephalopathies spanning genetic and acquired causes. Several of these channelopathies have exquisite responses to specific antiseizure medications (ASMs), while others ASMs may prove ineffective or even worsen seizures. Some channelopathies demonstrate phenotypic pleiotropy and can cause other neurological conditions outside of epilepsy. This review aims to provide a comprehensive exploration of the pathophysiology of seizure generation, ion channels implicated in epilepsy, and several genetic epilepsies due to ion channel dysfunction. We outline the clinical presentation, pathogenesis, and the current state of basic science and clinical research for these channelopathies. In addition, we briefly look at potential precision therapy approaches emerging for these disorders.
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Affiliation(s)
- Andy Cheuk-Him Ng
- Clinical Neuroscience and Pediatric Neurology, Department of Pediatrics, Cumming School of Medicine, Alberta Children's Hospital, University of Calgary, 28 Oki Drive NW, Calgary, AB, T3B 6A8, Canada
- Division of Neurology, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta and Stollery Children's Hospital, Edmonton, AB, Canada
| | - Mohamed Chahine
- Department of Medicine, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
- CERVO, Brain Research Centre, Quebec City, Canada
| | - Morris H Scantlebury
- Clinical Neuroscience and Pediatric Neurology, Department of Pediatrics, Cumming School of Medicine, Alberta Children's Hospital, University of Calgary, 28 Oki Drive NW, Calgary, AB, T3B 6A8, Canada
- Hotchkiss Brain Institute and Alberta Children's Hospital Research Institute, Calgary, Canada
| | - Juan P Appendino
- Clinical Neuroscience and Pediatric Neurology, Department of Pediatrics, Cumming School of Medicine, Alberta Children's Hospital, University of Calgary, 28 Oki Drive NW, Calgary, AB, T3B 6A8, Canada.
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Xiang Y, Li F, Song Z, Yi Z, Yang C, Xue J, Zhang Y. Two pediatric patients with hemiplegic migraine presenting as acute encephalopathy: case reports and a literature review. Front Pediatr 2023; 11:1214837. [PMID: 37576133 PMCID: PMC10419215 DOI: 10.3389/fped.2023.1214837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 07/10/2023] [Indexed: 08/15/2023] Open
Abstract
Introduction Hemiplegic migraine (HM) is a rare subtype of migraine. HM in children may be atypical in the initial stage of the disease, which could easily lead to misdiagnosis. Methods We report two cases of atypical hemiplegic migraine that onset as an acute encephalopathy. And a comprehensive search was performed using PubMed, Web of Science, and Scopus. We selected only papers that reported complete clinical information about the patients with CACNA1A or ATP1A2 gene mutation. Results Patient #1 showed a de novo mutation, c.674C>A (p. Pro225His), in exon 5 of the CACNA1A gene. And patient #2 showed a missense mutation (c.2143G>A, p. Gly715Arg) in exon 16 of the ATP1A2. Together with our two cases, a total of 160 patients (73 CACNA1A and 87 ATP1A2) were collected and summarized finally. Discussion Acute encephalopathy is the main manifestation of severe attacks of HM in children, which adds to the difficulty of diagnosis. Physicians should consider HM in the differential diagnosis of patients presenting with somnolence, coma, or convulsion without structural, epileptic, infectious, or inflammatory explanation. When similar clinical cases appear, gene detection is particularly important, which is conducive to early diagnosis and treatment. Early recognition and treatment of the disease can help improve the prognosis.
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Affiliation(s)
| | | | | | | | | | | | - Ying Zhang
- Department of Pediatric Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China
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Noseda R. Cerebro-Cerebellar Networks in Migraine Symptoms and Headache. FRONTIERS IN PAIN RESEARCH 2022; 3:940923. [PMID: 35910262 PMCID: PMC9326053 DOI: 10.3389/fpain.2022.940923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
The cerebellum is associated with the biology of migraine in a variety of ways. Clinically, symptoms such as fatigue, motor weakness, vertigo, dizziness, difficulty concentrating and finding words, nausea, and visual disturbances are common in different types of migraine. The neural basis of these symptoms is complex, not completely known, and likely involve activation of both specific and shared circuits throughout the brain. Posterior circulation stroke, or neurosurgical removal of posterior fossa tumors, as well as anatomical tract tracing in animals, provided the first insights to theorize about cerebellar functions. Nowadays, with the addition of functional imaging, much progress has been done on cerebellar structure and function in health and disease, and, as a consequence, the theories refined. Accordingly, the cerebellum may be useful but not necessary for the execution of motor, sensory or cognitive tasks, but, rather, would participate as an efficiency facilitator of neurologic functions by improving speed and skill in performance of tasks produced by the cerebral area to which it is reciprocally connected. At the subcortical level, critical regions in these processes are the basal ganglia and thalamic nuclei. Altogether, a modulatory role of the cerebellum over multiple brain regions appears compelling, mainly by considering the complexity of its reciprocal connections to common neural networks involved in motor, vestibular, cognitive, affective, sensory, and autonomic processing—all functions affected at different phases and degrees across the migraine spectrum. Despite the many associations between cerebellum and migraine, it is not known whether this structure contributes to migraine initiation, symptoms generation or headache. Specific cerebellar dysfunction via genetically driven excitatory/inhibitory imbalances, oligemia and/or increased risk to white matter lesions has been proposed as a critical contributor to migraine pathogenesis. Therefore, given that neural projections and functions of many brainstem, midbrain and forebrain areas are shared between the cerebellum and migraine trigeminovascular pathways, this review will provide a synopsis on cerebellar structure and function, its role in trigeminal pain, and an updated overview of relevant clinical and preclinical literature on the potential role of cerebellar networks in migraine pathophysiology.
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Affiliation(s)
- Rodrigo Noseda
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- *Correspondence: Rodrigo Noseda
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Start Me Up: How Can Surrounding Gangliosides Affect Sodium-Potassium ATPase Activity and Steer towards Pathological Ion Imbalance in Neurons? Biomedicines 2022; 10:biomedicines10071518. [PMID: 35884824 PMCID: PMC9313118 DOI: 10.3390/biomedicines10071518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/21/2022] [Accepted: 06/24/2022] [Indexed: 12/04/2022] Open
Abstract
Gangliosides, amphiphilic glycosphingolipids, tend to associate laterally with other membrane constituents and undergo extensive interactions with membrane proteins in cis or trans configurations. Studies of human diseases resulting from mutations in the ganglioside biosynthesis pathway and research on transgenic mice with the same mutations implicate gangliosides in the pathogenesis of epilepsy. Gangliosides are reported to affect the activity of the Na+/K+-ATPase, the ubiquitously expressed plasma membrane pump responsible for the stabilization of the resting membrane potential by hyperpolarization, firing up the action potential and ion homeostasis. Impaired Na+/K+-ATPase activity has also been hypothesized to cause seizures by several mechanisms. In this review we present different epileptic phenotypes that are caused by impaired activity of Na+/K+-ATPase or changed membrane ganglioside composition. We further discuss how gangliosides may influence Na+/K+-ATPase activity by acting as lipid sorting machinery providing the optimal stage for Na+/K+-ATPase function. By establishing a distinct lipid environment, together with other membrane lipids, gangliosides possibly modulate Na+/K+-ATPase activity and aid in “starting up” and “turning off” this vital pump. Therefore, structural changes of neuronal membranes caused by altered ganglioside composition can be a contributing factor leading to aberrant Na+/K+-ATPase activity and ion imbalance priming neurons for pathological firing.
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Duan R, Li HM, Hu WB, Hong CG, Chen ML, Cao J, Wang ZX, Chen CY, Yin F, Hu ZH, Li JD, Xie H, Liu ZZ. Recurrent de novo single point variant on the gene encoding Na +/K + pump results in epilepsy. Prog Neurobiol 2022; 216:102310. [PMID: 35724808 DOI: 10.1016/j.pneurobio.2022.102310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/28/2022] [Accepted: 06/15/2022] [Indexed: 10/18/2022]
Abstract
The etiology of epilepsy remains undefined in two-thirds of patients. Here, we identified a de novo variant of ATP1A2 (c.2426 T > G, p.Leu809Arg), which encodes the α2 subunit of Na+/K+-ATPase, from a family with idiopathic epilepsy. This variant caused epilepsy with hemiplegic migraine in the study patients. We generated the point variant mouse model Atp1a2L809R, which recapitulated the epilepsy observed in the study patients. In Atp1a2L809R/WT mice, convulsions were observed and cognitive and memory function was impaired. This variant affected the potassium binding function of the protein, disabling its ion transport ability, thereby increasing the frequency of nerve impulses. Valproate (VPA) and Carbamazepine (CBZ) have limited therapeutic efficacy in ameliorating the epileptic syndromes of Atp1a2L809R/WT mice. Our work revealed that ATP1A2L809R variants cause a predisposition to epilepsy. Moreover, we provide a point variant mouse model for epilepsy research and drug screening.
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Affiliation(s)
- Ran Duan
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China; Movement System Injury and Repair Research Center, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Hong-Ming Li
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China; Movement System Injury and Repair Research Center, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Wen-Bao Hu
- Institute of Molecular Precision Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Chun-Gu Hong
- Movement System Injury and Repair Research Center, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Meng-Lu Chen
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China; Movement System Injury and Repair Research Center, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Jia Cao
- Movement System Injury and Repair Research Center, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Zhen-Xing Wang
- Movement System Injury and Repair Research Center, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Chun-Yuan Chen
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China; Movement System Injury and Repair Research Center, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Fei Yin
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Zhong-Hua Hu
- Institute of Molecular Precision Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Jia-Da Li
- State Key Laboratory of Medical Genetics, School of Life Sciences, Central South University, Changsha, Hunan 410078, China
| | - Hui Xie
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China; Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China; Movement System Injury and Repair Research Center, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China; Hunan Key Laboratory of Organ Injury, Aging and Regenerative Medicine, Changsha, Hunan 410008, China; Hunan Key Laboratory of Bone Joint Degeneration and Injury, Changsha, Hunan 410008, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan 410008, China.
| | - Zheng-Zhao Liu
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China; Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China; Movement System Injury and Repair Research Center, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China; Hunan Key Laboratory of Organ Injury, Aging and Regenerative Medicine, Changsha, Hunan 410008, China.
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Frattale I, Ruscitto C, Papetti L, Ursitti F, Sforza G, Moavero R, Ferilli MAN, Tarantino S, Balestri M, Vigevano F, Mazzone L, Valeriani M. Migraine and Its Equivalents: What Do They Share? A Narrative Review on Common Pathophysiological Patterns. Life (Basel) 2021; 11:1392. [PMID: 34947923 PMCID: PMC8705894 DOI: 10.3390/life11121392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/30/2021] [Accepted: 12/10/2021] [Indexed: 01/02/2023] Open
Abstract
Migraine is the first in order of frequency of the neurological disorders, affecting both adult and paediatric populations. It is also the first cause of primary headaches in children. Migraine equivalents are periodic disorders that can be associated with migraine or considered as prognostic features of a future migraine manifestation. Despite the mechanisms underlying migraine and its equivalents are not entirely clear, several elements support the hypothesis of common pathophysiological patterns shared by these conditions. The aim of this review is thus to analyze the literature in order to highlight which currently known mechanisms may be common between migraine and its equivalents.
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Affiliation(s)
- Ilaria Frattale
- Child Neurology and Psychiatry Unit, Systems Medicine Department, Tor Vergata University, Hospital of Rome, 00165 Rome, Italy; (I.F.); (C.R.); (R.M.); (L.M.)
| | - Claudia Ruscitto
- Child Neurology and Psychiatry Unit, Systems Medicine Department, Tor Vergata University, Hospital of Rome, 00165 Rome, Italy; (I.F.); (C.R.); (R.M.); (L.M.)
| | - Laura Papetti
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (L.P.); (F.U.); (G.S.); (M.A.N.F.); (S.T.); (M.B.); (F.V.)
| | - Fabiana Ursitti
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (L.P.); (F.U.); (G.S.); (M.A.N.F.); (S.T.); (M.B.); (F.V.)
| | - Giorgia Sforza
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (L.P.); (F.U.); (G.S.); (M.A.N.F.); (S.T.); (M.B.); (F.V.)
| | - Romina Moavero
- Child Neurology and Psychiatry Unit, Systems Medicine Department, Tor Vergata University, Hospital of Rome, 00165 Rome, Italy; (I.F.); (C.R.); (R.M.); (L.M.)
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (L.P.); (F.U.); (G.S.); (M.A.N.F.); (S.T.); (M.B.); (F.V.)
| | - Michela Ada Noris Ferilli
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (L.P.); (F.U.); (G.S.); (M.A.N.F.); (S.T.); (M.B.); (F.V.)
| | - Samuela Tarantino
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (L.P.); (F.U.); (G.S.); (M.A.N.F.); (S.T.); (M.B.); (F.V.)
| | - Martina Balestri
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (L.P.); (F.U.); (G.S.); (M.A.N.F.); (S.T.); (M.B.); (F.V.)
| | - Federico Vigevano
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (L.P.); (F.U.); (G.S.); (M.A.N.F.); (S.T.); (M.B.); (F.V.)
| | - Luigi Mazzone
- Child Neurology and Psychiatry Unit, Systems Medicine Department, Tor Vergata University, Hospital of Rome, 00165 Rome, Italy; (I.F.); (C.R.); (R.M.); (L.M.)
| | - Massimiliano Valeriani
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (L.P.); (F.U.); (G.S.); (M.A.N.F.); (S.T.); (M.B.); (F.V.)
- Center for Sensory-Motor Interaction, Aalborg University, 9220 Aalborg Øst, Denmark
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Eren-Koçak E, Dalkara T. Ion Channel Dysfunction and Neuroinflammation in Migraine and Depression. Front Pharmacol 2021; 12:777607. [PMID: 34858192 PMCID: PMC8631474 DOI: 10.3389/fphar.2021.777607] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 10/22/2021] [Indexed: 01/15/2023] Open
Abstract
Migraine and major depression are debilitating disorders with high lifetime prevalence rates. Interestingly these disorders are highly comorbid and show significant heritability, suggesting shared pathophysiological mechanisms. Non-homeostatic function of ion channels and neuroinflammation may be common mechanisms underlying both disorders: The excitation-inhibition balance of microcircuits and their modulation by monoaminergic systems, which depend on the expression and function of membrane located K+, Na+, and Ca+2 channels, have been reported to be disturbed in both depression and migraine. Ion channels and energy supply to synapses not only change excitability of neurons but can also mediate the induction and maintenance of inflammatory signaling implicated in the pathophysiology of both disorders. In this respect, Pannexin-1 and P2X7 large-pore ion channel receptors can induce inflammasome formation that triggers release of pro-inflammatory mediators from the cell. Here, the role of ion channels involved in the regulation of excitation-inhibition balance, synaptic energy homeostasis as well as inflammatory signaling in migraine and depression will be reviewed.
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Affiliation(s)
- Emine Eren-Koçak
- Institute of Neurological Sciences and Psychiatry, Hacettepe University, Ankara, Turkey.,Department of Psychiatry, Medical Faculty, Hacettepe University, Ankara, Turkey
| | - Turgay Dalkara
- Institute of Neurological Sciences and Psychiatry, Hacettepe University, Ankara, Turkey
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Li Y, Tang W, Kang L, Kong S, Dong Z, Zhao D, Liu R, Yu S. Functional correlation of ATP1A2 mutations with phenotypic spectrum: from pure hemiplegic migraine to its variant forms. J Headache Pain 2021; 22:92. [PMID: 34384358 PMCID: PMC8359390 DOI: 10.1186/s10194-021-01309-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/02/2021] [Indexed: 12/15/2022] Open
Abstract
Background Mutations in ATP1A2, the gene encoding the α2 subunit of Na+/K+-ATPase, are the main cause of familial hemiplegic migraine type 2 (FHM2). The clinical presentation of FHM2 with mutations in the same gene varies from pure FHM to severe forms with epilepsy and intellectual disability, but the correlation of these symptoms with different ATP1A2 mutations is still unclear. Methods Ten ATP1A2 missense mutations were selected according to different phenotypes of FHM patients. They caused pure FHM (FHM: R65W, R202Q, R593W, G762S), FHM with epilepsy (FHME: R548C, E825K, R938P), or FHM with epilepsy and intellectual disability (FHMEI: T378N, G615R, D718N). After ouabain resistance and fluorescence modification, plasmids carrying those mutations were transiently transfected into HEK293T and HeLa cells. The biochemical functions were studied including cell survival assays, membrane protein extraction, western blotting, and Na+/K+-ATPase activity tests. The electrophysiological functions of G762S, R938P, and G615R mutations were investigated in HEK293T cells using whole-cell patch-clamp. Homology modeling was performed to determine the locational distribution of ATP1A2 mutations. Results Compared with wild-type pumps, all mutations showed a similar level of protein expression and decreased cell viability in the presence of 1 µM ouabain, and there was no significant difference among the mutant groups. The changes in Na+/K+-ATPase activity were correlated with the severity of FHM phenotypes. In the presence of 100 µM ouabain, the Na+/K+-ATPase activity was FHM > FHME > FHMEI. The ouabain-sensitive Na+/K+-ATPase activity of each mutant was significantly lower than that of the wild-type protein, and there was no significant difference among all mutant groups. Whole-cell voltage-clamp recordings in HEK293T cells showed that the ouabain-sensitive pump currents of G615R were significantly reduced, while those of G762S and R938P were comparable to those of the wild-type strain. Conclusions ATP1A2 mutations cause phenotypes ranging from pure FHM to FHM with epilepsy and intellectual disability due to varying degrees of deficits in biochemical and electrophysiological properties of Na+/K+-ATPase. Mutations associated with intellectual disability presented with severe impairment of Na+/K+-ATPase. Whether epilepsy is accompanied, or the type of epilepsy did not seem to affect the degree of impairment of pump function. Supplementary Information The online version contains supplementary material available at 10.1186/s10194-021-01309-4.
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Affiliation(s)
- Yingji Li
- Department of Neurology, The First Medical Center of Chinese PLA General Hospital, Fuxing Road 28, Haidian District, 100853, Beijing, China
| | - Wenjing Tang
- Department of Neurology, The First Medical Center of Chinese PLA General Hospital, Fuxing Road 28, Haidian District, 100853, Beijing, China
| | - Li Kang
- Department of Neurology, The First Medical Center of Chinese PLA General Hospital, Fuxing Road 28, Haidian District, 100853, Beijing, China.,School of Medicine, Nankai University, 300071, Tianjin, China
| | - Shanshan Kong
- Department of Neurology, The First Medical Center of Chinese PLA General Hospital, Fuxing Road 28, Haidian District, 100853, Beijing, China
| | - Zhao Dong
- Department of Neurology, The First Medical Center of Chinese PLA General Hospital, Fuxing Road 28, Haidian District, 100853, Beijing, China
| | - Dengfa Zhao
- Department of Neurology, The First Medical Center of Chinese PLA General Hospital, Fuxing Road 28, Haidian District, 100853, Beijing, China
| | - Ruozhuo Liu
- Department of Neurology, The First Medical Center of Chinese PLA General Hospital, Fuxing Road 28, Haidian District, 100853, Beijing, China
| | - Shengyuan Yu
- Department of Neurology, The First Medical Center of Chinese PLA General Hospital, Fuxing Road 28, Haidian District, 100853, Beijing, China.
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Abstract
Migraine is a complex genetic brain disorder with an intricate pathogenesis and polymorphous clinical presentations, particularly in children. In this Perspective, we describe the different phenotypes of migraine in children, including conditions that have been referred to in the International Classification of Headache Disorders as "syndromes that may be related to migraine''. Evidence is presented for the integration of abdominal migraine, cyclical vomiting syndrome, benign paroxysmal vertigo, benign paroxysmal torticollis and infantile colic into the unified diagnosis of 'childhood migraine syndrome' on the basis of clinical and epidemiological characteristics, and shared inheritance. In our opinion, such integration will guide clinicians from specialities other than neurology to consider migraine in the assessment of children with these disorders, as well as stimulate research into the genetics, pathophysiology and clinical features of all disorders within the syndrome. A diagnosis of childhood migraine syndrome would also enable patients to benefit from inclusion in clinical trials of old and new migraine treatments, thus potentially increasing the number of treatment options available.
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Cognitive dysfunction in a patient with migraine and APT1A2 mutation: a case report. Neurol Sci 2021; 42:5425-5431. [PMID: 33904005 DOI: 10.1007/s10072-021-05284-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 04/22/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Hemiplegic migraine (HM) is a rare type of migraine with aura. Some reports have described the clinical manifestations in HM patients with the ATP1A2 mutation. But the impact of the ATP1A2 mutation on cognitive profile in HM patients has not been evaluated in detail. Here we report a patient with cognitive dysfunction in specific area. CASE PRESENTATION A 15-year-old boy with an aura that included disturbances in consciousness, associated with fever, vomiting, hemiplegia, and aphasia. He was diagnosed with HM with the ATP1A2 mutation before. He had trouble in mathematics and depicting three-dimensional things. CONCLUSIONS The HM with ATP1A2 patient could develop permanent cognitive dysfunction. Therefore, the cognitive quotient should be carefully and comprehensively evaluated.
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Hasırcı Bayır BR, Tutkavul K, Eser M, Baykan B. Epilepsy in patients with familial hemiplegic migraine. Seizure 2021; 88:87-94. [PMID: 33839563 DOI: 10.1016/j.seizure.2021.03.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 03/26/2021] [Accepted: 03/28/2021] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE The coexistence of epilepsy in familial hemiplegic migraine (FHM) has not been reviewed systematically. We investigated the associations of epilepsy in patients with FHM with CACNA1A, ATP1A2, SCN1A or PRRT2 mutations along with clinical and genetic data. MATERIALS AND METHODS We performed a search in the PubMed bibliographic database and the Cochrane Library was screened for eligible studies, from April 1997 to December 2020. Additionally, Online Mendelian Inheritance in Man (OMIM) was searched for mutations in the CACNA1A, ATP1A2, SCN1A and PRRT2 genes. Brief reports, letters, and original articles about FHM and epilepsy were included in the review if their mutations and clinical course of diseases were identified. RESULTS Of the included patients with FHM whose information could be accessed, there were 28 families and 195 individuals, 78 of whom had epilepsy; 30 patients had focal epilepsy and 30 patients had generalized epilepsy. All mutations except ATP1A2, which could not be evaluated due to insufficient data, revealed first epilepsy then HM. In 60 patients for whom the epilepsy prognosis was evaluated, only 3.5% of patients were drug-resistant, and the remainder had a self-limited course or responded to anti-epileptic drug treatment. CONCLUSION Mutations in all three and possibly four FHM genes can cause epilepsy. Contrary to our expectations, the well-known epilepsy gene SCN1A mutations are not the leading cause; the highest number of cases associated with epilepsy belongs to the ATP1A2 mutation. Drug-resistant forms of epilepsy are rare in all FHM mutations, and this information is important for counseling patients.
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Affiliation(s)
- Buse Rahime Hasırcı Bayır
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey; Department of Neurology, Haydarpaşa Numune Research and Training Hospital, Istanbul, Turkey.
| | - Kemal Tutkavul
- Department of Neurology, Haydarpaşa Numune Research and Training Hospital, Istanbul, Turkey.
| | - Metin Eser
- Department of Medical Genetics, Ümraniye Research and Training Hospital, Istanbul, Turkey.
| | - Betül Baykan
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey; Neuroscience Department, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey.
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García-Hernández JL, Corchete LA, Marcos-Alcalde Í, Gómez-Puertas P, Fons C, Lazo PA. Pathogenic convergence of CNVs in genes functionally associated to a severe neuromotor developmental delay syndrome. Hum Genomics 2021; 15:11. [PMID: 33557955 PMCID: PMC7871650 DOI: 10.1186/s40246-021-00309-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/26/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Complex developmental encephalopathy syndromes might be the consequence of unknown genetic alterations that are likely to contribute to the full neurological phenotype as a consequence of pathogenic gene combinations. METHODS To identify the additional genetic contribution to the neurological phenotype, we studied as a test case a boy, with a KCNQ2 exon-7 partial duplication, by single-nucleotide polymorphism (SNP) microarray to detect copy-number variations (CNVs). RESULTS The proband presented a cerebral palsy like syndrome with a severe motor and developmental encephalopathy. The SNP array analysis detected in the proband several de novo CNVs, nine partial gene losses (LRRC55, PCDH9, NALCN, RYR3, ELAVL2, CDH13, ATP1A2, SLC17A5, ANO3), and two partial gene duplications (PCDH19, EFNA5). The biological functions of these genes are associated with ion channels such as calcium, chloride, sodium, and potassium with several membrane proteins implicated in neural cell-cell interactions, synaptic transmission, and axon guidance. Pathogenically, these functions can be associated to cerebral palsy, seizures, dystonia, epileptic crisis, and motor neuron dysfunction, all present in the patient. CONCLUSIONS Severe motor and developmental encephalopathy syndromes of unknown origin can be the result of a phenotypic convergence by combination of several genetic alterations in genes whose physiological function contributes to the neurological pathogenic mechanism.
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Affiliation(s)
- Juan L García-Hernández
- Molecular Mechanisms of Cancer Program, Instituto de Biología Molecular y Celular del Cáncer, Consejo Superior de Investigaciones Científicas (CSIC), Universidad de Salamanca, Salamanca, Spain.,Instituto de Investigación Biomédica de Salamanca (IBSAL), Departamento de Hematología, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Luis A Corchete
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Departamento de Hematología, Hospital Universitario de Salamanca, Salamanca, Spain.,Network Center for Biomedical Research in Cancer (CIBERONC), Salamanca, Spain
| | - Íñigo Marcos-Alcalde
- Centro de Biología Molecular Severo Ochoa, CSIC-Universidad Autónoma de Madrid, Cantoblanco, Madrid, Spain.,Biosciences Research Institute, School of Experimental Sciences, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | - Paulino Gómez-Puertas
- Centro de Biología Molecular Severo Ochoa, CSIC-Universidad Autónoma de Madrid, Cantoblanco, Madrid, Spain
| | - Carmen Fons
- Neurology Department, Hospital Sant Joan de Déu, Sant Joan de Déu Research Institute, Esplugues de Llobregat, Barcelona and CIBERER, Instituto de Salud Carlos III, Barcelona, Spain.
| | - Pedro A Lazo
- Molecular Mechanisms of Cancer Program, Instituto de Biología Molecular y Celular del Cáncer, Consejo Superior de Investigaciones Científicas (CSIC), Universidad de Salamanca, Salamanca, Spain. .,Instituto de Investigación Biomédica de Salamanca (IBSAL), Departamento de Hematología, Hospital Universitario de Salamanca, Salamanca, Spain.
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Mantegazza M, Cestèle S. Pathophysiological mechanisms of migraine and epilepsy: Similarities and differences. Neurosci Lett 2017; 667:92-102. [PMID: 29129678 DOI: 10.1016/j.neulet.2017.11.025] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 11/08/2017] [Accepted: 11/08/2017] [Indexed: 01/03/2023]
Abstract
Migraine and epilepsy are episodic disorders with distinct features, but they have some clinical and pathophysiological overlaps. We review here clinical overlaps between seizures and migraine attacks, activities of neuronal networks observed during seizures and migraine attacks, and molecular and cellular mechanisms of migraine identified in genetic forms, focusing on genetic variants identified in hemiplegic migraine and their functional effects. Epilepsy and migraine can be generated by dysfunctions of the same neuronal networks, but these dysfunctions can be disease-specific, even if pathogenic mutations target the same protein. Studies of rare monogenic forms have allowed the identification of some molecular/cellular dysfunctions that provide a window on pathological mechanisms: we have begun to disclose the tip of the iceberg.
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Affiliation(s)
- Massimo Mantegazza
- Université Côte d'Azur (UCA), 660 route des Lucioles, 06560 Valbonne, Sophia Antipolis, France; Institute of Molecular and Cellular Pharmacology (IPMC), CNRS UMR7275, 660 Route des Lucioles, 06560 Valbonne, Sophia Antipolis, France.
| | - Sandrine Cestèle
- Université Côte d'Azur (UCA), 660 route des Lucioles, 06560 Valbonne, Sophia Antipolis, France; Institute of Molecular and Cellular Pharmacology (IPMC), CNRS UMR7275, 660 Route des Lucioles, 06560 Valbonne, Sophia Antipolis, France
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14
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Kingston WS, Schwedt TJ. The Relationship Between Headaches with Epileptic and Non-epileptic Seizures: a Narrative Review. Curr Pain Headache Rep 2017; 21:17. [DOI: 10.1007/s11916-017-0617-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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15
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Prontera P, Sarchielli P, Caproni S, Bedetti C, Cupini LM, Calabresi P, Costa C. Epilepsy in hemiplegic migraine: Genetic mutations and clinical implications. Cephalalgia 2017; 38:361-373. [DOI: 10.1177/0333102416686347] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective We performed a systematic review on the comorbidities of familial/sporadic hemiplegic migraine (F/SHM) with seizure/epilepsy in patients with CACNA1A, ATP1A2 or SCN1A mutations, to identify the genotypes associated and investigate for the presence of mutational hot spots. Methods We performed a search in MEDLINE and in the Human Gene Mutation and Leiden Open Variation Databases for mutations in the CACNA1A, ATP1A2 and SCN1A genes. After having examined the clinical characteristics of the patients, we selected those having HM and seizures, febrile seizures or epilepsy. For each gene, we determined both the frequency and the positions at protein levels of these mutations, as well as the penetrance of epilepsy within families. Results Concerning F/SHM-Epilepsy1 (F/SHME1) and F/SHME2 endophenotypes, we observed a prevalent involvement of the transmembrane domains, and a strong correlation in F/SHME1 when the positively charged amino acids were involved. The penetrance of epilepsy within the families was highest for patients carrying mutation in the CACNA1A gene (60%), and lower in those having SCN1A (33.3%) and ATP1A2 (30.9%) mutations. Conclusion Among the HM cases with seizure/epilepsy, we observed mutational hot spots in the transmembrane domains of CACNA1A and ATP1A2 proteins. These findings could lead to a better understanding of the pathological mechanisms underlying migraine and epilepsy, therein guaranteeing the most appropriate therapeutic approach.
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Affiliation(s)
- P Prontera
- Centro di Riferimento Regionale di Genetica Medica, Ospedale S Maria della Misericordia, Perugia, Italy
| | - P Sarchielli
- Clinica Neurologica, Università degli Studi di Perugia, Dipartimento di Medicina, Ospedale S Maria della Misericordia, Perugia, Italy
| | - S Caproni
- Clinica Neurologica, Università degli Studi di Perugia, Dipartimento di Medicina, Ospedale S Maria della Misericordia, Perugia, Italy
| | - C Bedetti
- Clinica Neurologica, Università degli Studi di Perugia, Dipartimento di Medicina, Ospedale S Maria della Misericordia, Perugia, Italy
| | - LM Cupini
- Centro Cefalee, UOC Neurologia, Ospedale S Eugenio, Rome, Italy
| | - P Calabresi
- Clinica Neurologica, Università degli Studi di Perugia, Dipartimento di Medicina, Ospedale S Maria della Misericordia, Perugia, Italy
- IRCCS Santa Lucia Foundation, Rome, Italy
| | - C Costa
- Clinica Neurologica, Università degli Studi di Perugia, Dipartimento di Medicina, Ospedale S Maria della Misericordia, Perugia, Italy
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Huang Y, Xiao H, Qin X, Nong Y, Zou D, Wu Y. The genetic relationship between epilepsy and hemiplegic migraine. Neuropsychiatr Dis Treat 2017; 13:1175-1179. [PMID: 28479855 PMCID: PMC5411172 DOI: 10.2147/ndt.s132451] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Epilepsy and migraine are common diseases of the nervous system and share genetic and pathophysiological mechanisms. Familial hemiplegic migraine is an autosomal dominant disease. It is often used as a model of migraine. Four genes often contain one or more mutations in both epilepsy and hemiplegic migraine patients (ie, CACNA1A, ATP1A2, SCN1A, and PRRT2). A better understanding of the shared genetics of epilepsy and hemiplegic migraine may reveal new strategic directions for research and treatment of both the disorders.
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Affiliation(s)
- Yiqing Huang
- Department of Neurology, Guigang City People's Hospital and the Eighth Affiliated Hospital of Guangxi Medical University, Guigang, People's Republic of China
| | - Hai Xiao
- Department of Neurology, Guigang City People's Hospital and the Eighth Affiliated Hospital of Guangxi Medical University, Guigang, People's Republic of China
| | - Xingyue Qin
- Department of Neurology, Guigang City People's Hospital and the Eighth Affiliated Hospital of Guangxi Medical University, Guigang, People's Republic of China
| | - Yuan Nong
- Department of Neurology, Guigang City People's Hospital and the Eighth Affiliated Hospital of Guangxi Medical University, Guigang, People's Republic of China
| | - Donghua Zou
- Department of Neurology, The Fifth Affiliated Hospital of Guangxi Medical University and the First People's Hospital of Nanning, Nanning, People's Republic of China
| | - Yuan Wu
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China
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17
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Plato BM. Rare Complications of Migraine With Aura. Headache 2016; 56:1373-9. [DOI: 10.1111/head.12879] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 05/27/2016] [Indexed: 01/03/2023]
Affiliation(s)
- Brian M. Plato
- Norton Headache and Concussion Center; Norton Neuroscience Institute; Louisville KY USA
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Friedrich T, Tavraz NN, Junghans C. ATP1A2 Mutations in Migraine: Seeing through the Facets of an Ion Pump onto the Neurobiology of Disease. Front Physiol 2016; 7:239. [PMID: 27445835 PMCID: PMC4914835 DOI: 10.3389/fphys.2016.00239] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 06/03/2016] [Indexed: 12/31/2022] Open
Abstract
Mutations in four genes have been identified in familial hemiplegic migraine (FHM), from which CACNA1A (FHM type 1) and SCN1A (FHM type 3) code for neuronal voltage-gated calcium or sodium channels, respectively, while ATP1A2 (FHM type 2) encodes the α2 isoform of the Na(+),K(+)-ATPase's catalytic subunit, thus classifying FHM primarily as an ion channel/ion transporter pathology. FHM type 4 is attributed to mutations in the PRRT2 gene, which encodes a proline-rich transmembrane protein of as yet unknown function. The Na(+),K(+)-ATPase maintains the physiological gradients for Na(+) and K(+) ions and is, therefore, critical for the activity of ion channels and transporters involved neuronal excitability, neurotransmitter uptake or Ca(2+) signaling. Strikingly diverse functional abnormalities have been identified for disease-linked ATP1A2 mutations which frequently lead to changes in the enzyme's voltage-dependent properties, kinetics, or apparent cation affinities, but some mutations are truly deleterious for enzyme function and thus cause full haploinsufficiency. Here, we summarize structural and functional data about the Na(+),K(+)-ATPase available to date and an overview is provided about the particular properties of the α2 isoform that explain its physiological relevance in electrically excitable tissues. In addition, current concepts about the neurobiology of migraine, the correlations between primary brain dysfunction and mechanisms of headache pain generation are described, together with insights gained recently from modeling approaches in computational neuroscience. Then, a survey is given about ATP1A2 mutations implicated in migraine cases as documented in the literature with focus on mutations that were described to completely destroy enzyme function, or lead to misfolded or mistargeted protein in particular model cell lines. We also discuss whether or not there are correlations between these most severe mutational effects and clinical phenotypes. Finally, perspectives for future research on the implications of Na(+),K(+)-ATPase mutations in human pathologies are presented.
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Affiliation(s)
- Thomas Friedrich
- Department of Physical Chemistry/Bioenergetics, Institute of Chemistry, Technical University of BerlinBerlin, Germany
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Sowell MK, Youssef PE. The Comorbidity of Migraine and Epilepsy in Children and Adolescents. Semin Pediatr Neurol 2016; 23:83-91. [PMID: 27017028 DOI: 10.1016/j.spen.2016.01.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Migraine and epilepsy share a number of clinical attributes, including pathophysiology and clinical expression. Both are paroxysmal in nature and thus constitute episodic disorders, yet either may be chronic and/or recurrent. Epileptic seizures and migraine headaches may be mistaken one for the other and may even overlap. In particular, occipital lobe seizures may be misdiagnosed as migraine auras. In this article, we review the relationship between migraine and epilepsy, including the known genetic contributions to both conditions, prodromal, ictal, and postictal headache and shared pathophysiology and treatment options. We describe clinical conditions in which both migraine and epilepsy are prominent features. Lastly, we discuss electronecephaographic abnormalities that have been known to occur in individuals with migraine.
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Affiliation(s)
- Michael K Sowell
- Department of Neurology, University of Louisville School of Medicine, Louisville, KY.
| | - Paul E Youssef
- Division of Child and Adolescent Neurology, Mayo Clinic Rochester, Rochester, MN
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Abstract
The term spreading depolarization (SD) refers to waves of abrupt, sustained mass depolarization in gray matter of the CNS. SD, which spreads from neuron to neuron in affected tissue, is characterized by a rapid near-breakdown of the neuronal transmembrane ion gradients. SD can be induced by hypoxic conditions--such as from ischemia--and facilitates neuronal death in energy-compromised tissue. SD has also been implicated in migraine aura, where SD is assumed to ascend in well-nourished tissue and is typically benign. In addition to these two ends of the "SD continuum," an SD wave can propagate from an energy-depleted tissue into surrounding, well-nourished tissue, as is often the case in stroke and brain trauma. This review presents the neurobiology of SD--its triggers and propagation mechanisms--as well as clinical manifestations of SD, including overlaps and differences between migraine aura and stroke, and recent developments in neuromonitoring aimed at better diagnosis and more targeted treatments.
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Affiliation(s)
- Jens P Dreier
- Department of Neurology, Charité University Medicine Berlin, 10117 Berlin, Germany; Department of Experimental Neurology, Charité University Medicine Berlin, 10117 Berlin, Germany; Center for Stroke Research, Charité University Medicine Berlin, 10117 Berlin, Germany.
| | - Clemens Reiffurth
- Department of Experimental Neurology, Charité University Medicine Berlin, 10117 Berlin, Germany; Center for Stroke Research, Charité University Medicine Berlin, 10117 Berlin, Germany
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Qu J, Yang ZQ, Zhang Y, Mao CX, Wang ZB, Mao XY, Zhou BT, Yin JY, He H, Long HY, Gong JE, Xiao B, Zhou HH, Liu ZQ. Common variants of ATP1A3 but not ATP1A2 are associated with Chinese genetic generalized epilepsies. J Neurol Sci 2015; 354:56-62. [DOI: 10.1016/j.jns.2015.04.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Revised: 04/01/2015] [Accepted: 04/27/2015] [Indexed: 12/26/2022]
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