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Kivan H, Al Hussein S. Sturge-Weber Syndrome: A Case Embedded With All the Features of Spectrum. Cureus 2023; 15:e36224. [PMID: 37069887 PMCID: PMC10105493 DOI: 10.7759/cureus.36224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 03/18/2023] Open
Abstract
Sturge-Weber syndrome (SWS) is a rare neurocutaneous vascular disorder characterized by a facial birthmark known as a port-wine stain (PWS), eye abnormalities, and abnormal blood vessels in the brain. It is basically a multisystem disorder that can involve the nervous system, skin, and eyes (phakomatosis). We report a case of a 14-year-old female who presented to the outpatient department with a complaint of upper lip swelling. She had a visible PWS since birth on the left side of her face, which was extending onto the right side of the face as well. She had two episodes of paroxysmal hemiparesis that were four years apart. Moreover, she was diagnosed with epilepsy when she was three years old. She was treated for glaucoma as well when she was nine years old. She was diagnosed with SWS based on her medical history, grossly visible PWS, and neuroimaging findings. Treatment is mostly symptomatic, as no definitive treatment is yet available.
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Robert J, Marchand A, Mazereeuw-Hautier J, Boccara O, Martin L, Chiaverini C, Beneton N, Vabres P, Balguerie X, Plantin P, Bessis D, Barbarot S, Dadban A, Droitcourt C, Samimi M, Morel B, Caille A, Maruani A, Leducq S. Quality of life of children with capillary malformations of the lower limbs: Evolution and associated factors. Data from the French national paediatric cohort, CONAPE. Ann Dermatol Venereol 2022; 149:271-275. [PMID: 35810006 DOI: 10.1016/j.annder.2022.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 02/16/2022] [Accepted: 03/30/2022] [Indexed: 01/19/2023]
Affiliation(s)
- J Robert
- University Hospital Center of Tours (CHRU), Department of Dermatology, Unit of Pediatric Dermatology, 37044 Tours Cedex 9, France; CHRU Tours, Reference center for genodermatoses and rare skin diseases - vascular anomalies (MAGEC), 37000 Tours, France
| | - A Marchand
- University Hospital Center of Tours (CHRU), Department of Dermatology, Unit of Pediatric Dermatology, 37044 Tours Cedex 9, France; CHRU Tours, Reference center for genodermatoses and rare skin diseases - vascular anomalies (MAGEC), 37000 Tours, France; CHRU Tours, Clinical Investigation Center-Inserm 1415, 37000 Tours, France
| | - J Mazereeuw-Hautier
- Department of Dermatology and Reference center for genodermatoses and rare skin diseases (MAGEC), Hospital Larrey, University Hospital Center of Toulouse, 31059 Toulouse Cedex 9, France
| | - O Boccara
- Department of Dermatology and Reference center for genodermatoses and rare skin diseases (MAGEC), France Université Paris, Paris-centre, Institut Imagine, Hôpital Universitaire Necker-Enfants Malades, AP-HP, 75015 Paris, France
| | - L Martin
- Department of Dermatology, University Hospital Center of Angers, 49000 Angers, France
| | - C Chiaverini
- Department of Dermatology, University Hospital Center of Nice, 06000 Nice, France
| | - N Beneton
- Department of Dermatology, Hospital Center of le Mans, 72000 Le Mans, France
| | - P Vabres
- Department of Dermatology, University Hospital Center of Dijon, Reference center for genodermatoses and rare skin diseases (MAGEC), 21000 Dijon, France
| | - X Balguerie
- Department of Dermatology, University Hospital Center of Rouen, 76000 Rouen, France
| | - P Plantin
- Department of Dermatology, Hospital Center of Quimper, 29000 Quimper, France
| | - D Bessis
- Department of Dermatology, University Hospital Center of Montpellier, 34000 Montpellier, France
| | - S Barbarot
- Department of Dermatology, University Hospital Center of Nantes, 44000 Nantes, France
| | - A Dadban
- Department of Dermatology, University Hospital Center of Amiens, 80000 Amiens, France
| | - C Droitcourt
- Department of Dermatology, University Hospital Center of Rennes, 35000 Rennes, France
| | - M Samimi
- University Hospital Center of Tours (CHRU), Department of Dermatology, Unit of Pediatric Dermatology, 37044 Tours Cedex 9, France
| | - B Morel
- CHRU Tours, Reference center for genodermatoses and rare skin diseases - vascular anomalies (MAGEC), 37000 Tours, France; CHRU Tours, Department of Pediatric Radiology, 37000 Tours, France
| | - A Caille
- CHRU Tours, Clinical Investigation Center-Inserm 1415, 37000 Tours, France; Universities of Tours and Nantes, SPHERE-INSERM 1246, 37000 Tours, France
| | - A Maruani
- University Hospital Center of Tours (CHRU), Department of Dermatology, Unit of Pediatric Dermatology, 37044 Tours Cedex 9, France; CHRU Tours, Reference center for genodermatoses and rare skin diseases - vascular anomalies (MAGEC), 37000 Tours, France; CHRU Tours, Clinical Investigation Center-Inserm 1415, 37000 Tours, France; Universities of Tours and Nantes, SPHERE-INSERM 1246, 37000 Tours, France
| | - S Leducq
- University Hospital Center of Tours (CHRU), Department of Dermatology, Unit of Pediatric Dermatology, 37044 Tours Cedex 9, France; CHRU Tours, Reference center for genodermatoses and rare skin diseases - vascular anomalies (MAGEC), 37000 Tours, France; Universities of Tours and Nantes, SPHERE-INSERM 1246, 37000 Tours, France.
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Powell S, Fosi T, Sloneem J, Hawkins C, Richardson H, Aylett S. Neurological presentations and cognitive outcome in Sturge-Weber syndrome. Eur J Paediatr Neurol 2021; 34:21-32. [PMID: 34293629 DOI: 10.1016/j.ejpn.2021.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 06/03/2021] [Accepted: 07/07/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION This study of children with Sturge-Weber syndrome (SWS) profiled neurological presentations; compared patients with (+) and without (-) port-wine stain (PWS); and determined risk factors for intellectual and language impairments. METHODS A retrospective case note review was conducted at a national centre. RESULTS This cohort (n = 140, male 72, median follow up 114 months) showed sex parity. Intellectual disability ("ID": IQ ≤ 70) affected half (66), being severe (IQ ≤ 40) in two-fifths (27) with ID. Language disorder (core score≤70) affected half (57). Neurological presentations were: status epilepticus 57% (80), hemiplegia 58% (81), headaches 36% (50) and acutely acquired neurological deficits lasting over 24 h 40% (56). One-seventh (20) were PWS(-). This group had: fewer lobes with angioma (p < 0.0001); and less frequent ID (p = 0.002) or language disorder (p = 0.013). Seizure frequency and status epilepticus prevalence did not differ from PWS(+). ID and language disorder were associated with: more lobes with angioma; earlier seizure onset; more frequent status epilepticus and seizure clusters. On multivariable analysis recurrent status epilepticus (p = 0.037) and multi-lobe involvement (p = 0.002) increased the risk of severe intellectual disability. Active epilepsy was associated with language disorder (p = 0.030). CONCLUSIONS This is the largest reported series documenting detailed developmental profiles of children with SWS, including ID and ASD. PWS(+) shows high rates of ID and language disorder. PWS(-) SWS has a more favourable outcome. Cognitive outcome is contingent on number of affected lobes and bilateral involvement. Epilepsy exerts an additional deleterious effect on language and cognition. A high percentage of children have a history of status epilepticus, with evidence that this impacts language and cognitive outcomes. Acutely acquired neurological deficits did not penalise either. Regular structured clinical and developmental assessment permit greater identification of neurological and neurodevelopmental impairments in SWS, and appropriate support.
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Affiliation(s)
- Sebastian Powell
- University College London Medical School, London, Gower Street, WC1E 6BT, United Kingdom.
| | - Tangunu Fosi
- Great Ormond Street Hospital for Children Neurodisability Department, Great Ormond Street, UCL Great Ormond Street Institute of Child Health Clinical Neurosciences, London, United Kingdom
| | - Jenny Sloneem
- Great Ormond Street Hospital for Children Neurodisability Department, Great Ormond Street, London, United Kingdom
| | - Christina Hawkins
- Great Ormond Street Hospital for Children Neurodisability Department, Great Ormond Street, London, United Kingdom
| | - Hanna Richardson
- Great Ormond Street Hospital for Children Neurodisability Department, Great Ormond Street, London, United Kingdom
| | - Sarah Aylett
- Great Ormond Street Hospital for Children Neurodisability Department, Great Ormond Street, UCL Great Ormond Street Institute of Child Health Clinical Neurosciences, London, United Kingdom
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Sloneem J, Moss J, Powell S, Hawkins C, Fosi T, Richardson H, Aylett S. The prevalence and profile of autism in Sturge-Weber syndrome. J Autism Dev Disord 2021; 52:1942-1955. [PMID: 34043129 DOI: 10.1007/s10803-021-05062-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2021] [Indexed: 10/21/2022]
Abstract
A systematic retrospective case note review was undertaken to investigate autism diagnostic factors in 124 individuals with Sturge-Weber syndrome (SWS). Social Responsiveness Scale questionnaires were then analysed to explore the severity and profile of autism characteristics in 70 participants. Thirty-two to forty percent of participants had a clinical diagnosis of autism and half of those without a diagnosis showed significant social communication difficulties. Children had a relative strength in social awareness and social motivation, which are typically much reduced in people with autism. This finding may explain why, to date, the diagnosis has often been overlooked in this population. The research therefore suggests that children with Sturge-Weber should be screened to identify social communications difficulties and provided with timely support.
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Affiliation(s)
- Jenny Sloneem
- Neurodisability Psychology, Great Ormond Street Hospital, London, WC1N 3JH, UK.
| | - Jo Moss
- University of Surrey, Guilford, GU2 7XH, Surrey, UK
| | - Sebastian Powell
- Great Ormond Street Hospital, London, WC1N 3JH, UK.,University College London, London, WC1E 6BT, UK
| | | | - Tang Fosi
- UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
| | | | - Sarah Aylett
- Great Ormond Street Hospital, London, WC1N 3JH, UK
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The lump of the medial canthus as diagnostic clue to cerebro-facial venous metameric syndrome: Report of a case. North Clin Istanb 2020; 7:508-511. [PMID: 33163889 PMCID: PMC7603845 DOI: 10.14744/nci.2020.02259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 06/15/2020] [Indexed: 11/23/2022] Open
Abstract
The Cerebro-Facial Venous Metameric Syndrome is characterized by ipsilateral venous/lymphatic anomalies involving simultaneously the brain and the face with a metameric distribution. This case report to describe a case of Cerebro-Facial Venous Metameric Syndrome presenting with a lump of the medial canthus. This was a case report a 24-year-old woman with a history of a mild headache, complained of a sporadic (at least once a month) serous leakage from the left eye and a small cutaneous protuberance in the left medial canthus, without focal neurological symptoms. The patient underwent brain Magnetic Resonance Imaging and findings were suggestive of a Cerebro-Facial Venous Metameric Syndrome 1-2. When multiple and ipsilateral vascular anomalies are observed, it should be considered the presence of Cerebro-Facial Metameric Syndrome, even without neurological symptoms and port-wine stains. Follow-up is mandatory, especially if there are cavernomas or facial arterio-venous malformations due to the risk of bleeding.
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Sturge-Weber syndrome: an update on the relevant issues for neurosurgeons. Childs Nerv Syst 2020; 36:2553-2570. [PMID: 32564157 DOI: 10.1007/s00381-020-04695-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/21/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Sturge-Weber syndrome (SWS) is a neurocutaneous facomatosis characterized by facial and leptomeningeal angioma, glaucoma, seizures, and neurological disability. Therefore, a challenging multidisciplinary interaction is required for its management. The goal of this paper is to review the main aspects of SWS and to present an illustrative pediatric series. METHODS The pertinent literature has been analyzed, focused mainly on etiopathogenesis, pathology, clinical features, diagnostic tools, management, and outcome of the disease. Moreover, a series of 11 children operated on for refractory epilepsy between 2005 and 2015 (minimum follow-up 5 years, mean follow-up 9.6 years) is reported. The series consists of six boys and five girls with 6.5-month and 16.2-month mean age at seizure onset and at surgery, respectively. Seizures affected all children, followed by hemiparesis and psychomotor delay (81%), glaucoma (54%), and other neurological deficits (45%). RESULTS All children underwent hemispherectomy (anatomical in three cases, functional in two cases, hemispherotomy in six cases); one patient needed a redo hemispherotomy. Mortality was nil; disseminated intravascular coagulation and interstitial pneumonia occurred in one patient each; three children had subdural fluid collection. Eight patients (72%) are in the ILAE Class 1 (completely seizure and aura free), two in Class 2 (only auras, no seizure), and one in Class 3 (1-3 seizure days per year). AEDs discontinuation was possible in 73% of cases. The most important news from the literature concerned the pathogenesis (role of the mutation of the GNAQ gene in the abnormal SWS vasculogenesis), the clinical findings (the features and pathogenesis of the stroke-like episodes are being understood), the diagnostic tools (quantitative MRI and EEG), and both the medical (migraine, seizures) and surgical management (epilepsy). The epileptic outcome of SWS patients is very good (80% are seizure-free), if compared with other hemispheric syndromes. The quality of life is affected by the neurological and cognitive deficits. CONCLUSIONS SWS still is an etiological and clinical challenge. However, the improvements over the time are consistent. In particular, the neurosurgical treatment of refractory epilepsy provides very good results as long as the indication to treatment is correct.
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Sebold AJ, Ahmed AS, Ryan TC, Cohen BA, Jampel HD, Suskauer SJ, Zabel TA, Comi AM, Rybczynski S. Suicide Screening in Sturge-Weber Syndrome: An Important Issue in Need of Further Study. Pediatr Neurol 2020; 110:80-86. [PMID: 32660870 DOI: 10.1016/j.pediatrneurol.2020.03.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 02/17/2020] [Accepted: 03/08/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Sturge-Weber syndrome is a neurocutaneous disorder associated with epilepsy, glaucoma, cognitive impairments, and a port-wine birthmark. Although individuals with Sturge-Weber syndrome are vulnerable to known risk factors for suicide, including chronic illness and physical differences (port-wine birthmark), frequency of suicidal ideation and attempts, and the clinical factors associated with suicide risk, in patients with Sturge-Weber syndrome is unknown. METHODS As a part of routine hospital practice, all outpatients aged eight years and older underwent suicide risk screening during nursing triage using a standardized suicide screening tool. Suicide risk screening results, demographic variables, and medical history (as available) for patients with Sturge-Weber syndrome (N = 34; median age = 15.5; range = 8 to 47 years, 44% male) and other neurological conditions seen at the same institution (N = 369; median age = 14; range = 8 to 78 years, 66% male) were used for retrospective within- and between-group analysis. RESULTS In the combined sample of Sturge-Weber syndrome and neurologically involved patients, a positive suicide risk screen was related to Sturge-Weber syndrome diagnosis (P = 0.043); analysis by sex showed increased risk of Sturge-Weber syndrome diagnosis in males (P = 0.008), but not in females. Within the Sturge-Weber syndrome group, use of a selective serotonin reuptake inhibitor (P = 0.019) was related to a positive risk screen. CONCLUSION People with Sturge-Weber syndrome may be at greater risk of suicidal thoughts or behaviors than those with other neurological conditions. Further study of suicide risk in patients with Sturge-Weber syndrome is needed.
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Affiliation(s)
- Alison J Sebold
- Neurology, Hugo Moser Kennedy Krieger Research Institute, Baltimore, Maryland
| | - Amelia S Ahmed
- DeBusk College of Osteopathic Medicine, Lincoln Memorial University, Harrogate, Tennessee
| | - Taylor C Ryan
- Johns Hopkins University, School of Public Health, Baltimore, Maryland
| | - Bernard A Cohen
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Henry D Jampel
- Glaucoma Center of Excellence, Wilmer Ophthalmological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stacy J Suskauer
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland; Kennedy Krieger Institute, Baltimore, Maryland; Johns Hopkins University School of Medicine, Departments of Physical Medicine and Rehabilitation, Baltimore, Maryland
| | - T Andrew Zabel
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, Maryland; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Anne M Comi
- Neurology, Hugo Moser Kennedy Krieger Research Institute, Baltimore, Maryland; Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland.
| | - Suzanne Rybczynski
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Pediatric Rehabilitation Medicine, Kennedy Krieger Institute, Baltimore, Maryland
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Kalaitzi CK, Sakkas D. Brief psychotic disorder associated with Sturge—Weber syndrome. Eur Psychiatry 2020; 20:356-7. [PMID: 16018933 DOI: 10.1016/j.eurpsy.2005.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2005] [Accepted: 04/19/2005] [Indexed: 11/20/2022] Open
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Luat AF, Juhász C, Loeb JA, Chugani HT, Falchek SJ, Jain B, Greene-Roethke C, Amlie-Lefond C, Ball KL, Davis A, Pinto A. Neurological Complications of Sturge-Weber Syndrome: Current Status and Unmet Needs. Pediatr Neurol 2019; 98:31-38. [PMID: 31272784 DOI: 10.1016/j.pediatrneurol.2019.05.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 05/28/2019] [Accepted: 05/30/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE We aimed to identify the current status and major unmet needs in the management of neurological complications in Sturge-Weber syndrome. METHODS An expert panel consisting of neurologists convened during the Sturge-Weber Foundation Clinical Care Network conference in September 2018. Literature regarding current treatment strategies for neurological complications was reviewed. RESULTS Although strong evidence-based standards are lacking, the implementation of consensus-based standards of care and outcome measures to be shared across all Sturge-Weber Foundation Clinical Care Network Centers are needed. Each patient with Sturge-Weber syndrome should have an individualized seizure action plan. There is a need to determine the appropriate abortive and preventive treatment of migraine headaches in Sturge-Weber syndrome. Likewise, a better understanding and better diagnostic modalities and treatments are needed for stroke-like episodes. As behavioral problems are common, the appropriate screening tools for mental illnesses and the timing for screening should be established. Brain magnetic resonance imaging (MRI) preferably done after age one year is the primary imaging modality of choice to establish the diagnosis, although advances in MRI techniques can improve presymptomatic diagnosis to identify patients eligible for preventive drug trials. CONCLUSION We identified the unmet needs in the management of neurological complications in Sturge-Weber syndrome. We define a minimum standard brain MRI protocol to be used by Sturge-Weber syndrome centers. Future multicenter clinical trials on specific treatments of Sturge-Weber syndrome-associated neurological complications are needed. An improved national clinical database is critically needed to understand its natural course, and for retrospective and prospective measures of treatment efficacy.
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Affiliation(s)
- Aimee F Luat
- Department of Pediatrics, Wayne State University Children's Hospital of Michigan, Detroit, Michigan; Department of Neurology, Wayne State University Children's Hospital of Michigan, Detroit, Michigan
| | - Csaba Juhász
- Department of Pediatrics, Wayne State University Children's Hospital of Michigan, Detroit, Michigan; Department of Neurology, Wayne State University Children's Hospital of Michigan, Detroit, Michigan
| | - Jeffrey A Loeb
- Department of Neurology and Rehabilitation, University of Illinois, Chicago, Illinois
| | - Harry T Chugani
- Department of Neurology, New York University School of Medicine, New York, New York
| | - Stephen J Falchek
- Department of Neurology, Nemours duPont Hospital for Children, Wilmington, Delaware; Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Badal Jain
- Department of Neurology, Nemours duPont Hospital for Children, Wilmington, Delaware; Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Carol Greene-Roethke
- Department of Neurology, Nemours duPont Hospital for Children, Wilmington, Delaware; Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | | | - Amy Davis
- Department of Neurosciences, Cook Children's Healthcare System, Forth Worth, Texas
| | - Anna Pinto
- Department of Neurology, Harvard Medical School, Children's Hospital Boston, Boston, Massachusetts.
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Gallop F, Fosi T, Prabhakar P, Aylett SE. Flunarizine for Headache Prophylaxis in Children With Sturge-Weber Syndrome. Pediatr Neurol 2019; 93:27-33. [PMID: 30686627 DOI: 10.1016/j.pediatrneurol.2018.11.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 11/14/2018] [Accepted: 11/20/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Children with Sturge-Weber syndrome can experience severe headache with or without transient hemiparesis. Flunarizine, a calcium antagonist, has been used for migraine. The experience with flunarizine for headache in a cohort of children at a national center for Sturge-Weber syndrome is reviewed, reporting its efficacy and adverse effect in this population. METHODS We collected data from health care professionals' documentation on headache (severity, frequency, duration) before and on flunarizine in 20 children with Sturge-Weber syndrome. Adverse effects reported during flunarizine treatment were collated. The Wilcoxon signed rank test was used to determine the significance of pre- versus post-treatment effect. RESULTS Flunarizine was used for headache alone (13) or mixed migrainous episodes and vascular events (7). The median duration of treatment was 145 days (range 43 to 1864 days). Flunarizine reduced headache severity (z = -3.354, P = 0.001), monthly frequency (z = -2.585, P = 0.01), and duration (z = -2.549, P = 0.01). Flunarizine was discontinued owing to intolerable adverse effects in a minority (2). Sedation and weight gain were the most common side effects. There were no reports of behavior change or extrapyramidal features. CONCLUSIONS The most effective management for headaches in patients with Sturge-Weber syndrome has not been established. This retrospective observational study found benefit of flunarizine prophylaxis on headache severity, frequency, and duration in children with Sturge-Weber syndrome without severe side effects. Flunarizine is not licensed for use in the United Kingdom, but these data support its off-license specialist use for headache prophylaxis in Sturge-Weber syndrome.
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Affiliation(s)
- Felicity Gallop
- Neurosciences, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Tangunu Fosi
- Neurosciences, Great Ormond Street Hospital NHS Foundation Trust, London, UK; Clinical Neurosciences, UCL- Institute of Child Health, London, UK.
| | - Ponnudas Prabhakar
- Neurosciences, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Sarah Elizabeth Aylett
- Neurosciences, Great Ormond Street Hospital NHS Foundation Trust, London, UK; Clinical Neurosciences, UCL- Institute of Child Health, London, UK
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Gittins S, Steel D, Brunklaus A, Newsom-Davis I, Hawkins C, Aylett SE. Autism spectrum disorder, social communication difficulties, and developmental comorbidities in Sturge-Weber syndrome. Epilepsy Behav 2018; 88:1-4. [PMID: 30195931 DOI: 10.1016/j.yebeh.2018.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 08/05/2018] [Accepted: 08/06/2018] [Indexed: 11/18/2022]
Abstract
Sturge-Weber syndrome (SWS) is a neurocutaneous disorder characterized by the combination of a facial naevus flammeus and pial angioma, often associated with learning difficulties and/or epilepsy. Here, we report on the neuropsychological characteristics of a cohort of 92 children with SWS seen at a national referral center between 2002 and 2015. Almost a quarter (24%) had a diagnosis of autism spectrum disorder (ASD), with 45% overall having evidence of social communication difficulties (SCD). Autism spectrum disorder was more commonly seen in those individuals with bilateral angioma (p = 0.021). Significant behavioral difficulties were reported in 50% while 26% had difficulties with sleep. Difficulties with social communication, behavior, and sleep were closely associated with one another. They were not, however, significantly associated with markers of epilepsy severity and were noted to occur even in children without epilepsy. The prevalence of ASD/SCD, sleep difficulties, and behavioral disorders seen in SWS is high and reflects the complex needs of this group.
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Affiliation(s)
- Samuel Gittins
- Neurosciences Department, Great Ormond Street Hospital NHS Foundation Trust, London, UK; University College London Medical School, London, UK
| | - Dora Steel
- Neurosciences Department, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Andreas Brunklaus
- Neurosciences Department, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Imogen Newsom-Davis
- Neurosciences Department, Great Ormond Street Hospital NHS Foundation Trust, London, UK; Developmental Neurosciences Programme of the UCL Institute of Child Health, London, UK
| | - Christina Hawkins
- Neurosciences Department, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Sarah E Aylett
- Neurosciences Department, Great Ormond Street Hospital NHS Foundation Trust, London, UK; Developmental Neurosciences Programme of the UCL Institute of Child Health, London, UK.
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Mohammadipanah F, Salimi F. Potential biological targets for bioassay development in drug discovery of Sturge-Weber syndrome. Chem Biol Drug Des 2017; 91:359-369. [PMID: 28941044 DOI: 10.1111/cbdd.13112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 06/10/2017] [Accepted: 09/18/2017] [Indexed: 01/02/2023]
Abstract
Sturge-Weber Syndrome (SWS) is a neurocutaneous disease with clinical manifestations including ocular (glaucoma), cutaneous (port-wine birthmark), neurologic (seizures), and vascular problems. Molecular mechanisms of SWS pathogenesis are initiated by the somatic mutation in GNAQ. Therefore, no definite treatments exist for SWS and treatment options only mitigate the intensity of its clinical manifestations. Biological assay design for drug discovery against this syndrome demands comprehensive knowledge on mechanisms which are involved in its pathogenesis. By analysis of the interrelated molecular targets of SWS, some in vitro bioassay systems can be allotted for drug screening against its progression. Development of such platforms of bioassay can bring along the implementation of high-throughput screening of natural or synthetic compounds in drug discovery programs. Regarding the fact that study of molecular targets and their integration in biological assay design can facilitate the process of effective drug discovery; some potential biological targets and their respective biological assay for SWS drug discovery are propounded in this review. For this purpose, some biological targets for SWS drug discovery such as acetylcholinesterase, alkaline phosphatase, GABAergic receptors, Hypoxia-Inducible Factor (HIF)-1α and 2α are suggested.
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Affiliation(s)
- Fatemeh Mohammadipanah
- Department of Microbial Biotechnology, School of Biology and Center of Excellence in Phylogeny of Living Organisms, College of Science, University of Tehran, Tehran, Iran
| | - Fatemeh Salimi
- Department of Microbial Biotechnology, School of Biology and Center of Excellence in Phylogeny of Living Organisms, College of Science, University of Tehran, Tehran, Iran
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Maraña Pérez A, Ruiz-Falcó Rojas M, Puertas Martín V, Domínguez Carral J, Carreras Sáez I, Duat Rodríguez A, Sánchez González V. Analysis of Sturge–Weber syndrome: A retrospective study of multiple associated variables. NEUROLOGÍA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.nrleng.2015.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Comi AM, Sahin M, Hammill A, Kaplan EH, Juhász C, North P, Ball KL, Levin AV, Cohen B, Morris J, Lo W, Roach ES. Leveraging a Sturge-Weber Gene Discovery: An Agenda for Future Research. Pediatr Neurol 2016; 58:12-24. [PMID: 27268758 PMCID: PMC5509161 DOI: 10.1016/j.pediatrneurol.2015.11.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 11/21/2015] [Indexed: 12/20/2022]
Abstract
Sturge-Weber syndrome (SWS) is a vascular neurocutaneous disorder that results from a somatic mosaic mutation in GNAQ, which is also responsible for isolated port-wine birthmarks. Infants with SWS are born with a cutaneous capillary malformation (port-wine birthmark) of the forehead or upper eyelid which can signal an increased risk of brain and/or eye involvement prior to the onset of specific symptoms. This symptom-free interval represents a time when a targeted intervention could help to minimize the neurological and ophthalmologic manifestations of the disorder. This paper summarizes a 2015 SWS workshop in Bethesda, Maryland that was sponsored by the National Institutes of Health. Meeting attendees included a diverse group of clinical and translational researchers with a goal of establishing research priorities for the next few years. The initial portion of the meeting included a thorough review of the recent genetic discovery and what is known of the pathogenesis of SWS. Breakout sessions related to neurology, dermatology, and ophthalmology aimed to establish SWS research priorities in each field. Key priorities for future development include the need for clinical consensus guidelines, further work to develop a clinical trial network, improvement of tissue banking for research purposes, and the need for multiple animal and cell culture models of SWS.
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Affiliation(s)
- Anne M Comi
- Department of Neurology, Kennedy Krieger Institute and Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Mustafa Sahin
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Adrienne Hammill
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
| | - Emma H Kaplan
- Department of Neurology, Kennedy Krieger Institute and Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Csaba Juhász
- Department of Pediatrics, Wayne State University School of Medicine, Detroit, Michigan; Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan
| | - Paula North
- Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Karen L Ball
- The Sturge-Weber Foundation, Randolph, New Jersey
| | - Alex V Levin
- Department of Ophthalmology, Wills Eye Hospital, Sidney Kimmel Medical College, Thomas University, Philadelphia, Pennsylvania; Department of Pediatrics, Wills Eye Hospital, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Bernard Cohen
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jill Morris
- National Institute of Neurologic Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Warren Lo
- Departments of Pediatrics and Neurology, The Ohio State University College of Medicine and Nationwide Children's Hospital, Columbus, Ohio
| | - E Steve Roach
- Departments of Pediatrics and Neurology, The Ohio State University College of Medicine and Nationwide Children's Hospital, Columbus, Ohio
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Maraña Pérez AI, Ruiz-Falcó Rojas ML, Puertas Martín V, Domínguez Carral J, Carreras Sáez I, Duat Rodríguez A, Sánchez González V. Analysis of Sturge-Weber syndrome: A retrospective study of multiple associated variables. Neurologia 2016; 32:363-370. [PMID: 26964511 DOI: 10.1016/j.nrl.2015.12.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 12/10/2015] [Accepted: 12/21/2015] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Sturge-Weber syndrome is a congenital vascular disorder characterised by facial capillary malformation (port-wine stain) associated with venous and capillary malformations in the brain and eye. Neurological symptoms and alterations in other locations may also be observed. OBJECTIVES This study describes the clinical and epidemiological characteristics and different treatments in a cohort of patients diagnosed with Sturge-Weber syndrome in a tertiary hospital. MATERIAL AND METHODS This comparative, retrospective and cross-sectional study was conducted by reviewing the medical records of patients diagnosed with Sturge-Weber syndrome between 1998 and 2013. RESULTS The study included 13 patients (54% male, 46% female) diagnosed with Sturge-Weber syndrome. The mean age at diagnosis was 15 months. Leptomeningeal angiomatosis was present in 100% of cases: right hemisphere (46%), left hemisphere (38%), and bilateral (15%). Facial angioma was present in 61% of the cases: right (23%), left (38%) and bilateral (7%). Other skin disorders were found in 23% of the cases, including 2 with hemilateral involvement on the side where facial and leptomeningeal angiomatosis was present and one case of generalised cutis marmorata. Ocular disease was found in 77% of patients; the most common conditions were glaucoma (46%), strabismus (23%) and choroidal angioma (23%). Epilepsy was present in 100% of the cases, with partial seizures (simple or complex) being the most frequent (62%). Seizure control was highly variable; 31% of the patients had needed to try more than 3 drugs, 15% 3 drugs, and 31% 2 drugs, while 23% experienced good seizure control with monotherapy. One patient required surgery for epilepsy (left hemispherectomy) and has been seizure-free since then. The most frequent observations in electroencephalograms were spikes, polyspikes, and wave spikes in the lobes affected by leptomeningeal angiomatosis (46%). Other neurological symptoms were hemiparesis (39%), recurrent headaches (39%), stroke-like episodes (23%), psychomotor retardation (46%), and mental retardation (46%). Leptomeningeal calcifications could be seen in 85% of patient MRIs, as well as increased calcification in 70%; 54% of the patients had been treated with aspirin. CONCLUSIONS There are multiple clinical manifestations of Sturge-Weber syndrome. Being familiar with all of them is vitally important for diagnosing and for monitoring and treating the condition correctly, which will improve the quality of life of these patients.
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Affiliation(s)
- A I Maraña Pérez
- Servicio de Neuropediatría, Hospital Infantil Universitario Niño Jesús, Madrid, España.
| | - M L Ruiz-Falcó Rojas
- Servicio de Neuropediatría, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - V Puertas Martín
- Servicio de Neuropediatría, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - J Domínguez Carral
- Servicio de Neuropediatría, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - I Carreras Sáez
- Servicio de Neuropediatría, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - A Duat Rodríguez
- Servicio de Neuropediatría, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - V Sánchez González
- Servicio de Neuropediatría, Hospital Infantil Universitario Niño Jesús, Madrid, España
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Graham DL, Buendia MA, Chapman MA, Durai HH, Stanwood GD. Deletion of Gαq in the telencephalon alters specific neurobehavioral outcomes. Synapse 2015; 69:434-45. [PMID: 25963901 DOI: 10.1002/syn.21830] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 05/01/2015] [Accepted: 05/04/2015] [Indexed: 02/04/2023]
Abstract
G(αq) -coupled receptors are ubiquitously expressed throughout the brain and body, and it has been shown that these receptors and associated signaling cascades are involved in a number of functional outputs, including motor function and learning and memory. Genetic alterations to G(αq) have been implicated in neurodevelopmental disorders such as Sturge-Weber syndrome. Some of these associated disease outcomes have been modeled in laboratory animals, but as G(αq) is expressed in all cell types, it is difficult to differentiate the underlying circuitry or causative neuronal population. To begin to address neuronal cell type diversity in G(αq) function, we utilized a conditional knockout mouse whereby G(αq) was eliminated from telencephalic glutamatergic neurons. Unlike the global G(αq) knockout mouse, we found that these conditional knockout mice were not physically different from control mice, nor did they exhibit any gross motor abnormalities. However, similarly to the constitutive knockout animal, G(αq) conditional knockout mice demonstrated apparent deficits in spatial working memory. Loss of G(αq) from glutamatergic neurons also produced enhanced sensitivity to cocaine-induced locomotion, suggesting that cortical G(αq) signaling may limit behavioral responses to psychostimulants. Screening for a variety of markers of forebrain neuronal architecture revealed no obvious differences in the conditional knockouts, suggesting that the loss of G(αq) in telencephalic excitatory neurons does not result in major alterations in brain structure or neuronal differentiation. Taken together, our results define specific modulation of spatial working memory and psychostimulant responses through disruptions in G(αq) signaling within cerebral cortical glutamatergic neurons.
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Affiliation(s)
- Devon L Graham
- Department of Biomedical Sciences, Florida State University College of Medicine, Tallahassee, Florida, 32303
| | - Matthew A Buendia
- Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, Tennessee, 37232
| | - Michelle A Chapman
- Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, Tennessee, 37232
| | - Heather H Durai
- Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, Tennessee, 37232
| | - Gregg D Stanwood
- Department of Biomedical Sciences, Florida State University College of Medicine, Tallahassee, Florida, 32303
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Kavanaugh B, Sreenivasan A, Bachur C, Papazoglou A, Comi A, Zabel TA. [Formula: see text]Intellectual and adaptive functioning in Sturge-Weber Syndrome. Child Neuropsychol 2015; 22:635-648. [PMID: 25952468 PMCID: PMC4868126 DOI: 10.1080/09297049.2015.1028349] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The present study examined the intellectual and adaptive functioning in a sample of children and young adults with Sturge-Weber Syndrome (SWS). A total of 80 research participants from a SWS study database underwent full neurological evaluation as part of their participation or concurrent medical care. Twenty-nine of the participants received neuropsychological evaluations. Analyses indicated no significant demographic or neurological differences between those who did and did not receive neuropsychological evaluations. Overall, the neuropsychological evaluation sample displayed significantly lower functioning relative to published normative data across domains of intellectual and adaptive functioning. Thirty-two percent of the sample displayed impaired performance (standard score ≤ 75) in intellectual functioning and 58% displayed impaired performance in adaptive functioning. Hemiparesis status independently predicted overall adaptive functioning while seizure frequency independently predicted overall intellectual functioning. Younger participants displayed significantly higher (more intact) ratings in adaptive functioning compared to older participants, specifically in overall adaptive functioning, motor skills, and community living skills. A composite measure of neurological status (SWS-NRS) incorporating seizure and hemiparesis status effectively distinguished between individuals with impaired or nonimpaired adaptive and intellectual functioning and showed promise as a screening method for identifying individuals with more involved intellectual and/or adaptive needs.
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Affiliation(s)
- Brian Kavanaugh
- Department of Behavioral Psychology, Kennedy Krieger Institute
| | | | | | - Aimilia Papazoglou
- Department of Neuropsychology, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Anne Comi
- Hunter Nelson Sturge-Weber Center, Kennedy Krieger Institute
- Department of Neurology, Johns Hopkins University School of Medicine
| | - T. Andrew Zabel
- Department of Neuropsychology, Kennedy Krieger Institute
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
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Topical rapamycin combined with pulsed dye laser in the treatment of capillary vascular malformations in Sturge-Weber syndrome: Phase II, randomized, double-blind, intraindividual placebo-controlled clinical trial. J Am Acad Dermatol 2015; 72:151-8.e1. [DOI: 10.1016/j.jaad.2014.10.011] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 09/26/2014] [Accepted: 10/08/2014] [Indexed: 11/29/2022]
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Abstract
Purpose:To review the clinical and neuroimaging features of a large series of patients with Sturge-Weber syndrome (SWS) seen over a 40-year period.Methods:Fifty-five patients with SWS (30 males and 25 females), were studied between 1965 and 2004. Results of neurological and ophthalmological examinations, electroencephalographic, and neuroimaging studies were reviewed. All patients were seen by one of the authors (I. P-C).Results:Epilepsy, hemiparesis, mental retardation and ocular problems were the most frequent and severe features of patients with Sturge-Weber syndrome in this series. The facial nevus flammeus was unilateral in 35 (63.5%) patients, bilateral in 17 (31%) and absent in 3 (5.5%) of the patients with leptomeningeal angiomas. Seven (41%) of the 17 patients with bilateral nevus flammeus had unilateral leptomeningeal angiomas. Seizures occurred in 47 patients (85.5%). Complete seizure control was obtained in 20 patients (42.5%), but in 2 of these 20 patients seizures were controlled only after lobectomy. All patients with unilateral or bilateral upper eyelid nevus flammeus had ipsilateral, unilateral or bilateral choroid-retinal angiomas. Only 20 (36%) of the 55 patients had low-normal or borderline intelligence (IQs<70). No relationship was observed between the size of the facial nevus flammeus and the severity of the brain lesion.Conclusions:Epilepsy, hemiparesis, mental retardation and ocular problems were the most frequent and severe features of patients with Sturge-Weber syndrome in this series. Cerebral lesions followed a progressive course during early childhood, but not later. Early surgical treatment controlled the seizures but other neurological problems such as hemiparesis and intellectual deficits showed a less satisfactory response. Early onset of seizures and poor response to medical treatment, bilateral cerebral involvement and unilateral severe lesions were indicative of a poor prognosis. Limited intelligence and social skills, poor aesthetic appearance and seizures complicated the integration of SWS patients. These features must be addressed in order for the patients improve social interactions, obtain gainful employment and achieve a better quality of life.
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Lance EI, Lanier KE, Zabel TA, Comi AM. Stimulant use in patients with sturge-weber syndrome: safety and efficacy. Pediatr Neurol 2014; 51:675-80. [PMID: 25439578 PMCID: PMC4392725 DOI: 10.1016/j.pediatrneurol.2013.11.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 11/11/2013] [Accepted: 11/13/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Sturge-Weber syndrome is characterized by a facial port-wine birthmark, vascular eye abnormalities, and a leptomeningeal angioma. Attention and behavioral issues are common in Sturge-Weber syndrome. However, literature evidence for stimulant treatment is minimal. This study evaluates stimulant medication safety and efficacy in individuals with Sturge-Weber syndrome. METHODS The research database of the Hunter Nelson Sturge-Weber Center (n = 210 subjects in the database) was reviewed for stimulant use. Twelve patients (mean age 10.5 years, age range 4 to 21 years) on stimulants were seen between 2003 and 2012. A retrospective chart review obtained comorbid diagnoses, stimulant type and dosage, medication side effects, vital signs, and medication efficacy. RESULTS All 12 patients had brain involvement (unilateral, nine; bilateral, three). Additional comorbidities included epilepsy (twelve), hemiparesis (eight), headaches (eight), and vision deficits (six). Eight patients reported side effects, primarily appetite suppression (four) and headaches (three). There were no statistically significant changes in weight or blood pressure 6 months after medication initiation. Medication efficacy was subjectively reported in 11 patients. Seven patients remained on stimulants at their most recent follow-up visit. CONCLUSIONS This study preliminarily evaluates stimulant medication use in a small group of Sturge-Weber syndrome patients. Stimulants were tolerated and effective in most subjects. Side effects were mostly minor and medication did not negatively affect growth or vital signs. Stimulant medication may be a safe and effective intervention for Sturge-Weber syndrome children with attention issues/attention deficit hyperactivity disorder. Further studies with larger sample sizes are needed.
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Affiliation(s)
- Eboni I. Lance
- Department of Neurodevelopmental Medicine, Kennedy Krieger Institute, Baltimore, MD,Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD,Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Kira E. Lanier
- Department of Neurodevelopmental Medicine, Kennedy Krieger Institute, Baltimore, MD
| | - T. Andrew Zabel
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD
| | - Anne M. Comi
- Department of Neurodevelopmental Medicine, Kennedy Krieger Institute, Baltimore, MD,Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD,Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD
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Abstract
Sturge-Weber syndrome is a rare sporadic neurocutaneous syndrome the hallmark of which is a facial port-wine stain involving the first division of the trigeminal nerve, ipsilateral leptomeningeal angiomata and angioma involving the ipsilateral eye. Our understanding of the disease process has vastly improved since it was first described in 1879, with recent identification of an activating somatic mutation in the GNAQ gene found in association with both Sturge-Weber syndrome and non-syndromic facial port-wine stain. Sturge-Weber syndrome is marked by a variable but usually progressive course in early childhood characterised by seizures, stroke-like episodes, headaches, neurological and cognitive deterioration, hemiparesis, glaucoma and visual field defects. More recently, the increased prevalance of otolaryngological, endocrine and emotional-behavioural issues have been established. Neurophysiology and neuroimaging studies provide information regarding the evolution of changes in Sturge-Weber syndrome over time. Early recognition and aggressive management of symptoms remains cornerstone in the management of this syndrome. An international collaborative effort is needed to maximise our understanding of the natural history and response to interventions in Sturge-Weber Syndrome.
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Quintard B, Gana K, Constant A, Quintric C, Taïeb A, Léauté-Labrèze C. Social isolation in parents of children with hemangiomas: Effects of coping styles and emotional distress. PSYCHOL HEALTH MED 2013; 18:698-704. [DOI: 10.1080/13548506.2013.766351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
OPINION STATEMENT We try to see the babies prior to the onset of symptoms so that their parents can receive anticipatory guidance regarding seizures and how to recognize and respond to them and so that proper referrals to ophthalmology can be made. If there is any concern on history, exam, or EEG then we obtain a magnetic resonance imaging (MRI) with contrast. If presymptomatic diagnosis of brain involvement is made then treatment with low-dose aspirin is offered and if the brain involvement is extensively bilateral then an anticonvulsant such as levetiracetam is offered as well. Seizures are treated aggressively with a goal of obtaining and maintaining complete seizure suppression as much as possible often with a combination of low-dose aspirin and two anticonvulsants such as levetiracetam and oxcarbazepine. For many patients, this will provide adequate control of their seizures and stroke-like episodes. If the patient fails medical management and seizures are regular and accompanied by plateaued development, significant hemiparesis and visual field deficit and the patient is unilaterally involved and a surgical candidate then surgical management is urged. When the seizures are less regular, little or no hemiparesis or visual field deficit exist, and development is reasonable then this decision is more difficult. For bilaterally involved patients surgery is usually not a good option unless seizures are very severe and mostly coming from one side. Other therapeutic options include the ketogenic/Atkins diet and vagal nerve stimulator although in our experience these usually do not result in cessation of seizures. Endocrine problems occur with increased frequency and must be treated when they are present. The recent discovery of the somatic mutation causing Sturge-Weber syndrome holds promise for new treatment options in the future.
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Affiliation(s)
- Catherine D Bachur
- Neurology and Developmental Medicine, Hugo W. Moser Research Institute at Kennedy Krieger, 801 N. Broadway, Room 553, Baltimore, MD, 21205, USA,
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Lance EI, Sreenivasan AK, Zabel TA, Kossoff EH, Comi AM. Aspirin use in Sturge-Weber syndrome: side effects and clinical outcomes. J Child Neurol 2013; 28:213-8. [PMID: 23112247 PMCID: PMC4373084 DOI: 10.1177/0883073812463607] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Sturge-Weber syndrome is a neurocutaneous disorder with skin, eye, and brain involvement. Prior series suggest about 50% of patients have seizures/neurodeterioration. Low-dose (3-5 mg/kg/d) aspirin use in this population is controversial. This study further addresses the side effects and outcomes of low-dose aspirin usage in Sturge-Weber syndrome. Fifty-eight subjects on aspirin with brain involvement were analyzed in a retrospective chart review. Charts were evaluated for brain involvement, age at first seizure, and side effects. Subjects' clinical stability was compared using neurologic scores. The majority of subjects had neurologic scores reflecting reasonable seizure control (91%), none or mild hemiparesis (57%), no vision impairment (71%), and none or mild cognitive impairment (80%). Forty-nine reported no significant side effects, and 9 reported either allergic reaction or minimal to significant bleeding on aspirin. This cohort's clinical experience adds significant support for low-dose aspirin use to optimize neurodevelopmental outcome in Sturge-Weber syndrome with minimal side effects.
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Affiliation(s)
- Eboni I. Lance
- Department of Neurodevelopmental Medicine, Kennedy Krieger Institute, Baltimore, MD, USA,Department of Pediatrics, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Aditya K. Sreenivasan
- Department of Neurodevelopmental Medicine, Kennedy Krieger Institute, Baltimore, MD, USA
| | - T. Andrew Zabel
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Eric H. Kossoff
- Department of Pediatrics, Johns Hopkins Hospital, Baltimore, MD, USA,Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Anne M. Comi
- Department of Neurodevelopmental Medicine, Kennedy Krieger Institute, Baltimore, MD, USA,Department of Pediatrics, Johns Hopkins Hospital, Baltimore, MD, USA,Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA
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Raches D, Hiscock M, Chapieski L. Behavioral and academic problems in children with Sturge-Weber syndrome: differences between children with and without seizures. Epilepsy Behav 2012; 25:457-63. [PMID: 23000106 DOI: 10.1016/j.yebeh.2012.06.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 05/11/2012] [Accepted: 06/08/2012] [Indexed: 11/28/2022]
Abstract
Although Sturge-Weber (SWS) syndrome is associated with behavioral and academic problems in childhood, it is unknown whether those problems are concomitants of the disorder itself or of the seizure disorder that is common in SWS. We compared two groups of children with SWS-- one with seizures (n=20) and one without seizures (n=14)--on parent-report and teacher-report measures of behavioral and academic functioning. The two subgroups were compared with each other as well as with children with epilepsy alone (n=29) and a group of healthy controls (n=21). The SWS group with seizures was more impaired than the seizure-free group on 9 of 15 measures and the children with seizures were 10 times as likely to have received special education services. Overall, children with SWS and seizures were similar to the epilepsy group, whereas children with SWS and no seizures were similar to the controls.
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Lo W, Marchuk DA, Ball KL, Juhász C, Jordan LC, Ewen JB, Comi A. Updates and future horizons on the understanding, diagnosis, and treatment of Sturge-Weber syndrome brain involvement. Dev Med Child Neurol 2012; 54:214-23. [PMID: 22191476 PMCID: PMC3805257 DOI: 10.1111/j.1469-8749.2011.04169.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To review recent developments in the understanding, diagnosis, and treatment of Sturge-Weber syndrome (SWS). METHOD Members of the Brain Vascular Malformation Consortium Sturge-Weber Syndrome National Workgroup contributed their expertise to review the literature and present promising directions for research. RESULTS The increasing number of reports dealing with SWS over the last decade reflects progress in the diagnosis and understanding of the neurological involvement. The proliferation of centers and advocacy groups to care for patients with SWS and to stimulate research has aided the development of new insights into the clinical manifestations and the pathophysiology of neurological progression, and the development of novel hypotheses to direct future research. Many key questions remain, but the tools and networks to answer them are being developed. INTERPRETATION This review summarizes important new knowledge and presents new research directions that are likely to provide further insights, earlier diagnosis, improved treatments, and possibly, prevention of this syndrome.
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Affiliation(s)
- Warren Lo
- Departments of Pediatrics and Neurology, Nationwide Children’s Hospital, Columbus, OH
| | - Douglas A. Marchuk
- Department of Molecular Genetics and Microbiology, Duke University Medical Center, Durham NC
| | | | - Csaba Juhász
- Departments of Pediatrics and Neurology Wayne State University of Medicine, Detroit, MI
| | - Lori C. Jordan
- Department of Neurology and Pediatrics, Vanderbilt University, Nashville, TN
| | - Joshua B. Ewen
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute Hugo Moser Research Institute, Baltimore MD, USA
| | - Anne Comi
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute Hugo Moser Research Institute, Baltimore MD, USA
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Madaan V, Dewan V, Ramaswamy S, Sharma A. Behavioral manifestations of sturge-weber syndrome: a case report. PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2011; 8:198-200. [PMID: 16964314 PMCID: PMC1557469 DOI: 10.4088/pcc.v08n0402] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2005] [Accepted: 12/23/2005] [Indexed: 10/20/2022]
Abstract
Sturge-Weber syndrome is a neurocutaneous syndrome that manifests with vascular malformations involving the brain, eye, and skin. We report the case of an elderly patient suffering from Sturge-Weber syndrome who presented with episodic "angry" slapping symptoms to a psychiatric facility. A detailed history, physical and mental-state examination, and elaborate neuropsychological, neuroimaging, and laboratory assessment were undertaken. Clinically, the "angry" slapping episodes were diagnosed as complex partial seizures that improved in frequency with an increase in the dose of the antiepileptic medication. We also have attempted to identify the pathophysiology of such behavioral episodes in Sturge-Weber syndrome. This case report underlines the need for detailed laboratory and neuroimaging work-up in the elderly presenting with atypical symptoms. It also emphasizes the need for identification of and differentiation between similar atypical presentations and appropriate management of resources by the medical staff.
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Abstract
Sturge-Weber syndrome (SWS) is characterized by seizures, port-wine birthmarks, vascular malformations, and rarely studied psychobehavioral features. This study describes a small group of outpatients (N = 16, age, 3-34 years) with Sturge-Weber syndrome seeking medical services (due to seizures, ophthalmological, and dermatological problems among others). The patients were screened for psychiatric diagnoses. The most frequent diagnoses were mood disorder (31%), disruptive behavior disorder (25%), and adjustment disorder (25%). A substance-related disorder was the most frequent in adults (67%). A significant association was found between disruptive behavior disorder not otherwise specified and more left frontal and left parietal involvement. A trend toward significant association of having a seizure in the past 3 months with disruptive behavior disorder not otherwise specified was observed. Problems with mood, attention, sleep, learning, and substance use were common. Disruptive behavior disorders and their association with medical conditions should be further investigated.
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Zabel TA, Reesman J, Wodka EL, Gray R, Suskauer SJ, Turin E, Ferenc LM, Lin DDM, Kossoff EH, Comi AM. Neuropsychological features and risk factors in children with Sturge-Weber syndrome: four case reports. Clin Neuropsychol 2010; 24:841-59. [PMID: 20560093 DOI: 10.1080/13854046.2010.485133] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Sturge-Weber Syndrome (SWS) is a rare neurocutaneous disorder involving facial capillary malformation (port-wine birthmark) and vascular malformation of the brain that is frequently associated with epilepsy, stroke-like episodes, cognitive deficits, motor impairment, and/or visual field cut. The four cases presented here (ages 8-9, two females) illustrate the broad range of physiologic involvement and associated neuropsychological functioning in SWS, and argue against the idea of a "typical" SWS neuropsychological presentation. Rather, we highlight a preliminary collection of disease status/severity factors thought to impact neuropsychological presentation in SWS, including degree of cortical involvement (unilateral versus bilateral; posterior only versus posterior/anterior), age at time of seizure onset, extent of seizure control, history of stroke-like episodes, and magnitude of neurologic decline/deficit. We discuss the need for broad-based assessment in this medical population, as various impairment combinations (e.g., perceptual, language, executive) create unique presentations as well as the need for individualized intervention.
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Affiliation(s)
- T Andrew Zabel
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD 21231, USA.
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Abstract
Sturge-Weber syndrome is a rare neurocutaneous disorder that often results in functional impairment caused by motor (typically hemiparesis) and cognitive deficits. A retrospective chart review of physiatric evaluation of 30 individuals, aged 4 mos to 55 yrs (median age, 2.4 yrs), with Sturge-Weber syndrome with brain involvement was conducted for the purpose of summarizing physiatric findings and recommendations in this cohort. Presence or absence of motor, cognitive, and behavioral concerns and need for orthoses, spasticity management, and therapy services were noted. Hemiparesis was common, but the need for intervention for spasticity was rare. Cognitive and behavioral concerns were noted frequently, meriting additional evaluation. Case vignettes are presented to highlight (1) a child with repeated functional setbacks in association with increased seizure frequency who, with seizure control, demonstrated return to functional baseline and subsequent further skill development and (2) a child with Sturge-Weber syndrome who made functional gains with constraint-induced movement therapy.
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Govori V, Gjikolli B, Ajvazi H, Morina N. Management of patient with Sturge-Weber syndrome: a case report. CASES JOURNAL 2009; 2:9394. [PMID: 20072683 PMCID: PMC2806399 DOI: 10.1186/1757-1626-2-9394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Accepted: 12/23/2009] [Indexed: 11/22/2022]
Abstract
Introduction Sturge-Weber syndrome sometimes referred to as encephalotrigeminal angiomatosis, is a rare congenital neurological and skin disorder. Case presentation This is case report of a 18-year-old mentally disabled boy, with long-standing seizures, with a port-wine nevi on the left side of the face along the distribution of trigeminal nerve. Interictal encephalogram showed bilateral slow activity, pronounced in the left hemisphere, with epileptogenic activity in the left temporo-parietal region. Skull radiograph, computerized tomography and magnetic resonance imaging showed intracranial calcifications and atrophy of the left brain hemisphere. Conclusion Professional counseling and support in addition to drug treatment can provide help to patients and their family to overcome their problems and improve the treatment outcome.
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Affiliation(s)
- Valbona Govori
- Neurology Clinic, University Clinical Center of Kosova, Prishtina, Republic of Kosova
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Reesman J, Gray R, Suskauer SJ, Ferenc LM, Kossoff EH, Lin DDM, Turin E, Comi AM, Brice PJ, Zabel TA. Hemiparesis is a clinical correlate of general adaptive dysfunction in children and adolescents with Sturge-Weber syndrome. J Child Neurol 2009; 24:701-8. [PMID: 19359254 DOI: 10.1177/0883073808329529] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study sought to identify neurologic correlates of adaptive functioning in individuals with Sturge-Weber syndrome. A total of 18 children, adolescents, and young adults with Sturge-Weber syndrome with brain involvement were recruited from our Sturge-Weber center. All underwent neurologic examination (including review of clinical brain magnetic resonance imaging) and neuropsychological assessment. Neuropsychological assessment included measures of intellectual ability and standardized parent report of adaptive functioning. Overall, Full Scale IQ and ratings of global adaptive functioning were both lower than the population-based norms (P < .05). Negative correlations were identified between adaptive functioning ratings, clinician ratings of cortical abnormality, and ratings of neurologic status. Hemiparesis (minimal versus prominent) was the only individual component of the rating scales that differentiated between individuals with nonimpaired and impaired adaptive functioning scores. Information obtained during neurological examination of children and adolescents with Sturge-Weber syndrome particularly hemiparetic status is useful for identifying children who may need additional intervention.
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Chugani HT, Juhász C, Behen ME, Ondersma R, Muzik O. Autism with facial port-wine stain: a new syndrome? Pediatr Neurol 2007; 37:192-9. [PMID: 17765807 DOI: 10.1016/j.pediatrneurol.2007.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2007] [Revised: 04/17/2007] [Accepted: 05/14/2007] [Indexed: 10/22/2022]
Abstract
The hallmark of Sturge-Weber syndrome is leptomeningeal angiomatosis. Over 15 years, four children were identified (2 boys, age 2.9-6 years) with unilateral facial port-wine stain, referred for presumable Sturge-Weber syndrome but who were also autistic. Computed tomography and magnetic resonance imaging scans failed to show evidence of leptomeningeal angioma in all four children. Three of the children had a history of seizures. Detailed neuropsychologic testing of three children revealed a similar presentation, characterized by developmental disturbance, particularly involving delayed onset of language, and early-emerging social atypicality. Positron emission tomography scanning of cerebral glucose metabolism revealed hypometabolism in the bilateral medial temporal regions, anterior cingulate gyrus, frontal cortex, right temporal cortex, and cerebellum. The pattern of glucose hypometabolism differed from that of 12 children with infantile autism (age 2.7-7.9 years) who had mild left medial temporal but more severe right temporal cortical hypometabolism and showed a reversal of normal frontotemporal asymmetry of glucose metabolism. Unilateral facial port-wine stain and autism with no intracranial angioma on conventional imaging may represent a rare clinical entity distinct from both infantile autism and previously described variants of Sturge-Weber syndrome.
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Affiliation(s)
- Harry T Chugani
- Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan 48201, USA.
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McCune SK, Mathis LL, Cocchetto DM, Ball K, Rodriguez W. Safer, Better, More Appropriate: Clinical Trial Design for Pediatric Drug Labels. ACTA ACUST UNITED AC 2006. [DOI: 10.1177/009286150604000207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
Neurocutaneous syndromes are disorders characterized by a neurological abnormality and cutaneous manifestations. Three of the more common neurocutaneous syndromes are Sturge-Weber syndrome, tuberous sclerosis, and neurofibromatosis. This review focuses on the cognitive and behavioral features of these syndromes.
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Affiliation(s)
- Charles M Zaroff
- Comprehensive Epilepsy Center, New York University, 403 East 34th Street, New York, NY 10016, USA.
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Breugem CC, Merkus MP, Smitt JHS, Legemate DA, van der Horst CMAM. Quality of life in patients with vascular malformations of the lower extremity. ACTA ACUST UNITED AC 2005; 57:754-63. [PMID: 15544773 DOI: 10.1016/j.bjps.2004.05.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2003] [Accepted: 05/13/2004] [Indexed: 01/19/2023]
Abstract
With the exception of capillary malformations (port-wine stains), the adverse psychosocial effects of vascular malformations have not received much attention in the medical literature. We, therefore, studied health related quality of life of patients with vascular malformations located primarily on the lower extremity, who presented to us over a 10-year period. Patient's self-assessment of quality of life was measured by the Multiple Outcomes Study (MOS) Short Form Health Survey Questionnaire (SF-36). Several possible predictors were also examined. Eighty-one patients (33 male, 48 female), aged 14-61 years, completed the SF-36. Seventy-one patients (88%) had a low flow lesion. Twenty-three patients (28%) had hypertrophy of the lower extremity, while 11 patients (14%) had hypotrophy. Sixty-nine patients (85%) had the vascular malformation located only on the lower extremity. Six (7%) also had their upper extremity (hand) involved, and 20 patients (24.7%) had >10% TBSA affected. Eight patients (10%) needed special shoes. Fifty-one patients (63%) had a previously performed MRI, of which 62.7% (32/51) had muscle involvement. Fifty-one patients (63%) had been operated on. Of the 34 patients wearing elastic compression stockings, 25 patients (74%) indicated that they were satisfied with the stockings. Compared to the general population sample, the SF-36 questionnaire indicated that our vascular malformation patients reported impaired vitality and higher levels of pain, while no differences were seen regarding the other dimensions of quality of life. Demographic, clinical and therapy characteristics could explain quality of life only to a limited extent. Explained variability of the SF-36 dimensions ranged from 0% for mental health to 34.5% for role functioning physical. To our surprise, this study suggests that patients with vascular malformations located primarily on the lower extremity do not have a greatly decreased quality of life when compared to the general Dutch population.
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Affiliation(s)
- Corstiaan C Breugem
- Department of Plastic, Reconstructive and Hand Surgery, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
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Abstract
Sturge-Weber syndrome is a neurocutaneous disorder classically presenting with a facial port-wine stain, vascular eye abnormalities, and an ipsilateral occipital leptomeningeal angioma. Children with Sturge-Weber syndrome often develop progressive neurologic problems. Data on the pathophysiology of Sturge-Weber syndrome are briefly reviewed. The embryologic, genetic, and pathologic considerations are discussed, as are theories regarding the mechanisms of the degenerative brain changes. Sturge-Weber syndrome likely results from an early embryologic malformation of vascular development affecting the development of the nearby skin, eye, and brain structures. Studies suggest that complex molecular interactions contribute to the abnormal development and function of blood vessels in Sturge-Weber syndrome. Neurologic deterioration in Sturge-Weber syndrome is likely secondary to impaired blood flow to the brain and is worsened by the presence of seizures. Insights from related areas are discussed, and future research studies are suggested.
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Affiliation(s)
- Anne M Comi
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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