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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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Zalaquett NG, Salameh E, Kim JM, Ghanbarian E, Tawk K, Abouzari M. The Dawn and Advancement of the Knowledge of the Genetics of Migraine. J Clin Med 2024; 13:2701. [PMID: 38731230 PMCID: PMC11084801 DOI: 10.3390/jcm13092701] [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: 03/20/2024] [Revised: 04/29/2024] [Accepted: 04/30/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Migraine is a prevalent episodic brain disorder known for recurrent attacks of unilateral headaches, accompanied by complaints of photophobia, phonophobia, nausea, and vomiting. Two main categories of migraine are migraine with aura (MA) and migraine without aura (MO). Main body: Early twin and population studies have shown a genetic basis for these disorders, and efforts have been invested since to discern the genes involved. Many techniques, including candidate-gene association studies, loci linkage studies, genome-wide association, and transcription studies, have been used for this goal. As a result, several genes were pinned with concurrent and conflicting data among studies. It is important to understand the evolution of techniques and their findings. Conclusions: This review provides a chronological understanding of the different techniques used from the dawn of migraine genetic investigations and the genes linked with the migraine subtypes.
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Affiliation(s)
- Nader G. Zalaquett
- Faculty of Medicine, American University of Beirut, Beirut 1107, Lebanon
| | - Elio Salameh
- Faculty of Medicine, American University of Beirut, Beirut 1107, Lebanon
| | - Jonathan M. Kim
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA 92697, USA
| | - Elham Ghanbarian
- Department of Neurology, University of California, Irvine, CA 92617, USA
| | - Karen Tawk
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA 92697, USA
| | - Mehdi Abouzari
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA 92697, USA
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Dai L, Ding C, Tian X, Liu M, Ma Y, Chen C, Ren X, Li H. The clinical spectrum associated with ATP1A2 variants in Chinese pediatric patients. Brain Dev 2023; 45:422-431. [PMID: 37142513 DOI: 10.1016/j.braindev.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 05/06/2023]
Abstract
PURPOSE To evaluate the clinical spectrum associated with ATP1A2 variants in Chinese children with hemiplegia, migraines, encephalopathy or seizures. METHODS Sixteen children (12 males and 4 females), including ten patients with ATP1A2 variants whose cases had been published previously, were identified using next-generation sequencing. RESULTS Fifteen patients had FHM2 (familial hemiplegic migraine type 2), including three who had AHC (alternating hemiplegia of childhood) and one who had drug-resistant focal epilepsy. Thirteen patients had DD (developmental delay). The onset of febrile seizures, which occurred between 5 months and 2 years 5 months (median 1 year 3 months) was earlier than the onset of HM (hemiplegic migraine), which occurred between 1 year 5 months and 13 years (median 3 years 11 months). Disturbance of consciousness subsided first, at 40 h to 9 days (median 4.5 days); hemiplegia and aphasia were resolved slowly, taking 30 min to 6 months (median 17.5 days) for the former and 24 h to over 1 year (median 14.5 days) for the latter. Cranial MRI showed edema in the cerebral hemispheres, mainly the left hemisphereacute attacks. All thirteen FHM2 patients recovered to baseline in 30 min to 6 months. Fifteen patients had between 1 and 7 (median 2) total attacks between the baseline and follow-up timepoints. We report twelve missense variants, including a novel variant ATP1A2 variant, p.G855E. CONCLUSIONS The known genotypic and phenotypic spectra of Chinese patients with ATP1A2-related disorders were further expanded. Recurrent febrile seizures and DD combined with paroxysmal hemiplegia and encephalopathy should raise the clinical suspicion of FHM2. The avoidance of triggers and thus the prevention of attacks may be the most effective therapy for FHM2.
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Affiliation(s)
- Lifang Dai
- Department of Neurology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, China
| | - Changhong Ding
- Department of Neurology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, China; Department of Neurology, Baoding Children's Hospital, Baoding, Hebei 071000, China.
| | - Xiaojuan Tian
- Department of Neurology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, China
| | - Ming Liu
- Department of Neurology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, China
| | - Yuping Ma
- Department of Neurology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, China
| | - Chunhong Chen
- Department of Neurology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, China
| | - Xiaotun Ren
- Department of Neurology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, China
| | - Hua Li
- Department of Neurology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, China
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Gosalia H, Karsan N, Goadsby PJ. Genetic Mechanisms of Migraine: Insights from Monogenic Migraine Mutations. Int J Mol Sci 2023; 24:12697. [PMID: 37628876 PMCID: PMC10454024 DOI: 10.3390/ijms241612697] [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: 07/06/2023] [Revised: 08/01/2023] [Accepted: 08/06/2023] [Indexed: 08/27/2023] Open
Abstract
Migraine is a disabling neurological disorder burdening patients globally. Through the increasing development of preclinical and clinical experimental migraine models, advancing appreciation of the extended clinical phenotype, and functional neuroimaging studies, we can further our understanding of the neurobiological basis of this highly disabling condition. Despite increasing understanding of the molecular and chemical architecture of migraine mechanisms, many areas require further investigation. Research over the last three decades has suggested that migraine has a strong genetic basis, based on the positive family history in most patients, and this has steered exploration into possibly implicated genes. In recent times, human genome-wide association studies and rodent genetic migraine models have facilitated our understanding, but most migraine seems polygenic, with the monogenic migraine mutations being considerably rarer, so further large-scale studies are required to elucidate fully the genetic underpinnings of migraine and the translation of these to clinical practice. The monogenic migraine mutations cause severe aura phenotypes, amongst other symptoms, and offer valuable insights into the biology of aura and the relationship between migraine and other conditions, such as vascular disease and sleep disorders. This review will provide an outlook of what is known about some monogenic migraine mutations, including familial hemiplegic migraine, familial advanced sleep-phase syndrome, and cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy.
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Affiliation(s)
- Helin Gosalia
- Headache Group, The Wolfson Sensory, Pain and Rehabilitation Centre, NIHR King’s Clinical Research Facility, & SLaM Biomedical Research Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 9PJ, UK; (H.G.); (N.K.)
| | - Nazia Karsan
- Headache Group, The Wolfson Sensory, Pain and Rehabilitation Centre, NIHR King’s Clinical Research Facility, & SLaM Biomedical Research Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 9PJ, UK; (H.G.); (N.K.)
| | - Peter J. Goadsby
- Headache Group, The Wolfson Sensory, Pain and Rehabilitation Centre, NIHR King’s Clinical Research Facility, & SLaM Biomedical Research Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 9PJ, UK; (H.G.); (N.K.)
- Department of Neurology, University of California, Los Angeles, CA 90095, USA
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5
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Kessi M, Chen B, Pang N, Yang L, Peng J, He F, Yin F. The genotype-phenotype correlations of the CACNA1A-related neurodevelopmental disorders: a small case series and literature reviews. Front Mol Neurosci 2023; 16:1222321. [PMID: 37555011 PMCID: PMC10406136 DOI: 10.3389/fnmol.2023.1222321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 07/10/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Genotype-phenotype correlations of the CACNA1A-related neurodevelopmental disorders such as global developmental delay (GDD)/intellectual disability (ID), epileptic encephalopathy (EE), and autism spectrum disorder (ASD) are unknown. We aimed to summarize genotype-phenotype correlations and potential treatment for CACNA1A-related neurodevelopmental disorders. METHODS Six children diagnosed with CACNA1A-related neurodevelopmental disorders at Xiangya Hospital, Central South University from April 2018 to July 2021 were enrolled. The PubMed database was systematically searched for all reported patients with CACNA1A-related neurodevelopmental disorders until February 2023. Thereafter, we divided patients into several groups for comparison. RESULTS Six patients were recruited from our hospital. Three cases presented with epilepsy, five with GDD/ID, five with ataxia, and two with ASD. The variants included p.G701R, p.R279C, p.D1644N, p.Y62C, p.L1422Sfs*8, and p. R1664Q [two gain-of-function (GOF) and four loss-of-function (LOF) variants]. About 187 individuals with GDD/ID harboring 123 variants were found (case series plus data from literature). Of those 123 variants, p.A713T and p.R1664* were recurrent, 37 were LOF, and 7 were GOF. GOF variants were linked with severe-profound GDD/ID while LOF variants were associated with mild-moderate GDD/ID (p = 0.001). The p.A713T variant correlated with severe-profound GDD/ID (p = 0.003). A total of 130 epileptic patients harboring 83 variants were identified. The epileptic manifestations included status epilepticus (n = 64), provoked seizures (n = 49), focal seizures (n = 37), EE (n = 29), absence seizures (n = 26), and myoclonic seizures (n = 10). About 49 (42.20%) patients had controlled seizures while 67 (57.80%) individuals remained with refractory seizures. Status epilepticus correlated with variants located on S4, S5, and S6 (p = 0.000). Among the 83 epilepsy-related variants, 23 were recurrent, 32 were LOF, and 11 were GOF. Status epilepticus was linked with GOF variants (p = 0.000). LOF variants were associated with absence seizures (p = 0.000). Six patients died at an early age (3 months to ≤5 years). We found 18 children with ASD. Thirteen variants including recurrent ones were identified in those 18 cases. GOF changes were more linked to ASD. CONCLUSION The p.A713T variant is linked with severe-profound GDD/ID. More than half of CACNA1A-related epilepsy is refractory. The most common epileptic manifestation is status epilepticus, which correlates with variants located on S4, S5, and S6.
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Affiliation(s)
- Miriam Kessi
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China
- Hunan Intellectual and Developmental Disabilities Research Center, Pediatrics, Changsha, China
- Clinical Research Center for Children’s Neurodevelopmental Disabilities of Hunan Province, Xiangya Hospital, Central South University, Changsha, China
| | - Baiyu Chen
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China
- Hunan Intellectual and Developmental Disabilities Research Center, Pediatrics, Changsha, China
- Clinical Research Center for Children’s Neurodevelopmental Disabilities of Hunan Province, Xiangya Hospital, Central South University, Changsha, China
| | - Nan Pang
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China
- Hunan Intellectual and Developmental Disabilities Research Center, Pediatrics, Changsha, China
- Clinical Research Center for Children’s Neurodevelopmental Disabilities of Hunan Province, Xiangya Hospital, Central South University, Changsha, China
| | - Lifen Yang
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China
- Hunan Intellectual and Developmental Disabilities Research Center, Pediatrics, Changsha, China
- Clinical Research Center for Children’s Neurodevelopmental Disabilities of Hunan Province, Xiangya Hospital, Central South University, Changsha, China
| | - Jing Peng
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China
- Hunan Intellectual and Developmental Disabilities Research Center, Pediatrics, Changsha, China
- Clinical Research Center for Children’s Neurodevelopmental Disabilities of Hunan Province, Xiangya Hospital, Central South University, Changsha, China
| | - Fang He
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China
- Hunan Intellectual and Developmental Disabilities Research Center, Pediatrics, Changsha, China
- Clinical Research Center for Children’s Neurodevelopmental Disabilities of Hunan Province, Xiangya Hospital, Central South University, Changsha, China
| | - Fei Yin
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China
- Hunan Intellectual and Developmental Disabilities Research Center, Pediatrics, Changsha, China
- Clinical Research Center for Children’s Neurodevelopmental Disabilities of Hunan Province, Xiangya Hospital, Central South University, Changsha, China
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Mangano GD, Capizzi MR, Mantuano E, Veneziano L, Santangelo G, Quatrosi G, Nardello R, Raieli V. Familial hemiplegic migraine in pediatric patients: A genetic, clinical, and follow-up study. Headache 2023. [PMID: 37326332 DOI: 10.1111/head.14582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 05/03/2023] [Accepted: 05/05/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVE The aim of this study was to describe a cohort of pediatric patients with genetically confirmed familial hemiplegic migraine (FHM). The knowledge of genotype-phenotype correlations may suggest prognostic factors associated with severe phenotypes. BACKGROUND Hemiplegic migraine is a rare disease and data concerning the pediatric population are even more rare as they are often extrapolated from mixed cohorts. METHODS We selected patients who met International Classification of Headache Disorders, third edition criteria for FHM, who had a molecular diagnosis, and whose first attack occurred under the age of 18 years. RESULTS We enrolled nine patients (seven males and two females) first referred to our three centers. Three of the nine (33%) patients had calcium voltage-gated channel subunit alpha1 A (CACNA1A) mutations, five (55%) had ATPase Na+/K+ transporting subunit alpha 2 (ATP1A2) mutations, and one had both genetic mutations. The patients experienced at least one aura feature other than hemiplegia during the first attack. The mean (SD) duration of HM attacks in the sample was 11.3 (17.1) h; 3.8 (6.1) h in the ATP1A2 group, and 24.3 (23.5) h in the CACNA1A group. The mean (SD, range) duration of follow-up was 7.4 (2.2, 3-10) years. During the first year from the disorder's onset, only four patients had additional attacks. Over the course of follow-up, the attack frequency overall was 0.4 attacks/year without a difference between the two groups (CACNA1A and ATP1A2). CONCLUSION The study data show that most of our patients with early-onset FHM experienced infrequent and non-severe attacks, which improved over time. Furthermore, the clinical course revealed neither the appearance of novel neurological disorders or a deterioration of basic neurological or cognitive functioning.
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Affiliation(s)
- Giuseppe Donato Mangano
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), University of Palermo, Palermo, Italy
| | - Maria Rita Capizzi
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical, Specialities "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Elide Mantuano
- Institute of Translational Pharmacology, National Research Council, Rome, Italy
| | - Liana Veneziano
- Institute of Translational Pharmacology, National Research Council, Rome, Italy
| | - Giuseppe Santangelo
- Child Neuropsychiatry Department, P.O. Di Cristina, ARNAS Civico, Palermo, Italy
| | - Giuseppe Quatrosi
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - Rosaria Nardello
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical, Specialities "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Vincenzo Raieli
- Child Neuropsychiatry Department, P.O. Di Cristina, ARNAS Civico, Palermo, Italy
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Bonemazzi I, Brunello F, Pin JN, Pecoraro M, Sartori S, Nosadini M, Toldo I. Hemiplegic Migraine in Children and Adolescents. J Clin Med 2023; 12:jcm12113783. [PMID: 37297978 DOI: 10.3390/jcm12113783] [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: 04/15/2023] [Revised: 05/18/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Only a few studies have focused on hemiplegic migraine (HM) in children despite its early age of onset. The aim of this review is to describe the peculiar characteristics of pediatric HM. METHODS This is a narrative review based on 14 studies on pediatric HM selected from 262 papers. RESULTS Different from HM in adults, pediatric HM affects both genders equally. Early transient neurological symptoms (prolonged aphasia during a febrile episode, isolated seizures, transient hemiparesis, and prolonged clumsiness after minor head trauma) can precede HM long before its onset. The prevalence of non-motor auras among children is lower than it is in adults. Pediatric sporadic HM patients have longer and more severe attacks compared to familial cases, especially during the initial years after disease onset, while familial HM cases tend to have the disease for longer. During follow-up, the frequency, intensity, and duration of HM attacks often decrease. The outcome is favorable in most patients; however, neurological conditions and comorbidities can be associated. CONCLUSION Further studies are needed to better define the clinical phenotype and the natural history of pediatric HM and to refine genotype-phenotype correlations in order to improve the knowledge on HM physiopathology, diagnosis, and outcome.
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Affiliation(s)
- Ilaria Bonemazzi
- Juvenile Headache Center, Department of Woman's and Child's Health, University Hospital of Padua, 35128 Padua, Italy
| | - Francesco Brunello
- Juvenile Headache Center, Department of Woman's and Child's Health, University Hospital of Padua, 35128 Padua, Italy
| | - Jacopo Norberto Pin
- Juvenile Headache Center, Department of Woman's and Child's Health, University Hospital of Padua, 35128 Padua, Italy
| | - Mattia Pecoraro
- Juvenile Headache Center, Department of Woman's and Child's Health, University Hospital of Padua, 35128 Padua, Italy
| | - Stefano Sartori
- Juvenile Headache Center, Department of Woman's and Child's Health, University Hospital of Padua, 35128 Padua, Italy
| | - Margherita Nosadini
- Juvenile Headache Center, Department of Woman's and Child's Health, University Hospital of Padua, 35128 Padua, Italy
| | - Irene Toldo
- Juvenile Headache Center, Department of Woman's and Child's Health, University Hospital of Padua, 35128 Padua, Italy
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Grangeon L, Lange KS, Waliszewska-Prosół M, Onan D, Marschollek K, Wiels W, Mikulenka P, Farham F, Gollion C, Ducros A. Genetics of migraine: where are we now? J Headache Pain 2023; 24:12. [PMID: 36800925 PMCID: PMC9940421 DOI: 10.1186/s10194-023-01547-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 02/07/2023] [Indexed: 02/21/2023] Open
Abstract
Migraine is a complex brain disorder explained by the interaction of genetic and environmental factors. In monogenic migraines, including familial hemiplegic migraine and migraine with aura associated with hereditary small-vessel disorders, the identified genes code for proteins expressed in neurons, glial cells, or vessels, all of which increase susceptibility to cortical spreading depression. The study of monogenic migraines has shown that the neurovascular unit plays a prominent role in migraine. Genome-wide association studies have identified numerous susceptibility variants that each result in only a small increase in overall migraine risk. The more than 180 known variants belong to several complex networks of "pro-migraine" molecular abnormalities, which are mainly neuronal or vascular. Genetics has also highlighted the importance of shared genetic factors between migraine and its major co-morbidities, including depression and high blood pressure. Further studies are still needed to map all of the susceptibility loci for migraine and then to understand how these genomic variants lead to migraine cell phenotypes.
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Affiliation(s)
- Lou Grangeon
- grid.41724.340000 0001 2296 5231Neurology Department, CHU de Rouen, Rouen, France
| | - Kristin Sophie Lange
- grid.6363.00000 0001 2218 4662Neurology Department, Charité – Universitätsmedizin Berlin, Berlin, Germany ,grid.6363.00000 0001 2218 4662Center for Stroke Research Berlin (CSB), Charité – Universitätsmedizin, Berlin, Germany
| | - Marta Waliszewska-Prosół
- grid.4495.c0000 0001 1090 049XDepartment of Neurology, Wrocław Medical University, Wrocław, Poland
| | - Dilara Onan
- grid.14442.370000 0001 2342 7339Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Ankara, Turkey
| | - Karol Marschollek
- grid.4495.c0000 0001 1090 049XDepartment of Neurology, Wrocław Medical University, Wrocław, Poland
| | - Wietse Wiels
- grid.8767.e0000 0001 2290 8069Department of Neurology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Petr Mikulenka
- grid.412819.70000 0004 0611 1895Department of Neurology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Fatemeh Farham
- grid.411705.60000 0001 0166 0922Headache Department, Iranian Centre of Neurological Researchers, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Cédric Gollion
- grid.411175.70000 0001 1457 2980Neurology Department, CHU de Toulouse, Toulouse, France
| | - Anne Ducros
- Neurology Department, CHU de Montpellier, 80 avenue Augustin Fliche, 34295, Montpellier, France.
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Schaare D, Sarasua SM, Lusk L, Parthasarathy S, Wang L, Helbig I, Boccuto L. Concomitant Calcium Channelopathies Involving CACNA1A and CACNA1F: A Case Report and Review of the Literature. Genes (Basel) 2023; 14:400. [PMID: 36833327 PMCID: PMC9956337 DOI: 10.3390/genes14020400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 01/30/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
Calcium channels are an integral component in maintaining cellular function. Alterations may lead to channelopathies, primarily manifested in the central nervous system. This study describes the clinical and genetic features of a unique 12-year-old boy harboring two congenital calcium channelopathies, involving the CACNA1A and CACNA1F genes, and provides an unadulterated view of the natural history of sporadic hemiplegic migraine type 1 (SHM1) due to the patient's inability to tolerate any preventative medication. The patient presents with episodes of vomiting, hemiplegia, cerebral edema, seizure, fever, transient blindness, and encephalopathy. He is nonverbal, nonambulatory, and forced to have a very limited diet due to abnormal immune responses. The SHM1 manifestations apparent in the subject are consistent with the phenotype described in the 48 patients identified as part of a systematic literature review. The ocular symptoms of CACNA1F align with the family history of the subject. The presence of multiple pathogenic variants make it difficult to identify a clear phenotype-genotype correlation in the present case. Moreover, the detailed case description and natural history along with the comprehensive review of the literature contribute to the understanding of this complex disorder and point to the need for comprehensive clinical assessments of SHM1.
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Affiliation(s)
- Donna Schaare
- Ph.D. Program in Healthcare Genetics and Genomics, School of Nursing, College of Behavioral, Social and Health Sciences, Clemson University, Clemson, SC 29634, USA
| | - Sara M. Sarasua
- Ph.D. Program in Healthcare Genetics and Genomics, School of Nursing, College of Behavioral, Social and Health Sciences, Clemson University, Clemson, SC 29634, USA
| | - Laina Lusk
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | | | - Liangjiang Wang
- Department of Genetics and Biochemistry, College of Science, Clemson University, Clemson, SC 29634, USA
| | - Ingo Helbig
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Luigi Boccuto
- Ph.D. Program in Healthcare Genetics and Genomics, School of Nursing, College of Behavioral, Social and Health Sciences, Clemson University, Clemson, SC 29634, USA
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10
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Sun J, Zheng Y, Chen Z, Wang Y. The role of Na + -K + -ATPase in the epileptic brain. CNS Neurosci Ther 2022; 28:1294-1302. [PMID: 35751846 PMCID: PMC9344081 DOI: 10.1111/cns.13893] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 05/25/2022] [Accepted: 05/26/2022] [Indexed: 11/26/2022] Open
Abstract
Na+-K+-ATPase, a P-type ATP-powered ion transporter on cell membrane, plays a vital role in cellular excitability. Cellular hyperexcitability, accompanied by hypersynchronous firing, is an important basis for seizures/epilepsy. An increasing number of studies point to a significant contribution of Na+-K+-ATPase to epilepsy, although discordant results exist. In this review, we comprehensively summarize the structure and physiological function of Na+-K+-ATPase in the central nervous system and critically evaluate the role of Na+-K+-ATPase in the epileptic brain. Importantly, we further provide perspectives on some possible research directions and discuss its potential as a therapeutic target for the treatment of epilepsy.
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Affiliation(s)
- Jinyi Sun
- Institute of Pharmacology & Toxicology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Yang Zheng
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, China
| | - Zhong Chen
- Institute of Pharmacology & Toxicology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China.,Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, China.,Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yi Wang
- Institute of Pharmacology & Toxicology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China.,Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, China.,Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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11
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Genetic paroxysmal neurological disorders featuring episodic ataxia and epilepsy. Eur J Med Genet 2022; 65:104450. [DOI: 10.1016/j.ejmg.2022.104450] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 02/02/2022] [Accepted: 02/06/2022] [Indexed: 01/25/2023]
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12
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Bauer PR, Tolner EA, Keezer MR, Ferrari MD, Sander JW. Headache in people with epilepsy. Nat Rev Neurol 2021; 17:529-544. [PMID: 34312533 DOI: 10.1038/s41582-021-00516-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2021] [Indexed: 02/06/2023]
Abstract
Epidemiological estimates indicate that individuals with epilepsy are more likely to experience headaches, including migraine, than individuals without epilepsy. Headaches can be temporally unrelated to seizures, or can occur before, during or after an episode; seizures and migraine attacks are mostly not temporally linked. The pathophysiological links between headaches (including migraine) and epilepsy are complex and have not yet been fully elucidated. Correct diagnoses and appropriate treatment of headaches in individuals with epilepsy is essential, as headaches can contribute substantially to disease burden. Here, we review the insights that have been made into the associations between headache and epilepsy over the past 5 years, including information on the pathophysiological mechanisms and genetic variants that link the two disorders. We also discuss the current best practice for the management of headaches co-occurring with epilepsy and highlight future challenges for this area of research.
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Affiliation(s)
- Prisca R Bauer
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany.
| | - Else A Tolner
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands.,Department of Human Genetics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Mark R Keezer
- Research Centre of the Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.,School of Public Health, Université de Montréal, Montreal, Quebec, Canada.,Stichting Epilepsie Instellingen Nederland, Heemstede, The Netherlands
| | - Michel D Ferrari
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Josemir W Sander
- Stichting Epilepsie Instellingen Nederland, Heemstede, The Netherlands.,NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London, UK.,Chalfont Centre for Epilepsy, Chalfont St Peter, UK
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13
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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: 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: 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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14
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Stubberud A, O'Connor E, Tronvik E, Houlden H, Matharu M. R1352Q CACNA1A Variant in a Patient with Sporadic Hemiplegic Migraine, Ataxia, Seizures and Cerebral Oedema: A Case Report. Case Rep Neurol 2021; 13:123-130. [PMID: 33790770 PMCID: PMC7989667 DOI: 10.1159/000512275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 10/07/2020] [Indexed: 11/19/2022] Open
Abstract
Mutations in the CACNA1A gene show a wide range of neurological phenotypes including hemiplegic migraine, ataxia, mental retardation and epilepsy. In some cases, hemiplegic migraine attacks can be triggered by minor head trauma and culminate in encephalopathy and cerebral oedema. A 37-year-old male without a family history of complex migraine experienced hemiplegic migraine attacks from childhood. The attacks were usually triggered by minor head trauma, and on several occasions complicated with encephalopathy and cerebral oedema. Genetic testing of the proband and unaffected parents revealed a de novo heterozygous nucleotide missense mutation in exon 25 of the CACNA1A gene (c.4055G>A, p.R1352Q). The R1352Q CACNA1A variant shares the phenotype with other described CACNA1A mutations and highlights the interesting association of trauma as a precipitant for hemiplegic migraine. Subjects with early-onset sporadic hemiplegic migraine triggered by minor head injury or associated with seizures, ataxia or episodes of encephalopathy should be screened for mutations. These patients should also be advised to avoid activities that may result in head trauma, and anticonvulsants should be considered as prophylactic migraine therapy.
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Affiliation(s)
- Anker Stubberud
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, United Kingdom.,Department of Neuromedicine and Movement Sciences, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | - Emer O'Connor
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, United Kingdom.,Department of Neuromuscular Disorders, UCL Queen Square Institute of Neurology, Queen Square, London, United Kingdom
| | - Erling Tronvik
- Department of Neuromedicine and Movement Sciences, NTNU Norwegian University of Science and Technology, Trondheim, Norway.,Department of Neurology, St. Olavs Hospital, Trondheim, Norway
| | - Henry Houlden
- Department of Neuromuscular Disorders, UCL Queen Square Institute of Neurology, Queen Square, London, United Kingdom
| | - Manjit Matharu
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, United Kingdom
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15
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Huang D, Liu M, Wang H, Zhang B, Zhao D, Ling W, Wang M, Feng J, Shen Y, Chen X. De novo ATP1A2 variants in two Chinese children with alternating hemiplegia of childhood upgraded the gene-disease relationship and variant classification: a case report. BMC Med Genomics 2021; 14:95. [PMID: 33794876 PMCID: PMC8017680 DOI: 10.1186/s12920-021-00947-6] [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: 11/19/2020] [Accepted: 03/25/2021] [Indexed: 11/10/2022] Open
Abstract
Background ATP1A2 gene mutation has been indicated to cause alternating hemiplegia of childhood (AHC); however, limited evidence supports this relationship so far.
Case presentation We reported two Chinese patients with de novo ATP1A2 variants (c.970G>A and c.889G>A). Both patients presented with episodes of alternating hemiplegia, seizures and mild developmental delay. Brain magnetic resonance imaging revealed abnormal signals in both patients. Conclusions The new genetic evidence we reported here strengthened the gene–disease relationship, and the gene curation level between ATP1A2 and AHC became “Moderate” following the ClinGen Standard Operation Procedure. Consequently, the two variants can be reclassified as likely pathogenic.
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Affiliation(s)
- Danping Huang
- Department of Neurology, Children's Hospital of Soochow University, No. 92 Zhongnan Street, Soochow, 215000, Jiangsu, China
| | - Min Liu
- Department of Neurology, Children's Hospital of Soochow University, No. 92 Zhongnan Street, Soochow, 215000, Jiangsu, China
| | - Hongying Wang
- Department of Laboratory, Children's Hospital of Soochow University, Soochow, Jiangsu, China
| | - Bingbing Zhang
- Department of Neurology, Children's Hospital of Soochow University, No. 92 Zhongnan Street, Soochow, 215000, Jiangsu, China
| | - Dongjing Zhao
- Department of Neurology, Children's Hospital of Soochow University, No. 92 Zhongnan Street, Soochow, 215000, Jiangsu, China
| | - Weihao Ling
- Department of Neurology, Children's Hospital of Soochow University, No. 92 Zhongnan Street, Soochow, 215000, Jiangsu, China
| | - Manli Wang
- Department of Neurology, Children's Hospital of Soochow University, No. 92 Zhongnan Street, Soochow, 215000, Jiangsu, China
| | - Jun Feng
- Department of Neurology, Children's Hospital of Soochow University, No. 92 Zhongnan Street, Soochow, 215000, Jiangsu, China
| | - Yiping Shen
- Genetic and Metabolic Central Laboratory, Birth Defect Prevention Research Institute, Maternal and Child Health Hospital, Children's Hospital of Guangxi Zhuang Autonomous Region, No. 225 Xinyang Street, Nanning, 530000, Guangxi, China. .,Division of Genetics and Genomics, Boston Children's Hospital, Boston, MA, USA.
| | - Xuqin Chen
- Department of Neurology, Children's Hospital of Soochow University, No. 92 Zhongnan Street, Soochow, 215000, Jiangsu, China.
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16
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Hoshino K, Sweadner KJ, Kawarai T, Saute JA, Freitas J, Damásio J, Donis KC, Kimura K, Fukuda H, Hayashi M, Higuchi T, Ikeda Y, Ozelius LJ, Kaji R. Rapid-Onset Dystonia-Parkinsonism Phenotype Consistency for a Novel Variant of ATP1A3 in Patients Across 3 Global Populations. NEUROLOGY-GENETICS 2021; 7:e562. [PMID: 33977143 PMCID: PMC8105889 DOI: 10.1212/nxg.0000000000000562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 11/24/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Kyoko Hoshino
- Segawa Memorial Neurological Clinic for Children (K.H., K.K., H.F., M.H.), Tokyo, Japan; Department of Neurosurgery (K.J.S.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Clinical Neuroscience (T.K., R.K.), Institute of Biomedical Sciences, Tokushima University, Japan; Medical Genetics Division (J.A.S., K.C.D.) and Neurology Division (J.A.S.), Hospital de Clínicas de Porto Alegre (HCPA); Graduate Program in Medicine: Medical Sciences and Internal Medicine Department (J.A.S.), Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Neurophysiology Division (J.F., J.D.), Hospital de Santo António, Centro Hospitalar Universitário do Porto; UniGene (J.F., J.D.), Instituto de Biologia Molecular e Celular, i3s Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal; Department of Diagnostic Radiology and Nuclear Medicine (T.H.), Gunma University Graduate School of Medicine, Japan; Department of Neurology (Y.I.), Gunma University Graduate School of Medicine, Japan; and Department of Neurology (L.J.O.), Massachusetts General Hospital, Charlestown
| | - Kathleen J Sweadner
- Segawa Memorial Neurological Clinic for Children (K.H., K.K., H.F., M.H.), Tokyo, Japan; Department of Neurosurgery (K.J.S.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Clinical Neuroscience (T.K., R.K.), Institute of Biomedical Sciences, Tokushima University, Japan; Medical Genetics Division (J.A.S., K.C.D.) and Neurology Division (J.A.S.), Hospital de Clínicas de Porto Alegre (HCPA); Graduate Program in Medicine: Medical Sciences and Internal Medicine Department (J.A.S.), Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Neurophysiology Division (J.F., J.D.), Hospital de Santo António, Centro Hospitalar Universitário do Porto; UniGene (J.F., J.D.), Instituto de Biologia Molecular e Celular, i3s Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal; Department of Diagnostic Radiology and Nuclear Medicine (T.H.), Gunma University Graduate School of Medicine, Japan; Department of Neurology (Y.I.), Gunma University Graduate School of Medicine, Japan; and Department of Neurology (L.J.O.), Massachusetts General Hospital, Charlestown
| | - Toshitaka Kawarai
- Segawa Memorial Neurological Clinic for Children (K.H., K.K., H.F., M.H.), Tokyo, Japan; Department of Neurosurgery (K.J.S.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Clinical Neuroscience (T.K., R.K.), Institute of Biomedical Sciences, Tokushima University, Japan; Medical Genetics Division (J.A.S., K.C.D.) and Neurology Division (J.A.S.), Hospital de Clínicas de Porto Alegre (HCPA); Graduate Program in Medicine: Medical Sciences and Internal Medicine Department (J.A.S.), Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Neurophysiology Division (J.F., J.D.), Hospital de Santo António, Centro Hospitalar Universitário do Porto; UniGene (J.F., J.D.), Instituto de Biologia Molecular e Celular, i3s Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal; Department of Diagnostic Radiology and Nuclear Medicine (T.H.), Gunma University Graduate School of Medicine, Japan; Department of Neurology (Y.I.), Gunma University Graduate School of Medicine, Japan; and Department of Neurology (L.J.O.), Massachusetts General Hospital, Charlestown
| | - Jonas Alex Saute
- Segawa Memorial Neurological Clinic for Children (K.H., K.K., H.F., M.H.), Tokyo, Japan; Department of Neurosurgery (K.J.S.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Clinical Neuroscience (T.K., R.K.), Institute of Biomedical Sciences, Tokushima University, Japan; Medical Genetics Division (J.A.S., K.C.D.) and Neurology Division (J.A.S.), Hospital de Clínicas de Porto Alegre (HCPA); Graduate Program in Medicine: Medical Sciences and Internal Medicine Department (J.A.S.), Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Neurophysiology Division (J.F., J.D.), Hospital de Santo António, Centro Hospitalar Universitário do Porto; UniGene (J.F., J.D.), Instituto de Biologia Molecular e Celular, i3s Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal; Department of Diagnostic Radiology and Nuclear Medicine (T.H.), Gunma University Graduate School of Medicine, Japan; Department of Neurology (Y.I.), Gunma University Graduate School of Medicine, Japan; and Department of Neurology (L.J.O.), Massachusetts General Hospital, Charlestown
| | - Joel Freitas
- Segawa Memorial Neurological Clinic for Children (K.H., K.K., H.F., M.H.), Tokyo, Japan; Department of Neurosurgery (K.J.S.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Clinical Neuroscience (T.K., R.K.), Institute of Biomedical Sciences, Tokushima University, Japan; Medical Genetics Division (J.A.S., K.C.D.) and Neurology Division (J.A.S.), Hospital de Clínicas de Porto Alegre (HCPA); Graduate Program in Medicine: Medical Sciences and Internal Medicine Department (J.A.S.), Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Neurophysiology Division (J.F., J.D.), Hospital de Santo António, Centro Hospitalar Universitário do Porto; UniGene (J.F., J.D.), Instituto de Biologia Molecular e Celular, i3s Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal; Department of Diagnostic Radiology and Nuclear Medicine (T.H.), Gunma University Graduate School of Medicine, Japan; Department of Neurology (Y.I.), Gunma University Graduate School of Medicine, Japan; and Department of Neurology (L.J.O.), Massachusetts General Hospital, Charlestown
| | - Joana Damásio
- Segawa Memorial Neurological Clinic for Children (K.H., K.K., H.F., M.H.), Tokyo, Japan; Department of Neurosurgery (K.J.S.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Clinical Neuroscience (T.K., R.K.), Institute of Biomedical Sciences, Tokushima University, Japan; Medical Genetics Division (J.A.S., K.C.D.) and Neurology Division (J.A.S.), Hospital de Clínicas de Porto Alegre (HCPA); Graduate Program in Medicine: Medical Sciences and Internal Medicine Department (J.A.S.), Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Neurophysiology Division (J.F., J.D.), Hospital de Santo António, Centro Hospitalar Universitário do Porto; UniGene (J.F., J.D.), Instituto de Biologia Molecular e Celular, i3s Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal; Department of Diagnostic Radiology and Nuclear Medicine (T.H.), Gunma University Graduate School of Medicine, Japan; Department of Neurology (Y.I.), Gunma University Graduate School of Medicine, Japan; and Department of Neurology (L.J.O.), Massachusetts General Hospital, Charlestown
| | - Karina C Donis
- Segawa Memorial Neurological Clinic for Children (K.H., K.K., H.F., M.H.), Tokyo, Japan; Department of Neurosurgery (K.J.S.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Clinical Neuroscience (T.K., R.K.), Institute of Biomedical Sciences, Tokushima University, Japan; Medical Genetics Division (J.A.S., K.C.D.) and Neurology Division (J.A.S.), Hospital de Clínicas de Porto Alegre (HCPA); Graduate Program in Medicine: Medical Sciences and Internal Medicine Department (J.A.S.), Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Neurophysiology Division (J.F., J.D.), Hospital de Santo António, Centro Hospitalar Universitário do Porto; UniGene (J.F., J.D.), Instituto de Biologia Molecular e Celular, i3s Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal; Department of Diagnostic Radiology and Nuclear Medicine (T.H.), Gunma University Graduate School of Medicine, Japan; Department of Neurology (Y.I.), Gunma University Graduate School of Medicine, Japan; and Department of Neurology (L.J.O.), Massachusetts General Hospital, Charlestown
| | - Kazue Kimura
- Segawa Memorial Neurological Clinic for Children (K.H., K.K., H.F., M.H.), Tokyo, Japan; Department of Neurosurgery (K.J.S.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Clinical Neuroscience (T.K., R.K.), Institute of Biomedical Sciences, Tokushima University, Japan; Medical Genetics Division (J.A.S., K.C.D.) and Neurology Division (J.A.S.), Hospital de Clínicas de Porto Alegre (HCPA); Graduate Program in Medicine: Medical Sciences and Internal Medicine Department (J.A.S.), Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Neurophysiology Division (J.F., J.D.), Hospital de Santo António, Centro Hospitalar Universitário do Porto; UniGene (J.F., J.D.), Instituto de Biologia Molecular e Celular, i3s Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal; Department of Diagnostic Radiology and Nuclear Medicine (T.H.), Gunma University Graduate School of Medicine, Japan; Department of Neurology (Y.I.), Gunma University Graduate School of Medicine, Japan; and Department of Neurology (L.J.O.), Massachusetts General Hospital, Charlestown
| | - Hideki Fukuda
- Segawa Memorial Neurological Clinic for Children (K.H., K.K., H.F., M.H.), Tokyo, Japan; Department of Neurosurgery (K.J.S.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Clinical Neuroscience (T.K., R.K.), Institute of Biomedical Sciences, Tokushima University, Japan; Medical Genetics Division (J.A.S., K.C.D.) and Neurology Division (J.A.S.), Hospital de Clínicas de Porto Alegre (HCPA); Graduate Program in Medicine: Medical Sciences and Internal Medicine Department (J.A.S.), Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Neurophysiology Division (J.F., J.D.), Hospital de Santo António, Centro Hospitalar Universitário do Porto; UniGene (J.F., J.D.), Instituto de Biologia Molecular e Celular, i3s Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal; Department of Diagnostic Radiology and Nuclear Medicine (T.H.), Gunma University Graduate School of Medicine, Japan; Department of Neurology (Y.I.), Gunma University Graduate School of Medicine, Japan; and Department of Neurology (L.J.O.), Massachusetts General Hospital, Charlestown
| | - Masaharu Hayashi
- Segawa Memorial Neurological Clinic for Children (K.H., K.K., H.F., M.H.), Tokyo, Japan; Department of Neurosurgery (K.J.S.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Clinical Neuroscience (T.K., R.K.), Institute of Biomedical Sciences, Tokushima University, Japan; Medical Genetics Division (J.A.S., K.C.D.) and Neurology Division (J.A.S.), Hospital de Clínicas de Porto Alegre (HCPA); Graduate Program in Medicine: Medical Sciences and Internal Medicine Department (J.A.S.), Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Neurophysiology Division (J.F., J.D.), Hospital de Santo António, Centro Hospitalar Universitário do Porto; UniGene (J.F., J.D.), Instituto de Biologia Molecular e Celular, i3s Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal; Department of Diagnostic Radiology and Nuclear Medicine (T.H.), Gunma University Graduate School of Medicine, Japan; Department of Neurology (Y.I.), Gunma University Graduate School of Medicine, Japan; and Department of Neurology (L.J.O.), Massachusetts General Hospital, Charlestown
| | - Tetsuya Higuchi
- Segawa Memorial Neurological Clinic for Children (K.H., K.K., H.F., M.H.), Tokyo, Japan; Department of Neurosurgery (K.J.S.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Clinical Neuroscience (T.K., R.K.), Institute of Biomedical Sciences, Tokushima University, Japan; Medical Genetics Division (J.A.S., K.C.D.) and Neurology Division (J.A.S.), Hospital de Clínicas de Porto Alegre (HCPA); Graduate Program in Medicine: Medical Sciences and Internal Medicine Department (J.A.S.), Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Neurophysiology Division (J.F., J.D.), Hospital de Santo António, Centro Hospitalar Universitário do Porto; UniGene (J.F., J.D.), Instituto de Biologia Molecular e Celular, i3s Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal; Department of Diagnostic Radiology and Nuclear Medicine (T.H.), Gunma University Graduate School of Medicine, Japan; Department of Neurology (Y.I.), Gunma University Graduate School of Medicine, Japan; and Department of Neurology (L.J.O.), Massachusetts General Hospital, Charlestown
| | - Yoshio Ikeda
- Segawa Memorial Neurological Clinic for Children (K.H., K.K., H.F., M.H.), Tokyo, Japan; Department of Neurosurgery (K.J.S.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Clinical Neuroscience (T.K., R.K.), Institute of Biomedical Sciences, Tokushima University, Japan; Medical Genetics Division (J.A.S., K.C.D.) and Neurology Division (J.A.S.), Hospital de Clínicas de Porto Alegre (HCPA); Graduate Program in Medicine: Medical Sciences and Internal Medicine Department (J.A.S.), Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Neurophysiology Division (J.F., J.D.), Hospital de Santo António, Centro Hospitalar Universitário do Porto; UniGene (J.F., J.D.), Instituto de Biologia Molecular e Celular, i3s Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal; Department of Diagnostic Radiology and Nuclear Medicine (T.H.), Gunma University Graduate School of Medicine, Japan; Department of Neurology (Y.I.), Gunma University Graduate School of Medicine, Japan; and Department of Neurology (L.J.O.), Massachusetts General Hospital, Charlestown
| | - Laurie J Ozelius
- Segawa Memorial Neurological Clinic for Children (K.H., K.K., H.F., M.H.), Tokyo, Japan; Department of Neurosurgery (K.J.S.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Clinical Neuroscience (T.K., R.K.), Institute of Biomedical Sciences, Tokushima University, Japan; Medical Genetics Division (J.A.S., K.C.D.) and Neurology Division (J.A.S.), Hospital de Clínicas de Porto Alegre (HCPA); Graduate Program in Medicine: Medical Sciences and Internal Medicine Department (J.A.S.), Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Neurophysiology Division (J.F., J.D.), Hospital de Santo António, Centro Hospitalar Universitário do Porto; UniGene (J.F., J.D.), Instituto de Biologia Molecular e Celular, i3s Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal; Department of Diagnostic Radiology and Nuclear Medicine (T.H.), Gunma University Graduate School of Medicine, Japan; Department of Neurology (Y.I.), Gunma University Graduate School of Medicine, Japan; and Department of Neurology (L.J.O.), Massachusetts General Hospital, Charlestown
| | - Ryuji Kaji
- Segawa Memorial Neurological Clinic for Children (K.H., K.K., H.F., M.H.), Tokyo, Japan; Department of Neurosurgery (K.J.S.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Clinical Neuroscience (T.K., R.K.), Institute of Biomedical Sciences, Tokushima University, Japan; Medical Genetics Division (J.A.S., K.C.D.) and Neurology Division (J.A.S.), Hospital de Clínicas de Porto Alegre (HCPA); Graduate Program in Medicine: Medical Sciences and Internal Medicine Department (J.A.S.), Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Neurophysiology Division (J.F., J.D.), Hospital de Santo António, Centro Hospitalar Universitário do Porto; UniGene (J.F., J.D.), Instituto de Biologia Molecular e Celular, i3s Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal; Department of Diagnostic Radiology and Nuclear Medicine (T.H.), Gunma University Graduate School of Medicine, Japan; Department of Neurology (Y.I.), Gunma University Graduate School of Medicine, Japan; and Department of Neurology (L.J.O.), Massachusetts General Hospital, Charlestown
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17
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Indelicato E, Boesch S. From Genotype to Phenotype: Expanding the Clinical Spectrum of CACNA1A Variants in the Era of Next Generation Sequencing. Front Neurol 2021; 12:639994. [PMID: 33737904 PMCID: PMC7960780 DOI: 10.3389/fneur.2021.639994] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 02/08/2021] [Indexed: 12/15/2022] Open
Abstract
Ion channel dysfunction is a key pathological substrate of episodic neurological disorders. A classical gene associated to paroxysmal movement disorders is CACNA1A, which codes for the pore-forming subunit of the neuronal calcium channel P/Q. Non-polyglutamine CACNA1A variants underlie familial hemiplegic ataxia type 1 (FHM1) and episodic ataxia type 2 (EA2). Classical paroxysmal manifestations of FHM1 are migraine attacks preceded by motor aura consisting of hemiparesis, aphasia, and disturbances of consciousness until coma. Patients with EA2 suffer of recurrent episodes of vertigo, unbalance, diplopia, and vomiting. Beyond these typical presentations, several reports highlighted manifold clinical features associated with P/Q channelopathies, from chronic progressive cerebellar ataxia to epilepsy and psychiatric disturbances. These manifestations may often outlast the burden of classical episodic symptoms leading to pitfalls in the diagnostic work-up. Lately, the spreading of next generation sequencing techniques linked de novo CACNA1A variants to an even broader phenotypic spectrum including early developmental delay, autism spectrum disorders, epileptic encephalopathy, and early onset paroxysmal dystonia. The age-dependency represents a striking new aspect of these phenotypes und highlights a pivotal role for P/Q channels in the development of the central nervous system in a defined time window. While several reviews addressed the clinical presentation and treatment of FHM1 and EA2, an overview of the newly described age-dependent manifestations is lacking. In this Mini-Review we present a clinical update, delineate genotype-phenotype correlations as well as summarize evidence on the pathophysiological mechanisms underlying the expanded phenotype associated with CACNA1A variants.
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Affiliation(s)
| | - Sylvia Boesch
- Center for Rare Movement Disorders Innsbruck, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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18
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Calame DG, Houck K, Lotze T, Emrick L, Parnes M. A novel ATP1A2 variant associated with severe stepwise regression, hemiplegia, epilepsy and movement disorders in two unrelated patients. Eur J Paediatr Neurol 2021; 31:21-26. [PMID: 33578253 DOI: 10.1016/j.ejpn.2021.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 01/03/2021] [Accepted: 01/10/2021] [Indexed: 11/25/2022]
Abstract
Pathogenic variants in ATP1A2, a gene encoding the α subunit of the Na,K-ATPase, cause familial hemiplegic migraine type 2 (FHM2). In contrast, pathogenic variants in ATP1A3, an ATP1A2 paralog, cause alternating hemiplegia of childhood (AHC), a severe neurodevelopmental disorder with infantile onset hemiplegic attacks, seizures, dystonia, chorea and developmental delay. Despite high sequence homology with ATP1A3, ATP1A2 variants rarely associate with severe phenotypes resembling those linked to ATP1A3. Here we describe two unrelated patients with infantile onset hemiplegic attacks, refractory epilepsy, movement disorders, abnormal eye movements and truncal ataxia with a shared de novo variant in ATP1A2, c.2438T > A (p.Met813Lys). The variant is not found in population databases, is predicted to be damaging by in silico analysis, and affects a highly conserved residue. Both patients experienced severe attacks with unilateral cerebral edema followed by sustained, stepwise regression. This report highlights the need to sequence ATP1A2 in the workup of patients with features of AHC that do not fulfill AHC diagnostic criteria.
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Affiliation(s)
- Daniel G Calame
- Baylor College of Medicine, Department of Pediatric Neurology and Developmental Neuroscience, Houston, TX, USA.
| | - Kimberly Houck
- Baylor College of Medicine, Department of Pediatric Neurology and Developmental Neuroscience, Houston, TX, USA
| | - Timothy Lotze
- Baylor College of Medicine, Department of Pediatric Neurology and Developmental Neuroscience, Houston, TX, USA
| | - Lisa Emrick
- Baylor College of Medicine, Department of Pediatric Neurology and Developmental Neuroscience, Houston, TX, USA
| | - Mered Parnes
- Baylor College of Medicine, Department of Pediatric Neurology and Developmental Neuroscience, Houston, TX, USA
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19
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Gandini MA, Souza IA, Ferron L, Innes AM, Zamponi GW. The de novo CACNA1A pathogenic variant Y1384C associated with hemiplegic migraine, early onset cerebellar atrophy and developmental delay leads to a loss of Cav2.1 channel function. Mol Brain 2021; 14:27. [PMID: 33557884 PMCID: PMC7871581 DOI: 10.1186/s13041-021-00745-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 02/02/2021] [Indexed: 12/12/2022] Open
Abstract
CACNA1A pathogenic variants have been linked to several neurological disorders including familial hemiplegic migraine and cerebellar conditions. More recently, de novo variants have been associated with severe early onset developmental encephalopathies. CACNA1A is highly expressed in the central nervous system and encodes the pore-forming CaVα1 subunit of P/Q-type (Cav2.1) calcium channels. We have previously identified a patient with a de novo missense mutation in CACNA1A (p.Y1384C), characterized by hemiplegic migraine, cerebellar atrophy and developmental delay. The mutation is located at the transmembrane S5 segment of the third domain. Functional analysis in two predominant splice variants of the neuronal Cav2.1 channel showed a significant loss of function in current density and changes in gating properties. Moreover, Y1384 variants exhibit differential splice variant-specific effects on recovery from inactivation. Finally, structural analysis revealed structural damage caused by the tyrosine substitution and changes in electrostatic potentials.
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Affiliation(s)
- Maria A Gandini
- Department of Physiology and Pharmacology, Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Ivana A Souza
- Department of Physiology and Pharmacology, Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Laurent Ferron
- Department of Physiology and Pharmacology, Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - A Micheil Innes
- Department of Medical Genetics and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Gerald W Zamponi
- Department of Physiology and Pharmacology, Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
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20
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Indelicato E, Unterberger I, Nachbauer W, Eigentler A, Amprosi M, Zeiner F, Haberlandt E, Kaml M, Gizewski E, Boesch S. The electrophysiological footprint of CACNA1A disorders. J Neurol 2021; 268:2493-2505. [PMID: 33544220 PMCID: PMC8217028 DOI: 10.1007/s00415-021-10415-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 01/16/2021] [Accepted: 01/17/2021] [Indexed: 12/14/2022]
Abstract
Objectives CACNA1A variants underlie three neurological disorders: familial hemiplegic migraine type 1 (FHM1), episodic ataxia type 2 (EA2) and spinocerebellar ataxia type 6 (SCA6). EEG is applied to study their episodic manifestations, but findings in the intervals did not gain attention up to date. Methods We analyzed repeated EEG recordings performed between 1994 and 2019 in a large cohort of genetically confirmed CACNA1A patients. EEG findings were compared with those of CACNA1A-negative phenocopies. A review of the related literature was performed. Results 85 EEG recordings from 38 patients (19 EA2, 14 FHM1, 5 SCA6) were analyzed. Baseline EEG was abnormal in 55% of cases (12 EA2, 9 FHM1). The most common finding was a lateralized intermittent slowing, mainly affecting the temporal region. Slowing was more pronounced after a recent attack but was consistently detected in the majority of patients also during the follow-up. Interictal epileptic discharges (IEDs) were detected in eight patients (7 EA2,1 FHM1). EEG abnormalities and especially IEDs were significantly associated with younger age at examination (16 ± 9 vs 43 ± 21 years in those without epileptic changes, p = 0.003) and with earlier onset of disease (1 (1–2) vs 12 (5–45) years, p = 0.0009). EEG findings in CACNA1A-negative phenocopies (n = 15) were largely unremarkable (p = 0.03 in the comparison with CACNA1A patients). Conclusions EEG abnormalities between attacks are highly prevalent in episodic CACNA1A disorders and especially associated with younger age at examination and earlier disease onset. Our findings underpin an age-dependent effect of CACNA1A variants, with a more severe impairment when P/Q channel dysfunction manifests early in life.
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Affiliation(s)
- Elisabetta Indelicato
- Center for Rare Movement Disorders Innsbruck, Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Iris Unterberger
- Epileptology Division, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Wolfgang Nachbauer
- Center for Rare Movement Disorders Innsbruck, Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Andreas Eigentler
- Center for Rare Movement Disorders Innsbruck, Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Matthias Amprosi
- Center for Rare Movement Disorders Innsbruck, Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Fiona Zeiner
- Department of Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | - Edda Haberlandt
- Department of Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria
- Department of Pediatrics, City Hospital, Dornbirn, Austria
| | - Manuela Kaml
- Epileptology Division, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Elke Gizewski
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Sylvia Boesch
- Center for Rare Movement Disorders Innsbruck, Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
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21
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Rudenskaya G, Sermyagina I, Chukhrova A, Dadali E, Lozier E, Shchagina O. Diversity of CACNA1A-related disorders. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:106-111. [DOI: 10.17116/jnevro2021121121106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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22
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Di Stefano V, Rispoli MG, Pellegrino N, Graziosi A, Rotondo E, Napoli C, Pietrobon D, Brighina F, Parisi P. Diagnostic and therapeutic aspects of hemiplegic migraine. J Neurol Neurosurg Psychiatry 2020; 91:764-771. [PMID: 32430436 PMCID: PMC7361005 DOI: 10.1136/jnnp-2020-322850] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/22/2020] [Accepted: 04/24/2020] [Indexed: 01/25/2023]
Abstract
Hemiplegic migraine (HM) is a clinically and genetically heterogeneous condition with attacks of headache and motor weakness which may be associated with impaired consciousness, cerebellar ataxia and intellectual disability. Motor symptoms usually last <72 hours and are associated with visual or sensory manifestations, speech impairment or brainstem aura. HM can occur as a sporadic HM or familiar HM with an autosomal dominant mode of inheritance. Mutations in CACNA1A, ATP1A2 and SCN1A encoding proteins involved in ion transport are implicated. The pathophysiology of HM is close to the process of typical migraine with aura, but appearing with a lower threshold and more severity. We reviewed epidemiology, clinical presentation, diagnostic assessment, differential diagnosis and treatment of HM to offer the best evidence of this rare condition. The differential diagnosis of HM is broad, including other types of migraine and any condition that can cause transitory neurological signs and symptoms. Neuroimaging, cerebrospinal fluid analysis and electroencephalography are useful, but the diagnosis is clinical with a genetic confirmation. The management relies on the control of triggering factors and even hospitalisation in case of long-lasting auras. As HM is a rare condition, there are no randomised controlled trials, but the evidence for the treatment comes from small studies.
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Affiliation(s)
- Vincenzo Di Stefano
- Department of Biomedicine, Neuroscience and Advanced Diagnostic (BIND), University of Palermo, Palermo, Sicilia, Italy
| | - Marianna Gabriella Rispoli
- Department of Neuroscience Imaging and Clinical Sciences, 'G. d'Annunzio' University, Universita degli Studi Gabriele d'Annunzio Chieti e Pescara, Chieti Scalo, Chieti, Italy
| | - Noemi Pellegrino
- Pediatrics, University Gabriele d'Annunzio of Chieti Pescara Department of Medicine and Aging Science, Chieti, Abruzzo, Italy
| | - Alessandro Graziosi
- Pediatrics, University Gabriele d'Annunzio of Chieti Pescara Department of Medicine and Aging Science, Chieti, Abruzzo, Italy
| | - Eleonora Rotondo
- Pediatrics, University Gabriele d'Annunzio of Chieti Pescara Department of Medicine and Aging Science, Chieti, Abruzzo, Italy
| | - Christian Napoli
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Roma, Lazio, Italy
| | - Daniela Pietrobon
- Department of Biomedical Sciences & Padova Neuroscience Center, University of Padova, Padova, Italy.,CNR Neuroscience Institute, Padova, Italy
| | - Filippo Brighina
- Department of Biomedicine, Neuroscience and Advanced Diagnostic (BIND), University of Palermo, Palermo, Sicilia, Italy
| | - Pasquale Parisi
- Dipartimento di Neuroscienze Salute Mentale e Organi di Senso (NESMOS), University of Rome La Sapienza Faculty of Medicine and Psychology, Roma, Lazio, Italy
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23
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Nardello R, Plicato G, Mangano GD, Gennaro E, Mangano S, Brighina F, Raieli V, Fontana A. Two distinct phenotypes, hemiplegic migraine and episodic Ataxia type 2, caused by a novel common CACNA1A variant. BMC Neurol 2020; 20:155. [PMID: 32336275 PMCID: PMC7183684 DOI: 10.1186/s12883-020-01704-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 03/27/2020] [Indexed: 12/18/2022] Open
Abstract
Background To investigate the genetic and environmental factors responsible for phenotype variability in a family carrying a novel CACNA1A missense mutation. Mutations in the CACNA1A gene were identified as responsible for at least three autosomal dominant disorders: FHM1 (Familial Hemiplegic Migraine), EA2 (Episodic Ataxia type 2), and SCA6 (Spinocerebellar Ataxia type 6). Overlapping clinical features within individuals of some families sharing the same CACNA1A mutation are not infrequent. Conversely, reports with distinct phenotypes within the same family associated with a common CACNA1A mutation are very rare. Case presentation A clinical, molecular, neuroradiological, neuropsychological, and neurophysiological study was carried out in proband and his carrier mother. The new heterozygous missense variant c.4262G > A (p.Arg1421Gln) in the CACNA1A gene was detected in the two affected family members. The proband showed a complex clinical presentation characterized by developmental delay, poor motor coordination, hemiplegic migraine attacks, behavioral dysregulation, and EEG abnormalities. The mother showed typical episodic ataxia attacks during infancy with no other comorbidities and mild cerebellar signs at present neurological evaluation. Conclusions The proband and his mother exhibit two distinct clinical phenotypes. It can be hypothesized that other unknown modifying genes and/or environmental factors may cooperate to generate the wide intrafamilial variability.
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Affiliation(s)
- Rosaria Nardello
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialities, Specialities "G. D'Alessandro," University of Palermo, Palermo, Italy
| | - Giorgia Plicato
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialities, Specialities "G. D'Alessandro," University of Palermo, Palermo, Italy
| | - Giuseppe Donato Mangano
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialities, Specialities "G. D'Alessandro," University of Palermo, Palermo, Italy
| | - Elena Gennaro
- UOC Laboratorio di Genetica Umana, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Salvatore Mangano
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialities, Specialities "G. D'Alessandro," University of Palermo, Palermo, Italy.
| | - Filippo Brighina
- Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo, Palermo, Italy
| | - Vincenzo Raieli
- Child Neuropsychiatry Department, Di Cristina - ARNAS Civico Hospital, Palermo, Italy
| | - Antonina Fontana
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialities, Specialities "G. D'Alessandro," University of Palermo, Palermo, Italy
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24
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Jing T, Ma J, Zhao H, Zhang J, Jiang N, Ma D. MAST1 modulates neuronal differentiation and cell cycle exit via P27 in neuroblastoma cells. FEBS Open Bio 2020; 10:1104-1114. [PMID: 32291963 PMCID: PMC7262902 DOI: 10.1002/2211-5463.12860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/13/2020] [Accepted: 04/09/2020] [Indexed: 12/22/2022] Open
Abstract
Although 19p13.13 microdeletion syndrome has been consistently associated with intellectual disability, overgrowth, and macrocephaly, the underlying mechanisms remain unclear. MAST1, a member of the microtubule‐associated serine/threonine kinase family, has been suggested as a potential candidate gene responsible for neurologic abnormalities in 19p13.13 microdeletion syndrome, but its role in nervous system development remains to be elucidated. Here, we investigated how MAST1 contributes to neuronal development. We report that MAST1 is upregulated during neuronal differentiation of the human neuroblastoma cell line, SH‐SY5Y. Inhibition of MAST1 expression by RNA interference attenuated neuronal differentiation of SH‐SY5Y cells. Cell cycle analyses revealed that MAST1‐depleted cells did not undergo cell cycle arrest after RA treatment. Consistent with this observation, the number of EdU‐positive cells significantly increased in MAST1 knockdown cells. Intriguingly, levels of P27, a cyclin‐dependent kinase inhibitor, were also increased during neuronal differentiation, and MAST1 knockdown reduced the expression of P27. Moreover, reduced neuronal differentiation caused by MAST1 depletion was rescued partially by P27 overexpression in SH‐SY5Y cells. Collectively, these results suggest that MAST1 influences nervous system development by affecting neuronal differentiation through P27.
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Affiliation(s)
- Tianrui Jing
- Key Laboratory of Metabolism and Molecular Medicine, Ministry of Education, Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences & Institutes of Biomedical Sciences, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jing Ma
- Department of Facial Plastic and Reconstructive Surgery, ENT Institute, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Huanqiang Zhao
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Jin Zhang
- Key Laboratory of Metabolism and Molecular Medicine, Ministry of Education, Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences & Institutes of Biomedical Sciences, Shanghai Medical College, Fudan University, Shanghai, China
| | - Nan Jiang
- Key Laboratory of Metabolism and Molecular Medicine, Ministry of Education, Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences & Institutes of Biomedical Sciences, Shanghai Medical College, Fudan University, Shanghai, China
| | - Duan Ma
- Key Laboratory of Metabolism and Molecular Medicine, Ministry of Education, Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences & Institutes of Biomedical Sciences, Shanghai Medical College, Fudan University, Shanghai, China.,Children's Hospital, Fudan University, Shanghai, China
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25
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Tyagi S, Ribera AB, Bannister RA. Zebrafish as a Model System for the Study of Severe Ca V2.1 (α 1A) Channelopathies. Front Mol Neurosci 2020; 12:329. [PMID: 32116539 PMCID: PMC7018710 DOI: 10.3389/fnmol.2019.00329] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 12/23/2019] [Indexed: 02/02/2023] Open
Abstract
The P/Q-type CaV2.1 channel regulates neurotransmitter release at neuromuscular junctions (NMJ) and many central synapses. CACNA1A encodes the pore-containing α1A subunit of CaV2.1 channels. In humans, de novo CACNA1A mutations result in a wide spectrum of neurological, neuromuscular, and movement disorders, such as familial hemiplegic migraine type 1 (FHM1), episodic ataxia type 2 (EA2), as well as a more recently discovered class of more severe disorders, which are characterized by ataxia, hypotonia, cerebellar atrophy, and cognitive/developmental delay. Heterologous expression of CaV2.1 channels has allowed for an understanding of the consequences of CACNA1A missense mutations on channel function. In contrast, a mechanistic understanding of how specific CACNA1A mutations lead in vivo to the resultant phenotypes is lacking. In this review, we present the zebrafish as a model to both study in vivo mechanisms of CACNA1A mutations that result in synaptic and behavioral defects and to screen for effective drug therapies to combat these and other CaV2.1 channelopathies.
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Affiliation(s)
- Sidharth Tyagi
- Medical Scientist Training Program, Yale University School of Medicine, New Haven, CT, United States
| | - Angeles B Ribera
- Department of Physiology and Biophysics, University of Colorado School of Medicine, Aurora, CO, United States
| | - Roger A Bannister
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, United States.,Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, Baltimore, MD, United States
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26
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Maksemous N, Smith RA, Sutherland HG, Maher BH, Ibrahim O, Nicholson GA, Carpenter EP, Lea RA, Cader MZ, Griffiths LR. Targeted next generation sequencing identifies a genetic spectrum of DNA variants in patients with hemiplegic migraine. CEPHALALGIA REPORTS 2019. [DOI: 10.1177/2515816319881630] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: Hemiplegic migraine in both familial (FHM) and sporadic (SHM) forms is a rare subtype of migraine with aura that can be traced to mutations in the CACNA1A, ATP1A2 and SCN1A genes. It is characterised by severe attacks of typical migraine accompanied by hemiparesis, as well as episodes of complex aura that vary significantly between individuals. Methods: Using a targeted next generation sequencing (NGS) multigene panel, we have sequenced the genomic DNA of 172 suspected hemiplegic migraine cases, in whom no mutation had previously been found by Sanger sequencing (SS) of a limited number of exons with high mutation frequency in FHM genes. Results: Genetic screening identified 29 variants, 10 of which were novel, in 35 cases in the three FHM genes ( CACNA1A, ATP1A2 and SCN1A). Interestingly, in this suspected HM cohort, the ATP1A2 gene harboured the highest number of variants with 24/35 cases (68.6%), while CACNA1A ranked the second gene, with 5 variants identified in 7/35 cases (20%). All detected variants were confirmed by SS and were absent in 100 non-migraine healthy control individuals. Assessment of variants with the American College of Medical Genetics and Genomics guidelines classified 8 variants as pathogenic, 3 as likely pathogenic and 18 as variants of unknown significance. Targeted NGS gene panel increased the diagnostic yield by fourfold over iterative SS in our diagnostics facility. Conclusion: We have identified 29 potentially causative variants in an Australian and New Zealand cohort of suspected HM cases and found that the ATP1A2 gene was the most commonly mutated gene. Our results suggest that screening using NGS multigene panels to investigate ATP1A2 alongside CACNA1A and SCN1A is a clinically useful and efficient method.
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Affiliation(s)
- Neven Maksemous
- Genomics Research Centre, Institute of Health and Biomedical Innovation (IHBI), School of Biomedical Sciences, Queensland University of Technology (QUT), Kelvin Grove campus, Brisbane, Australia
| | - Robert A Smith
- Genomics Research Centre, Institute of Health and Biomedical Innovation (IHBI), School of Biomedical Sciences, Queensland University of Technology (QUT), Kelvin Grove campus, Brisbane, Australia
| | - Heidi G Sutherland
- Genomics Research Centre, Institute of Health and Biomedical Innovation (IHBI), School of Biomedical Sciences, Queensland University of Technology (QUT), Kelvin Grove campus, Brisbane, Australia
| | - Bridget H Maher
- Genomics Research Centre, Institute of Health and Biomedical Innovation (IHBI), School of Biomedical Sciences, Queensland University of Technology (QUT), Kelvin Grove campus, Brisbane, Australia
| | - Omar Ibrahim
- Genomics Research Centre, Institute of Health and Biomedical Innovation (IHBI), School of Biomedical Sciences, Queensland University of Technology (QUT), Kelvin Grove campus, Brisbane, Australia
| | - Garth A Nicholson
- Department of Biomedical Sciences, Faculty of Medicine, and Health Sciences, Research Institute, Concord Hospital and ANZAC Research Institute, The University of Sydney, Sydney, Australia
| | | | - Rod A Lea
- Genomics Research Centre, Institute of Health and Biomedical Innovation (IHBI), School of Biomedical Sciences, Queensland University of Technology (QUT), Kelvin Grove campus, Brisbane, Australia
| | - M Zameel Cader
- Departments of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Lyn R Griffiths
- Genomics Research Centre, Institute of Health and Biomedical Innovation (IHBI), School of Biomedical Sciences, Queensland University of Technology (QUT), Kelvin Grove campus, Brisbane, Australia
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Toldo I, Brunello F, Morao V, Perissinotto E, Valeriani M, Pruna D, Tozzi E, Moscano F, Farello G, Frusciante R, Carotenuto M, Lisotto C, Ruffatti S, Maggioni F, Termine C, Di Rosa G, Nosadini M, Sartori S, Battistella PA. First Attack and Clinical Presentation of Hemiplegic Migraine in Pediatric Age: A Multicenter Retrospective Study and Literature Review. Front Neurol 2019; 10:1079. [PMID: 31681150 PMCID: PMC6803542 DOI: 10.3389/fneur.2019.01079] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 09/24/2019] [Indexed: 01/04/2023] Open
Abstract
Background: Data on clinical presentation of Hemiplegic Migraine (HM) are quite limited in the literature, particularly in the pediatric age. The aim of the present study is to describe in detail the phenotypic features at onset and during the first years of disease of sporadic (SHM) and familial (FHM) pediatric hemiplegic migraine and to review the pertinent literature. Results: Retrospective study of a cohort of children and adolescents diagnosed with hemiplegic migraine, recruited from 11 Italian specialized Juvenile Headache Centers. Forty-six cases (24 females) were collected and divided in two subgroups: 32 SHM (16 females), 14 FHM (8 females). Mean age at onset was 10.5 ± 3.8 y (range: 2–16 y). Mean duration of motor aura was 3.5 h (range: 5 min−48 h). SHM cases experienced more prolonged attacks than FHM cases, with significantly longer duration of both motor aura and of total HM attack. Sensory (65%) and basilar-type auras (63%) were frequently associated to the motor aura, without significant differences between SHM and FHM. At follow-up (mean duration 4.4 years) the mean frequency of attacks was 2.2 per year in the first year after disease onset, higher in FHM than in SHM cases (3.9 vs. 1.5 per year, respectively). A literature review retrieved seven studies, all but one were based on mixed adults and children cohorts. Conclusions: This study represents the first Italian pediatric series of HM ever reported, including both FHM and SHM patients. Our cohort highlights that in the pediatric HM has an heterogeneous clinical onset. Children present fewer non-motor auras as compared to adults and in some cases the first attack is preceded by transient neurological signs and symptoms in early childhood. In SHM cases, attacks were less frequent but more severe and prolonged, while FHM patients had less intense but more frequent attacks and a longer phase of active disease. Differently from previous studies, the majority of our cases, even with early onset and severe attacks, had a favorable clinical evolution.
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Affiliation(s)
- Irene Toldo
- Department of Woman's and Child's Health, Juvenile Headache Centre, University Hospital of Padua, Padua, Italy
| | - Francesco Brunello
- Department of Woman's and Child's Health, Juvenile Headache Centre, University Hospital of Padua, Padua, Italy
| | - Veronica Morao
- Department of Woman's and Child's Health, Juvenile Headache Centre, University Hospital of Padua, Padua, Italy
| | - Egle Perissinotto
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiologic, Vascular, Thoracic Sciences and Public Health, University of Padova, Padua, Italy
| | | | - Dario Pruna
- Unit of Pediatric Neurology and Epileptology, "Brotzu" Hospital, Cagliari, Italy
| | - Elisabetta Tozzi
- Child Neuropsychiatry Unit, Juvenile Headache Center, University of L'Aquila, L'Aquila, Italy
| | - Filomena Moscano
- Child Neuropsychiatric Unit, Women, Children and Adolescents Health Department, University Hospital S.Orsola-Malpighi, Bologna, Italy
| | - Giovanni Farello
- Pediatric Clinic, Department of Life, Health and Environmental Science, University of L'Aquila, L'Aquila, Italy
| | | | - Marco Carotenuto
- Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | | | - Ferdinando Maggioni
- Department of Neurosciences, Headache Centre, University Hospital of Padua, Padua, Italy
| | - Cristiano Termine
- Child Neuropsychiatry Unit, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Gabriella Di Rosa
- Child Neuropsychiatry Unit, Department of Human Pathology of the Adult and Developmental Age, University Hospital "G. Martino", Messina, Italy
| | - Margherita Nosadini
- Department of Woman's and Child's Health, Juvenile Headache Centre, University Hospital of Padua, Padua, Italy
| | - Stefano Sartori
- Department of Woman's and Child's Health, Juvenile Headache Centre, University Hospital of Padua, Padua, Italy
| | - Pier Antonio Battistella
- Department of Woman's and Child's Health, Juvenile Headache Centre, University Hospital of Padua, Padua, Italy
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Rispoli MG, Di Stefano V, Mantuano E, De Angelis MV. Novel missense mutation in the ATP1A2 gene associated with atypical sporapedic hemiplegic migraine. BMJ Case Rep 2019; 12:12/10/e231129. [PMID: 31586957 DOI: 10.1136/bcr-2019-231129] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Hemiplegic migraine (HM) is a rare subtype of migraine with aura in which attacks include transient motor weakness or hemiparesis that can last several days. HM is linked to mutations in three different genes, CACNA1A, ATP1A2 and SCN1A, which encode for ion transporters. The clinical spectrum includes atypical symptoms such as impaired consciousness, epileptic seizures, permanent cerebellar ataxia or mental retardation. We describe a novel mutation found in the ATP1A2 gene in a patient with late-onset HM. His attacks were characterised by motor weakness associated with altered mental status, diplopia and ataxia. He also showed up MRI abnormalities and incomplete response to prophylactic therapy with verapamil. Late-onset HM should be considered among the possible causes of focal neurological deficits even in older patients with cerebrovascular risk factors when a stroke appears to be more likely.
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Affiliation(s)
| | - Vincenzo Di Stefano
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d' annunzio" University, Chieti, Italy
| | - Elide Mantuano
- Institute of Translational Pharmacology, National Research Council of Italy, Rome, Italy
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Abstract
Transient disturbances in neurologic function are disturbing features of migraine attacks. Aura types include binocular visual, hemi-sensory, language and unilateral motor symptoms. Because of the gradual spreading quality of visual and sensory symptoms, they were thought to arise from the cerebral cortex. Motor symptoms previously included as a type of migraine aura were reclassified as a component of hemiplegic migraine. ICHD-3 criteria of the International Headache Society, added brainstem aura and retinal aura as separate subtypes. The susceptibility to all types of aura is likely to be included by complex and perhaps epigenetic factors.
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Affiliation(s)
- Rod Foroozan
- Baylor College of Medicine, 6565 Fannin NC-205, Houston, TX 77030, USA.
| | - F Michael Cutrer
- Mayo Clinic, 200 First Street, Southwest, Rochester, MN 55905, USA
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30
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Distinct effects of Q925 mutation on intracellular and extracellular Na + and K + binding to the Na +, K +-ATPase. Sci Rep 2019; 9:13344. [PMID: 31527711 PMCID: PMC6746705 DOI: 10.1038/s41598-019-50009-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 09/03/2019] [Indexed: 11/09/2022] Open
Abstract
Three Na+ sites are defined in the Na+-bound crystal structure of Na+, K+-ATPase. Sites I and II overlap with two K+ sites in the K+-bound structure, whereas site III is unique and Na+ specific. A glutamine in transmembrane helix M8 (Q925) appears from the crystal structures to coordinate Na+ at site III, but does not contribute to K+ coordination at sites I and II. Here we address the functional role of Q925 in the various conformational states of Na+, K+-ATPase by examining the mutants Q925A/G/E/N/L/I/Y. We characterized these mutants both enzymatically and electrophysiologically, thereby revealing their Na+ and K+ binding properties. Remarkably, Q925 substitutions had minor effects on Na+ binding from the intracellular side of the membrane - in fact, mutations Q925A and Q925G increased the apparent Na+ affinity - but caused dramatic reductions of the binding of K+ as well as Na+ from the extracellular side of the membrane. These results provide insight into the changes taking place in the Na+-binding sites, when they are transformed from intracellular- to extracellular-facing orientation in relation to the ion translocation process, and demonstrate the interaction between sites III and I and a possible gating function of Q925 in the release of Na+ at the extracellular side.
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31
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Parisi P, Paolino MC, Raucci U, Della Vecchia N, Belcastro V, Villa MP, Striano P. Ictal Epileptic Headache: When Terminology Is Not a Moot Question. Front Neurol 2019; 10:785. [PMID: 31396147 PMCID: PMC6664028 DOI: 10.3389/fneur.2019.00785] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 07/08/2019] [Indexed: 11/13/2022] Open
Abstract
The relationship between headache and epilepsy is complex and despite the nature of this association is not yet clear. In the last few years, it has been progressively introduced the concept of the “ictal epileptic headache” that was included in the recently revised International Classification of Headaches Disorders 3rd edition (ICHD-3-revised). The diagnostic criteria for ictal epileptic headache (IEH) suggested in 2012 were quite restrictive thus leading to the underestimation of this phenomenon. However, these criteria have not yet been included into the ICHD-3 revision published in 2018, thus creating confusion among both, physicians and experts in this field. Here, we highlight the importance to strictly apply the original IEH criteria explaining the reasons through the analysis of the clinical, historical, epidemiological and pathophysiological characteristics of the IEH itself. In addition, we discuss the issues related to the neurophysiopathological link between headache and epilepsy as well as to the classification of these epileptic events as “autonomic seizure.”
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Affiliation(s)
- Pasquale Parisi
- Chair of Pediatrics, Child Neurology, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Maria Chiara Paolino
- Chair of Pediatrics, Child Neurology, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Umberto Raucci
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Vincenzo Belcastro
- Neurology Unit, Department of Neuroscience, Sant'Anna Hospital, Como, Italy
| | - Maria Pia Villa
- Chair of Pediatrics, Child Neurology, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Pasquale Striano
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genova, Italy.,Paediatric Neurology and Muscular Diseases Unit, G. Gaslini' Institute, Genova, Italy
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32
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Nagarajan E, Bollu PC, Manjamalai S, Yelam A, Qureshi AI. White Matter Hyperintensities in Patients with Sporadic Hemiplegic Migraine. J Neuroimaging 2019; 29:730-736. [PMID: 31304994 DOI: 10.1111/jon.12656] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 06/26/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND AND PURPOSE To identify the differences in overall occurrence, location, and disease burden of white matter hyperintensities (WMH) in patients with sporadic hemiplegic migraine (SHM) and patients with migraine headaches. METHODS We included patients who met diagnostic criteria proposed by the third International Classification of Headache Disorders (ICHD-3) for SHM and migraine headache. WMHs were identified using T2 fluid-attenuated inversion recovery axial sequence and classified based upon the location. The disease burden was assessed using Scheltens visual rating scale. RESULTS Fifty patients met the diagnostic criteria for SHM and 100 patients for migraine headache. Patients in the study group were similar to the control group in terms of age (47.7 ± 12.2 years vs. 48.17 ± 9.7 years; P = .814) and gender (M: F; 14:36 vs. M: F 25:75; P = .693). WMH were found in 28 (56%) patients with SHM and 44 (44%) in patients with migraine headache. The proportion of patients with WMH was not different between the two groups (P = .166). On univariate analysis, the proportion of patients with WMH in parietal, occipital, and infratentorial regions was higher in patients with SHM. White matter burden determined by visual rating scale and proportion of patients with lesions ≥5 mm in diameter was also significantly higher in patients with SHM. On multivariate analysis, the WMH occurrence in the parietal lobe (P = .043) was found to be significantly higher in SHM. CONCLUSIONS The WMH occurrence in patients with SHM is significantly more in the parietal lobe when compared to those with migraine headaches. WMH burden was also higher in patients with SHM, and larger white matter lesions occurred more frequently in these patients with SHM (compared to ordinary migraineurs).
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Affiliation(s)
| | - Pradeep C Bollu
- Department of Neurology, University of Missouri, Columbia, Missouri
| | | | - Anudeep Yelam
- Department of Neurology, University of Missouri, Columbia, Missouri
| | - Adnan I Qureshi
- Department of Neurology, University of Missouri, Columbia, Missouri.,Zeenat Qureshi Stroke Institute, St. Cloud, Minnesota
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33
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Sutherland HG, Albury CL, Griffiths LR. Advances in genetics of migraine. J Headache Pain 2019; 20:72. [PMID: 31226929 PMCID: PMC6734342 DOI: 10.1186/s10194-019-1017-9] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 05/24/2019] [Indexed: 02/06/2023] Open
Abstract
Background Migraine is a complex neurovascular disorder with a strong genetic component. There are rare monogenic forms of migraine, as well as more common polygenic forms; research into the genes involved in both types has provided insights into the many contributing genetic factors. This review summarises advances that have been made in the knowledge and understanding of the genes and genetic variations implicated in migraine etiology. Findings Migraine is characterised into two main types, migraine without aura (MO) and migraine with aura (MA). Hemiplegic migraine is a rare monogenic MA subtype caused by mutations in three main genes - CACNA1A, ATP1A2 and SCN1A - which encode ion channel and transport proteins. Functional studies in cellular and animal models show that, in general, mutations result in impaired glutamatergic neurotransmission and cortical hyperexcitability, which make the brain more susceptible to cortical spreading depression, a phenomenon thought to coincide with aura symptoms. Variants in other genes encoding ion channels and solute carriers, or with roles in regulating neurotransmitters at neuronal synapses, or in vascular function, can also cause monogenic migraine, hemiplegic migraine and related disorders with overlapping symptoms. Next-generation sequencing will accelerate the finding of new potentially causal variants and genes, with high-throughput bioinformatics analysis methods and functional analysis pipelines important in prioritising, confirming and understanding the mechanisms of disease-causing variants. With respect to common migraine forms, large genome-wide association studies (GWAS) have greatly expanded our knowledge of the genes involved, emphasizing the role of both neuronal and vascular pathways. Dissecting the genetic architecture of migraine leads to greater understanding of what underpins relationships between subtypes and comorbid disorders, and may have utility in diagnosis or tailoring treatments. Further work is required to identify causal polymorphisms and the mechanism of their effect, and studies of gene expression and epigenetic factors will help bridge the genetics with migraine pathophysiology. Conclusions The complexity of migraine disorders is mirrored by their genetic complexity. A comprehensive knowledge of the genetic factors underpinning migraine will lead to improved understanding of molecular mechanisms and pathogenesis, to enable better diagnosis and treatments for migraine sufferers.
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Affiliation(s)
- Heidi G Sutherland
- Genomics Research Centre, Institute of Health and Biomedical Innovation. School of Biomedical Sciences, Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Cassie L Albury
- Genomics Research Centre, Institute of Health and Biomedical Innovation. School of Biomedical Sciences, Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Lyn R Griffiths
- Genomics Research Centre, Institute of Health and Biomedical Innovation. School of Biomedical Sciences, Queensland University of Technology (QUT), Brisbane, QLD, Australia.
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34
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Tang W, Zhang M, Qiu E, Kong S, Li Y, Liu H, Dong Z, Yu S. A Chinese family with familial hemiplegic migraine type 2 due to a novel missense mutation in ATP1A2. Cephalalgia 2019; 39:1382-1395. [PMID: 31053037 DOI: 10.1177/0333102419847738] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background ATP1A2 has been identified as the genetic cause of familial hemiplegic migraine type 2. Over 80 ATP1A2 mutations have been reported, but no data from Chinese family studies has been included. Here, we report the first familial hemiplegic migraine type 2 Chinese family with a novel missense mutation. Methods Clinical manifestations in the family were recorded. Blood samples from patients and the unaffected members were collected for whole-exome sequencing to identify the pathogenic mutation. Seven online softwares (SIFT, PolyPhen-2, PROVEAN, PANTHER, MutationTaster2, MutationAssessor and PMut) were used for predicting the pathogenic potential of the mutation. PredictProtein, Jpred 4 and PyMOL were used to analyze structural changes of the protein. The mutation function was further tested by Methylthiazolyldiphenyl-tetrazolium bromide (MTT) assay. Results All patients in the family had typical hemiplegic migraine attacks. Co-segregation of the mutation with the migraine phenotype in four generations, with 10 patients, was completed. The identified novel mutation, G762S in ATP1A2, exhibited the disease-causing feature by all the predictive softwares. The mutation impaired the local structure of the protein and decreased cell viability. Conclusion G762S in ATP1A2 is a novel pathogenic mutation identified in a Chinese family with familial hemiplegic migraine, which causes loss of function by changing the protein structure of the Na+/K+-ATPase α2 subunit.
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Affiliation(s)
- Wenjing Tang
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Meichen Zhang
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Enchao Qiu
- Department of Neurology, The First Affiliated Hospital of Chinese PLA General Hospital, Beijing, China
| | - Shanshan Kong
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Yingji Li
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Huanxian Liu
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Zhao Dong
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Shengyuan Yu
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
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35
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Lecoquierre F, Duffourd Y, Vitobello A, Bruel AL, Urteaga B, Coubes C, Garret P, Nambot S, Chevarin M, Jouan T, Moutton S, Tran-Mau-Them F, Philippe C, Sorlin A, Faivre L, Thauvin-Robinet C. Variant recurrence in neurodevelopmental disorders: the use of publicly available genomic data identifies clinically relevant pathogenic missense variants. Genet Med 2019; 21:2504-2511. [DOI: 10.1038/s41436-019-0518-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 04/12/2019] [Indexed: 12/19/2022] Open
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36
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Pan R, Qi X, Wang F, Chong Y, Li X, Chen Q. Correlations of Calcium Voltage-Gated Channel Subunit Alpha1 A (CACNA1A) Gene Polymorphisms with Benign Paroxysmal Positional Vertigo. Med Sci Monit 2019; 25:946-951. [PMID: 30710491 PMCID: PMC6368824 DOI: 10.12659/msm.912359] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background The aim of this study was to investigate the correlations of calcium voltage-gated channel subunit alpha1 A (CACNA1A) gene polymorphisms with benign paroxysmal positional vertigo (BPPV). Material/Methods A total of 120 BPPV patients and 60 healthy controls were enrolled according to the diagnostic criteria in the Guideline of Diagnosis and Treatment of Benign Paroxysmal Positional Vertigo (2017). Clinical and biochemical data were collected, the rs2074880 (T/G) polymorphisms in the CACNA1A gene were detected using TaqMan-MGB probe method, and the correlations of BPPV with predisposing factors were analyzed through logistic analysis. Results The BPPV group had higher levels of cholesterol and uric acid than in the control group (p<0.05). The cholesterol and uric acid levels were positively correlated with BPPV (p<0.05) [odds ratio (OR)=2.298 (1.252–4.350), 95% confidence interval (95% CI)=1.123 (0.987–1.987)]. The distribution frequency of TT genotype was higher than that of GG genotype (χ2=9.907, p=0.002, OR=0.279, 95% CI=0.123–0.633). In the BPPV group, cholesterol and uric acid levels of TT genotype were elevated compared with those in GG genotype (p<0.05). Conclusions The onset of BPPV is related to the increased levels of cholesterol and uric acid, as well as the dominant homozygous mutation of rs2074880 (T/G) in the CACNA1A gene.
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Affiliation(s)
- Ruichun Pan
- Southern Medical University, Guangzhou, Guangdong, China (mainland).,Department of Neurology, Baotou Central Hospital, Baotou, Inner Mongolia, China (mainland)
| | - Xiaokun Qi
- Southern Medical University, Guangzhou, Guangdong, China (mainland).,Department of Neurology, Navy General Hospital, Beijing, China (mainland)
| | - Fei Wang
- Department of Neurology, First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, Inner Mongolia, China (mainland)
| | - Yi Chong
- Department of Neurology, Baotou Central Hospital, Baotou, Inner Mongolia, China (mainland)
| | - Xia Li
- Department of Neurology, Baotou Central Hospital, Baotou, Inner Mongolia, China (mainland)
| | - Qiang Chen
- Department of Neurology, Baotou Central Hospital, Baotou, Inner Mongolia, China (mainland)
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Mancini V, Mastria G, Frantellizzi V, Troiani P, Zampatti S, Carboni S, Giardina E, Campopiano R, Gambardella S, Turchi F, Petolicchio B, Toscano M, Liberatore M, Viganò A, Di Piero V. Migrainous Infarction in a Patient With Sporadic Hemiplegic Migraine and Cystic Fibrosis: A 99mTc-HMPAO Brain SPECT Study. Headache 2019; 59:253-258. [DOI: 10.1111/head.13472] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Valentina Mancini
- Department of Human Neurosciences; Sapienza University of Rome; Rome Italy
| | - Giulio Mastria
- Department of Human Neurosciences; Sapienza University of Rome; Rome Italy
| | - Viviana Frantellizzi
- Department of Radiological, Oncological and Anatomopathological Sciences; Sapienza University of Rome; Rome Italy
| | - Patrizia Troiani
- Department of Pediatrics; Sapienza University of Rome; Rome Italy
| | - Stefania Zampatti
- Genomic Medicine Laboratory UILDM; IRCCS Santa Lucia Foundation; Rome Italy
- Molecular Genetics Center; IRCCS Neuromed; Pozzilli Italy
| | - Stefania Carboni
- Genomic Medicine Laboratory UILDM; IRCCS Santa Lucia Foundation; Rome Italy
| | - Emiliano Giardina
- Genomic Medicine Laboratory UILDM; IRCCS Santa Lucia Foundation; Rome Italy
- Department of Biomedicine and Prevention; University of Rome “Tor Vergata”; Rome Italy
| | | | | | - Federica Turchi
- Department of Human Neurosciences; Sapienza University of Rome; Rome Italy
| | | | | | - Mauro Liberatore
- Department of Radiological, Oncological and Anatomopathological Sciences; Sapienza University of Rome; Rome Italy
| | - Alessandro Viganò
- Department of Human Neurosciences; Sapienza University of Rome; Rome Italy
| | - Vittorio Di Piero
- Department of Human Neurosciences; Sapienza University of Rome; Rome Italy
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Indelicato E, Nachbauer W, Karner E, Eigentler A, Wagner M, Unterberger I, Poewe W, Delazer M, Boesch S. The neuropsychiatric phenotype in CACNA1A mutations: a retrospective single center study and review of the literature. Eur J Neurol 2018; 26:66-e7. [PMID: 30063100 DOI: 10.1111/ene.13765] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 07/24/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND PURPOSE CACNA1A encodes the α1 subunit of the neuronal calcium channel P/Q. CACNA1A mutations underlie three allelic disorders: familial hemiplegic migraine type 1 (FHM1), episodic ataxia type 2 (EA2) and spinocerebellar ataxia type 6 (SCA6). A clear-cut genotype-phenotype correlation is often lacking since clinical manifestations may overlap. Several case reports have described cognitive and behavioral features in CACNA1A disorders, but studies in larger case series are lacking. METHODS Genetically confirmed CACNA1A cases were retrieved from the database of the ataxia outpatient clinic of the Department of Neurology at Innsbruck Medical University. Clinical charts and neuropsychological test results were retrospectively analyzed. In addition, a review of the literature including only genetically confirmed cases was performed. RESULTS Forty-four CACNA1A cases were identified in our database. Delayed psychomotor milestones and poor school performance were described in seven (four FHM1, three EA2) and eight (three FHM1, five EA2) patients, respectively. Psychiatric comorbidities were diagnosed in eight patients (two FHM1, six EA2). Neuropsychological testing was available for 23 patients (11 FHM1, 10 EA2, two SCA6). Various cognitive deficits were documented in 21 cases (all patients except one SCA6). Impairments were predominantly seen in figural memory, visuoconstructive abilities and verbal fluency. In the literature, an early psychomotor delay is described in several children with EA2 and FHM1, whilst reports of cognitive and psychiatric findings from adult cases are scarce. CONCLUSIONS Neuropsychiatric manifestations are common in episodic CACNA1A disorders. In the case of otherwise unexplained developmental delay and a positive family history, CACNA1A mutations should be considered in the differential diagnosis.
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Affiliation(s)
- E Indelicato
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - W Nachbauer
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - E Karner
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - A Eigentler
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - M Wagner
- Department of Neuroradiology, Innsbruck Medical University, Innsbruck, Austria
| | - I Unterberger
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - W Poewe
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - M Delazer
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - S Boesch
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
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Perrotta A, Gambardella S, Ambrosini A, Anastasio MG, Albano V, Fornai F, Pierelli F. A Novel ATP1A2 Gene Variant Associated With Pure Sporadic Hemiplegic Migraine Improved After Patent Foramen Ovale Closure: A Case Report. Front Neurol 2018; 9:332. [PMID: 29867740 PMCID: PMC5966544 DOI: 10.3389/fneur.2018.00332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 04/25/2018] [Indexed: 01/03/2023] Open
Abstract
We describe the case of one patient with pure sporadic hemiplegic migraine (SHM) with a novel ATP1A2 gene variant and a large patent foramen ovale (PFO) with atrial septal aneurysm. In hemiplegic migraine (HM), the relationship between incomplete penetrance, environmental triggers, and phenotypic expression is underdetermined. A genetic evaluation of the proband was requested for the HM associated genes and extended to the members of his family. Genetic analysis revealed a never described before ATP1A2 gene mutation, inherited by his father, who never experienced motor aura but only typical visual aura. The proband—but not his father—was also affected by a large PFO with atrial septal aneurysm. SHM patient showed a marked reduction in motor aura episodes per year in the 12 months following the PFO percutaneous closure, followed by a complete remission from attacks at least in the following 24 months. We speculated that as well as incomplete penetrance of the novel mutation and natural history of the disease, an additional pathological condition such as the PFO could contribute to the phenotypical expression in this case of HM.
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Affiliation(s)
| | | | | | | | | | - Francesco Fornai
- IRCCS Neuromed, Pozzilli, Italy.,Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Francesco Pierelli
- IRCCS Neuromed, Pozzilli, Italy.,Unit of Neurorehabilitation, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Istituto Chirurgico Ortopedico Traumatologico (ICOT), Latina, Italy
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Hiekkala ME, Vuola P, Artto V, Häppölä P, Häppölä E, Vepsäläinen S, Cuenca-León E, Lal D, Gormley P, Hämäläinen E, Ilmavirta M, Nissilä M, Säkö E, Sumelahti ML, Harno H, Havanka H, Keski-Säntti P, Färkkilä M, Palotie A, Wessman M, Kaunisto MA, Kallela M. The contribution of CACNA1A, ATP1A2 and SCN1A mutations in hemiplegic migraine: A clinical and genetic study in Finnish migraine families. Cephalalgia 2018; 38:1849-1863. [PMID: 29486580 DOI: 10.1177/0333102418761041] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objective To study the position of hemiplegic migraine in the clinical spectrum of migraine with aura and to reveal the importance of CACNA1A, ATP1A2 and SCN1A in the development of hemiplegic migraine in Finnish migraine families. Methods The International Classification of Headache Disorders 3rd edition criteria were used to determine clinical characteristics and occurrence of hemiplegic migraine, based on detailed questionnaires, in a Finnish migraine family collection consisting of 9087 subjects. Involvement of CACNA1A, ATP1A2 and SCN1A was studied using whole exome sequencing data from 293 patients with hemiplegic migraine. Results Overall, hemiplegic migraine patients reported clinically more severe headache and aura episodes than non-hemiplegic migraine with aura patients. We identified two mutations, c.1816G>A (p.Ala606Thr) and c.1148G>A (p.Arg383His), in ATP1A2 and one mutation, c.1994C>T (p.Thr665Met) in CACNA1A. Conclusions The results highlight hemiplegic migraine as a clinically and genetically heterogeneous disease. Hemiplegic migraine patients do not form a clearly separate group with distinct symptoms, but rather have an extreme phenotype in the migraine with aura continuum. We have shown that mutations in CACNA1A, ATP1A2 and SCN1A are not the major cause of the disease in Finnish hemiplegic migraine patients, suggesting that there are additional genetic factors contributing to the phenotype.
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Affiliation(s)
| | - Pietari Vuola
- 1 Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.,2 Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - Ville Artto
- 2 Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - Paavo Häppölä
- 3 Institute for Molecular Medicine Finland FIMM, HiLIFE, University of Helsinki, Helsinki, Finland
| | - Elisa Häppölä
- 1 Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
| | - Salli Vepsäläinen
- 2 Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - Ester Cuenca-León
- 4 Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, UK.,5 Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, and Harvard Medical School, Boston, USA
| | - Dennis Lal
- 5 Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, and Harvard Medical School, Boston, USA.,6 Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, USA.,7 Analytic and Translational Genetics Unit, Massachusetts General Hospital and Harvard Medical School, Boston, USA.,8 Cologne Center for Genomics, University of Cologne, Cologne, Germany
| | - Padhraig Gormley
- 5 Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, and Harvard Medical School, Boston, USA.,6 Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, USA.,9 Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA.,10 Medical and Population Genetics Program, Broad Institute of MIT and Harvard, Cambridge, USA
| | - Eija Hämäläinen
- 3 Institute for Molecular Medicine Finland FIMM, HiLIFE, University of Helsinki, Helsinki, Finland
| | - Matti Ilmavirta
- 11 Department of Neurology, Central Hospital Central Finland, Jyväskylä, Finland
| | | | - Erkki Säkö
- 13 Turku Headache Center, Turku, Finland
| | | | - Hanna Harno
- 15 Clinical Neurosciences, Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hannele Havanka
- 16 Regional State Administrative Agency for Northern Finland, Oulu, Finland
| | | | - Markus Färkkilä
- 2 Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - Aarno Palotie
- 3 Institute for Molecular Medicine Finland FIMM, HiLIFE, University of Helsinki, Helsinki, Finland.,4 Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, UK.,5 Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, and Harvard Medical School, Boston, USA.,6 Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, USA.,7 Analytic and Translational Genetics Unit, Massachusetts General Hospital and Harvard Medical School, Boston, USA.,9 Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA.,10 Medical and Population Genetics Program, Broad Institute of MIT and Harvard, Cambridge, USA
| | - Maija Wessman
- 1 Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.,3 Institute for Molecular Medicine Finland FIMM, HiLIFE, University of Helsinki, Helsinki, Finland
| | - Mari Anneli Kaunisto
- 3 Institute for Molecular Medicine Finland FIMM, HiLIFE, University of Helsinki, Helsinki, Finland
| | - Mikko Kallela
- 2 Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
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Benke PJ, Duchowny M, McKnight D. Biotin and Acetazolamide for Treatment of an Unusual Child With Autism Plus Lack of Nail and Hair Growth. Pediatr Neurol 2018; 79:61-64. [PMID: 29413639 DOI: 10.1016/j.pediatrneurol.2017.10.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 10/13/2017] [Accepted: 10/14/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Patients with autism spectrum disorder and developmental delay or encephalopathy rarely demonstrate no or negligible hair and nail growth, suggesting a biotin-responsive clinical disorder. METHODS A ten-year-old girl presented with features of autism spectrum disorder, isolated headaches, and episodes of headaches and limb shaking. Her medical history revealed that her hair and nails did not grow. Administration of biotin restored her nail and hair growth and improved intellectual ability and school performance. Her episodes of headaches, single limb shaking, and loss of consciousness responded to administration of acetazolamide, and her school performance and social skills further improved. RESULTS A de novo c.1091 C > T, p.T364M pathogenic variant was found in the ATP1A2 gene by whole-exome sequencing, but a genetic etiology in the biotin-responsive metabolic pathways was not identified. CONCLUSIONS The combination of biotin and acetazolamide treatment was successful in restoring normal mental function and school performance. Poor or no clinical nail and hair growth in any child with a developmental delay-autism spectrum disorder presentation should be considered as evidence for a biotin-responsive genetic disorder even when exome testing is negative.
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Affiliation(s)
- Paul J Benke
- Genetics Division, Joe DiMaggio Children's Hospital, and Charles E. Schmidt College of Medicine, Hollywood, Florida.
| | - Michael Duchowny
- Neurology Division, Nicklaus Children's Hospital, Miami, Florida
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Han KH, Oh DY, Lee S, Lee C, Han JH, Kim MY, Park HR, Park MK, Kim NKD, Lee J, Yi E, Kim JM, Kim JW, Chae JH, Oh SH, Park WY, Choi BY. ATP1A3 mutations can cause progressive auditory neuropathy: a new gene of auditory synaptopathy. Sci Rep 2017; 7:16504. [PMID: 29184165 PMCID: PMC5705773 DOI: 10.1038/s41598-017-16676-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 11/16/2017] [Indexed: 12/21/2022] Open
Abstract
The etiologies and prevalence of sporadic, postlingual-onset, progressive auditory neuropathy spectrum disorder (ANSD) have rarely been documented. Thus, we aimed to evaluate the prevalence and molecular etiologies of these cases. Three out of 106 sporadic progressive hearing losses turned out to manifest ANSD. Through whole exome sequencing and subsequent bioinformatics analysis, two out of the three were found to share a de novo variant, p.E818K of ATP1A3, which had been reported to cause exclusively CAPOS (cerebellar ataxia, areflexia, pes cavus, optic atrophy, and sensorineural hearing loss) syndrome. However, hearing loss induced by CAPOS has never been characterized to date. Interestingly, the first proband did not manifest any features of CAPOS, except subclinical areflexia; however, the phenotypes of second proband was compatible with that of CAPOS, making this the first reported CAPOS allele in Koreans. This ANSD phenotype was compatible with known expression of ATP1A3 mainly in the synapse between afferent nerve and inner hair cells. Based on this, cochlear implantation (CI) was performed in the first proband, leading to remarkable benefits. Collectively, the de novo ATP1A3 variant can cause postlingual-onset auditory synaptopathy, making this gene a significant contributor to sporadic progressive ANSD and a biomarker ensuring favorable short-term CI outcomes.
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Affiliation(s)
- Kyu-Hee Han
- Department of Otorhinolaryngology, National Medical Center, Seoul, Korea
| | - Doo-Yi Oh
- Department of Otorhinolaryngology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seungmin Lee
- Department of Otorhinolaryngology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Chung Lee
- Samsung Genome Institute, Samsung Medical Center, Seoul, Korea.,Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Korea
| | - Jin Hee Han
- Department of Otorhinolaryngology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Min Young Kim
- Department of Otorhinolaryngology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hye-Rim Park
- Department of Otorhinolaryngology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Moo Kyun Park
- Department of Otorhinolaryngology, Seoul National University Hospital, Seoul, Korea
| | - Nayoung K D Kim
- Samsung Genome Institute, Samsung Medical Center, Seoul, Korea
| | - Jaekwang Lee
- Division of Functional Food Research, Korea Food Research Institute (KFRI), Seongnam, Korea
| | - Eunyoung Yi
- College of Pharmacy and Natural Medicine Research Institute, Mokpo National University, Muan, Korea
| | - Jong-Min Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jeong-Whun Kim
- Department of Otorhinolaryngology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jong-Hee Chae
- Department of Pediatrics, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul, Korea
| | - Seung Ha Oh
- Department of Otorhinolaryngology, Seoul National University Hospital, Seoul, Korea
| | - Woong-Yang Park
- Samsung Genome Institute, Samsung Medical Center, Seoul, Korea.,Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Korea.,Department of Molecular Cell Biology, School of Medicine, Sungkyunkwan University, Seoul, Korea
| | - Byung Yoon Choi
- Department of Otorhinolaryngology, Seoul National University Bundang Hospital, Seongnam, Korea.
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Smith DR, Stanley CM, Foss T, Boles RG, McKernan K. Rare genetic variants in the endocannabinoid system genes CNR1 and DAGLA are associated with neurological phenotypes in humans. PLoS One 2017; 12:e0187926. [PMID: 29145497 PMCID: PMC5690672 DOI: 10.1371/journal.pone.0187926] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 10/27/2017] [Indexed: 12/24/2022] Open
Abstract
Rare genetic variants in the core endocannabinoid system genes CNR1, CNR2, DAGLA, MGLL and FAAH were identified in molecular testing data from 6,032 patients with a broad spectrum of neurological disorders. The variants were evaluated for association with phenotypes similar to those observed in the orthologous gene knockouts in mice. Heterozygous rare coding variants in CNR1, which encodes the type 1 cannabinoid receptor (CB1), were found to be significantly associated with pain sensitivity (especially migraine), sleep and memory disorders—alone or in combination with anxiety—compared to a set of controls without such CNR1 variants. Similarly, heterozygous rare variants in DAGLA, which encodes diacylglycerol lipase alpha, were found to be significantly associated with seizures and neurodevelopmental disorders, including autism and abnormalities of brain morphology, compared to controls. Rare variants in MGLL, FAAH and CNR2 were not associated with any neurological phenotypes in the patients tested. Diacylglycerol lipase alpha synthesizes the endocannabinoid 2-AG in the brain, which interacts with CB1 receptors. The phenotypes associated with rare CNR1 variants are reminiscent of those implicated in the theory of clinical endocannabinoid deficiency syndrome. The severe phenotypes associated with rare DAGLA variants underscore the critical role of rapid 2-AG synthesis and the endocannabinoid system in regulating neurological function and development. Mapping of the variants to the 3D structure of the type 1 cannabinoid receptor, or primary structure of diacylglycerol lipase alpha, reveals clustering of variants in certain structural regions and is consistent with impacts to function.
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Affiliation(s)
- Douglas R. Smith
- Courtagen Life Sciences, Inc., Woburn, MA, United States of America
- * E-mail:
| | | | - Theodore Foss
- Courtagen Life Sciences, Inc., Woburn, MA, United States of America
| | - Richard G. Boles
- Courtagen Life Sciences, Inc., Woburn, MA, United States of America
| | - Kevin McKernan
- Courtagen Life Sciences, Inc., Woburn, MA, United States of America
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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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46
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Abstract
Headache and seizures are two of the most common complaints seen in the field of pediatric neurology with headache being number one. Both these conditions may coexist. Where the difficulty begins is when the symptoms are not clear cut in making a diagnosis, and conditions are possible as either an atypical seizure or migraine variant. What further complicates matters is the fact that there are many underlying neurologic conditions that carry with them a higher likelihood of developing both headaches and seizures, making each a distinct possibility when obtaining a history from a parent about unusual spells. Although differentiating between seizure and headache may not be easy, with a focused yet thorough history and appropriate use of investigative tools, it can be done. Coming to the correct diagnosis is only the start; once seizures and or headaches have been appropriately diagnosed then the real challenge begins and that is finding a way to successfully treat the headaches and seizures. Within pediatric neurology, the acute options tend to be more diagnosis specific whereas the prophylactic ones may overlap and treat both headaches and seizures. In the following review, we will discuss the epidemiology of pediatric headaches and seizures, the overlap between these 2 conditions in diagnosis, as well as how to tell them apart, and the treatment options and prognosis of both common neurologic disorders in children.
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Affiliation(s)
- Christopher B Oakley
- Departments of Neurology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Eric H Kossoff
- Departments of Neurology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
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Indelicato E, Nachbauer W, Eigentler A, Donnemiller E, Wagner M, Unterberger I, Boesch S. Ten years of follow-up in a large family with familial hemiplegic migraine type 1: Clinical course and implications for treatment. Cephalalgia 2017; 38:1167-1176. [PMID: 28856914 DOI: 10.1177/0333102417715229] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Familial hemiplegic migraine (FHM) is a rare, genetic form of migraine with aura. The severity of the aura imposes an effective prophylaxis that is currently based on standard anti-migraine drugs. To this concern, only short-term reports are currently available. Methods Eight patients from a multigenerational FHM type 1 family harbouring a T666M mutation in the CACNA1A gene were referred to our ataxia outpatient clinic. Medical history, general and neurological examination as well as therapeutic approaches were recorded regularly on a routine basis for an average period of 13 years (range 9-15 years). Brain imaging studies and EEG data were also collected. Results Our long-term follow-up revealed that ictal manifestations, which usually improve after the adolescence, may reoccur later in the adulthood. Permanent neurological signs as assessed by means of clinical evaluation as well as follow-up MRIs, EEGs and neuropsychological testing remained stable. Interval therapy with non-selective calcium antagonists reduced the burden of migraine attacks and was well tolerated in the long term.
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Affiliation(s)
- Elisabetta Indelicato
- 1 Department of Neurology, Medical University Innsbruck, Anichstrasse, Innsbruck, Austria
| | - Wolfgang Nachbauer
- 1 Department of Neurology, Medical University Innsbruck, Anichstrasse, Innsbruck, Austria
| | - Andreas Eigentler
- 1 Department of Neurology, Medical University Innsbruck, Anichstrasse, Innsbruck, Austria
| | - Evelin Donnemiller
- 2 Department of Nuclear Medicine, 27280 Medical University Innsbruck , Anichstrasse, Innsbruck, Austria
| | - Michaela Wagner
- 3 Department of Neuroradiology, 27280 Medical University Innsbruck , Anichstrasse, Innsbruck, Austria
| | - Iris Unterberger
- 1 Department of Neurology, Medical University Innsbruck, Anichstrasse, Innsbruck, Austria
| | - Sylvia Boesch
- 1 Department of Neurology, Medical University Innsbruck, Anichstrasse, Innsbruck, Austria
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Ambrosini A, D'Onofrio M, Buzzi MG, Arisi I, Grieco GS, Pierelli F, Santorelli FM, Schoenen J. Possible Involvement of the CACNA1E Gene in Migraine: A Search for Single Nucleotide Polymorphism in Different Clinical Phenotypes. Headache 2017; 57:1136-1144. [PMID: 28573794 DOI: 10.1111/head.13107] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 03/03/2017] [Accepted: 03/04/2017] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To search for differences in prevalence of a CACNA1E variant between migraine without aura, various phenotypes of migraine with aura, and healthy controls. BACKGROUND Familial hemiplegic migraine type 1 (FHM1) is associated with mutations in the CACNA1A gene coding for the alpha 1A (Cav 2.1) pore-forming subunit of P/Q voltage-dependent Ca2+ channels. These mutations are not found in the common forms of migraine with or without aura. The alpha 1E subunit (Cav 2.3) is the counterpart of Cav 2.1 in R-type Ca2+ channels, has different functional properties, and is encoded by the CACNA1E gene. METHODS First, we performed a total exon sequencing of the CACNA1E gene in three probands selected because they had no abnormalities in the three FHM genes. In a patient suffering from basilar-type migraine, we identified a single nucleotide polymorphism (SNP) in exon 20 of the CACNA1E gene (Asp859Glu - rs35737760; Minor Allele Frequency 0.2241) hitherto not studied in migraine. In a second step, we determined its occurrence in four groups by direct sequencing on blood genomic DNA: migraine patients without aura (N = 24), with typical aura (N = 55), complex neurological auras (N = 19; hemiplegic aura: N = 15; brain stem aura: N = 4), and healthy controls (N = 102). RESULTS The Asp859Glu - rs35737760 SNP of the CACNA1E gene was present in 12.7% of control subjects and in 20.4% of the total migraine group. In the migraine group it was significantly over-represented in patients with complex neurological auras (42.1%), OR 4.98 (95% CI: 1.69-14.67, uncorrected P = .005, Bonferroni P = .030, 2-tailed Fisher's exact test). There was no significant difference between migraine with typical aura (10.9%) and controls. CONCLUSIONS We identified a polymorphism in exon 20 of the CACNA1E gene (Asp859Glu - rs35737760) that is more prevalent in hemiplegic and brain stem aura migraine. This missense variant causes a change from aspartate to glutamate at position 859 of the Cav 2.3 protein and might modulate the function of R-type Ca2+ channels. It could thus be relevant for migraine with complex neurological aura, although this remains to be proven.
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Affiliation(s)
| | - Mara D'Onofrio
- European Brain Research Institute "Rita Levi Montalcini,", Rome, Italy.,CNR, Rome, Italy
| | | | - Ivan Arisi
- European Brain Research Institute "Rita Levi Montalcini,", Rome, Italy
| | - Gaetano S Grieco
- C. Mondino National Institute of Neurology Foundation, Pavia, Italy
| | | | | | - Jean Schoenen
- Headache Research Unit, Citadelle Hospital, University of Liège, Liège, Belgium
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Kissoon NR, Cutrer FM. Aura and Other Neurologic Dysfunction in or with Migraine. Headache 2017; 57:1179-1194. [DOI: 10.1111/head.13101] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 04/04/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Narayan R. Kissoon
- Division of Headache, Department of Neurology; Mayo Clinic; Rochester MN USA
| | - Fred Michael Cutrer
- Division of Headache, Department of Neurology; Mayo Clinic; Rochester MN USA
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50
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Sutherland HG, Griffiths LR. Genetics of Migraine: Insights into the Molecular Basis of Migraine Disorders. Headache 2017; 57:537-569. [PMID: 28271496 DOI: 10.1111/head.13053] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 01/09/2017] [Indexed: 12/20/2022]
Abstract
Migraine is a complex, debilitating neurovascular disorder, typically characterized by recurring, incapacitating attacks of severe headache often accompanied by nausea and neurological disturbances. It has a strong genetic basis demonstrated by rare migraine disorders caused by mutations in single genes (monogenic), as well as familial clustering of common migraine which is associated with polymorphisms in many genes (polygenic). Hemiplegic migraine is a dominantly inherited, severe form of migraine with associated motor weakness. Family studies have found that mutations in three different ion channels genes, CACNA1A, ATP1A2, and SCN1A can be causal. Functional studies of these mutations has shown that they can result in defective regulation of glutamatergic neurotransmission and the excitatory/inhibitory balance in the brain, which lowers the threshold for cortical spreading depression, a wave of cortical depolarization thought to be involved in headache initiation mechanisms. Other putative genes for monogenic migraine include KCKN18, PRRT2, and CSNK1D, which can also be involved with other disorders. There are a number of primarily vascular disorders caused by mutations in single genes, which are often accompanied by migraine symptoms. Mutations in NOTCH3 causes cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), a hereditary cerebrovascular disease that leads to ischemic strokes and dementia, but in which migraine is often present, sometimes long before the onset of other symptoms. Mutations in the TREX1 and COL4A1 also cause vascular disorders, but often feature migraine. With respect to common polygenic migraine, genome-wide association studies have now identified single nucleotide polymorphisms at 38 loci significantly associated with migraine risk. Functions assigned to the genes in proximity to these loci suggest that both neuronal and vascular pathways also contribute to the pathophysiology of common migraine. Further studies are required to fully understand these findings and translate them into treatment options for migraine patients.
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Affiliation(s)
- Heidi G Sutherland
- Genomics Research Centre, School of Biomedical Sciences, Institute of Health and Biomedical Innovation, QUT, Musk Ave, Kelvin Grove, QLD, 4059, Australia
| | - Lyn R Griffiths
- Genomics Research Centre, School of Biomedical Sciences, Institute of Health and Biomedical Innovation, QUT, Musk Ave, Kelvin Grove, QLD, 4059, Australia
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