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Olivé-Cirera G, Fonseca E, Cantarín-Extremera V, Vázquez-López M, Jiménez-Legido M, González-Álvarez V, Ribeiro-Constante J, Camacho-Salas A, Martí I, Cancho-Candela R, Martínez-González MJ, Saiz A, Armangué T. Impact of COVID-19 in Immunosuppressed Children With Neuroimmunologic Disorders. Neurol Neuroimmunol Neuroinflamm 2022; 9:e1101. [PMID: 34759018 PMCID: PMC8587734 DOI: 10.1212/nxi.0000000000001101] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/14/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVES To investigate whether children receiving immunosuppressive therapies for neuroimmunologic disorders had (1) increased susceptibility to SARS-CoV2 infection or to develop more severe forms of COVID-19; (2) increased relapses or autoimmune complications if infected; and (3) changes in health care delivery during the pandemic. METHODS Patients with and without immunosuppressive treatment were recruited to participate in a retrospective survey evaluating the period from March 14, 2020, to March 30, 2021. Demographics, clinical features, type of immunosuppressive treatment, suspected or confirmed COVID-19 in the patients or cohabitants, and changes in care delivery were recorded. RESULTS One hundred fifty-three children were included: 84 (55%) female, median age 13 years (interquartile range [8-16] years), 79 (52%) on immunosuppressive treatment. COVID-19 was suspected or confirmed in 17 (11%) (all mild), with a frequency similar in patients with and without immunosuppressive treatment (11/79 [14%] vs 6/74 [8%], p = 0.3085). The frequency of neurologic relapses was similar in patients with (18%) and without (21%) COVID-19. Factors associated with COVID-19 included having cohabitants with COVID-19 (p < 0.001) and lower blood levels of vitamin D (p = 0.039). Return to face-to-face schooling or mask type did not influence the risk of infection, although 43(28%) children had contact with a classmate with COVID-19. Clinic visits changed from face to face to remote for 120 (79%) patients; 110 (92%) were satisfied with the change. DISCUSSION In this cohort of children with neuroimmunologic disorders, the frequency of COVID-19 was low and not affected by immunosuppressive therapies. The main risk factors for developing COVID-19 were having cohabitants with COVID-19 and low vitamin D levels.
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Affiliation(s)
- Gemma Olivé-Cirera
- From the Pediatric Neuroimmunology Program (G.O.-C.,E.F.,A.S.,T.A.), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clinic, University of Barcelona; Pediatric Neurology Unit of Parc Taulí Hospital of Sabadell (G.O.-C.), Barcelona; Pediatric Neurology Unit of Hospital Infantil Universitario Niño Jesús (V.C.-E.,M.J.-L.), Madrid; Pediatric Neurology Unit of Hospital Gregorio Marañón (M.V.-L.), Madrid; Pediatric Neuroimmunology Unit (V.G.-A.,J.R.-C.,T.A.), Neurology Service, Sant Joan de Déu (SJD) Children's Hospital, University of Barcelona; Pediatric Neurology Unit of Hospital Universitario 12 de Octubre, Complutense University of Madrid (A.C.S.); Pediatric Neurology Unit of Hospital Universitario Donostia (I.M.), Guipuzcoa; Pediatric Neurology Unit of Hospital Universitario Río Hortega (R.C.-C.), Valladolid; and Pediatric Neurology Unit of Cruces University Hospital (M.J.M.-G.), Bilbao, Spain
| | - Elianet Fonseca
- From the Pediatric Neuroimmunology Program (G.O.-C.,E.F.,A.S.,T.A.), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clinic, University of Barcelona; Pediatric Neurology Unit of Parc Taulí Hospital of Sabadell (G.O.-C.), Barcelona; Pediatric Neurology Unit of Hospital Infantil Universitario Niño Jesús (V.C.-E.,M.J.-L.), Madrid; Pediatric Neurology Unit of Hospital Gregorio Marañón (M.V.-L.), Madrid; Pediatric Neuroimmunology Unit (V.G.-A.,J.R.-C.,T.A.), Neurology Service, Sant Joan de Déu (SJD) Children's Hospital, University of Barcelona; Pediatric Neurology Unit of Hospital Universitario 12 de Octubre, Complutense University of Madrid (A.C.S.); Pediatric Neurology Unit of Hospital Universitario Donostia (I.M.), Guipuzcoa; Pediatric Neurology Unit of Hospital Universitario Río Hortega (R.C.-C.), Valladolid; and Pediatric Neurology Unit of Cruces University Hospital (M.J.M.-G.), Bilbao, Spain
| | - Verónica Cantarín-Extremera
- From the Pediatric Neuroimmunology Program (G.O.-C.,E.F.,A.S.,T.A.), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clinic, University of Barcelona; Pediatric Neurology Unit of Parc Taulí Hospital of Sabadell (G.O.-C.), Barcelona; Pediatric Neurology Unit of Hospital Infantil Universitario Niño Jesús (V.C.-E.,M.J.-L.), Madrid; Pediatric Neurology Unit of Hospital Gregorio Marañón (M.V.-L.), Madrid; Pediatric Neuroimmunology Unit (V.G.-A.,J.R.-C.,T.A.), Neurology Service, Sant Joan de Déu (SJD) Children's Hospital, University of Barcelona; Pediatric Neurology Unit of Hospital Universitario 12 de Octubre, Complutense University of Madrid (A.C.S.); Pediatric Neurology Unit of Hospital Universitario Donostia (I.M.), Guipuzcoa; Pediatric Neurology Unit of Hospital Universitario Río Hortega (R.C.-C.), Valladolid; and Pediatric Neurology Unit of Cruces University Hospital (M.J.M.-G.), Bilbao, Spain
| | - María Vázquez-López
- From the Pediatric Neuroimmunology Program (G.O.-C.,E.F.,A.S.,T.A.), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clinic, University of Barcelona; Pediatric Neurology Unit of Parc Taulí Hospital of Sabadell (G.O.-C.), Barcelona; Pediatric Neurology Unit of Hospital Infantil Universitario Niño Jesús (V.C.-E.,M.J.-L.), Madrid; Pediatric Neurology Unit of Hospital Gregorio Marañón (M.V.-L.), Madrid; Pediatric Neuroimmunology Unit (V.G.-A.,J.R.-C.,T.A.), Neurology Service, Sant Joan de Déu (SJD) Children's Hospital, University of Barcelona; Pediatric Neurology Unit of Hospital Universitario 12 de Octubre, Complutense University of Madrid (A.C.S.); Pediatric Neurology Unit of Hospital Universitario Donostia (I.M.), Guipuzcoa; Pediatric Neurology Unit of Hospital Universitario Río Hortega (R.C.-C.), Valladolid; and Pediatric Neurology Unit of Cruces University Hospital (M.J.M.-G.), Bilbao, Spain
| | - María Jiménez-Legido
- From the Pediatric Neuroimmunology Program (G.O.-C.,E.F.,A.S.,T.A.), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clinic, University of Barcelona; Pediatric Neurology Unit of Parc Taulí Hospital of Sabadell (G.O.-C.), Barcelona; Pediatric Neurology Unit of Hospital Infantil Universitario Niño Jesús (V.C.-E.,M.J.-L.), Madrid; Pediatric Neurology Unit of Hospital Gregorio Marañón (M.V.-L.), Madrid; Pediatric Neuroimmunology Unit (V.G.-A.,J.R.-C.,T.A.), Neurology Service, Sant Joan de Déu (SJD) Children's Hospital, University of Barcelona; Pediatric Neurology Unit of Hospital Universitario 12 de Octubre, Complutense University of Madrid (A.C.S.); Pediatric Neurology Unit of Hospital Universitario Donostia (I.M.), Guipuzcoa; Pediatric Neurology Unit of Hospital Universitario Río Hortega (R.C.-C.), Valladolid; and Pediatric Neurology Unit of Cruces University Hospital (M.J.M.-G.), Bilbao, Spain
| | - Verónica González-Álvarez
- From the Pediatric Neuroimmunology Program (G.O.-C.,E.F.,A.S.,T.A.), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clinic, University of Barcelona; Pediatric Neurology Unit of Parc Taulí Hospital of Sabadell (G.O.-C.), Barcelona; Pediatric Neurology Unit of Hospital Infantil Universitario Niño Jesús (V.C.-E.,M.J.-L.), Madrid; Pediatric Neurology Unit of Hospital Gregorio Marañón (M.V.-L.), Madrid; Pediatric Neuroimmunology Unit (V.G.-A.,J.R.-C.,T.A.), Neurology Service, Sant Joan de Déu (SJD) Children's Hospital, University of Barcelona; Pediatric Neurology Unit of Hospital Universitario 12 de Octubre, Complutense University of Madrid (A.C.S.); Pediatric Neurology Unit of Hospital Universitario Donostia (I.M.), Guipuzcoa; Pediatric Neurology Unit of Hospital Universitario Río Hortega (R.C.-C.), Valladolid; and Pediatric Neurology Unit of Cruces University Hospital (M.J.M.-G.), Bilbao, Spain
| | - Juliana Ribeiro-Constante
- From the Pediatric Neuroimmunology Program (G.O.-C.,E.F.,A.S.,T.A.), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clinic, University of Barcelona; Pediatric Neurology Unit of Parc Taulí Hospital of Sabadell (G.O.-C.), Barcelona; Pediatric Neurology Unit of Hospital Infantil Universitario Niño Jesús (V.C.-E.,M.J.-L.), Madrid; Pediatric Neurology Unit of Hospital Gregorio Marañón (M.V.-L.), Madrid; Pediatric Neuroimmunology Unit (V.G.-A.,J.R.-C.,T.A.), Neurology Service, Sant Joan de Déu (SJD) Children's Hospital, University of Barcelona; Pediatric Neurology Unit of Hospital Universitario 12 de Octubre, Complutense University of Madrid (A.C.S.); Pediatric Neurology Unit of Hospital Universitario Donostia (I.M.), Guipuzcoa; Pediatric Neurology Unit of Hospital Universitario Río Hortega (R.C.-C.), Valladolid; and Pediatric Neurology Unit of Cruces University Hospital (M.J.M.-G.), Bilbao, Spain
| | - Ana Camacho-Salas
- From the Pediatric Neuroimmunology Program (G.O.-C.,E.F.,A.S.,T.A.), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clinic, University of Barcelona; Pediatric Neurology Unit of Parc Taulí Hospital of Sabadell (G.O.-C.), Barcelona; Pediatric Neurology Unit of Hospital Infantil Universitario Niño Jesús (V.C.-E.,M.J.-L.), Madrid; Pediatric Neurology Unit of Hospital Gregorio Marañón (M.V.-L.), Madrid; Pediatric Neuroimmunology Unit (V.G.-A.,J.R.-C.,T.A.), Neurology Service, Sant Joan de Déu (SJD) Children's Hospital, University of Barcelona; Pediatric Neurology Unit of Hospital Universitario 12 de Octubre, Complutense University of Madrid (A.C.S.); Pediatric Neurology Unit of Hospital Universitario Donostia (I.M.), Guipuzcoa; Pediatric Neurology Unit of Hospital Universitario Río Hortega (R.C.-C.), Valladolid; and Pediatric Neurology Unit of Cruces University Hospital (M.J.M.-G.), Bilbao, Spain
| | - Itxaso Martí
- From the Pediatric Neuroimmunology Program (G.O.-C.,E.F.,A.S.,T.A.), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clinic, University of Barcelona; Pediatric Neurology Unit of Parc Taulí Hospital of Sabadell (G.O.-C.), Barcelona; Pediatric Neurology Unit of Hospital Infantil Universitario Niño Jesús (V.C.-E.,M.J.-L.), Madrid; Pediatric Neurology Unit of Hospital Gregorio Marañón (M.V.-L.), Madrid; Pediatric Neuroimmunology Unit (V.G.-A.,J.R.-C.,T.A.), Neurology Service, Sant Joan de Déu (SJD) Children's Hospital, University of Barcelona; Pediatric Neurology Unit of Hospital Universitario 12 de Octubre, Complutense University of Madrid (A.C.S.); Pediatric Neurology Unit of Hospital Universitario Donostia (I.M.), Guipuzcoa; Pediatric Neurology Unit of Hospital Universitario Río Hortega (R.C.-C.), Valladolid; and Pediatric Neurology Unit of Cruces University Hospital (M.J.M.-G.), Bilbao, Spain
| | - Ramon Cancho-Candela
- From the Pediatric Neuroimmunology Program (G.O.-C.,E.F.,A.S.,T.A.), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clinic, University of Barcelona; Pediatric Neurology Unit of Parc Taulí Hospital of Sabadell (G.O.-C.), Barcelona; Pediatric Neurology Unit of Hospital Infantil Universitario Niño Jesús (V.C.-E.,M.J.-L.), Madrid; Pediatric Neurology Unit of Hospital Gregorio Marañón (M.V.-L.), Madrid; Pediatric Neuroimmunology Unit (V.G.-A.,J.R.-C.,T.A.), Neurology Service, Sant Joan de Déu (SJD) Children's Hospital, University of Barcelona; Pediatric Neurology Unit of Hospital Universitario 12 de Octubre, Complutense University of Madrid (A.C.S.); Pediatric Neurology Unit of Hospital Universitario Donostia (I.M.), Guipuzcoa; Pediatric Neurology Unit of Hospital Universitario Río Hortega (R.C.-C.), Valladolid; and Pediatric Neurology Unit of Cruces University Hospital (M.J.M.-G.), Bilbao, Spain
| | - María Jesús Martínez-González
- From the Pediatric Neuroimmunology Program (G.O.-C.,E.F.,A.S.,T.A.), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clinic, University of Barcelona; Pediatric Neurology Unit of Parc Taulí Hospital of Sabadell (G.O.-C.), Barcelona; Pediatric Neurology Unit of Hospital Infantil Universitario Niño Jesús (V.C.-E.,M.J.-L.), Madrid; Pediatric Neurology Unit of Hospital Gregorio Marañón (M.V.-L.), Madrid; Pediatric Neuroimmunology Unit (V.G.-A.,J.R.-C.,T.A.), Neurology Service, Sant Joan de Déu (SJD) Children's Hospital, University of Barcelona; Pediatric Neurology Unit of Hospital Universitario 12 de Octubre, Complutense University of Madrid (A.C.S.); Pediatric Neurology Unit of Hospital Universitario Donostia (I.M.), Guipuzcoa; Pediatric Neurology Unit of Hospital Universitario Río Hortega (R.C.-C.), Valladolid; and Pediatric Neurology Unit of Cruces University Hospital (M.J.M.-G.), Bilbao, Spain
| | - Albert Saiz
- From the Pediatric Neuroimmunology Program (G.O.-C.,E.F.,A.S.,T.A.), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clinic, University of Barcelona; Pediatric Neurology Unit of Parc Taulí Hospital of Sabadell (G.O.-C.), Barcelona; Pediatric Neurology Unit of Hospital Infantil Universitario Niño Jesús (V.C.-E.,M.J.-L.), Madrid; Pediatric Neurology Unit of Hospital Gregorio Marañón (M.V.-L.), Madrid; Pediatric Neuroimmunology Unit (V.G.-A.,J.R.-C.,T.A.), Neurology Service, Sant Joan de Déu (SJD) Children's Hospital, University of Barcelona; Pediatric Neurology Unit of Hospital Universitario 12 de Octubre, Complutense University of Madrid (A.C.S.); Pediatric Neurology Unit of Hospital Universitario Donostia (I.M.), Guipuzcoa; Pediatric Neurology Unit of Hospital Universitario Río Hortega (R.C.-C.), Valladolid; and Pediatric Neurology Unit of Cruces University Hospital (M.J.M.-G.), Bilbao, Spain
| | - Thaís Armangué
- From the Pediatric Neuroimmunology Program (G.O.-C.,E.F.,A.S.,T.A.), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clinic, University of Barcelona; Pediatric Neurology Unit of Parc Taulí Hospital of Sabadell (G.O.-C.), Barcelona; Pediatric Neurology Unit of Hospital Infantil Universitario Niño Jesús (V.C.-E.,M.J.-L.), Madrid; Pediatric Neurology Unit of Hospital Gregorio Marañón (M.V.-L.), Madrid; Pediatric Neuroimmunology Unit (V.G.-A.,J.R.-C.,T.A.), Neurology Service, Sant Joan de Déu (SJD) Children's Hospital, University of Barcelona; Pediatric Neurology Unit of Hospital Universitario 12 de Octubre, Complutense University of Madrid (A.C.S.); Pediatric Neurology Unit of Hospital Universitario Donostia (I.M.), Guipuzcoa; Pediatric Neurology Unit of Hospital Universitario Río Hortega (R.C.-C.), Valladolid; and Pediatric Neurology Unit of Cruces University Hospital (M.J.M.-G.), Bilbao, Spain
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2
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Quesada-Espinosa JF, Garzón-Lorenzo L, Lezana-Rosales JM, Gómez-Rodríguez MJ, Sánchez-Calvin MT, Palma-Milla C, Gómez-Manjón I, Hidalgo-Mayoral I, Pérez de la Fuente R, Arteche-López A, Álvarez-Mora MI, Camacho-Salas A, Cruz-Rojo J, Lázaro-Rodríguez I, Morales-Conejo M, Nuñez-Enamorado N, Bustamante-Aragones A, Simón de Las Heras R, Gomez-Cano MA, Ramos-Gómez P, Sierra-Tomillo O, Juárez-Rufián A, Gallego-Merlo J, Rausell-Sánchez L, Moreno-García M, Sánchez Del Pozo J. First female with Allan-Herndon-Dudley syndrome and partial deletion of X-inactivation center. Neurogenetics 2021; 22:343-346. [PMID: 34296368 DOI: 10.1007/s10048-021-00660-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 07/15/2021] [Indexed: 10/20/2022]
Abstract
Allan-Herndon-Dudley is an X-linked recessive syndrome caused by pathogenic variants in the SLC16A2 gene. Clinical manifestations are a consequence of impaired thyroid metabolism and aberrant transport of thyroid hormones to the brain. Carrier females are generally asymptomatic and may show subtle symptoms of the disease. We describe a female with a complete Allan-Herndon-Dudley phenotype, carrying a de novo 543-kb deletion of the X chromosome. The deletion encompasses exon 1 of the SLC16A2 gene and JPX and FTX genes; it is known that the latter two genes participate in the X-inactivation process upregulating XIST gene expression. Subsequent studies in the patient demonstrated the preferential expression of the X chromosome with the JPX and FTX deletion.
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Affiliation(s)
- Juan F Quesada-Espinosa
- Genetics Department, 12 de Octubre University Hospital, Madrid, Spain. .,UDISGEN (Unidad de Dismorfología y Genética), 12 de Octubre University Hospital, Madrid, Spain.
| | - Lucía Garzón-Lorenzo
- UDISGEN (Unidad de Dismorfología y Genética), 12 de Octubre University Hospital, Madrid, Spain. .,Pediatrics Department, Endocrinology Unit, 12 de Octubre University Hospital, Madrid, Spain.
| | - José M Lezana-Rosales
- Genetics Department, 12 de Octubre University Hospital, Madrid, Spain.,UDISGEN (Unidad de Dismorfología y Genética), 12 de Octubre University Hospital, Madrid, Spain
| | - María J Gómez-Rodríguez
- Genetics Department, 12 de Octubre University Hospital, Madrid, Spain.,UDISGEN (Unidad de Dismorfología y Genética), 12 de Octubre University Hospital, Madrid, Spain.,Cancer Research Network (CIBERONC), 28029, Madrid, Spain
| | - María T Sánchez-Calvin
- Genetics Department, 12 de Octubre University Hospital, Madrid, Spain.,UDISGEN (Unidad de Dismorfología y Genética), 12 de Octubre University Hospital, Madrid, Spain
| | - Carmen Palma-Milla
- Genetics Department, 12 de Octubre University Hospital, Madrid, Spain.,UDISGEN (Unidad de Dismorfología y Genética), 12 de Octubre University Hospital, Madrid, Spain
| | - Irene Gómez-Manjón
- Genetics Department, 12 de Octubre University Hospital, Madrid, Spain.,UDISGEN (Unidad de Dismorfología y Genética), 12 de Octubre University Hospital, Madrid, Spain
| | - Irene Hidalgo-Mayoral
- Genetics Department, 12 de Octubre University Hospital, Madrid, Spain.,UDISGEN (Unidad de Dismorfología y Genética), 12 de Octubre University Hospital, Madrid, Spain
| | - Rubén Pérez de la Fuente
- Genetics Department, 12 de Octubre University Hospital, Madrid, Spain.,UDISGEN (Unidad de Dismorfología y Genética), 12 de Octubre University Hospital, Madrid, Spain
| | - Ana Arteche-López
- Genetics Department, 12 de Octubre University Hospital, Madrid, Spain.,UDISGEN (Unidad de Dismorfología y Genética), 12 de Octubre University Hospital, Madrid, Spain
| | - María I Álvarez-Mora
- Genetics Department, 12 de Octubre University Hospital, Madrid, Spain.,Biochemistry and Molecular Genetics Department, Hospital Clinic of Barcelona and Fundació Clínic Per La Recerca Biomèdica, Barcelona, Spain
| | - Ana Camacho-Salas
- Pediatrics Department, Neurology Unit, 12 de Octubre University Hospital, Madrid, Spain
| | - Jaime Cruz-Rojo
- UDISGEN (Unidad de Dismorfología y Genética), 12 de Octubre University Hospital, Madrid, Spain.,Pediatrics Department, Endocrinology Unit, 12 de Octubre University Hospital, Madrid, Spain
| | - Irene Lázaro-Rodríguez
- UDISGEN (Unidad de Dismorfología y Genética), 12 de Octubre University Hospital, Madrid, Spain.,Pediatrics Department, Endocrinology Unit, 12 de Octubre University Hospital, Madrid, Spain
| | - Montserrat Morales-Conejo
- UDISGEN (Unidad de Dismorfología y Genética), 12 de Octubre University Hospital, Madrid, Spain.,Internal Medicine Department, 12 de Octubre University Hospital, Madrid, Spain
| | - Noemí Nuñez-Enamorado
- Pediatrics Department, Neurology Unit, 12 de Octubre University Hospital, Madrid, Spain
| | | | | | - María A Gomez-Cano
- UDISGEN (Unidad de Dismorfología y Genética), 12 de Octubre University Hospital, Madrid, Spain.,Pediatrics Department, Endocrinology Unit, 12 de Octubre University Hospital, Madrid, Spain
| | - Patricia Ramos-Gómez
- Genetics Department, 12 de Octubre University Hospital, Madrid, Spain.,UDISGEN (Unidad de Dismorfología y Genética), 12 de Octubre University Hospital, Madrid, Spain
| | - Ollalla Sierra-Tomillo
- Genetics Department, 12 de Octubre University Hospital, Madrid, Spain.,UDISGEN (Unidad de Dismorfología y Genética), 12 de Octubre University Hospital, Madrid, Spain
| | - Alexandra Juárez-Rufián
- Genetics Department, 12 de Octubre University Hospital, Madrid, Spain.,UDISGEN (Unidad de Dismorfología y Genética), 12 de Octubre University Hospital, Madrid, Spain
| | - Jesús Gallego-Merlo
- Department of Genetics, IIS-Fundación Jiménez Díaz UAM, CIBERER, Madrid, Spain
| | | | - Marta Moreno-García
- Genetics Department, 12 de Octubre University Hospital, Madrid, Spain.,UDISGEN (Unidad de Dismorfología y Genética), 12 de Octubre University Hospital, Madrid, Spain
| | - Jaime Sánchez Del Pozo
- UDISGEN (Unidad de Dismorfología y Genética), 12 de Octubre University Hospital, Madrid, Spain.,Pediatrics Department, Endocrinology Unit, 12 de Octubre University Hospital, Madrid, Spain
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3
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Alonso-Pérez J, González-Quereda L, Bello L, Guglieri M, Straub V, Gallano P, Semplicini C, Pegoraro E, Zangaro V, Nascimento A, Ortez C, Comi GP, Dam LT, De Visser M, van der Kooi AJ, Garrido C, Santos M, Schara U, Gangfuß A, Løkken N, Storgaard JH, Vissing J, Schoser B, Dekomien G, Udd B, Palmio J, D'Amico A, Politano L, Nigro V, Bruno C, Panicucci C, Sarkozy A, Abdel-Mannan O, Alonso-Jimenez A, Claeys KG, Gomez-Andrés D, Munell F, Costa-Comellas L, Haberlová J, Rohlenová M, Elke DV, De Bleecker JL, Dominguez-González C, Tasca G, Weiss C, Deconinck N, Fernández-Torrón R, López de Munain A, Camacho-Salas A, Melegh B, Hadzsiev K, Leonardis L, Koritnik B, Garibaldi M, de Leon-Hernández JC, Malfatti E, Fraga-Bau A, Richard I, Illa I, Díaz-Manera J. New genotype-phenotype correlations in a large European cohort of patients with sarcoglycanopathy. Brain 2021; 143:2696-2708. [PMID: 32875335 DOI: 10.1093/brain/awaa228] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 05/25/2020] [Accepted: 05/27/2020] [Indexed: 12/17/2022] Open
Abstract
Sarcoglycanopathies comprise four subtypes of autosomal recessive limb-girdle muscular dystrophies (LGMDR3, LGMDR4, LGMDR5 and LGMDR6) that are caused, respectively, by mutations in the SGCA, SGCB, SGCG and SGCD genes. In 2016, several clinicians involved in the diagnosis, management and care of patients with LGMDR3-6 created a European Sarcoglycanopathy Consortium. The aim of the present study was to determine the clinical and genetic spectrum of a large cohort of patients with sarcoglycanopathy in Europe. This was an observational retrospective study. A total of 33 neuromuscular centres from 13 different European countries collected data of the genetically confirmed patients with sarcoglycanopathy followed-up at their centres. Demographic, genetic and clinical data were collected for this study. Data from 439 patients from 13 different countries were collected. Forty-three patients were not included in the analysis because of insufficient clinical information available. A total of 159 patients had a confirmed diagnosis of LGMDR3, 73 of LGMDR4, 157 of LGMDR5 and seven of LGMDR6. Patients with LGMDR3 had a later onset and slower progression of the disease. Cardiac involvement was most frequent in LGMDR4. Sixty per cent of LGMDR3 patients carried one of the following mutations, either in a homozygous or heterozygous state: c.229C>T, c.739G>A or c.850C>T. Similarly, the most common mutations in LMGDR5 patients were c.525delT or c.848G>A. In LGMDR4 patients the most frequent mutation was c.341C>T. We identified onset of symptoms before 10 years of age and residual protein expression lower than 30% as independent risk factors for losing ambulation before 18 years of age, in LGMDR3, LGMDR4 and LGMDR5 patients. This study reports clinical, genetic and protein data of a large European cohort of patients with sarcoglycanopathy. Improving our knowledge about these extremely rare autosomal recessive forms of LGMD was helped by a collaborative effort of neuromuscular centres across Europe. Our study provides important data on the genotype-phenotype correlation that is relevant for the design of natural history studies and upcoming interventional trials in sarcoglycanopathies.
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Affiliation(s)
- Jorge Alonso-Pérez
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Lidia González-Quereda
- U705 CIBERER, Genetics Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain.,Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Spain
| | - Luca Bello
- Department of Neuroscience, University of Padova, Padova, Italy
| | - Michela Guglieri
- John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Volker Straub
- John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Pia Gallano
- U705 CIBERER, Genetics Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain.,Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Spain
| | | | - Elena Pegoraro
- Department of Neuroscience, University of Padova, Padova, Italy
| | | | - Andrés Nascimento
- Neuromuscular Disorder Unit, Hospital Sant Joan de Deu, Barcelona, Spain
| | - Carlos Ortez
- Neuromuscular Disorder Unit, Hospital Sant Joan de Deu, Barcelona, Spain
| | - Giacomo Pietro Comi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Dino Ferrari Centre, University of Milan, Milan, Italy
| | - Leroy Ten Dam
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Marianne De Visser
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - A J van der Kooi
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Cristina Garrido
- Neuropediatric Department, Centro Hospitalar do Porto, Porto, Portugal
| | - Manuela Santos
- Neuropediatric Department, Centro Hospitalar do Porto, Porto, Portugal
| | - Ulrike Schara
- Neuromuscular Centre for Children and Adolescents, Department of Paediatric Neurology, University Hospital Essen, Essen, Germany
| | - Andrea Gangfuß
- Neuromuscular Centre for Children and Adolescents, Department of Paediatric Neurology, University Hospital Essen, Essen, Germany
| | - Nicoline Løkken
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - Jesper Helbo Storgaard
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - John Vissing
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - Benedikt Schoser
- Friedrich-Baur-Institute, Department of Neurology Klinikum München Ludwig-Maximilians-University Munich, Munich, Germany
| | | | - Bjarne Udd
- Neuromuscular Research Center, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Johanna Palmio
- Neuromuscular Research Center, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Adele D'Amico
- Unit of Neuromuscular and Neurodegenerative Diseases, Department of Neurosciences, Bambino Gesù Children's Hospital, Rome, Italy
| | - Luisa Politano
- Cardiomiology and Medical Genetics, Department of Experimental Medicine, University of Campania, Naples, Italy
| | - Vincenzo Nigro
- Department of Precision Medicine - University of Campania, Naples, Italy
| | - Claudio Bruno
- Center of Translational and Experimental Myology, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Chiara Panicucci
- Center of Translational and Experimental Myology, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Anna Sarkozy
- Dubowitz Neuromuscular Centre, MRC Centre for Neuromuscular Diseases, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Omar Abdel-Mannan
- Dubowitz Neuromuscular Centre, MRC Centre for Neuromuscular Diseases, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Alicia Alonso-Jimenez
- Neuromuscular Reference Center, Department of Neurology, Antwerp University Hospital, Antwerp, Belgium
| | - Kristl G Claeys
- Department of Neurology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.,Laboratory for Muscle Diseases and Neuropathies, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - David Gomez-Andrés
- Paediatric Neuromuscular disorders Unit, Pediatric Neurology, Vall d'Hebron University Hospital and Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain
| | - Francina Munell
- Paediatric Neuromuscular disorders Unit, Pediatric Neurology, Vall d'Hebron University Hospital and Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain
| | - Laura Costa-Comellas
- Paediatric Neuromuscular disorders Unit, Pediatric Neurology, Vall d'Hebron University Hospital and Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain
| | - Jana Haberlová
- Department of Child Neurology, Charles University, 2nd Medical School, University Hospital Motol, Prague, Czech Republic
| | - Marie Rohlenová
- Department of Child Neurology, Charles University, 2nd Medical School, University Hospital Motol, Prague, Czech Republic
| | - De Vos Elke
- Department of Neurology, Ghent University and University Hospital Ghent, Ghent, Belgium
| | - Jan L De Bleecker
- Department of Neurology, Ghent University and University Hospital Ghent, Ghent, Belgium
| | - Cristina Dominguez-González
- Department of Neuroscience, University of Padova, Padova, Italy.,Neuromuscular Unit, Department of Neurology, Hospital Universitario 12 de Octubre, Instituto de Investigación imas12, Madrid, Spain
| | - Giorgio Tasca
- UOC Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Claudia Weiss
- Department of Neuropediatrics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Nicolas Deconinck
- Department of Neurology, Queen Fabiola Children's University Hospital (HUDERF), Free University of Brussels, Brussels, Belgium
| | | | - Adolfo López de Munain
- Neurosciences, BioDonostia Health Research Institute, Hospital Donostia, San Sebastián, Spain
| | - Ana Camacho-Salas
- Division of Child Neurology, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Béla Melegh
- Department of Medical Genetics, and Szentagothai Research Center, University of Pécs, School of Medicine, Pécs, Hungary
| | - Kinga Hadzsiev
- Department of Medical Genetics, and Szentagothai Research Center, University of Pécs, School of Medicine, Pécs, Hungary
| | - Lea Leonardis
- Institute of Clinical Neurophysiology, University Medical Centre, Department of Neurology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Blaz Koritnik
- Institute of Clinical Neurophysiology, University Medical Centre, Department of Neurology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Matteo Garibaldi
- Neuromuscular and Rare Disease Center, Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), SAPIENZA Università di Roma, Rome, Italy
| | | | - Edoardo Malfatti
- Department of Neurology, Raymond-Poincaré teaching hospital, centre de référence des maladies neuromusculaires Nord/Est/Ile-de-France, AP-HP, Garches, France
| | | | - Isabelle Richard
- Integrare (UMR_S951), Inserm, Généthon, Univ Evry, Université Paris-Saclay, 91002, Evry, France
| | - Isabel Illa
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Neuroscience, University of Padova, Padova, Italy
| | - Jordi Díaz-Manera
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,U705 CIBERER, Genetics Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain.,John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
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Vila-Bedmar S, Quijada-Fraile P, Martinez-Azorin F, Hernández-Lain A, Cancho-Candela R, Núñez-Enamorado N, Camacho-Salas A. EP.18Mutations in TRAPPC11 are associated with Rett-like syndrome in absence of significant muscle involvement. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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5
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Víllora-Morcillo N, Quijada-Fraile P, Martín-Hernández E, Camacho-Salas A, García-Silva MT, Martinez De Aragón A, Berenguer-Potenciano M. Neuroradiological Features of Six Patients with Propionic Acidemia. J Pediatr Neurol 2018. [DOI: 10.1055/s-0037-1606353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AbstractPropionic acidemia (PA) is a rare autosomal recessive neurometabolic disorder caused by propionyl-CoA carboxylase deficiency. Diffuse brain atrophy, myelination delay, and basal ganglia abnormalities, either chronic or transient, have been previously reported in brain magnetic resonance imaging (MRI) of patients with PA. Clinical manifestations are heterogeneous and long-term outcome of affected individuals is unpredictable.Neuroradiological studies and clinical symptoms of six patients diagnosed with PA were reported in our center between 1999 and 2015. Brain MRI was performed in all patients (sagittal T1-weighted images, axial T2-weighted images, coronal FLAIR images, and axial diffusion-weighted images) and magnetic resonance spectroscopy (MRS) in four of them. Follow-up MRI abnormalities are heterogeneous and highly variable over time, in some cases even reversible. New neuroradiological findings are for the first time reported here as cerebellum signal changes, posterior brain stem diffusion restriction, and cortical development malformations. We suggest including serial MRI in follow-up programs as a monitoring tool in assessing intracerebral changes in PA, but more data are required to evaluate the benefits of serial MRI in PA patients.
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Affiliation(s)
| | - Pilar Quijada-Fraile
- Inborn Errors of Metabolism and Mitochondrial Disease Unit, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Elena Martín-Hernández
- Inborn Errors of Metabolism and Mitochondrial Disease Unit, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Ana Camacho-Salas
- Pediatric Neurology Unit, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Maria Teresa García-Silva
- Inborn Errors of Metabolism and Mitochondrial Disease Unit, Hospital Universitario 12 de Octubre, Madrid, Spain
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Soriano-Ramos M, Navarro-Abia V, Enamorado NN, Camacho-Salas A, De Aragón AM, García-Hoyos M, de Las Heras RS. Steroids for familial acute necrotizing encephalopathy: A future investment? Clin Neurol Neurosurg 2018; 174:134-136. [PMID: 30241006 DOI: 10.1016/j.clineuro.2018.09.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 08/09/2018] [Accepted: 09/06/2018] [Indexed: 10/28/2022]
Affiliation(s)
- María Soriano-Ramos
- Department of Pediatric Neurology, Hospital Universitario 12 de Octubre, Avenida de Córdoba s/n, 28041, Madrid, Spain.
| | - Virginia Navarro-Abia
- Department of Pediatric Neurology, Hospital Universitario 12 de Octubre, Avenida de Córdoba s/n, 28041, Madrid, Spain.
| | - Noemí Núñez Enamorado
- Department of Pediatric Neurology, Hospital Universitario 12 de Octubre, Avenida de Córdoba s/n, 28041, Madrid, Spain.
| | - Ana Camacho-Salas
- Department of Pediatric Neurology, Hospital Universitario 12 de Octubre, Avenida de Córdoba s/n, 28041, Madrid, Spain.
| | - Ana Martínez De Aragón
- Department of Neuroradiology, Hospital Universitario 12 de Octubre, Avenida de Córdoba s/n, 28041, Madrid, Spain.
| | - María García-Hoyos
- Department of Medical Genetics, Instituto de Medicina Genómica (IMEGEN), Calle Catedrático Agustín Escardino, 9, 46980, Paterna Valencia, Spain.
| | - Rogelio Simón de Las Heras
- Department of Pediatric Neurology, Hospital Universitario 12 de Octubre, Avenida de Córdoba s/n, 28041, Madrid, Spain.
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7
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Navarro-Abia V, Soriano-Ramos M, Núñez-Enamorado N, Camacho-Salas A, Martinez-de Aragón A, Martín-Hernández E, Simón-de Las Heras R. Hydrocephalus in pyridoxine-dependent epilepsy: New case and literature review. Brain Dev 2018; 40:348-352. [PMID: 29295802 DOI: 10.1016/j.braindev.2017.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 12/05/2017] [Accepted: 12/06/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Pyridoxine-dependent epilepsy (PDE) is a rare disorder of the lysine metabolism, characterized by a pharmacoresistant epileptic encephalopathy that usually begins in the neonatal period. However, its phenotypic spectrum is wide and not limited to seizures. We report a new case of PDE who developed hydrocephalus, along with an exhaustive review of the literature. CASE REPORT Our patient presented with seizures at 13 h of life. Antiepileptic drugs, vitamins and cofactors were required to achieve seizure control. Laboratory tests were congruent with PDE. She remained seizure-free until age five months, when seizures reappeared in the context of increasing head size and irritability. A cranial ultrasound showed hydrocephalus, for which she underwent ventriculoperitoneal shunting. DISCUSSION Seven other patients with same features have been previously reported. Seizure onset occurred within the first 7 days in all patients. Most of the children developed hydrocephalus at 6-7 months of age. In 4 out of 7 a genetic mutation was identified, despite the accurate etiology of hydrocephalus was unknown in most of them. The case we report behaved similarly to the others previously described. We postulate that the pathogenesis of this complication could be related to the high expression of antiquitin in choroid plexus epithelium, where the cerebrospinal fluid is produced. CONCLUSIONS patients with PDE should be closely monitored, since they may present severe complications. We highlight the development of hydrocephalus, an uncommon but potentially life-threatening problem reported in 8 patients up to present time.
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Affiliation(s)
- Virginia Navarro-Abia
- Division of Child Neurology, Hospital Universitario 12 de Octubre, Avenida de Córdoba s/n, 28041 Madrid, Spain.
| | - María Soriano-Ramos
- Division of Child Neurology, Hospital Universitario 12 de Octubre, Avenida de Córdoba s/n, 28041 Madrid, Spain
| | - Noemí Núñez-Enamorado
- Division of Child Neurology, Hospital Universitario 12 de Octubre, Avenida de Córdoba s/n, 28041 Madrid, Spain
| | - Ana Camacho-Salas
- Division of Child Neurology, Hospital Universitario 12 de Octubre, Avenida de Córdoba s/n, 28041 Madrid, Spain
| | - Ana Martinez-de Aragón
- Division of Neuroradiology, Hospital Universitario 12 de Octubre, Avenida de Córdoba s/n, 28041 Madrid, Spain
| | - Elena Martín-Hernández
- Pediatric Unit of Rare Diseases, Mitochondrial and Inherited Metabolic Disorders, Hospital Universitario 12 de Octubre, Avenida de Córdoba s/n, 28041 Madrid, Spain
| | - Rogelio Simón-de Las Heras
- Division of Child Neurology, Hospital Universitario 12 de Octubre, Avenida de Córdoba s/n, 28041 Madrid, Spain
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Villora-Morcillo N, Cordero-Castro C, Berenguer-Potenciano M, Rodriguez-Martin JI, Lucendo-Jimenez L, Camacho-Salas A. [Presumed perinatal ischemic stroke: risk factors and clinical and radiological findings]. Rev Neurol 2017; 64:543-548. [PMID: 28608354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Presumed perinatal ischemic stroke is a frequent cause of neurological sequelae. We aimed to describe the different clinical findings and risk factors and to analyse the differences according the vascular origin. PATIENTS AND METHODS Retrospective, descriptive study of patients diagnosed with presumed perinatal ischemic stroke attended at a tertiary pediatric hospital from 1990 to 2015. RESULTS 44 patients were included. A total of 24 patients (55%) had arterial ischemic stroke and 20 (45%) had periventricular venous infarction. Delay in diagnosis was significantly higher in patients with periventricular venous infarction compared to those with arterial ischemic stroke (14 and 8 months respectively; p = 0.025). Most patients presented with asymmetrical motor development (90%), only < 5% with seizures or non motor delays. Subsequent epilepsy at follow-up was significantly more prevalent in arterial ischemic stroke group (p = 0.020). We determined risk factors theoretically involved in the pathogenesis of presumed perinatal ischemic stroke: prenatal, obstetrical, perinatal, prothrombotic and cardiac. No significant differences between risk factors and vascular origin were found. Prothrombotic abnormalities were common (48.3%). CONCLUSIONS Investigation in risk factors implicated in presumed perinatal ischemic stroke is required to develop prevention strategies. Delay in diagnosis is higher in periventricular venous infarction group.
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Vila-Bedmar S, Ostos-Moliz F, Camacho-Salas A. Pediatric Multiple Sclerosis Presenting as Area Postrema Syndrome. Pediatr Neurol 2017; 70:83-84. [PMID: 28286009 DOI: 10.1016/j.pediatrneurol.2017.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 02/02/2017] [Accepted: 02/04/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Sara Vila-Bedmar
- Department of Neurology, Hospital Universitario 12 de Octubre, Madrid, Spain.
| | | | - Ana Camacho-Salas
- Department of Neurology, Hospital Universitario 12 de Octubre, Madrid, Spain
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Barragan-Martinez D, Nunez-Enamorado N, Berenguer-Potenciano M, Villora-Morcillo N, Martinez de Aragon A, Camacho-Salas A. [Language disorders in acute cerebellitis: beyond dysarthria]. Rev Neurol 2017; 64:27-30. [PMID: 28000909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Acute cerebellitis is one of the main causes of cerebellar syndrome in infancy. Among the wide range of manifestations, headache and ataxia being the most predominant, we can find other less frequent, although nonetheless interesting, ones, such as language disorders, which go beyond the well-known cerebellar dysarthria. The different combinations in which the symptoms can appear, especially when not accompanied by ataxia, make the condition a real challenge for the clinician. CASE REPORTS Two patients, aged 2 and 4 years, with clinical features, lab tests and neuroimaging results consistent with parainfectious acute cerebellitis. Both of them also presented a striking language disorder, one in the form of cerebellar mutism and the other in the form of hypofluency and agrammatism, the latter also developing in the absence of ataxia. Both cases progressed favourably, and mild speech alterations persisted in the follow-up visits. CONCLUSIONS Cases such as these expand the range of clinical manifestations of acute cerebellitis. The involvement of the cerebellum in neurocognitive processes like language is becoming increasingly more important and, although many aspects are still only speculations, managing to define its true role will have important repercussions on the diagnosis, treatment and long-term prognosis of these patients.
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Bachiller-Carnicero L, Berenguer-Potenciano M, Camacho-Salas A, Martínez de Aragón A, Gonzalo-Martínez JF. [Idiopathic intracranial hypotension associated with occult spinal dysraphism]. Rev Neurol 2015; 61:524-525. [PMID: 26602808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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12
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Piris-Borregas S, Vicente-Santamaría S, Martínez de Aragón A, Camacho-Salas A. [Carotid dissection as the cause of perinatal strokes]. Rev Neurol 2015; 60:335-336. [PMID: 25806485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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13
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Berenguer-Potenciano M, Villora-Morcillo N, Nunez-Enamorado N, Perez-Alonso V, Camacho-Salas A, Simon-De Las Heras R. [Therapeutic response to pyridoxine and pyridostigmine in a paediatric case of severe peripheral and cranial polyneuropathy due to vincristine]. Rev Neurol 2015; 60:91-92. [PMID: 25583593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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14
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Díaz-Díaz J, Camacho-Salas A, Núñez-Enamorado N, Carro-Rodríguez MA, Sánchez-Galán V, Martínez de Aragón A, Simón-De Las Heras R. [Stroke in paediatric patients with sickle-cell anaemia]. Rev Neurol 2014; 59:153-157. [PMID: 25059265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Sickle-cell anaemia is the severe homozygotic form of drepanocytosis, a genetic disorder that often occurs among black people and which is characterised by the production of haemoglobin S, chronic hemolytic anaemia and tissue ischaemia due to alterations in blood flow. A quarter of the patients presented neurological manifestations; 8-10% of children will have a stroke. AIM. To analyse the cases of stroke in children with sickle-cell anaemia in our centre. PATIENTS AND METHODS We conducted a retrospective descriptive study of children with sickle-cell anaemia and stroke. RESULTS Five patients (two Dominicans and three Guineans) with sickle-cell anaemia and stroke; one patient suffered two episodes of stroke. The mean age was 27 months. Five of the episodes were ischaemic infarctions. Stroke was the initial form of presentation of drepanocytosis on three occasions. Two of the strokes occurred within a context of pneumococcal meningitis. Four of the patients had previously reported fever. The initial clinical picture was hemiparesis in four cases. Mean haemoglobin on diagnosing the stroke was 6.5 g/dL. Transcranial ultrasound imaging revealed alterations in three patients and, in all the patients, magnetic resonance imaging revealed lesions, which were bilateral in half the cases. Following the stroke, a hypertransfusion regimen protocol was established and only one patient presented a new stroke. This same patient went on to develop moya-moya disease and was submitted to an indirect revascularisation; the patient progressed well, without presenting any new ischaemic events. CONCLUSIONS Drepanocytosis is a disease that is emerging in our setting as a result of immigration. It should be suspected in cases of paediatric strokes associated to anaemia, above all in black children under the age of five who were not submitted to neonatal screening.
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Camacho-Salas A, Núñez-Enamorado N, Zamora B, Hernández-Laín A, Simón-De Las Heras R. [Neurodevelopmental disorders as the presenting symptom of Duchenne's muscular dystrophy]. Rev Neurol 2014; 58:187-188. [PMID: 24504883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Pablos-Sánchez T, Oliveros-Leal L, Núñez-Enamorado N, Camacho-Salas A, Moreno-Villares JM, Simón-De las Heras R. [The use of the ketogenic diet as treatment for refractory epilepsy in the paediatric age]. Rev Neurol 2014; 58:55-62. [PMID: 24399621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Between 23% and 25% of epileptic children are refractory to antiepileptic drugs. In recent times there has been a renewed interest in the ketogenic diet as treatment in these patients who are not candidates for other therapeutic options. AIMS. To evaluate the effectiveness and safety of treatment with the ketogenic diet in an important number of paediatric patients with refractory epilepsy in our centre and to determine whether the results obtained are consistent with others recently reported in the literature. PATIENTS AND METHODS A retrospective review was conducted of the medical records of 41 children with refractory epilepsy treated with the ketogenic diet, mostly the Radcliffe II-type diet, between 1998 and 2011. Their median age on starting the diet was 3.92 years old. RESULTS At six months after beginning the diet, the number of crises was reduced by at least 50% in 36.84% of the sample (10.53% of the children reached a 90% reduction and 5.26% no longer suffered crises). Around 50% of those in the youngest age group responded positively. Some tolerable, transient side effects were experienced by 58.54% of the patients, consisting mainly in high levels of cholesterol and constipation; no variations in the anthropomorphic parameters were observed. CONCLUSIONS The ketogenic diet is a good therapeutic alternative in cases of refractory epilepsy in the paediatric age. Moreover, the younger the child is on starting on the diet, the more likely he or she is to gain benefits from it. In general it is well tolerated. Regular check-ups with supervision of these patients' nutrition are of great importance.
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Fernández-Ramos JA, López-Laso E, Simón-De Las Heras R, Camino-León R, Guerra-García P, Camacho-Salas A, Aguilar-Quintero M, Núñez-Enamorado N. [Aicardi syndrome: retrospective study of a series of seven case reports]. Rev Neurol 2013; 57:481-488. [PMID: 24265141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
INTRODUCTION The Aicardi syndrome is a disorder presumably X-linked dominant, classically defined by the triad of agenesis of the corpus callosum, chorioretinal lacunae and infantile spasms, with lethality in males. PATIENTS AND METHODS Retrospective descriptive study of patients diagnosed with Aicardi syndrome over a period of 29 years in two tertiary pediatric hospitals. RESULTS We found seven women that developed infantile spasms before 6 months of age, epileptic spasms persisting beyond infancy in two cases, a refractory symptomatic partial epilepsy in three patients, and well-controlled partial epilepsy in one girl. Six cases presented severe-profound mental retardation and moderate-severe in a girl. Two girls died at 2 and 6 years-old. In all patients neuroimaging studies showed agenesis of the corpus callosum, intracranial cysts and malformations of cortical development. Ophthalmological lesions were chorioretinal lacunae in seven cases, anophthalmia/microphthalmia in four girls and optic nerve coloboma in three patients. Other findings were congenital heart disease, costovertebral abnormalities, cervical lymphangioma and focal hypertrichosis. CONCLUSIONS The Aicardi syndrome should be suspected in girls with infantile spasms and agenesis of the corpus callosum. It is necessary to rule out these ophthalmologic abnormalities, malformations of cortical development and intracranial cysts. The prognosis is poor due to its high mortality and its evolution to refractory epilepsy and profound mental retardation.
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Gonzalez-Granado LI, Simon R, Camacho-Salas A. Subcutaneous route for refractory epilepsy. Pediatr Neurol 2013; 48:79. [PMID: 23290029 DOI: 10.1016/j.pediatrneurol.2012.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Nunez-Enamorado N, Camacho-Salas A, Belda-Hofheinz S, Cordero-Castro C, Simon-De Las Heras R, Saiz-Diaz R, Martinez-Sarries FJ, Martinez-Menendez B, Graus F. [Fast and spectacular clinical response to plasmapheresis in a paediatric case of anti-NMDA encephalitis]. Rev Neurol 2012; 54:420-424. [PMID: 22451129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Autoimmune encephalitis against N-methyl-D-aspartate (NMDA) receptors is being diagnosed more and more frequently in the paediatric age. It should be suspected in children with psychiatric symptoms, encephalopathy, abnormal movements or epileptic seizures. Paraneoplastic cases are less frequent than in adults. CASE REPORT We report the case of a boy, 2.5 years of age, with subacute encephalopathic signs and symptoms and epileptic seizures followed by behaviour disorders, neurological regression, dyskinesias and insomnia. Results of a cerebrospinal fluid study were normal, the magnetic resonance scan of the head revealed a focal periventricular lesion and diffuse leptomeningeal uptake; moreover, the serial electroencephalograms showed high-amplitude delta activity interspersed with generalised intercritical epileptiform activity. The patient was given empirical treatment with high doses of corticoids and intravenous immunoglobulins with no response. After showing up positive for antibodies against the NMDA receptor, plasmapheresis was begun, which led to his swift and spectacular recovery. After more than 18 months' follow-up, his sequelae are limited to mild behavioural and language alterations. He has had no relapses and has not needed any kind of maintenance treatment. CONCLUSIONS Anti-NMDA encephalitis is a treatable disorder and, sometimes, the first evidence of an underlying neoplasia, which makes its early recognition and treatment essential. Treatment of the non-paraneoplastic forms are based on immunotherapy: glucocorticoids, intravenous immunoglobulins, plasmapheresis and immunosuppressants. Plasmapheresis can bring about a fast, spectacular improvement.
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Villarejo A, Martin VP, Moreno-Ramos T, Camacho-Salas A, Porta-Etessam J, Bermejo-Pareja F. Mirrored-self misidentification in a patient without dementia: evidence for right hemispheric and bifrontal damage. Neurocase 2011; 17:276-84. [PMID: 20812138 DOI: 10.1080/13554794.2010.498427] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Mirrored-self misidentification, often referred as the 'mirror sign', is a delusion characterized by the inability to recognize one's own reflected image, often associated with the intact capacity to recognize others in the mirror. It has been described mainly in moderate or severe dementia, especially Alzheimer's disease. In the few reported cases without global cognitive impairment, right hemispheric and frontal dysfunctions have been described. We report a 90-year-old man with abrupt onset of the mirror sign after a minor right hemispheric ischemic stroke. Neuropsychological testing revealed preserved cognitive capacities, except for mild to moderate impairment of visuospatial skills, suggesting right hemisphere dysfunction. Neuroimaging showed a small right dorsolateral frontal infarct, and bifrontal encephalomalacia, consistent with a past history of head trauma. Scattered ischemic white matter lesions in posterior periventricular regions were also seen. It seems that the mirror sign is a multifactorial phenomenon that usually requires right hemispheric dysfunction (perceptual abnormalities, loss of familiarity) and frontal damage (loss of judgement and inability to correct wrong beliefs). The right frontal dorsolateral prefrontal cortex seems to have a crucial role in self-recognition.
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Affiliation(s)
- Alberto Villarejo
- Department of Neurology, Hospital Universitario '12 de Octubre', Madrid, Spain.
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Camacho-Salas A. [Infantile cerebral palsy: the importance of population registers]. Rev Neurol 2008; 47 Suppl 1:S15-S20. [PMID: 18767012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
INTRODUCTION Cerebral palsy (CP) is the most common cause of motor disability in the paediatric age. For several decades, a number of developed countries have kept registers that have been used to conduct population-based studies of CP. AIM. To determine what methodology is needed to keep a register of CP and in what ways it can be applied. DEVELOPMENT CP registers came into being as a means to monitor the prevalence of CP. Today they have become useful tools for organising health care services, conducting aetiological studies on CP, evaluating therapeutic interventions and assessing patients' quality of life. Setting up a register involves having an aim and a set of eligibility/exclusion criteria that have both been clearly defined beforehand. The quality of the register depends on its continuity, which means that there must be economic and human resources available to ensure long-term planning and the constant incorporation of new patients. Projects that are coordinated among several centres provide a greater study population and favour the utilisation of a common terminology. CONCLUSIONS The deficits associated to CP, together with its chronicity and the medical, social and educational implications it gives rise to, make it an extremely important health issue today. The ultimate aim of studies on CP should be to improve patients' quality of life and promote their full integration into the world around them.
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Affiliation(s)
- A Camacho-Salas
- Sección de Neurología Infantil, Servicio de Neurología, Hospital 12 de Octubre, Madrid, España.
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Camacho-Salas A, Pallás-Alonso CR, de la Cruz-Bértolo J, Simón-de Las Heras R, Mateos-Beato F. [Cerebral palsy: the concept and population-based registers]. Rev Neurol 2007; 45:503-508. [PMID: 17948217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
INTRODUCTION Cerebral palsy (CP) is the most common cause of motor disability in the paediatric age. For several decades, a number of developed countries have kept registers that have been used to conduct population-based studies of CP. In Spain, however, little attention has been paid to the epidemiology of CP. AIM To review the concept of CP today and to stimulate greater interest in researching into CP based on the experience of other countries. DEVELOPMENT The different definitions of CP cover motor sequelae secondary to an isolated brain injury that occurs in a developing brain. CP registers were started as a means of monitoring the prevalence of CP and planning suitable care for patients. Over the last decade projects have been carried out that involve the coordinated efforts of several centres; this provides a larger population for study and reduces the chances of confusion with respect to the terminology employed. In this regard, one notable line of work is that of the European CP group (SCPE), which gathers information about children with CP in 15 countries. Spain has been taking part in this project since 2003 through a group of researchers from the Hospital 12 de Octubre in Madrid. CONCLUSIONS From the very definition of the disorder, CP is a complex condition. A population-based study of CP in Spain should help to arouse a renewed interest in this condition in our country.
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Affiliation(s)
- A Camacho-Salas
- Servicio de Neurología, Sección de Neurología Infantil, Hospital Universitario 12 de Octubre, 28045, Madrid, Spain.
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Camacho-Salas A, Villarejo-Galende A, Moreno-Ramos T, Muñoz-González A, Millán-Juncos JM, Simón de las Heras R, Mateos-Beato F. [Dystrophic calcification in the brain after successful treatment of invasive aspergillosis]. Rev Neurol 2004; 39:492-3. [PMID: 15378464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Affiliation(s)
- A Camacho-Salas
- Sección de Neurorradiología, Hospital Universitario Doce de Octubre, Madrid, Spain.
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Villarejo-Galende A, Camacho-Salas A, Penas-Prado M, Juntas-Morales R, Gonzalez-de la Aleja J, Ramos A, Rodríguez-Vallejo A. [Spinal epidural abscess in a patient with septicaemia]. Rev Neurol 2003; 36:1152-5. [PMID: 12833235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
INTRODUCTION Spinal epidural abscess is a rare entity requiring early diagnosis and treatment. Sepsis is a factor with an unfavourable prognosis. CASE REPORT We report the case of a 57 year old female with acute low back pain who was admitted to hospital suffering from a state of septic shock and multiple organ failure secondary to an infection disseminated by Staphylococcus aureus, which was treated early on with vancomycin. The probable source of infection was assumed to be necrotizing fasciitis of the left arm. Once the acute phase had been overcome, serious paraparesis became apparent and this led to magnetic resonance imaging of the spine being carried out, the results of which showed the existence of a lumbar spondylodiscitis with associated epidural abscess. CONCLUSION In patients with sepsis and some previous symptom that arouses suspicion, it is important to consider this possible diagnosis, since treatment with antibiotics alone does not manage to prevent neurological complications in all cases.
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Affiliation(s)
- A Villarejo-Galende
- Servicio de Nuerología, Hospital Universitario Doce de Octubre, Madrid, España.
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Villarejo-Galende A, Camacho-Salas A, Penas-Prado M, García-Ramos R, Mendoza MC, Simón de las Heras R, Mateos-Beato F. [Unilateral isolated paralysis of the soft palate: a case report and a review of the literature]. Rev Neurol 2003; 36:337-9. [PMID: 12599130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
INTRODUCTION Unilateral isolated paralysis of the soft palate is a rare clinical entity. CASE REPORT We describe the case of a 12 year old girl who presented acute dysphagia, a nasal voice and regurgitation of liquids into the nose. Exploration revealed right velopalatine insufficiency with normal gag reflex and pharyngeal sensitivity. All the complementary studies, including magnetic resonance, lumbar puncture and viral serology tests, were normal. There are 28 similar cases in the literature, with the following characteristics: acute onset, appearing in infancy (96%), predominance in males (79%), recent respiratory infection (35%) and an excellent prognosis for recovery (85%). CONCLUSION This is probably a case of acute cranial mononeuropathy with a viral aetiology
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Affiliation(s)
- A Villarejo-Galende
- Servicio de Neurología, Sección de Neuropediatría, Hospital Universitario Doce de Octubre, Madrid, España.
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Camacho-Salas A, Martíez-Salio A, García-Morales I, Villarejo-Galende A, de la Peña P. [Periodic lateralised epileptiform discharges as a form of presentation of neurosyphilis]. Rev Neurol 2002; 35:734-7. [PMID: 12402225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
INTRODUCTION Neurosyphilis is a recognised cause of epileptic seizures, but its association with periodic lateralised epileptiform discharges (PLED) has been described only rarely, in spite of the fact that it gives rise to acute vascular lesions. CLINICAL CASE We report the case of a male patient who was diagnosed as having meningovascular syphilis after the onset of tonic clonic epileptic seizures and PLED in the left frontotemporal region. The initial neurological exploration revealed a syndrome of confusion and mild mixed, but predominantly motor, dysphasia. In complementary tests, the most noteworthy features were positive luetic serology in the blood and in cerebrospinal fluid (CSF), which was confirmed by means of treponemic assays. The patient was treated with penicillin for two weeks. The study was completed with a magnetic resonance (MR) brain scan that showed a small left temporal infarction, which was the origin of the clinical and electrical convulsive activity. The patient s evolution was satisfactory, with an improvement in the language disorder, and the seizures were controlled after the administration of phenytoin. The control electroencephalogram (EEG) that was performed later only showed a slowing in the known injured area. CONCLUSIONS PLED are an infrequent electroencephalographic pattern whose appearance has been linked with acute brain lesions, mainly with strokes, tumours and meningoencephalitis. When, exceptionally, they appear as a consequence of an ischemia secondary to meningovascular syphilis their significance, clinical features and prognosis do not differ from other causes of a cerebrovascular disease.
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Affiliation(s)
- A Camacho-Salas
- Servicio de Nurología, Hospital Universitario 12 de Octubre, Madrid, España.
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Camacho-Salas A, Vernet A, Colomer-Oferil J, Pineda-Marfà M, Campistol J, Ribó JM, Medina M. [Thymectomy in juvenile myasthenia gravis]. Rev Neurol 2002; 35:119-23. [PMID: 12221621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
INTRODUCTION Juvenile myasthenia gravis (JMG) is an infrequent autoimmune disease, the symptoms and therapeutic handling of which do not differ from those of the adult forms. Chronic treatment with corticoids very often causes side effects in childhood, which is why patients are being submitted to thymectomies at younger ages with better results. AIMS. To analyse the clinical and evolutionary profile of JMG treated by thymectomy in our centre. PATIENTS AND METHODS We report the case of four girls aged between 5 and 13 who were diagnosed as suffering from generalised myasthenia gravis (MG) with bulbar affectation. One of them started with a myasthenic crisis. The four of them were submitted to Tensilon s test, an electrophysiological study, determination of AChR, thoracic CT, and study of autoimmunity and thyroid functioning. After surgery the thymus was analysed histologically. RESULTS They all gave positive in Tensilon s test and were seropositive for AChR. They were treated with anticholinesterases, up to the maximum tolerated dose, and corticoids, without complete remission being accomplished and so they were submitted to a thymectomy in the first year of evolution. In three cases surgical approach was transsternal and in the other by means of a videothoracoscope. All the thymuses showed lymphoid hyperplasia. After a variable follow up the girls are at present asymptomatic, although none of them has been able to completely give up the pharmacological treatment. CONCLUSIONS Thymectomy is one of the mainstays of treatment for JMG. The ever more frequent use of videothoracoscopic techniques achieves results that are similar to those obtained by conventional surgery but with fewer post operative and aesthetic problems
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Affiliation(s)
- A Camacho-Salas
- Hospital Saint Joan de Déu, Esplugues de Ll, Barcelona, España
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