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Tumienė B, Juozapavičiūtė A, Andriukaitis V. Rare diseases: still on the fringes of universal health coverage in Europe. Lancet Reg Health Eur 2024; 37:100783. [PMID: 38169941 PMCID: PMC10758954 DOI: 10.1016/j.lanepe.2023.100783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/28/2023] [Accepted: 10/30/2023] [Indexed: 01/05/2024]
Abstract
Despite general advancements in population health indicators and universal health coverage, people living with rare diseases and their families still experience considerable unmet needs, including prolonged diagnostic journeys, limited treatment options, and a huge psychosocial burden due to the lack of coordinated, integrated care. Attainment of universal health coverage for rare diseases is dependent on fundamentally different health determinants and demands for different solutions. This involves consolidating expertise through Centers of Excellence, establishing efficient care pathways, fostering extensive collaboration at European and global levels in research and healthcare, and putting patients at the center of care. Furthermore, development of specific indicators and coding systems is crucial for monitoring progress. Only in this way Europe can strive towards a future where people living with rare diseases receive the same level of equitable, safe, high-quality healthcare as other members of the society, in alignment with the overarching goal of leaving no one behind.
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Affiliation(s)
- Birutė Tumienė
- Faculty of Medicine, Institute of Biomedical Sciences, Vilnius University, M. K. Ciurlionio str. 21, Vilnius LT-03101, Lithuania
- Vilnius University Hospital Santaros Klinikos, Rare Diseases Coordination Center, Santariskiu str. 2, Vilnius LT-08661, Lithuania
| | - Augutė Juozapavičiūtė
- Faculty of Medicine, Institute of Biomedical Sciences, Vilnius University, M. K. Ciurlionio str. 21, Vilnius LT-03101, Lithuania
- Vilnius University Hospital Santaros Klinikos, Rare Diseases Coordination Center, Santariskiu str. 2, Vilnius LT-08661, Lithuania
- Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, M. K. Ciurlionio str. 21, Vilnius LT-03101, Lithuania
| | - Vytenis Andriukaitis
- European Institute of Health and Sustainable Development, Petro Vileisio str. 18A - 301, Vilnius LT-10306, Lithuania
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Tumienė B, del Toro Riera M, Grikiniene J, Samaitiene-Aleknienė R, Praninskienė R, Monavari AA, Sykut-Cegielska J. Multidisciplinary Care of Patients with Inherited Metabolic Diseases and Epilepsy: Current Perspectives. J Multidiscip Healthc 2022; 15:553-566. [PMID: 35387391 PMCID: PMC8977775 DOI: 10.2147/jmdh.s251863] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 03/17/2022] [Indexed: 11/25/2022] Open
Abstract
More than 650 inherited metabolic diseases may present with epilepsy or seizures. These diseases are often multisystem, life-long and induce complex needs of patients and families. Multidisciplinary care involves all stages of disease management: diagnostics, specific or symptomatic, acute and chronic treatments, and integrated care that takes into account not only medical, but also manifold psychosocial, educational, vocational and other needs of patients and their caregivers. Care coordination is indispensable to ensure smooth transitions of care across life and disease stages, including management of emergencies, transition from pediatric to adult services and palliative care. Care pathways are highly diverse and have to find the right balance between highly specialized and locally provided services. While multidisciplinary teams consist of many professionals, a named supervising physician in a highly specialized healthcare setting and a care coordinator are highly important. As the greatest burden of care always falls onto the shoulders of patients and/or families, patient empowerment should be a part of every care pathway and include provision of required information, involvement into common decision-making, patient’s and family’s education, support for self-management, liaison with peer support groups and emotional/ psychological support. Due to the rarity and complexity of these diseases, sufficient expertise may not be available in a national healthcare system and cross-border services (virtual or physical) in the recently developed European Reference Networks should be ensured through the proper organization of referral systems in each EU and EEA country. Finally, digital technologies are particularly important in the provision of services for patients with rare diseases and can significantly increase the availability of highly specialized services and expertise.
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Affiliation(s)
- Birutė Tumienė
- Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Vilnius University Hospital Santaros klinikos, Vilnius, Lithuania
- Correspondence: Birutė Tumienė, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Santariskiu str. 2, Vilnius, LT-06681, Lithuania, Tel +370 614 45026, Email
| | - Mireia del Toro Riera
- Pediatric Neurology Department, Unit of Hereditary Metabolic Disorders, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Jurgita Grikiniene
- Clinic of Children’s Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Rūta Samaitiene-Aleknienė
- Clinic of Children’s Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Rūta Praninskienė
- Clinic of Children’s Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Ahmad Ardeshir Monavari
- National Centre for Inherited Metabolic Disorders, Children’s Health Ireland at Temple Street Dublin, Dublin, Ireland
- University College Dublin, Dublin, Ireland
| | - Jolanta Sykut-Cegielska
- Department of Inborn Errors of Metabolism and Paediatrics, the Institute of Mother and Child, Warsaw, Poland
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Horgan D, Borisch B, Cattaneo I, Caulfield M, Chiti A, Chomienne C, Cole A, Facey K, Hackshaw A, Hendolin M, Georges N, Kalra D, Tumienė B, von Meyenn M. Factors Affecting Citizen Trust and Public Engagement Relating to the Generation and Use of Real-World Evidence in Healthcare. Int J Environ Res Public Health 2022; 19:ijerph19031674. [PMID: 35162696 PMCID: PMC8835047 DOI: 10.3390/ijerph19031674] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/21/2022] [Accepted: 01/28/2022] [Indexed: 01/09/2023]
Abstract
The potential for the use of real-world data (RWD) to generate real-world evidence (RWE) that can inform clinical decision-making and health policy is increasingly recognized, albeit with hesitancy in some circles. If used appropriately, the rapidly expanding wealth of health data could improve healthcare research, delivery of care, and patient outcomes. However, this depends on two key factors: (1) building structures that increase the confidence and willingness of European Union (EU) citizens to permit the collection and use of their data, and (2) development of EU health policy to support and shape data collection infrastructures, methodologies, transmission, and use. The great potential for use of RWE in healthcare improvement merits careful exploration of the drivers of, and challenges preventing, efficient RWD curation. Literature-based research was performed to identify relevant themes and discussion topics for two sets of expert panels, organized by the European Alliance for Personalised Medicine. These expert panels discussed steps that would enable a gradual but steady growth in the quantity, quality, and beneficial deployment of RWE. Participants were selected to provide insight based on their professional medical, economic, patient, industry, or governmental experience. Here, we propose a framework that addresses public trust and access to data, cross-border governance, alignment of evidence frameworks, and demonstrable improvements in healthcare decisions. We also discuss key case studies that support these recommendations, in accordance with the discussions at the expert panels.
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Affiliation(s)
- Denis Horgan
- European Alliance for Personalised Medicine, 1040 Brussels, Belgium
- Correspondence: ; Tel.: +386-30-607-281
| | - Bettina Borisch
- Department of Histopathology, University of Geneva, 1202 Geneva, Switzerland;
| | | | - Mark Caulfield
- NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, UK;
| | - Arturo Chiti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy;
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Christine Chomienne
- Cell Biology-Hematology Department, Université de Paris INSERM, 75010 Paris, France;
| | - Amanda Cole
- Office of Health Economics, London SW1E 6QT, UK;
| | - Karen Facey
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh EH8 9YL, UK;
| | - Allan Hackshaw
- Faculty of Medical Sciences, University College London, London W1T 4TJ, UK;
| | - Minna Hendolin
- Sitra—The Finnish Innovation Fund, 00180 Helsinki, Finland;
| | | | - Dipak Kalra
- Faculty of Medicine and Health Sciences, University of Ghent, 9000 Ghent, Belgium;
| | - Birutė Tumienė
- Vilnius University Hospital Santariskiu Klinikos, 08661 Vilnius, Lithuania;
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Tumienė B, Peterlin B, Maver A, Utkus A. Contemporary scope of inborn errors of metabolism involving epilepsy or seizures. Metab Brain Dis 2018; 33:1781-1786. [PMID: 30006695 DOI: 10.1007/s11011-018-0288-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 07/10/2018] [Indexed: 01/15/2023]
Abstract
Many inborn errors of metabolism may present with epilepsy or seizures, however, current scope of these diseases is unknown. Due to available precision medicine approaches in many inborn errors of metabolism and sophisticated traditional diagnostics, this group of disorders is of special relevance to clinicians. Besides, as current treatment is challenging and unsuccessful in more than 30% of all epilepsy patients, these diseases may provide valuable models for ictogenesis and epileptogenesis studies and potentially pave the ways to identification of novel treatments. The aim of this study was to elucidate genetic architecture of inborn errors of metabolism involving epilepsy or seizures and to evaluate their diagnostic approaches. After extensive search, 880 human genes were identified with a considerable part, 373 genes (42%), associated with inborn errors of metabolism. The most numerous group comprised disorders of energy metabolism (115, 31% of all inborn errors of metabolism). A substantial number of these diseases (26%, 97/373) have established specific treatments, therefore timely diagnosis comes as an obligation. Highly heterogenous, overlapping and non-specific phenotypes in most of inborn errors of metabolism presenting with epilepsy or seizures usually preclude phenotype-driven diagnostics. Besides, as traditional diagnostics involves a range of specialized metabolic tests with low diagnostic yields and is generally inefficient and lengthy, next-generation sequencing-based methods were proposed as a cost-efficient one-step way to shorten "diagnostic odyssey". Extensive list of 373 epilepsy- or seizures-associated inborn errors of metabolism genes may be of value in development of gene panels and as a tool for variants' filtration.
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Affiliation(s)
- Birutė Tumienė
- Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Santariskiu 2, LT-08661, Vilnius, Lithuania.
- Vilnius University Hospital Santaros Klinikos, Santariskiu 2, LT-08661, Vilnius, Lithuania.
| | - Borut Peterlin
- Clinical Institute for Medical Genetics, Division of Gynecology, University of Ljubljana Medical Centre, Ljubljana, Slovenia
| | - Aleš Maver
- Clinical Institute for Medical Genetics, Division of Gynecology, University of Ljubljana Medical Centre, Ljubljana, Slovenia
| | - Algirdas Utkus
- Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Santariskiu 2, LT-08661, Vilnius, Lithuania
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Tumienė B, Maver A, Writzl K, Hodžić A, Čuturilo G, Kuzmanić-Šamija R, Čulić V, Peterlin B. Diagnostic exome sequencing of syndromic epilepsy patients in clinical practice. Clin Genet 2018; 93:1057-1062. [PMID: 29286531 DOI: 10.1111/cge.13203] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [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: 09/15/2017] [Revised: 12/21/2017] [Accepted: 12/22/2017] [Indexed: 02/04/2023]
Abstract
Although genetic revolution of recent years has vastly expanded a list of genes implicated in epilepsies, complex architecture of epilepsy genetics is still largely unknown, consequently, universally accepted workflows for epilepsy genetic testing in a clinical practice are missing. We present a comprehensive NGS-based diagnostic approach addressing both the clinical and genetic heterogeneity of disorders involving epilepsy or seizures. A bioinformatic panel of 862 epilepsy- or seizure-associated genes was applied to Mendeliome (4813 genes) or whole-exome sequencing data as a first stage, while the second stage included untargeted variant interpretation. Eighty-six consecutive patients with epilepsy or seizures associated with neurodevelopmental disorders and/or congenital malformations were investigated. Of the 86 probands, 42 harbored pathogenic and likely pathogenic variants, giving a diagnostic yield of 49%. Two patients were diagnosed with pathogenic copy number variations and 2 had causative mitochondrial DNA variants. Eleven patients (13%) were diagnosed with diseases with specific treatments. Besides, genomic approach in diagnostics had multiple additional benefits due to mostly non-specific, overlapping, not full-blown phenotypes and abilities to diagnose novel and ultra rare epilepsy-associated diseases. Likely pathogenic variants were identified in SOX5 gene, not previously associated with epilepsy, and UBA5, a recently associated with epilepsy gene.
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Affiliation(s)
- B Tumienė
- Clinical Institute for Medical Genetics, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Department of Human and Medical Genetics, Centre for Medical Genetics, Vilnius University, Vilnius, Lithuania
| | - A Maver
- Clinical Institute for Medical Genetics, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - K Writzl
- Clinical Institute for Medical Genetics, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - A Hodžić
- Clinical Institute for Medical Genetics, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - G Čuturilo
- Department of Medical Genetics, University Children's Hospital, Belgrade, Serbia
| | | | - V Čulić
- Department of Pediatrics, University Hospital Split, Split, Croatia
| | - B Peterlin
- Clinical Institute for Medical Genetics, University Medical Centre Ljubljana, Ljubljana, Slovenia
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Preiksaitiene E, Tumienė B, Maldžienė Ž, Pranckevičienė E, Morkūnienė A, Utkus A, Kučinskas V. Features of KAT6B-related disorders in a patient with 10q22.1q22.3 deletion. Ophthalmic Genet 2017; 38:383-386. [PMID: 27880066 DOI: 10.1080/13816810.2016.1227452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Blepharophimosis is a fixed reduction in the vertical distance between the upper and lower eyelids with short palpebral fissures. It is a rare facial malformation and is considered an important diagnostic feature in dysmorphic analysis. It is likely that many patients with blepharophimosis-mental retardation syndrome have submicroscopic chromosomal rearrangements, and the use of molecular karyotyping can narrow the known blepharophimosis-mental retardation-critical regions or clarify the effect of the haploinsufficiency of the involved genes on the phenotype. MATERIALS AND METHODS A female patient presented with bilateral blepharophimosis, ptosis, epicanthus inversus, telecanthus, low-set and small ears, other minor anomalies, hypotonia and psychomotor developmental delay. Metabolic investigations and array CGH analysis were performed. The results of molecular karyotyping were confirmed by real-time PCR analysis. RESULTS Molecular karyotyping revealed a 5.2 Mb deletion in the 10q22.1q22.3 region. Real-time PCR analysis of the proband and her parents confirmed the deletion in the proband and revealed its de novo origin. CONCLUSIONS With ptosis, hypotonia, and developmental delay as the main diagnostic features of our patient, the effect of histone acetyltransferase-encoding KAT6B gene haploinsufficiency was suspected to have a significant role in determining the phenotype. Detailed clinical characterization of the patient provided additional information on the clinical manifestation of the 10q22 deletion.
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Affiliation(s)
- Egle Preiksaitiene
- a Department of Human and Medical Genetics, Faculty of Medicine , Vilnius University , Vilnius , Lithuania
| | - Birutė Tumienė
- a Department of Human and Medical Genetics, Faculty of Medicine , Vilnius University , Vilnius , Lithuania
| | - Živilė Maldžienė
- a Department of Human and Medical Genetics, Faculty of Medicine , Vilnius University , Vilnius , Lithuania
| | - Erinija Pranckevičienė
- a Department of Human and Medical Genetics, Faculty of Medicine , Vilnius University , Vilnius , Lithuania
| | - Aušra Morkūnienė
- a Department of Human and Medical Genetics, Faculty of Medicine , Vilnius University , Vilnius , Lithuania
| | - Algirdas Utkus
- a Department of Human and Medical Genetics, Faculty of Medicine , Vilnius University , Vilnius , Lithuania
| | - Vaidutis Kučinskas
- a Department of Human and Medical Genetics, Faculty of Medicine , Vilnius University , Vilnius , Lithuania
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Tumienė B, Voisin N, Preikšaitienė E, Petroška D, Grikinienė J, Samaitienė R, Utkus A, Reymond A, Kučinskas V. Inflammatory myopathy in a patient with Aicardi-Goutières syndrome. Eur J Med Genet 2017; 60:154-158. [PMID: 28089741 DOI: 10.1016/j.ejmg.2016.12.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 08/08/2016] [Revised: 10/28/2016] [Accepted: 12/10/2016] [Indexed: 11/27/2022]
Abstract
Aicardi-Goutières syndrome (AGS) is an inflammatory disorder belonging to the recently characterized group of type I interferonopathies. The most consistently affected tissues in AGS are the central nervous system and skin, but various organ systems and tissues have been reported to be affected, pointing to the systemic nature of the disease. Here we describe a patient with AGS due to a homozygous p.Arg114His mutation in the TREX1 gene. The histologically proven inflammatory myopathy in our patient expands the range of clinical features of AGS. Histological signs of muscle biopsies in the proband, and in two other AGS patients described earlier, are similar to those seen in various autoimmune myositises and could be ascribed to inapproapriate IFN I activation. In view of signs of possible mitochondrial damage in AGS, we propose that mitochondrial DNA could be a trigger of autoimmune responses in AGS.
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Affiliation(s)
- Birutė Tumienė
- Department of Human and Medical Genetics, Centre for Medical Genetics, Vilnius University, Vilnius, Lithuania.
| | - Norine Voisin
- Center for Integrative Genomics, University of Lausanne, Lausanne, Switzerland
| | - Eglė Preikšaitienė
- Department of Human and Medical Genetics, Centre for Medical Genetics, Vilnius University, Vilnius, Lithuania
| | - Donatas Petroška
- Department of Pathology, Forensic Medicine and Pharmacology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania; National Centre of Pathology, Vilnius University Hospital Santariškių Klinikos, Vilnius, Lithuania
| | - Jurgita Grikinienė
- Clinic of Children's Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Rūta Samaitienė
- Clinic of Children's Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Algirdas Utkus
- Department of Human and Medical Genetics, Centre for Medical Genetics, Vilnius University, Vilnius, Lithuania
| | - Alexandre Reymond
- Center for Integrative Genomics, University of Lausanne, Lausanne, Switzerland
| | - Vaidutis Kučinskas
- Department of Human and Medical Genetics, Centre for Medical Genetics, Vilnius University, Vilnius, Lithuania
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Tumienė B, Utkus A. Epileptogenic malformations of cortical development: when evolution goes awry. Acta Med Litu 2014. [DOI: 10.6001/actamedica.v21i3.2993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background. Since the time of its origin in a mammalian ancestor, perhaps 250 million years ago, the neocortex has undergone expansion in both relative and absolute size. The complexity of the brain in vertebrates is proportional to the elaboration of the mechanisms controlling cortical development. Malformations of cortical development (MCD) are classified into three major groups that recapitulate the main developmental steps: cell proliferation, neuronal migration, or postmigrational cortical organization and connectivity. The main clinical manifestations of MCDs are epilepsy and / or intellectual disability. Seizures are the most common clinical feature, at least 75% of patients with MCDs will have epilepsy. Recent advances in neuroimaging techniques and revolutionary achievements in molecular biology led to an explosive increase in our knowledge of cerebral cortex development and malformations of cortical development (MCD). So far, more than 100 genes were associated with one or more types of MCD. However, the genetic cause still remains unidentified in the majority of cases.
Conclusions. Investigations of human malformations of cortical development as of a model of impaired neurodevelopment gave a lot of important insights into normal and abnormal brain development processes and practical benefits to MCD patients and their families. Recent achievements in genetic technologies led to a real explosion in such knowledge and are expected to yield even more additional information in the near future.
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Tumienė B, Utkus A, Kučinskas V. Imprinting and its disorders in evolutionary perspective. Acta Med Litu 2014. [DOI: 10.6001/actamedica.v21i3.2994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Bacground. Genomic imprinting is one of the best-studied epigenetic phenomena involving all the main epigenetic processes. Recent investigations led to a huge expansion of knowledge in this field and changed some established paradigms regarding imprinting establishment and maintenance. Evolutionary theories are intended to explain origins of imprinting and its evolutionary survival under the influence of selection pressure. The three main evolutionary theories based on selective asymmetry between maternally and paternally inherited alleles are kinship, sexual antagonism and maternal-offspring coadaptation theories. Though no one of them can explain all the aspects of imprinting, they are not mutually exclusive and multiple mechanisms may be at work at any given locus. Further evidences for imprinting importance come from investigations of human imprinting disorders. Eight of them have been described so far and multilocus imprinting defects have been recently discovered pointing to derangements in some common imprinting establishment / maintenance mechanisms.
Conclusions. Investigations of imprinting mechanisms, evolutionary origins and derangements led to some crucial discoveries in epigenetic processes shaping both health and disease, and a huge expansion of knowledge in imprinting is anticipated in the future, especially with wider application of advanced genetic technologies.
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Abstract
Although patients with benign childhood epilepsy with centrotemporal spikes exhibit a benign course of the disease, some of them display sleep and behavioral problems. Sixty-one patients with rolandic epilepsy, aged 6-11 years, were included in this study. The patients were divided into two subgroups according to the presence of seizures over the preceding 6 months. The control group comprised 25 patients without epilepsy and with similar characteristics in terms of age and sex. All patients underwent evaluation of sleep (Sleep Disturbance Scale for Children) and behavior (Lithuanian version of the Child Behaviour Checklist). Only patients who had had seizures over the preceding 6 months displayed significantly higher scores for sleep problems (disorders of excessive daytime sleepiness, disorders of sleep-wake transition, and scores for total sleep problems), worse sleep quality (longer sleep-onset latency), and behavioral problems (anxiety/depression, social problems, thought problems, attention problems, and aggressive behavior) than the patients of the control group. Our data add to evidence that active epilepsy has an impact on sleep and behavior. Clinically significant sleep problems were related to the higher risk of behavioral problems. Parents' ratings for existing sleep problems were sensitive to Sleep Disturbance Scale for Children scores above normal values.
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Affiliation(s)
- Rūta Samaitienė
- Clinic of Children's Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania, Vilnius, Lithuania.
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