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Monte G, Papetti L, Ursitti F, Sforza G, Tarantino S, Checchi Proietti M, D'Agnano D, Sciruicchio V, Valeriani M. Childhood primary stabbing headache: A double center study. Cephalalgia 2024; 44:3331024231225974. [PMID: 38215234 DOI: 10.1177/03331024231225974] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Abstract
BACKGROUND Primary stabbing headache (PSH) is an idiopathic headache disorder characterized by head pain occurring as a transient and localized single stab or a series of stabs. The present study aimed to examine the characteristics of childhood PSH and whether they fit the International Classification of Headache Disorders, 3rd edition (ICHD-3) criteria. We also investigated the association with migraine and episodic syndromes. METHODS In this retrospective study, we included 60 patients seen at two headache clinics (Rome and Bari) between 2016 and 2022. A headache-focused history was obtained. All patients had normal neurological examination. PSH was defined according to ICHD-3 criteria. RESULTS Twenty-three patients were male (38%) and median (range) age at disease onset was 8 (3-17) years. Stabs recurred with irregular frequency and their duration varied from a few seconds up to 30 minutes. Stabs were located in different head regions. Twenty-five patients (42%) underwent neuroimaging exams. Five children reported a limitation of daily activities and none had a chronic pattern. Forty-seven patients (78%) reported a family history of primary headache, especially migraine, and forty-three had episodic syndromes (i.e. infantile colic, benign paroxysmal vertigo, motion sickness, recurrent abdominal pain, cyclic vomiting). Twenty patients had an associated primary headache: 16 suffered from migraine and four suffered from tension type-headache. According to ICHD-3 criteria, thirty-one patients had a diagnosis of probable PSH as a result of a duration of stabs longer than a few seconds (>3 seconds). CONCLUSIONS Features of childhood PSH can vary widely. As seen in previous studies, several patients reported a stab duration longer than a few seconds and this might suggest that current ICHD-3 criteria may need adjustments to be suitable for children. High frequency of associated migraine and episodic syndromes could suggest a common pathophysiological mechanism between PSH and migraine. We can hypothesize that PSH and migraine attacks may be part of a spectrum of the same disease, although further evidence is needed. Larger studies with long-term follow-up are needed to improve understanding of this condition.
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Affiliation(s)
- Gabriele Monte
- Developmental Neurology Unit, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy
| | - Laura Papetti
- Developmental Neurology Unit, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy
| | - Fabiana Ursitti
- Developmental Neurology Unit, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy
| | - Giorgia Sforza
- Developmental Neurology Unit, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy
| | - Samuela Tarantino
- Developmental Neurology Unit, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy
| | - Martina Checchi Proietti
- Developmental Neurology Unit, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy
| | - Daniela D'Agnano
- Children Epilepsy and EEG Center, PO, San Paolo Hospital, Bari, Italy
| | | | - Massimiliano Valeriani
- Developmental Neurology Unit, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy
- Center for Sensory-Motor Interaction, Aalborg University, Denmark Neurology Unit, Aalborg, Denmark
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Sciruicchio V, D'Agnano D, Clemente L, Rutigliano A, Laporta A, de Tommaso M. Clinical Correlates of Osmophobia in Primary Headaches: An Observational Study in Child Cohorts. J Clin Med 2023; 12:jcm12082939. [PMID: 37109275 PMCID: PMC10144088 DOI: 10.3390/jcm12082939] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/31/2023] [Accepted: 04/16/2023] [Indexed: 04/29/2023] Open
Abstract
Primary headaches, especially migraines, have a significant impact on physical and mental health, as well as on the scholarly performance and quality of life of children and adolescents. Osmophobia could be a potential diagnostic marker of migraine diagnosis and disability. This multicenter observational cross-sectional study included 645 children, aged 8-15, with a diagnosis of primary headaches. We took into consideration the duration, intensity and frequency of headaches, pericranial tenderness, allodynia and osmophobia. In a subgroup of migraine children, we evaluated the migraine-related disability, Psychiatric Self-Administration Scales for Youths and Adolescents, and the Child Version of the Pain Catastrophizing Scale. Osmophobia was found to be present in 28.8% of individuals with primary headaches, with children suffering from migraines having the highest prevalence (35%). Migraine patients with osmophobia also showed a more severe clinical picture, with enhanced disability, anxiety, depression, pain catastrophizing, and allodynia symptoms (F Roy square 10.47 p < 0.001). The presence of osmophobia could help in identifying a clinical migraine phenotype coherent with an abnormal bio-behavioral allostatic model that is worthy of prospective observations and careful therapeutic management.
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Affiliation(s)
| | - Daniela D'Agnano
- Children Epilepsy and EEG Center, San Paolo Hospital, 70132 Bari, Italy
| | - Livio Clemente
- Neurophysiopathology Unit, DiBrain Department, Bari Aldo Moro University, 70121 Bari, Italy
| | | | - Anna Laporta
- Neurophysiopathology Unit, DiBrain Department, Bari Aldo Moro University, 70121 Bari, Italy
| | - Marina de Tommaso
- Neurophysiopathology Unit, DiBrain Department, Bari Aldo Moro University, 70121 Bari, Italy
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Manzo ML, Reina F, Correnti E, D'Aiuto F, D'Agnano D, Santangelo A, Vetri L, Santangelo G, Maniscalco L, Tripi G, Sciruicchio V, Raieli V. Evolution of Pediatric Migraine Patients Admitted at an Emergency Department after a 10-Year Follow-Up. J Clin Med 2023; 12:jcm12072475. [PMID: 37048559 PMCID: PMC10095507 DOI: 10.3390/jcm12072475] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/12/2023] [Accepted: 03/22/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Despite its high prevalence, the clinical course of pediatric migraine has not been fully understood, and previous studies present conflicting results. We present here the findings of a 10-year follow-up study involving children with severe migraine pain admitted to our emergency department. Furthermore, all studies were carried out on selected outpatient clinical case studies. Our aim was to evaluate a population of migraine children admitted to an emergency department because of increased severity or frequency of pain or even because of very anxious parents concerning their child's headache in order to describe their long-term outcomes, whether it differed from that of outpatient populations and to identify possible predictors of prognosis. METHODS We recruited 80 subjects with migraine headaches (mean age 8 years with a range of 4-14 years, 50% females), attending the baseline examination of a population admitted for a headache to the Emergency Department in the first half year of 2012. Of the 80 subjects, 48 (60%) were eligible for follow-up in 2022. We included in our study only patients diagnosed with migraine, according to the diagnostic criteria of the International Classification of Headache Disorders. All were contacted by telephone, and a semi-structured questionnaire was provided to them by email. The association between several possible prognostic factors (gender, familiar neurologic disorders, prenatal and perinatal disorders, social activities, sleep disorders, etc.) and the long-term persistence of migraine headaches were explored using logistic regression analysis. RESULTS Of 48 subjects with migraine headaches at baseline, 31 (65%) had persistent migraine, and 17 (35%) experienced remission. The preliminary results showed that the presence of neurologic disorders in parents (p < 0.01-odds ratio 9.34 (2.53-41.64) and sleep disorders (p < 0.01-odds ratio 13.18 (2.25-252.74) significantly predicted the 10-year persistence of migraine headaches, while the other considered predictors were found not to influence prognosis. CONCLUSIONS To our knowledge, this was the first study conducted on a selected pediatric population upon admission to the emergency room. Our study suggests that a population of pediatric migraine selected for admission to the emergency department also shows a favorable long-term prognosis, like the studies conducted in the outpatient sample. Familial neurological comorbidity and sleep disorders were unfavorable factors for predicting good outcomes.
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Affiliation(s)
- Maria Laura Manzo
- Child Neuropsychiatry Unit Department, Pro.M.I.S.E. "G D'Alessandro", University of Palermo, 90100 Palermo, Italy
| | - Federica Reina
- Child Neuropsychiatry Unit Department, Pro.M.I.S.E. "G D'Alessandro", University of Palermo, 90100 Palermo, Italy
| | - Edvige Correnti
- Child Neuropsychiatry Department, ISMEP-ARNAS Civico, 90100 Palermo, Italy
| | | | - Daniela D'Agnano
- Children Epilepsy and EEG Center, PO, San Paolo ASL, 70132 Bari, Italy
| | - Andrea Santangelo
- Pediatrics Department, AOUP Santa Chiara Hospital, 56126 Pisa, Italy
| | - Luigi Vetri
- Oasi Research Institute IRCCS, 94018 Troina, Italy
| | | | - Laura Maniscalco
- Child Neuropsychiatry Unit Department, Pro.M.I.S.E. "G D'Alessandro", University of Palermo, 90100 Palermo, Italy
| | - Gabriele Tripi
- Child Neuropsychiatry Unit Department, Pro.M.I.S.E. "G D'Alessandro", University of Palermo, 90100 Palermo, Italy
| | | | - Vincenzo Raieli
- Child Neuropsychiatry Department, ISMEP-ARNAS Civico, 90100 Palermo, Italy
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Correnti E, Lo Cascio S, Cernigliaro F, Rossi R, D'Agnano D, Grasso G, Pellegrino A, Lauria B, Santangelo A, Santangelo G, Tripi G, Versace A, Sciruicchio V, Raieli V. Idiopathic Non-Dental Facial Pain Syndromes in Italian Children: A Clinical Case Series. Life (Basel) 2023; 13:life13040861. [PMID: 37109390 PMCID: PMC10144764 DOI: 10.3390/life13040861] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/08/2023] [Accepted: 03/19/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND The orofacial pain syndromes (OFPs) are a heterogeneous group of syndromes characterized by painful attacks involving the orofacial structures. They may be summarily subdivided into two great categories: (1) orofacial pain mainly attributed to dental disorders such as dentoalveolar and myofascial orofacial pain or temporomandibular joint (TM) pain; (2) orofacial pain mainly attributed to non-dental pain as neuralgias, facial localization of primary headaches or idiopathic orofacial pain. The second group is uncommon, often described by single case reports, can often show overlapping symptoms with the first group, and represents a clinical challenge, carrying the risk of undervaluation and possibly invasive odontoiatric treatment. We aimed to describe a clinical pediatric series of non-dental orofacial pain and better to underline some topographic and clinical features associated with them. We retrospectively collected the data of children admitted to our headache centers (Bari, Palermo, Torino) from 2017 to 2021. Our inclusion criterion was the presence of non-dental orofacial pain following the topographic criteria of 3° International Classification of Headache Disorders (ICHD-3), and exclusion criteria included the pain syndromes attributed to the dental disorders and pain syndromes due to the secondary etiologies Results. Our sample comprised 43 subjects (23/20 M/F, in the range of ages 5-17). We classified them int: 23 primary headaches involving the facial territory during attacks, 2 facial trigeminal autonomic cephalalgias, 1 facial primary stabbing headache, 1 facial linear headache, 6 trochlear migraines, 1 orbital migraine 3 red ear syndrome and 6 atypical facial pain. All patients described debilitating pain for intensity (moderate/severe), 31 children had episodic attacks, and 12 had continuous pain. Almost all received drugs for acute treatment (less than 50% were satisfied), and some received non-pharmacological treatment associated with drug therapy Conclusion. Although rare OFP can occur in pediatric age, it can be debilitating if unrecognized and untreated, affecting the psychophysical well-being of young patients. We highlight the specific characteristics of the disorder for a more correct and earlier identification during the diagnostic process, already difficult in pediatric age, and to define the approach and possible treatment to prevent negative outcomes in adulthood.
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Affiliation(s)
- Edvige Correnti
- Child Neuropsychiatry Department, ISMEP, ARNAS Civico, 90100 Palermo, Italy
| | - Salvatore Lo Cascio
- Child Neuropsychiatry Unit Department, Pro.M.I.S.E. "G. D'Alessandro", University of Palermo, 90100 Palermo, Italy
| | - Federica Cernigliaro
- Child Neuropsychiatry Unit Department, Pro.M.I.S.E. "G. D'Alessandro", University of Palermo, 90100 Palermo, Italy
| | - Roberta Rossi
- Pediatric Headache Center, Pediatric Emergency Department, Regina Margherita Children's Hospital, 10126 Turin, Italy
| | - Daniela D'Agnano
- Children Epilepsy and EEG Center, San Paolo Hospital, ASL Bari, 70132 Bari, Italy
| | - Giulia Grasso
- Pediatric Headache Center, Pediatric Emergency Department, Regina Margherita Children's Hospital, 10126 Turin, Italy
| | - Annamaria Pellegrino
- Children Epilepsy and EEG Center, San Paolo Hospital, ASL Bari, 70132 Bari, Italy
| | - Barbara Lauria
- Pediatric Headache Center, Pediatric Emergency Department, Regina Margherita Children's Hospital, 10126 Turin, Italy
| | - Andrea Santangelo
- Pediatrics Department, AOUP Santa Chiara Hospital, 56126 Pisa, Italy
| | | | - Gabriele Tripi
- Child Neuropsychiatry Unit Department, Pro.M.I.S.E. "G. D'Alessandro", University of Palermo, 90100 Palermo, Italy
| | - Antonella Versace
- Pediatric Headache Center, Pediatric Emergency Department, Regina Margherita Children's Hospital, 10126 Turin, Italy
| | - Vittorio Sciruicchio
- Children Epilepsy and EEG Center, San Paolo Hospital, ASL Bari, 70132 Bari, Italy
| | - Vincenzo Raieli
- Child Neuropsychiatry Department, ISMEP, ARNAS Civico, 90100 Palermo, Italy
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Papetti L, Loro PAD, Tarantino S, Grazzi L, Guidetti V, Parisi P, Raieli V, Sciruicchio V, Termine C, Toldo I, Tozzi E, Verdecchia P, Carotenuto M, Battisti M, Celi A, D'Agnano D, Faedda N, Ferilli MA, Grillo G, Natalucci G, Onofri A, Pelizza MF, Ursitti F, Vasta M, Velardi M, Balestri M, Moavero R, Vigevano F, Valeriani M. I stay at home with headache. A survey to investigate how the lockdown for COVID-19 impacted on headache in Italian children. Cephalalgia 2020; 40:1459-1473. [PMID: 33146039 PMCID: PMC7684684 DOI: 10.1177/0333102420965139] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objective The present Italian multicenter study aimed at investigating whether the course of primary headache disorders in children and adolescents was changed during the lockdown necessary to contain the COVID-19 emergency in Italy. Methods During the lockdown, we submitted an online questionnaire to patients already diagnosed with primary headache disorders. Questions explored the course of headache, daily habits, psychological factors related to COVID-19, general mood and school stress. Answers were transformed into data for statistical analysis. Through a bivariate analysis, the main variables affecting the subjective trend of headache, and intensity and frequency of the attacks were selected. The significant variables were then used for the multivariate analysis. Results We collected the answers of 707 patients. In the multivariate analysis, we found that reduction of school effort and anxiety was the main factor explaining the improvement in the subjective trend of headache and the intensity and frequency of the attacks (p < 0.001). The greater the severity of headache, the larger was the clinical improvement (p < 0.001). Disease duration was negatively associated with the improvement (p < 0.001). It is noteworthy that clinical improvement was independent of prophylaxis (p > 0.05), presence of chronic headache disorders (p > 0.05) and geographical area (p > 0.05). Conclusions Our study showed that lifestyle modification represents the main factor impacting the course of primary headache disorders in children and adolescents. In particular, reduction in school-related stress during the lockdown was the main factor explaining the general headache improvement in our population.
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Affiliation(s)
- Laura Papetti
- Headache Center, Department of Neuroscience, Bambino Gesù Children's Hospital, Rome, Italy
| | | | - Samuela Tarantino
- Headache Center, Department of Neuroscience, Bambino Gesù Children's Hospital, Rome, Italy
| | - Licia Grazzi
- Headache Center, Neuroalgology Department, IRCCS Foundation "Carlo Besta" Neurological Institute, Milan, Italy
| | - Vincenzo Guidetti
- Department of Human Neuroscience, Section of Child and Adolescent Neuropsychiatry, "Sapienza" University, Rome, Italy
| | - Pasquale Parisi
- Child Neurology, Department of Neuroscience, Mental Health and Sense Organs, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Vincenzo Raieli
- Child Neuropsychiatry Unit - Ismep - ARNAS Civico, Palermo, Italy
| | - Vittorio Sciruicchio
- Children Epilepsy and EEG Center, PO, San Paolo ASL (Azienda Sanitaria Locale), Bari, Italy
| | - Cristiano Termine
- Department of Medicine and Surgery, University of Insubria and ASST dei Sette Laghi, Varese, Italy
| | - Irene Toldo
- Centro Cefalee per l'età Evolutiva, Dipartimento di Salute della Donna e del Bambino, Università degli Studi, Azienda Ospedaliera di Padova, Padova, Italy
| | - Elisabetta Tozzi
- Dipartimento di Medicina Clinica, Sanità Pubblica, Scienze della Vita e dell'ambiente, Università degli Studi dell'Aquila, L'Aquila, Italy
| | - Paola Verdecchia
- Department of Human Neuroscience, Section of Child and Adolescent Neuropsychiatry, "Sapienza" University, Rome, Italy
| | - Marco Carotenuto
- Neuropsichiatria Infantile, Dipartimento di Salute Mentale e Fisica e Medicina Preventiva, Università della Campania "Luigi Vanvitelli", Napoli, Italy
| | - Matteo Battisti
- Child Neurology, Department of Neuroscience, Mental Health and Sense Organs, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Angela Celi
- Department of Medicine and Surgery, University of Insubria and ASST dei Sette Laghi, Varese, Italy
| | - Daniela D'Agnano
- Children Epilepsy and EEG Center, PO, San Paolo ASL (Azienda Sanitaria Locale), Bari, Italy
| | - Noemi Faedda
- Department of Human Neuroscience, Section of Child and Adolescent Neuropsychiatry, "Sapienza" University, Rome, Italy
| | - Michela An Ferilli
- Headache Center, Department of Neuroscience, Bambino Gesù Children's Hospital, Rome, Italy
| | - Giovanni Grillo
- Child Neuropsychiatry Unit - Ismep - ARNAS Civico, Palermo, Italy
| | - Giulia Natalucci
- Department of Human Neuroscience, Section of Child and Adolescent Neuropsychiatry, "Sapienza" University, Rome, Italy
| | - Agnese Onofri
- Dipartimento di Medicina Clinica, Sanità Pubblica, Scienze della Vita e dell'ambiente, Università degli Studi dell'Aquila, L'Aquila, Italy
| | - Maria Federica Pelizza
- Centro Cefalee per l'età Evolutiva, Dipartimento di Salute della Donna e del Bambino, Università degli Studi, Azienda Ospedaliera di Padova, Padova, Italy
| | - Fabiana Ursitti
- Headache Center, Department of Neuroscience, Bambino Gesù Children's Hospital, Rome, Italy
| | - Michelangelo Vasta
- Unità di Neuropsichiatroia Infantile, Dipartimento di Medicina dei Sistemi, Università Tor Vergata, Rome, Italy
| | - Margherita Velardi
- Child Neurology, Department of Neuroscience, Mental Health and Sense Organs, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Martina Balestri
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, Rome, Italy
| | - Romina Moavero
- Headache Center, Department of Neuroscience, Bambino Gesù Children's Hospital, Rome, Italy.,Unità di Neuropsichiatroia Infantile, Dipartimento di Medicina dei Sistemi, Università Tor Vergata, Rome, Italy
| | - Federico Vigevano
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, Rome, Italy
| | - Massimiliano Valeriani
- Headache Center, Department of Neuroscience, Bambino Gesù Children's Hospital, Rome, Italy.,Center for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark
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Sciruicchio V, Simeone M, Foschino Barbaro MG, Tanzi RC, Delussi MD, Libro G, D'Agnano D, Basiliana R, de Tommaso M. Pain Catastrophizing in Childhood Migraine: An Observational Study in a Tertiary Headache Center. Front Neurol 2019; 10:114. [PMID: 30828315 PMCID: PMC6384232 DOI: 10.3389/fneur.2019.00114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 01/29/2019] [Indexed: 01/20/2023] Open
Abstract
Background: Migraine is the most common cause of primary headache in children leading to a decrease in the quality of life. During the last decade, pain catastrophizing construct became a major focus of interest in the study and treatment of pain. Aim of the study:To evaluate pain catastrophizing in episodic and chronic migraine children and adolescents selected in a tertiary headache Center. To test whether the children's pain catastrophizing might be associated (a) with the frequency of attacks and disability (b) with psychopathological aspects (c) with allodynia and total tenderness score as symptom of central sensitization. To test the best discriminating clinical variables and scores between episodic and chronic migraine, including pain catastrophizing.
Methods: We conducted a cross sectional observational study on consecutive pediatric patients affected by migraine. We selected 190 headache patients who met the diagnostic criteria for Migraine without aura, Migraine with aura and Chronic migraine. We submitted all children to the Child version of the Pain Catastrophizing Scale (PCS-C), and to the disability scale for migraine (PedMIDAS), general quality of life estimated by children (PedsQL) and parents (PedsQL-P), anxiety and depression (SAFA-A; SAFA-D) scales. We also evaluated headache frequency and the presence and severity of allodynia and pericranial tenderness. Results: No difference was detected in Total Pain Catastrophizing score (PCS-C) between chronic and episodic migraine groups (ANOVA F = 0.59, p = 0.70); the PedMIDAS, the PedsQL-P for physical functioning and the Total Tenderness Score were discriminant variables between episodic and chronic migraine. The PCS-C was not correlated with migraine related disability as expressed by Ped MIDAS, but it was significantly correlated with general low quality of life, allodynia, pericranial tenderness, anxiety, and depression. Conclusion: Pain catastrophizing seems a mental characteristic of a clinical phenotype with psychopathological traits and enhanced expression of central sensitization symptoms. This clinical profile causes general decline in quality of life in the child judgment, with a probable parents' underestimation. In childhood age, it would not be a feature of chronic migraine, but the possibility that it could predict this evolution is consistent and worthy of further prospective evaluation.
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Affiliation(s)
| | - Michele Simeone
- Associazione Italiana di Psicoterapia Cognitiva S.r.l (AIPC), Bari, Italy
| | - Maria Grazia Foschino Barbaro
- Associazione Italiana di Psicoterapia Cognitiva S.r.l (AIPC), Bari, Italy.,Psychological Pediatric Service, Policlinico General Hospital, Bari, Italy
| | | | - Marianna D Delussi
- Applied Neurophysiology and Pain Unit, Basic Medical, Neuroscience and Sensory System Department, Policlinico General Hospital, Bari Aldo Moro University, Bari, Italy
| | - Giuseppe Libro
- Applied Neurophysiology and Pain Unit, Basic Medical, Neuroscience and Sensory System Department, Policlinico General Hospital, Bari Aldo Moro University, Bari, Italy
| | | | | | - Marina de Tommaso
- Applied Neurophysiology and Pain Unit, Basic Medical, Neuroscience and Sensory System Department, Policlinico General Hospital, Bari Aldo Moro University, Bari, Italy
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Leuzzi V, D'Agnano D, Menotta M, Caputi C, Chessa L, Magnani M. Ataxia-telangiectasia: A new remitting form with a peculiar transcriptome signature. Neurol Genet 2018; 4:e228. [PMID: 29600275 PMCID: PMC5873729 DOI: 10.1212/nxg.0000000000000228] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 11/29/2017] [Indexed: 11/25/2022]
Abstract
Objective Ataxia-telangiectasia (AT) is a rare, severe, and ineluctably progressive multisystemic neurodegenerative disease. Variant AT phenotypes have been described in patients with mild- and late-onset neurologic deterioration and atypical features (dystonia and myoclonus). We report on the clinical characteristics and transcriptome profile of patients with a typical AT presentation and genotype who experienced an unexpected favorable course. Methods A 24-year-old woman developed, by the age of 3 years, all the classic symptoms of AT associated with increased alpha-fetoprotein levels, a compound AT-mutated (ATM) genotype with an inframe deletion c.2250G>A (p.Glu709_Lys750del42) and a missense mutation c.8122G>A (p.Asp2708Gln), and no residual ATM protein expression. By the age of 12 years, ataxia slowly disappeared, and a very mild choreic disorder was the only neurologic feature in adulthood. Brain MRI was normal. The blood transcriptome profile was assessed and compared with that of healthy controls and patients with the classic AT phenotype. Results The atypical clinical course of the patient was associated with a transitional transcriptome profile: while 90% of transcripts were expressed as in patients with the classic AT presentation, 10% of transcripts were expressed as in healthy controls. Conclusions The unexpected mild clinical outcome and transcriptome profile of this patient with AT suggest the existence of individual resilience to the altered ATM synthesis. Because of their possible prognostic and therapeutic implications, the identification of modifier factors affecting the phenotype would deserve further studies.
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Affiliation(s)
- Vincenzo Leuzzi
- Department of Pediatrics, Child Neurology and Psychiatry (V.L., D.D.A., C.C.), and Faculty of Medicine and Psychology (L.C.), Sapienza University of Rome "La Sapienza"; and Department of Biomolecular Sciences (M. Menotta, M. Magnani), University of Urbino "Carlo Bo," Italy
| | - Daniela D'Agnano
- Department of Pediatrics, Child Neurology and Psychiatry (V.L., D.D.A., C.C.), and Faculty of Medicine and Psychology (L.C.), Sapienza University of Rome "La Sapienza"; and Department of Biomolecular Sciences (M. Menotta, M. Magnani), University of Urbino "Carlo Bo," Italy
| | - Michele Menotta
- Department of Pediatrics, Child Neurology and Psychiatry (V.L., D.D.A., C.C.), and Faculty of Medicine and Psychology (L.C.), Sapienza University of Rome "La Sapienza"; and Department of Biomolecular Sciences (M. Menotta, M. Magnani), University of Urbino "Carlo Bo," Italy
| | - Caterina Caputi
- Department of Pediatrics, Child Neurology and Psychiatry (V.L., D.D.A., C.C.), and Faculty of Medicine and Psychology (L.C.), Sapienza University of Rome "La Sapienza"; and Department of Biomolecular Sciences (M. Menotta, M. Magnani), University of Urbino "Carlo Bo," Italy
| | - Luciana Chessa
- Department of Pediatrics, Child Neurology and Psychiatry (V.L., D.D.A., C.C.), and Faculty of Medicine and Psychology (L.C.), Sapienza University of Rome "La Sapienza"; and Department of Biomolecular Sciences (M. Menotta, M. Magnani), University of Urbino "Carlo Bo," Italy
| | - Mauro Magnani
- Department of Pediatrics, Child Neurology and Psychiatry (V.L., D.D.A., C.C.), and Faculty of Medicine and Psychology (L.C.), Sapienza University of Rome "La Sapienza"; and Department of Biomolecular Sciences (M. Menotta, M. Magnani), University of Urbino "Carlo Bo," Italy
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Menotta M, Biagiotti S, Spapperi C, Orazi S, Rossi L, Chessa L, Leuzzi V, D'Agnano D, Soresina A, Micheli R, Magnani M. ATM splicing variants as biomarkers for low dose dexamethasone treatment of A-T. Orphanet J Rare Dis 2017; 12:126. [PMID: 28679388 PMCID: PMC5498894 DOI: 10.1186/s13023-017-0669-2] [Citation(s) in RCA: 9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 06/12/2017] [Indexed: 12/31/2022] Open
Abstract
Background Ataxia Telangiectasia (AT) is a rare incurable genetic disease, caused by biallelic mutations in the Ataxia Telangiectasia-Mutated (ATM) gene. Treatment with glucocorticoid analogues has been shown to improve the neurological symptoms that characterize this syndrome. Nevertheless, the molecular mechanism underlying the glucocorticoid action in AT patients is not yet understood. Recently, we have demonstrated that Dexamethasone treatment may partly restore ATM activity in AT lymphoblastoid cells by a new ATM transcript, namely ATMdexa1. Results In the present study, the new ATMdexa1 transcript was also identified in vivo, specifically in the PMBCs of AT patients treated with intra-erythrocyte Dexamethasone (EryDex). In these patients it was also possible to isolate new “ATMdexa1 variants” originating from canonical and non-canonical splicing, each containing the coding sequence for the ATM kinase domain. The expression of the ATMdexa1 transcript family was directly related to treatment and higher expression levels of the transcript in patients’ blood correlated with a positive response to Dexamethasone therapy. Neither untreated AT patients nor untreated healthy volunteers possessed detectable levels of the transcripts. ATMdexa1 transcript expression was found to be elevated 8 days after the drug infusion, while it decreased 21 days after treatment. Conclusions For the first time, the expression of ATM splicing variants, similar to those previously observed in vitro, has been found in the PBMCs of patients treated with EryDex. These findings show a correlation between the expression of ATMdexa1 transcripts and the clinical response to low dose dexamethasone administration. Electronic supplementary material The online version of this article (doi:10.1186/s13023-017-0669-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michele Menotta
- Department of Biomolecular Sciences, University of Urbino "Carlo Bo", 61029, Urbino, PU, Italy.
| | - Sara Biagiotti
- Department of Biomolecular Sciences, University of Urbino "Carlo Bo", 61029, Urbino, PU, Italy
| | - Chiara Spapperi
- Department of Biomolecular Sciences, University of Urbino "Carlo Bo", 61029, Urbino, PU, Italy
| | - Sara Orazi
- Department of Biomolecular Sciences, University of Urbino "Carlo Bo", 61029, Urbino, PU, Italy
| | - Luigia Rossi
- Department of Biomolecular Sciences, University of Urbino "Carlo Bo", 61029, Urbino, PU, Italy
| | - Luciana Chessa
- Department of Clinical and Molecular Medicine, University "La Sapienza", 00198, Rome, Italy
| | - Vincenzo Leuzzi
- Department of Pediatrics and Child Neurology and Psychiatry, University "La Sapienza", Rome, Italy
| | - Daniela D'Agnano
- Department of Pediatrics and Child Neurology and Psychiatry, University "La Sapienza", Rome, Italy
| | - Annarosa Soresina
- Department of Clinical and Experimental Sciences, Pediatrics Clinic and Institute of Molecular Medicine "A. Nocivelli", Unit of Child Neurology and Psychiatry Spedali Civili and University of Brescia, Brescia, Italy
| | - Roberto Micheli
- Department of Clinical and Experimental Sciences, Pediatrics Clinic and Institute of Molecular Medicine "A. Nocivelli", Unit of Child Neurology and Psychiatry Spedali Civili and University of Brescia, Brescia, Italy
| | - Mauro Magnani
- Department of Biomolecular Sciences, University of Urbino "Carlo Bo", 61029, Urbino, PU, Italy
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Nissenkorn A, Borgohain R, Micheli R, Leuzzi V, Hegde AU, Mridula KR, Molinaro A, D'Agnano D, Yareeda S, Ben-Zeev B. Development of global rating instruments for pediatric patients with ataxia telangiectasia. Eur J Paediatr Neurol 2016; 20:140-6. [PMID: 26493850 DOI: 10.1016/j.ejpn.2015.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 07/12/2015] [Accepted: 09/09/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Ataxia telangiectasia (AT) is a neurodegenerative disorder with cerebellar and extrapyramidal features. Interventional and epidemiological studies in AT should rely on specific scales which encompass the specific neurological features, as well the early progressive course and the subsequent plateau. The aim of this study was to build a scale of the CGI type (Clinical Global Impression) which is disease specific, as well as to check the feasibility of the ICARS scale for ataxia in this population. METHODS We recruited 63 patients with ataxia, aged 10.76 ± 3.2 years, followed at 6 international AT centers, 49 of them (77.8%) with classical AT. All patients were evaluated for ataxia with ICARS scale. In patients with AT, two CGI scales were scored, unstructured as structured for which separate anchors were provided. RESULTS Mean ICARS score was 44.7 ± 20.52, and it's severity positively correlated with age (Spearman correlation, r = 0.46, p < 0.01). Mean CGI score was 2 (moderately involved). There was a high correlation between the structured and unstructured CGIs (Spearman correlation, r = 0.87, p < 0.01). Both CGI scales showed positive correlation between severity and increasing age (Spearman correlation r = 0.59, p < 0.01 for structured CGI and r = 0.61, p < 0.01 for unstructured). DISCUSSION We succeeded to build two CGI scales: structured and unstructured, which are disease specific for AT. The unstructured scale showed better connection to disease course; the sensitivity of the unstructured scale could be improved by adding anchors related to extrapyramidal features. In addition we showed that ataxia can be reliably measured in children with AT by using ICARS.
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Affiliation(s)
- Andreea Nissenkorn
- Pediatric Neurology Unit, Edmond and Lilly Safra Pediatric Hospital, Sheba Medical Center, Ramat Gan, Israel; The Service for Rare Diseases, Edmond and Lilly Safra Pediatric Hospital, Sheba Medical Center, Ramat Gan, Israel; The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Rupam Borgohain
- Department Neurology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, India
| | - Roberto Micheli
- Unit of Child Neurology and Psychiatry, Spedali Civili, Brescia, Italy
| | - Vincenzo Leuzzi
- Department of Pediatrics, Child Neurology and Psychiatry, University of Rome "La Sapienza", Italy
| | - Anaita Udwadia Hegde
- Pediatric Neurology, Jaslok Hospital and Research Center, Breach Candy Hospital Trust, Bai Jerbai Wadia Hospital for Children, Mumbai, India
| | | | - Anna Molinaro
- Unit of Child Neurology and Psychiatry, Spedali Civili, Brescia, Italy
| | - Daniela D'Agnano
- Department of Pediatrics, Child Neurology and Psychiatry, University of Rome "La Sapienza", Italy
| | - Sireesha Yareeda
- Department Neurology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, India
| | - Bruria Ben-Zeev
- Pediatric Neurology Unit, Edmond and Lilly Safra Pediatric Hospital, Sheba Medical Center, Ramat Gan, Israel; The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Leuzzi V, Micheli R, D'Agnano D, Molinaro A, Venturi T, Plebani A, Soresina A, Marini M, Ferremi Leali P, Quinti I, Pietrogrande MC, Finocchi A, Fazzi E, Chessa L, Magnani M. Positive effect of erythrocyte-delivered dexamethasone in ataxia-telangiectasia. Neurol Neuroimmunol Neuroinflamm 2015; 2:e98. [PMID: 25884015 PMCID: PMC4396528 DOI: 10.1212/nxi.0000000000000098] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 03/05/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Ataxia-telangiectasia (AT) is a rare, devastating neurodegenerative disease presenting with early-onset ataxia, oculocutaneous telangiectasia, immunodeficiency, radiosensitivity, and proneness to cancer. In a previous phase 2 study, we showed that 6 monthly infusions of autologous erythrocytes loaded with dexamethasone (EryDex; EryDel, Urbino, Italy) were effective in improving neurologic impairment in young patients with AT. The present article reports the results of the extension of this study for an additional 24-month period. METHODS After the end of the first trial, 4 patients continued to be treated with monthly EryDex infusions for an additional 24 months, and their clinical outcome was compared with that of 7 age-matched patients who stopped the treatment after the first 6 infusions. The protocol included serial assessment of ataxia (by International Cooperative Ataxia Rating Scale) and adaptive behavior (by Vineland Adaptive Behavior Scales) and clinical and laboratory tests revealing treatment- and steroid-dependent adverse effects, if present. RESULTS Patients in the extended study experienced a continuous neurologic improvement with respect to their pretreatment status, whereas controls showed a progressive neurologic deterioration (according to the natural history of the disease) after the discontinuation of the treatment. The delivery system we adopted proved to be safe and well-tolerated, and none of the side effects usually associated with the chronic administration of corticosteroids were observed during the entire trial. CONCLUSIONS These promising preliminary results call for a large-scale controlled study on protracted treatment of patients with AT with dexamethasone-loaded erythrocytes.
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Affiliation(s)
- Vincenzo Leuzzi
- Department of Pediatrics, Child Neurology and Psychiatry (V.L., D.D., T.V.), Department of Molecular Medicine (I.Q.), and Department of Clinical and Molecular Medicine (L.C.), Sapienza University of Rome, Italy; Unit of Child Neurology and Psychiatry (R.M., E.F.), Department of Clinical and Experimental Sciences, Pediatrics Clinic (A.P., A.S., M. Marini, P.F.L.), and Institute of Molecular Medicine A. Nocivelli (A.P., A.S., M. Marini, P.F.L.), Spedali Civili and University of Brescia, Brescia, Italy; School in Reproductive and Developmental Science (A.M.), University of Trieste and University of Brescia, Brescia, Italy; Department of Pediatrics (M.C.P.), University of Milan, Fondazione IRCCS Ca' Granda, Milan, Italy; Department of Pediatrics (A.F.), Bambino Gesù Children's Hospital and University of Tor Vergata, Rome, Italy; Department of Biomolecular Sciences (M. Magnani), University of Urbino "Carlo Bo," Urbino, Italy; and EryDel SpA (M. Magnani), Urbino, Italy
| | - Roberto Micheli
- Department of Pediatrics, Child Neurology and Psychiatry (V.L., D.D., T.V.), Department of Molecular Medicine (I.Q.), and Department of Clinical and Molecular Medicine (L.C.), Sapienza University of Rome, Italy; Unit of Child Neurology and Psychiatry (R.M., E.F.), Department of Clinical and Experimental Sciences, Pediatrics Clinic (A.P., A.S., M. Marini, P.F.L.), and Institute of Molecular Medicine A. Nocivelli (A.P., A.S., M. Marini, P.F.L.), Spedali Civili and University of Brescia, Brescia, Italy; School in Reproductive and Developmental Science (A.M.), University of Trieste and University of Brescia, Brescia, Italy; Department of Pediatrics (M.C.P.), University of Milan, Fondazione IRCCS Ca' Granda, Milan, Italy; Department of Pediatrics (A.F.), Bambino Gesù Children's Hospital and University of Tor Vergata, Rome, Italy; Department of Biomolecular Sciences (M. Magnani), University of Urbino "Carlo Bo," Urbino, Italy; and EryDel SpA (M. Magnani), Urbino, Italy
| | - Daniela D'Agnano
- Department of Pediatrics, Child Neurology and Psychiatry (V.L., D.D., T.V.), Department of Molecular Medicine (I.Q.), and Department of Clinical and Molecular Medicine (L.C.), Sapienza University of Rome, Italy; Unit of Child Neurology and Psychiatry (R.M., E.F.), Department of Clinical and Experimental Sciences, Pediatrics Clinic (A.P., A.S., M. Marini, P.F.L.), and Institute of Molecular Medicine A. Nocivelli (A.P., A.S., M. Marini, P.F.L.), Spedali Civili and University of Brescia, Brescia, Italy; School in Reproductive and Developmental Science (A.M.), University of Trieste and University of Brescia, Brescia, Italy; Department of Pediatrics (M.C.P.), University of Milan, Fondazione IRCCS Ca' Granda, Milan, Italy; Department of Pediatrics (A.F.), Bambino Gesù Children's Hospital and University of Tor Vergata, Rome, Italy; Department of Biomolecular Sciences (M. Magnani), University of Urbino "Carlo Bo," Urbino, Italy; and EryDel SpA (M. Magnani), Urbino, Italy
| | - Anna Molinaro
- Department of Pediatrics, Child Neurology and Psychiatry (V.L., D.D., T.V.), Department of Molecular Medicine (I.Q.), and Department of Clinical and Molecular Medicine (L.C.), Sapienza University of Rome, Italy; Unit of Child Neurology and Psychiatry (R.M., E.F.), Department of Clinical and Experimental Sciences, Pediatrics Clinic (A.P., A.S., M. Marini, P.F.L.), and Institute of Molecular Medicine A. Nocivelli (A.P., A.S., M. Marini, P.F.L.), Spedali Civili and University of Brescia, Brescia, Italy; School in Reproductive and Developmental Science (A.M.), University of Trieste and University of Brescia, Brescia, Italy; Department of Pediatrics (M.C.P.), University of Milan, Fondazione IRCCS Ca' Granda, Milan, Italy; Department of Pediatrics (A.F.), Bambino Gesù Children's Hospital and University of Tor Vergata, Rome, Italy; Department of Biomolecular Sciences (M. Magnani), University of Urbino "Carlo Bo," Urbino, Italy; and EryDel SpA (M. Magnani), Urbino, Italy
| | - Tullia Venturi
- Department of Pediatrics, Child Neurology and Psychiatry (V.L., D.D., T.V.), Department of Molecular Medicine (I.Q.), and Department of Clinical and Molecular Medicine (L.C.), Sapienza University of Rome, Italy; Unit of Child Neurology and Psychiatry (R.M., E.F.), Department of Clinical and Experimental Sciences, Pediatrics Clinic (A.P., A.S., M. Marini, P.F.L.), and Institute of Molecular Medicine A. Nocivelli (A.P., A.S., M. Marini, P.F.L.), Spedali Civili and University of Brescia, Brescia, Italy; School in Reproductive and Developmental Science (A.M.), University of Trieste and University of Brescia, Brescia, Italy; Department of Pediatrics (M.C.P.), University of Milan, Fondazione IRCCS Ca' Granda, Milan, Italy; Department of Pediatrics (A.F.), Bambino Gesù Children's Hospital and University of Tor Vergata, Rome, Italy; Department of Biomolecular Sciences (M. Magnani), University of Urbino "Carlo Bo," Urbino, Italy; and EryDel SpA (M. Magnani), Urbino, Italy
| | - Alessandro Plebani
- Department of Pediatrics, Child Neurology and Psychiatry (V.L., D.D., T.V.), Department of Molecular Medicine (I.Q.), and Department of Clinical and Molecular Medicine (L.C.), Sapienza University of Rome, Italy; Unit of Child Neurology and Psychiatry (R.M., E.F.), Department of Clinical and Experimental Sciences, Pediatrics Clinic (A.P., A.S., M. Marini, P.F.L.), and Institute of Molecular Medicine A. Nocivelli (A.P., A.S., M. Marini, P.F.L.), Spedali Civili and University of Brescia, Brescia, Italy; School in Reproductive and Developmental Science (A.M.), University of Trieste and University of Brescia, Brescia, Italy; Department of Pediatrics (M.C.P.), University of Milan, Fondazione IRCCS Ca' Granda, Milan, Italy; Department of Pediatrics (A.F.), Bambino Gesù Children's Hospital and University of Tor Vergata, Rome, Italy; Department of Biomolecular Sciences (M. Magnani), University of Urbino "Carlo Bo," Urbino, Italy; and EryDel SpA (M. Magnani), Urbino, Italy
| | - Annarosa Soresina
- Department of Pediatrics, Child Neurology and Psychiatry (V.L., D.D., T.V.), Department of Molecular Medicine (I.Q.), and Department of Clinical and Molecular Medicine (L.C.), Sapienza University of Rome, Italy; Unit of Child Neurology and Psychiatry (R.M., E.F.), Department of Clinical and Experimental Sciences, Pediatrics Clinic (A.P., A.S., M. Marini, P.F.L.), and Institute of Molecular Medicine A. Nocivelli (A.P., A.S., M. Marini, P.F.L.), Spedali Civili and University of Brescia, Brescia, Italy; School in Reproductive and Developmental Science (A.M.), University of Trieste and University of Brescia, Brescia, Italy; Department of Pediatrics (M.C.P.), University of Milan, Fondazione IRCCS Ca' Granda, Milan, Italy; Department of Pediatrics (A.F.), Bambino Gesù Children's Hospital and University of Tor Vergata, Rome, Italy; Department of Biomolecular Sciences (M. Magnani), University of Urbino "Carlo Bo," Urbino, Italy; and EryDel SpA (M. Magnani), Urbino, Italy
| | - Mirella Marini
- Department of Pediatrics, Child Neurology and Psychiatry (V.L., D.D., T.V.), Department of Molecular Medicine (I.Q.), and Department of Clinical and Molecular Medicine (L.C.), Sapienza University of Rome, Italy; Unit of Child Neurology and Psychiatry (R.M., E.F.), Department of Clinical and Experimental Sciences, Pediatrics Clinic (A.P., A.S., M. Marini, P.F.L.), and Institute of Molecular Medicine A. Nocivelli (A.P., A.S., M. Marini, P.F.L.), Spedali Civili and University of Brescia, Brescia, Italy; School in Reproductive and Developmental Science (A.M.), University of Trieste and University of Brescia, Brescia, Italy; Department of Pediatrics (M.C.P.), University of Milan, Fondazione IRCCS Ca' Granda, Milan, Italy; Department of Pediatrics (A.F.), Bambino Gesù Children's Hospital and University of Tor Vergata, Rome, Italy; Department of Biomolecular Sciences (M. Magnani), University of Urbino "Carlo Bo," Urbino, Italy; and EryDel SpA (M. Magnani), Urbino, Italy
| | - Pierino Ferremi Leali
- Department of Pediatrics, Child Neurology and Psychiatry (V.L., D.D., T.V.), Department of Molecular Medicine (I.Q.), and Department of Clinical and Molecular Medicine (L.C.), Sapienza University of Rome, Italy; Unit of Child Neurology and Psychiatry (R.M., E.F.), Department of Clinical and Experimental Sciences, Pediatrics Clinic (A.P., A.S., M. Marini, P.F.L.), and Institute of Molecular Medicine A. Nocivelli (A.P., A.S., M. Marini, P.F.L.), Spedali Civili and University of Brescia, Brescia, Italy; School in Reproductive and Developmental Science (A.M.), University of Trieste and University of Brescia, Brescia, Italy; Department of Pediatrics (M.C.P.), University of Milan, Fondazione IRCCS Ca' Granda, Milan, Italy; Department of Pediatrics (A.F.), Bambino Gesù Children's Hospital and University of Tor Vergata, Rome, Italy; Department of Biomolecular Sciences (M. Magnani), University of Urbino "Carlo Bo," Urbino, Italy; and EryDel SpA (M. Magnani), Urbino, Italy
| | - Isabella Quinti
- Department of Pediatrics, Child Neurology and Psychiatry (V.L., D.D., T.V.), Department of Molecular Medicine (I.Q.), and Department of Clinical and Molecular Medicine (L.C.), Sapienza University of Rome, Italy; Unit of Child Neurology and Psychiatry (R.M., E.F.), Department of Clinical and Experimental Sciences, Pediatrics Clinic (A.P., A.S., M. Marini, P.F.L.), and Institute of Molecular Medicine A. Nocivelli (A.P., A.S., M. Marini, P.F.L.), Spedali Civili and University of Brescia, Brescia, Italy; School in Reproductive and Developmental Science (A.M.), University of Trieste and University of Brescia, Brescia, Italy; Department of Pediatrics (M.C.P.), University of Milan, Fondazione IRCCS Ca' Granda, Milan, Italy; Department of Pediatrics (A.F.), Bambino Gesù Children's Hospital and University of Tor Vergata, Rome, Italy; Department of Biomolecular Sciences (M. Magnani), University of Urbino "Carlo Bo," Urbino, Italy; and EryDel SpA (M. Magnani), Urbino, Italy
| | - Maria C Pietrogrande
- Department of Pediatrics, Child Neurology and Psychiatry (V.L., D.D., T.V.), Department of Molecular Medicine (I.Q.), and Department of Clinical and Molecular Medicine (L.C.), Sapienza University of Rome, Italy; Unit of Child Neurology and Psychiatry (R.M., E.F.), Department of Clinical and Experimental Sciences, Pediatrics Clinic (A.P., A.S., M. Marini, P.F.L.), and Institute of Molecular Medicine A. Nocivelli (A.P., A.S., M. Marini, P.F.L.), Spedali Civili and University of Brescia, Brescia, Italy; School in Reproductive and Developmental Science (A.M.), University of Trieste and University of Brescia, Brescia, Italy; Department of Pediatrics (M.C.P.), University of Milan, Fondazione IRCCS Ca' Granda, Milan, Italy; Department of Pediatrics (A.F.), Bambino Gesù Children's Hospital and University of Tor Vergata, Rome, Italy; Department of Biomolecular Sciences (M. Magnani), University of Urbino "Carlo Bo," Urbino, Italy; and EryDel SpA (M. Magnani), Urbino, Italy
| | - Andrea Finocchi
- Department of Pediatrics, Child Neurology and Psychiatry (V.L., D.D., T.V.), Department of Molecular Medicine (I.Q.), and Department of Clinical and Molecular Medicine (L.C.), Sapienza University of Rome, Italy; Unit of Child Neurology and Psychiatry (R.M., E.F.), Department of Clinical and Experimental Sciences, Pediatrics Clinic (A.P., A.S., M. Marini, P.F.L.), and Institute of Molecular Medicine A. Nocivelli (A.P., A.S., M. Marini, P.F.L.), Spedali Civili and University of Brescia, Brescia, Italy; School in Reproductive and Developmental Science (A.M.), University of Trieste and University of Brescia, Brescia, Italy; Department of Pediatrics (M.C.P.), University of Milan, Fondazione IRCCS Ca' Granda, Milan, Italy; Department of Pediatrics (A.F.), Bambino Gesù Children's Hospital and University of Tor Vergata, Rome, Italy; Department of Biomolecular Sciences (M. Magnani), University of Urbino "Carlo Bo," Urbino, Italy; and EryDel SpA (M. Magnani), Urbino, Italy
| | - Elisa Fazzi
- Department of Pediatrics, Child Neurology and Psychiatry (V.L., D.D., T.V.), Department of Molecular Medicine (I.Q.), and Department of Clinical and Molecular Medicine (L.C.), Sapienza University of Rome, Italy; Unit of Child Neurology and Psychiatry (R.M., E.F.), Department of Clinical and Experimental Sciences, Pediatrics Clinic (A.P., A.S., M. Marini, P.F.L.), and Institute of Molecular Medicine A. Nocivelli (A.P., A.S., M. Marini, P.F.L.), Spedali Civili and University of Brescia, Brescia, Italy; School in Reproductive and Developmental Science (A.M.), University of Trieste and University of Brescia, Brescia, Italy; Department of Pediatrics (M.C.P.), University of Milan, Fondazione IRCCS Ca' Granda, Milan, Italy; Department of Pediatrics (A.F.), Bambino Gesù Children's Hospital and University of Tor Vergata, Rome, Italy; Department of Biomolecular Sciences (M. Magnani), University of Urbino "Carlo Bo," Urbino, Italy; and EryDel SpA (M. Magnani), Urbino, Italy
| | - Luciana Chessa
- Department of Pediatrics, Child Neurology and Psychiatry (V.L., D.D., T.V.), Department of Molecular Medicine (I.Q.), and Department of Clinical and Molecular Medicine (L.C.), Sapienza University of Rome, Italy; Unit of Child Neurology and Psychiatry (R.M., E.F.), Department of Clinical and Experimental Sciences, Pediatrics Clinic (A.P., A.S., M. Marini, P.F.L.), and Institute of Molecular Medicine A. Nocivelli (A.P., A.S., M. Marini, P.F.L.), Spedali Civili and University of Brescia, Brescia, Italy; School in Reproductive and Developmental Science (A.M.), University of Trieste and University of Brescia, Brescia, Italy; Department of Pediatrics (M.C.P.), University of Milan, Fondazione IRCCS Ca' Granda, Milan, Italy; Department of Pediatrics (A.F.), Bambino Gesù Children's Hospital and University of Tor Vergata, Rome, Italy; Department of Biomolecular Sciences (M. Magnani), University of Urbino "Carlo Bo," Urbino, Italy; and EryDel SpA (M. Magnani), Urbino, Italy
| | - Mauro Magnani
- Department of Pediatrics, Child Neurology and Psychiatry (V.L., D.D., T.V.), Department of Molecular Medicine (I.Q.), and Department of Clinical and Molecular Medicine (L.C.), Sapienza University of Rome, Italy; Unit of Child Neurology and Psychiatry (R.M., E.F.), Department of Clinical and Experimental Sciences, Pediatrics Clinic (A.P., A.S., M. Marini, P.F.L.), and Institute of Molecular Medicine A. Nocivelli (A.P., A.S., M. Marini, P.F.L.), Spedali Civili and University of Brescia, Brescia, Italy; School in Reproductive and Developmental Science (A.M.), University of Trieste and University of Brescia, Brescia, Italy; Department of Pediatrics (M.C.P.), University of Milan, Fondazione IRCCS Ca' Granda, Milan, Italy; Department of Pediatrics (A.F.), Bambino Gesù Children's Hospital and University of Tor Vergata, Rome, Italy; Department of Biomolecular Sciences (M. Magnani), University of Urbino "Carlo Bo," Urbino, Italy; and EryDel SpA (M. Magnani), Urbino, Italy
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11
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Ng J, Zhen J, Meyer E, Erreger K, Li Y, Kakar N, Ahmad J, Thiele H, Kubisch C, Rider NL, Morton DH, Strauss KA, Puffenberger EG, D'Agnano D, Anikster Y, Carducci C, Hyland K, Rotstein M, Leuzzi V, Borck G, Reith MEA, Kurian MA. Dopamine transporter deficiency syndrome: phenotypic spectrum from infancy to adulthood. ACTA ACUST UNITED AC 2014; 137:1107-19. [PMID: 24613933 PMCID: PMC3959557 DOI: 10.1093/brain/awu022] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Dopamine transporter deficiency syndrome is an SLC6A3-related progressive infantile-onset parkinsonism-dystonia that mimics cerebral palsy. Ng et al. describe clinical features and molecular findings in a new cohort of patients. They report infants with classical disease, as well as young adults manifesting as atypical juvenile-onset parkinsonism-dystonia, thereby expanding the disease spectrum. Dopamine transporter deficiency syndrome due to SLC6A3 mutations is the first inherited dopamine ‘transportopathy’ to be described, with a classical presentation of early infantile-onset progressive parkinsonism dystonia. In this study we have identified a new cohort of patients with dopamine transporter deficiency syndrome, including, most significantly, atypical presentation later in childhood with a milder disease course. We report the detailed clinical features, molecular genetic findings and in vitro functional investigations undertaken for adult and paediatric cases. Patients presenting with parkinsonism dystonia or a neurotransmitter profile characteristic of dopamine transporter deficiency syndrome were recruited for study. SLC6A3 mutational analysis was undertaken in all patients. The functional consequences of missense variants on the dopamine transporter were evaluated by determining the effect of mutant dopamine transporter on dopamine uptake, protein expression and amphetamine-mediated dopamine efflux using an in vitro cellular heterologous expression system. We identified eight new patients from five unrelated families with dopamine transporter deficiency syndrome. The median age at diagnosis was 13 years (range 1.5–34 years). Most significantly, the case series included three adolescent males with atypical dopamine transporter deficiency syndrome of juvenile onset (outside infancy) and progressive parkinsonism dystonia. The other five patients in the cohort presented with classical infantile-onset parkinsonism dystonia, with one surviving into adulthood (currently aged 34 years) and labelled as having ‘juvenile parkinsonism’. All eight patients harboured homozygous or compound heterozygous mutations in SLC6A3, of which the majority are previously unreported variants. In vitro studies of mutant dopamine transporter demonstrated multifaceted loss of dopamine transporter function. Impaired dopamine uptake was universally present, and more severely impacted in dopamine transporter mutants causing infantile-onset rather than juvenile-onset disease. Dopamine transporter mutants also showed diminished dopamine binding affinity, reduced cell surface transporter, loss of post-translational dopamine transporter glycosylation and failure of amphetamine-mediated dopamine efflux. Our data series expands the clinical phenotypic continuum of dopamine transporter deficiency syndrome and indicates that there is a phenotypic spectrum from infancy (early onset, rapidly progressive disease) to childhood/adolescence and adulthood (later onset, slower disease progression). Genotype–phenotype analysis in this cohort suggests that higher residual dopamine transporter activity is likely to contribute to postponing disease presentation in these later-onset adult cases. Dopamine transporter deficiency syndrome remains under-recognized and our data highlights that dopamine transporter deficiency syndrome should be considered as a differential diagnosis for both infantile- and juvenile-onset movement disorders, including cerebral palsy and juvenile parkinsonism.
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Affiliation(s)
- Joanne Ng
- 1 Neurosciences Unit, UCL Institute of Child Health, London, UK
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Chessa L, Leuzzi V, Plebani A, Soresina A, Micheli R, D'Agnano D, Venturi T, Molinaro A, Fazzi E, Marini M, Ferremi Leali P, Quinti I, Cavaliere FM, Girelli G, Pietrogrande MC, Finocchi A, Tabolli S, Abeni D, Magnani M. Intra-erythrocyte infusion of dexamethasone reduces neurological symptoms in ataxia teleangiectasia patients: results of a phase 2 trial. Orphanet J Rare Dis 2014; 9:5. [PMID: 24405665 PMCID: PMC3904207 DOI: 10.1186/1750-1172-9-5] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [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: 07/12/2013] [Accepted: 12/27/2013] [Indexed: 02/02/2023] Open
Abstract
Background Ataxia Teleangiectasia [AT] is a rare neurodegenerative disease characterized by early onset ataxia, oculocutaneous teleangiectasias, immunodeficiency, recurrent infections, radiosensitivity and proneness to cancer. No therapies are available for this devastating disease. Recent observational studies in few patients showed beneficial effects of short term treatment with betamethasone. To avoid the characteristic side effects of long-term administration of steroids we developed a method for encapsulation of dexamethasone sodium phosphate (DSP) into autologous erythrocytes (EryDex) allowing slow release of dexamethasone for up to one month after dosing. Aims of the study were: the assessment of the effect of EryDex in improving neurological symptoms and adaptive behaviour of AT patients; the safety and tolerability of the therapy. Methods Twenty two patients (F:M = 1; mean age 11.2 ± 3.5) with a confirmed diagnosis of AT and a preserved or partially supported gait were enrolled for the study. The subjects underwent for six months a monthly infusion of EryDex. Ataxia was assessed by the International Cooperative Ataxia Rating Scale (ICARS) and the adaptive behavior by Vineland Adaptive Behavior Scales (VABS). Clinical evaluations were performed at baseline and 1, 3, and 6 months. Results An improvement in ICARS (reduction of the score) was detected in the intention-to-treat (ITT) population (n = 22; p = 0.02) as well as in patients completing the study (per protocol PP) (n = 18; p = 0.01), with a mean reduction of 4 points (ITT) or 5.2 points (PP). When compared to baseline, a significant improvement were also found in VABS (increase of the score) (p < 0.0001, ITT, RMANOVA), with statistically significant increases at 3 and 6 months (p < 0.0001). A large inter-patient variability in the incorporation of DSP into erythrocytes was observed, with an evident positive effect of higher infusion dose on ICARS score decline. Moreover a more marked improvement was found in less neurologically impaired patients. Finally, a 19 month-extension study involving a subgroup of patients suggested that Erydex treatment can possibly delay the natural progression of the disease. EryDex was well tolerated; the most frequent side effects were common AT pathologies. Conclusions EryDex treatment led to a significant improvement in neurological symptoms, without association with the typical steroid side effects. Trial registration Current Controlled Trial
2010-022315-19SpA
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Affiliation(s)
| | - Vincenzo Leuzzi
- Department of Pediatrics and Child Neurology and Psychiatry, Sapienza Università di Roma, via dei Sabelli 108, 00185 Roma, Italy.
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