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Illescas S, Diaz-Osorio Y, Serradell A, Toro-Soria L, Musokhranova U, Juliá-Palacios N, Ribeiro-Constante J, Altafaj X, Olivella M, O'Callaghan M, Darling A, Armstrong J, Artuch R, García-Cazorla À, Oyarzábal A. Metabolic characterization of neurogenetic disorders involving glutamatergic neurotransmission. J Inherit Metab Dis 2024; 47:551-569. [PMID: 37932875 DOI: 10.1002/jimd.12689] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/28/2023] [Accepted: 11/02/2023] [Indexed: 11/08/2023]
Abstract
The study of inborn errors of neurotransmission has been mostly focused on monoamine disorders, GABAergic and glycinergic defects. The study of the glutamatergic synapse using the same approach than classic neurotransmitter disorders is challenging due to the lack of biomarkers in the CSF. A metabolomic approach can provide both insight into their molecular basis and outline novel therapeutic alternatives. We have performed a semi-targeted metabolomic analysis on CSF samples from 25 patients with neurogenetic disorders with an important expression in the glutamatergic synapse and 5 controls. Samples from patients diagnosed with MCP2, CDKL5-, GRINpathies and STXBP1-related encephalopathies were included. We have performed univariate (UVA) and multivariate statistical analysis (MVA), using Wilcoxon rank-sum test, principal component analysis (PCA), and OPLS-DA. By using the results of both analyses, we have identified the metabolites that were significantly altered and that were important in clustering the respective groups. On these, we performed pathway- and network-based analyses to define which metabolic pathways were possibly altered in each pathology. We have observed alterations in the tryptophan and branched-chain amino acid metabolism pathways, which interestingly converge on LAT1 transporter-dependency to cross the blood-brain barrier (BBB). Analysis of the expression of LAT1 transporter in brain samples from a mouse model of Rett syndrome (MECP2) revealed a decrease in the transporter expression, that was already noticeable at pre-symptomatic stages. The study of the glutamatergic synapse from this perspective advances the understanding of their pathophysiology, shining light on an understudied feature as is their metabolic signature.
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Affiliation(s)
- Sofía Illescas
- Synaptic Metabolism and Personalized Therapies Lab, Institut de Recerca Sant Joan de Déu, Department of Neurology and MetabERN, Esplugues de Llobregat, Barcelona, Spain
| | - Yaiza Diaz-Osorio
- Synaptic Metabolism and Personalized Therapies Lab, Institut de Recerca Sant Joan de Déu, Department of Neurology and MetabERN, Esplugues de Llobregat, Barcelona, Spain
| | - Anna Serradell
- Synaptic Metabolism and Personalized Therapies Lab, Institut de Recerca Sant Joan de Déu, Department of Neurology and MetabERN, Esplugues de Llobregat, Barcelona, Spain
| | - Lucía Toro-Soria
- Synaptic Metabolism and Personalized Therapies Lab, Institut de Recerca Sant Joan de Déu, Department of Neurology and MetabERN, Esplugues de Llobregat, Barcelona, Spain
| | - Uliana Musokhranova
- Synaptic Metabolism and Personalized Therapies Lab, Institut de Recerca Sant Joan de Déu, Department of Neurology and MetabERN, Esplugues de Llobregat, Barcelona, Spain
| | - Natalia Juliá-Palacios
- Synaptic Metabolism and Personalized Therapies Lab, Institut de Recerca Sant Joan de Déu, Department of Neurology and MetabERN, Esplugues de Llobregat, Barcelona, Spain
- Neurometabolic Unit, Hospital Sant Joan de Déu, Department of Neurology, Esplugues de Llobregat, Barcelona, Spain
| | - Juliana Ribeiro-Constante
- Synaptic Metabolism and Personalized Therapies Lab, Institut de Recerca Sant Joan de Déu, Department of Neurology and MetabERN, Esplugues de Llobregat, Barcelona, Spain
- Neurometabolic Unit, Hospital Sant Joan de Déu, Department of Neurology, Esplugues de Llobregat, Barcelona, Spain
| | - Xavier Altafaj
- Neurophysiology Laboratory, Department of Biomedicine, Institute of Neurosciences, Faculty of Medicine and Health Sciences, University of Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Mireia Olivella
- School of International Studies, ESCI-UPF, Barcelona, Spain
- Bioinformatics and Bioimaging Group, Faculty of Science, Technology and Engineering, University of Vic-Central University of Catalonia, Vic, Spain
| | - Mar O'Callaghan
- Synaptic Metabolism and Personalized Therapies Lab, Institut de Recerca Sant Joan de Déu, Department of Neurology and MetabERN, Esplugues de Llobregat, Barcelona, Spain
- Neurometabolic Unit, Hospital Sant Joan de Déu, Department of Neurology, Esplugues de Llobregat, Barcelona, Spain
- CIBERER-Spanish Biomedical Research Centre in Rare Diseases, Barcelona, Spain
| | - Alejandra Darling
- Synaptic Metabolism and Personalized Therapies Lab, Institut de Recerca Sant Joan de Déu, Department of Neurology and MetabERN, Esplugues de Llobregat, Barcelona, Spain
- Neurometabolic Unit, Hospital Sant Joan de Déu, Department of Neurology, Esplugues de Llobregat, Barcelona, Spain
| | - Judith Armstrong
- CIBERER-Spanish Biomedical Research Centre in Rare Diseases, Barcelona, Spain
- Department of Medical Genetics, Institut de Recerca Pediàtrica, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Rafael Artuch
- CIBERER-Spanish Biomedical Research Centre in Rare Diseases, Barcelona, Spain
- Clinical Biochemistry Department, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Àngels García-Cazorla
- Synaptic Metabolism and Personalized Therapies Lab, Institut de Recerca Sant Joan de Déu, Department of Neurology and MetabERN, Esplugues de Llobregat, Barcelona, Spain
- Neurometabolic Unit, Hospital Sant Joan de Déu, Department of Neurology, Esplugues de Llobregat, Barcelona, Spain
- CIBERER-Spanish Biomedical Research Centre in Rare Diseases, Barcelona, Spain
| | - Alfonso Oyarzábal
- Synaptic Metabolism and Personalized Therapies Lab, Institut de Recerca Sant Joan de Déu, Department of Neurology and MetabERN, Esplugues de Llobregat, Barcelona, Spain
- Neurometabolic Unit, Hospital Sant Joan de Déu, Department of Neurology, Esplugues de Llobregat, Barcelona, Spain
- CIBERER-Spanish Biomedical Research Centre in Rare Diseases, Barcelona, Spain
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Ribeiro-Constante J, Tristán-Noguero A, Martínez Calvo FF, Ibañez-Mico S, Peña Segura JL, Ramos-Fernández JM, Moyano Chicano MDC, Camino León R, Soto Insuga V, González Alguacil E, Valera Dávila C, Fernández-Jaén A, Plans L, Camacho A, Visa-Reñé N, Martin-Tamayo Blázquez MDP, Paredes-Carmona F, Marti-Carrera I, Hernández-Fabián A, Tomas Davi M, Sanchez MC, Herraiz LC, Pita PF, Gonzalez TB, O'Callaghan M, Iglesias Santa Polonia FF, Cazorla MR, Ferrando Lucas MT, González-Meneses A, Sala-Coromina J, Macaya A, Lasa-Aranzasti A, Cueto-González AM, Valera Párraga F, Campistol Plana J, Serrano M, Alonso X, Del Castillo-Berges D, Schwartz-Palleja M, Illescas S, Ramírez Camacho A, Sans Capdevila O, García-Cazorla A, Bayés À, Alonso-Colmenero I. Developmental outcome of electroencephalographic findings in SYNGAP1 encephalopathy. Front Cell Dev Biol 2024; 12:1321282. [PMID: 38505260 PMCID: PMC10948473 DOI: 10.3389/fcell.2024.1321282] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/22/2024] [Indexed: 03/21/2024] Open
Abstract
SYNGAP1 haploinsufficiency results in a developmental and epileptic encephalopathy (DEE) causing generalized epilepsies accompanied by a spectrum of neurodevelopmental symptoms. Concerning interictal epileptiform discharges (IEDs) in electroencephalograms (EEG), potential biomarkers have been postulated, including changes in background activity, fixation-off sensitivity (FOS) or eye closure sensitivity (ECS). In this study we clinically evaluate a new cohort of 36 SYNGAP1-DEE individuals. Standardized questionnaires were employed to collect clinical, electroencephalographic and genetic data. We investigated electroencephalographic findings, focusing on the cortical distribution of interictal abnormalities and their changes with age. Among the 36 SYNGAP1-DEE cases 18 presented variants in the SYNGAP1 gene that had never been previously reported. The mean age of diagnosis was 8 years and 8 months, ranging from 2 to 17 years, with 55.9% being male. All subjects had global neurodevelopmental/language delay and behavioral abnormalities; 83.3% had moderate to profound intellectual disability (ID), 91.7% displayed autistic traits, 73% experienced sleep disorders and 86.1% suffered from epileptic seizures, mainly eyelid myoclonia with absences (55.3%). A total of 63 VEEGs were revised, observing a worsening of certain EEG findings with increasing age. A disorganized background was observed in all age ranges, yet this was more common among older cases. The main IEDs were bilateral synchronous and asynchronous posterior discharges, accounting for ≥50% in all age ranges. Generalized alterations with maximum amplitude in the anterior region showed as the second most frequent IED (≥15% in all age ranges) and were also more common with increasing age. Finally, diffuse fast activity was much more prevalent in cases with 6 years or older. To the best of our knowledge, this is the first study to analyze EEG features across different age groups, revealing an increase in interictal abnormalities over infancy and adolescence. Our findings suggest that SYNGAP1 haploinsufficiency has complex effects in human brain development, some of which might unravel at different developmental stages. Furthermore, they highlight the potential of baseline EEG to identify candidate biomarkers and the importance of natural history studies to develop specialized therapies and clinical trials.
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Affiliation(s)
| | - Alba Tristán-Noguero
- Department of Genetics, Microbiology and Statistics, University of Barcelona, Barcelona, Spain
- Molecular Physiology of the Synapse Laboratory, Institut de Recerca Sant Pau (IR Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | - José Luis Peña Segura
- Pediatric Neurology Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | | | - Rafael Camino León
- Pediatric Neurology Department, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Víctor Soto Insuga
- Pediatric Neurology Department, Hospital Universitario Infantil del Niño Jesús, Madrid, Spain
| | - Elena González Alguacil
- Pediatric Neurology Department, Hospital Universitario Infantil del Niño Jesús, Madrid, Spain
| | - Carlos Valera Dávila
- Pediatric Neurology Department Sant Joan de Déu (SJD) Children’s Hospital, Barcelona, Spain
| | - Alberto Fernández-Jaén
- Pediatric Neurology Department, Neurogenetics Section, Hospital Universitario Quironsalud, Madrid, Spain
| | - Laura Plans
- Mental Health in Intellectual Disability Specialized Service Althaia, Xarxa Assistencial, Manresa, Spain
| | - Ana Camacho
- Pediatric Neurology Department, Hospital 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Nuria Visa-Reñé
- Paediatric Department, Arnau de Vilanova University Hospital, Lleida, Spain
| | | | | | - Itxaso Marti-Carrera
- Pediatric Neurology Department, Hospital Universitario Donostia, San Sebastian, Spain
| | | | - Meritxell Tomas Davi
- Mental Health in Intellectual Disability Specialized Service Althaia, Xarxa Assistencial, Manresa, Spain
| | - Merce Casadesus Sanchez
- Mental Health in Intellectual Disability Specialized Service Althaia, Xarxa Assistencial, Manresa, Spain
| | | | - Patricia Fuentes Pita
- Pediatric Neurology Department, Hospital Clínico Universitario Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Mar O'Callaghan
- Pediatric Neurology Department Sant Joan de Déu (SJD) Children’s Hospital, Barcelona, Spain
| | | | - María Rosario Cazorla
- Pediatric Neurology Department, Puerta de Hierro Majadahonda Universitary Hospital, Madrid, Spain
| | | | | | - Júlia Sala-Coromina
- Pediatric Neurology Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Bercelona, Spain
| | - Alfons Macaya
- Pediatric Neurology Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Bercelona, Spain
| | - Amaia Lasa-Aranzasti
- Department of Clinical and Molecular Genetic Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Bercelona, Spain
| | - Anna Ma Cueto-González
- Department of Clinical and Molecular Genetic Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Bercelona, Spain
| | | | - Jaume Campistol Plana
- Pediatric Neurology Department Sant Joan de Déu (SJD) Children’s Hospital, Barcelona, Spain
| | - Mercedes Serrano
- Pediatric Neurology Department Sant Joan de Déu (SJD) Children’s Hospital, Barcelona, Spain
| | - Xenia Alonso
- Pediatric Neurology Department Sant Joan de Déu (SJD) Children’s Hospital, Barcelona, Spain
| | - Diego Del Castillo-Berges
- Molecular Physiology of the Synapse Laboratory, Institut de Recerca Sant Pau (IR Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marc Schwartz-Palleja
- Eurecat, Technology Center of Catalonia, Multimedia Technologies, Barcelona, Spain
- Center for Brain and Cognition (CBC), Department of Information Technologies and Communications (DTIC), Pompeu Fabra University, Barcelona, Catalonia, Spain
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Sofía Illescas
- Pediatric Neurometabolism: Neural Communication Mechanisms and Personalized Therapies Pediatric Neurology Department: Neural Communication Mechanisms and Personalized Therapies Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Alia Ramírez Camacho
- Department of Child Neurology, Epilepsy and Neurophysiology Unit, Member of the ERN EpiCARE, Hospital Sant Joan de Dèu, Barcelona, Spain
| | - Oscar Sans Capdevila
- Pediatric Neurology Department Sant Joan de Déu (SJD) Children’s Hospital, Barcelona, Spain
| | - Angeles García-Cazorla
- Pediatric Neurology Department Sant Joan de Déu (SJD) Children’s Hospital, Barcelona, Spain
| | - Àlex Bayés
- Molecular Physiology of the Synapse Laboratory, Institut de Recerca Sant Pau (IR Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain
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Olivé-Cirera G, Fonseca E, Cantarín-Extremera V, Vázquez-López M, Jiménez-Legido M, González-Álvarez V, Ribeiro-Constante J, Camacho-Salas A, Martí I, Cancho-Candela R, Martínez-González MJ, Saiz A, Armangué T. Impact of COVID-19 in Immunosuppressed Children With Neuroimmunologic Disorders. Neurol Neuroimmunol Neuroinflamm 2022; 9:e1101. [PMID: 34759018 PMCID: PMC8587734 DOI: 10.1212/nxi.0000000000001101] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/14/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVES To investigate whether children receiving immunosuppressive therapies for neuroimmunologic disorders had (1) increased susceptibility to SARS-CoV2 infection or to develop more severe forms of COVID-19; (2) increased relapses or autoimmune complications if infected; and (3) changes in health care delivery during the pandemic. METHODS Patients with and without immunosuppressive treatment were recruited to participate in a retrospective survey evaluating the period from March 14, 2020, to March 30, 2021. Demographics, clinical features, type of immunosuppressive treatment, suspected or confirmed COVID-19 in the patients or cohabitants, and changes in care delivery were recorded. RESULTS One hundred fifty-three children were included: 84 (55%) female, median age 13 years (interquartile range [8-16] years), 79 (52%) on immunosuppressive treatment. COVID-19 was suspected or confirmed in 17 (11%) (all mild), with a frequency similar in patients with and without immunosuppressive treatment (11/79 [14%] vs 6/74 [8%], p = 0.3085). The frequency of neurologic relapses was similar in patients with (18%) and without (21%) COVID-19. Factors associated with COVID-19 included having cohabitants with COVID-19 (p < 0.001) and lower blood levels of vitamin D (p = 0.039). Return to face-to-face schooling or mask type did not influence the risk of infection, although 43(28%) children had contact with a classmate with COVID-19. Clinic visits changed from face to face to remote for 120 (79%) patients; 110 (92%) were satisfied with the change. DISCUSSION In this cohort of children with neuroimmunologic disorders, the frequency of COVID-19 was low and not affected by immunosuppressive therapies. The main risk factors for developing COVID-19 were having cohabitants with COVID-19 and low vitamin D levels.
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Affiliation(s)
- Gemma Olivé-Cirera
- From the Pediatric Neuroimmunology Program (G.O.-C.,E.F.,A.S.,T.A.), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clinic, University of Barcelona; Pediatric Neurology Unit of Parc Taulí Hospital of Sabadell (G.O.-C.), Barcelona; Pediatric Neurology Unit of Hospital Infantil Universitario Niño Jesús (V.C.-E.,M.J.-L.), Madrid; Pediatric Neurology Unit of Hospital Gregorio Marañón (M.V.-L.), Madrid; Pediatric Neuroimmunology Unit (V.G.-A.,J.R.-C.,T.A.), Neurology Service, Sant Joan de Déu (SJD) Children's Hospital, University of Barcelona; Pediatric Neurology Unit of Hospital Universitario 12 de Octubre, Complutense University of Madrid (A.C.S.); Pediatric Neurology Unit of Hospital Universitario Donostia (I.M.), Guipuzcoa; Pediatric Neurology Unit of Hospital Universitario Río Hortega (R.C.-C.), Valladolid; and Pediatric Neurology Unit of Cruces University Hospital (M.J.M.-G.), Bilbao, Spain
| | - Elianet Fonseca
- From the Pediatric Neuroimmunology Program (G.O.-C.,E.F.,A.S.,T.A.), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clinic, University of Barcelona; Pediatric Neurology Unit of Parc Taulí Hospital of Sabadell (G.O.-C.), Barcelona; Pediatric Neurology Unit of Hospital Infantil Universitario Niño Jesús (V.C.-E.,M.J.-L.), Madrid; Pediatric Neurology Unit of Hospital Gregorio Marañón (M.V.-L.), Madrid; Pediatric Neuroimmunology Unit (V.G.-A.,J.R.-C.,T.A.), Neurology Service, Sant Joan de Déu (SJD) Children's Hospital, University of Barcelona; Pediatric Neurology Unit of Hospital Universitario 12 de Octubre, Complutense University of Madrid (A.C.S.); Pediatric Neurology Unit of Hospital Universitario Donostia (I.M.), Guipuzcoa; Pediatric Neurology Unit of Hospital Universitario Río Hortega (R.C.-C.), Valladolid; and Pediatric Neurology Unit of Cruces University Hospital (M.J.M.-G.), Bilbao, Spain
| | - Verónica Cantarín-Extremera
- From the Pediatric Neuroimmunology Program (G.O.-C.,E.F.,A.S.,T.A.), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clinic, University of Barcelona; Pediatric Neurology Unit of Parc Taulí Hospital of Sabadell (G.O.-C.), Barcelona; Pediatric Neurology Unit of Hospital Infantil Universitario Niño Jesús (V.C.-E.,M.J.-L.), Madrid; Pediatric Neurology Unit of Hospital Gregorio Marañón (M.V.-L.), Madrid; Pediatric Neuroimmunology Unit (V.G.-A.,J.R.-C.,T.A.), Neurology Service, Sant Joan de Déu (SJD) Children's Hospital, University of Barcelona; Pediatric Neurology Unit of Hospital Universitario 12 de Octubre, Complutense University of Madrid (A.C.S.); Pediatric Neurology Unit of Hospital Universitario Donostia (I.M.), Guipuzcoa; Pediatric Neurology Unit of Hospital Universitario Río Hortega (R.C.-C.), Valladolid; and Pediatric Neurology Unit of Cruces University Hospital (M.J.M.-G.), Bilbao, Spain
| | - María Vázquez-López
- From the Pediatric Neuroimmunology Program (G.O.-C.,E.F.,A.S.,T.A.), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clinic, University of Barcelona; Pediatric Neurology Unit of Parc Taulí Hospital of Sabadell (G.O.-C.), Barcelona; Pediatric Neurology Unit of Hospital Infantil Universitario Niño Jesús (V.C.-E.,M.J.-L.), Madrid; Pediatric Neurology Unit of Hospital Gregorio Marañón (M.V.-L.), Madrid; Pediatric Neuroimmunology Unit (V.G.-A.,J.R.-C.,T.A.), Neurology Service, Sant Joan de Déu (SJD) Children's Hospital, University of Barcelona; Pediatric Neurology Unit of Hospital Universitario 12 de Octubre, Complutense University of Madrid (A.C.S.); Pediatric Neurology Unit of Hospital Universitario Donostia (I.M.), Guipuzcoa; Pediatric Neurology Unit of Hospital Universitario Río Hortega (R.C.-C.), Valladolid; and Pediatric Neurology Unit of Cruces University Hospital (M.J.M.-G.), Bilbao, Spain
| | - María Jiménez-Legido
- From the Pediatric Neuroimmunology Program (G.O.-C.,E.F.,A.S.,T.A.), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clinic, University of Barcelona; Pediatric Neurology Unit of Parc Taulí Hospital of Sabadell (G.O.-C.), Barcelona; Pediatric Neurology Unit of Hospital Infantil Universitario Niño Jesús (V.C.-E.,M.J.-L.), Madrid; Pediatric Neurology Unit of Hospital Gregorio Marañón (M.V.-L.), Madrid; Pediatric Neuroimmunology Unit (V.G.-A.,J.R.-C.,T.A.), Neurology Service, Sant Joan de Déu (SJD) Children's Hospital, University of Barcelona; Pediatric Neurology Unit of Hospital Universitario 12 de Octubre, Complutense University of Madrid (A.C.S.); Pediatric Neurology Unit of Hospital Universitario Donostia (I.M.), Guipuzcoa; Pediatric Neurology Unit of Hospital Universitario Río Hortega (R.C.-C.), Valladolid; and Pediatric Neurology Unit of Cruces University Hospital (M.J.M.-G.), Bilbao, Spain
| | - Verónica González-Álvarez
- From the Pediatric Neuroimmunology Program (G.O.-C.,E.F.,A.S.,T.A.), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clinic, University of Barcelona; Pediatric Neurology Unit of Parc Taulí Hospital of Sabadell (G.O.-C.), Barcelona; Pediatric Neurology Unit of Hospital Infantil Universitario Niño Jesús (V.C.-E.,M.J.-L.), Madrid; Pediatric Neurology Unit of Hospital Gregorio Marañón (M.V.-L.), Madrid; Pediatric Neuroimmunology Unit (V.G.-A.,J.R.-C.,T.A.), Neurology Service, Sant Joan de Déu (SJD) Children's Hospital, University of Barcelona; Pediatric Neurology Unit of Hospital Universitario 12 de Octubre, Complutense University of Madrid (A.C.S.); Pediatric Neurology Unit of Hospital Universitario Donostia (I.M.), Guipuzcoa; Pediatric Neurology Unit of Hospital Universitario Río Hortega (R.C.-C.), Valladolid; and Pediatric Neurology Unit of Cruces University Hospital (M.J.M.-G.), Bilbao, Spain
| | - Juliana Ribeiro-Constante
- From the Pediatric Neuroimmunology Program (G.O.-C.,E.F.,A.S.,T.A.), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clinic, University of Barcelona; Pediatric Neurology Unit of Parc Taulí Hospital of Sabadell (G.O.-C.), Barcelona; Pediatric Neurology Unit of Hospital Infantil Universitario Niño Jesús (V.C.-E.,M.J.-L.), Madrid; Pediatric Neurology Unit of Hospital Gregorio Marañón (M.V.-L.), Madrid; Pediatric Neuroimmunology Unit (V.G.-A.,J.R.-C.,T.A.), Neurology Service, Sant Joan de Déu (SJD) Children's Hospital, University of Barcelona; Pediatric Neurology Unit of Hospital Universitario 12 de Octubre, Complutense University of Madrid (A.C.S.); Pediatric Neurology Unit of Hospital Universitario Donostia (I.M.), Guipuzcoa; Pediatric Neurology Unit of Hospital Universitario Río Hortega (R.C.-C.), Valladolid; and Pediatric Neurology Unit of Cruces University Hospital (M.J.M.-G.), Bilbao, Spain
| | - Ana Camacho-Salas
- From the Pediatric Neuroimmunology Program (G.O.-C.,E.F.,A.S.,T.A.), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clinic, University of Barcelona; Pediatric Neurology Unit of Parc Taulí Hospital of Sabadell (G.O.-C.), Barcelona; Pediatric Neurology Unit of Hospital Infantil Universitario Niño Jesús (V.C.-E.,M.J.-L.), Madrid; Pediatric Neurology Unit of Hospital Gregorio Marañón (M.V.-L.), Madrid; Pediatric Neuroimmunology Unit (V.G.-A.,J.R.-C.,T.A.), Neurology Service, Sant Joan de Déu (SJD) Children's Hospital, University of Barcelona; Pediatric Neurology Unit of Hospital Universitario 12 de Octubre, Complutense University of Madrid (A.C.S.); Pediatric Neurology Unit of Hospital Universitario Donostia (I.M.), Guipuzcoa; Pediatric Neurology Unit of Hospital Universitario Río Hortega (R.C.-C.), Valladolid; and Pediatric Neurology Unit of Cruces University Hospital (M.J.M.-G.), Bilbao, Spain
| | - Itxaso Martí
- From the Pediatric Neuroimmunology Program (G.O.-C.,E.F.,A.S.,T.A.), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clinic, University of Barcelona; Pediatric Neurology Unit of Parc Taulí Hospital of Sabadell (G.O.-C.), Barcelona; Pediatric Neurology Unit of Hospital Infantil Universitario Niño Jesús (V.C.-E.,M.J.-L.), Madrid; Pediatric Neurology Unit of Hospital Gregorio Marañón (M.V.-L.), Madrid; Pediatric Neuroimmunology Unit (V.G.-A.,J.R.-C.,T.A.), Neurology Service, Sant Joan de Déu (SJD) Children's Hospital, University of Barcelona; Pediatric Neurology Unit of Hospital Universitario 12 de Octubre, Complutense University of Madrid (A.C.S.); Pediatric Neurology Unit of Hospital Universitario Donostia (I.M.), Guipuzcoa; Pediatric Neurology Unit of Hospital Universitario Río Hortega (R.C.-C.), Valladolid; and Pediatric Neurology Unit of Cruces University Hospital (M.J.M.-G.), Bilbao, Spain
| | - Ramon Cancho-Candela
- From the Pediatric Neuroimmunology Program (G.O.-C.,E.F.,A.S.,T.A.), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clinic, University of Barcelona; Pediatric Neurology Unit of Parc Taulí Hospital of Sabadell (G.O.-C.), Barcelona; Pediatric Neurology Unit of Hospital Infantil Universitario Niño Jesús (V.C.-E.,M.J.-L.), Madrid; Pediatric Neurology Unit of Hospital Gregorio Marañón (M.V.-L.), Madrid; Pediatric Neuroimmunology Unit (V.G.-A.,J.R.-C.,T.A.), Neurology Service, Sant Joan de Déu (SJD) Children's Hospital, University of Barcelona; Pediatric Neurology Unit of Hospital Universitario 12 de Octubre, Complutense University of Madrid (A.C.S.); Pediatric Neurology Unit of Hospital Universitario Donostia (I.M.), Guipuzcoa; Pediatric Neurology Unit of Hospital Universitario Río Hortega (R.C.-C.), Valladolid; and Pediatric Neurology Unit of Cruces University Hospital (M.J.M.-G.), Bilbao, Spain
| | - María Jesús Martínez-González
- From the Pediatric Neuroimmunology Program (G.O.-C.,E.F.,A.S.,T.A.), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clinic, University of Barcelona; Pediatric Neurology Unit of Parc Taulí Hospital of Sabadell (G.O.-C.), Barcelona; Pediatric Neurology Unit of Hospital Infantil Universitario Niño Jesús (V.C.-E.,M.J.-L.), Madrid; Pediatric Neurology Unit of Hospital Gregorio Marañón (M.V.-L.), Madrid; Pediatric Neuroimmunology Unit (V.G.-A.,J.R.-C.,T.A.), Neurology Service, Sant Joan de Déu (SJD) Children's Hospital, University of Barcelona; Pediatric Neurology Unit of Hospital Universitario 12 de Octubre, Complutense University of Madrid (A.C.S.); Pediatric Neurology Unit of Hospital Universitario Donostia (I.M.), Guipuzcoa; Pediatric Neurology Unit of Hospital Universitario Río Hortega (R.C.-C.), Valladolid; and Pediatric Neurology Unit of Cruces University Hospital (M.J.M.-G.), Bilbao, Spain
| | - Albert Saiz
- From the Pediatric Neuroimmunology Program (G.O.-C.,E.F.,A.S.,T.A.), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clinic, University of Barcelona; Pediatric Neurology Unit of Parc Taulí Hospital of Sabadell (G.O.-C.), Barcelona; Pediatric Neurology Unit of Hospital Infantil Universitario Niño Jesús (V.C.-E.,M.J.-L.), Madrid; Pediatric Neurology Unit of Hospital Gregorio Marañón (M.V.-L.), Madrid; Pediatric Neuroimmunology Unit (V.G.-A.,J.R.-C.,T.A.), Neurology Service, Sant Joan de Déu (SJD) Children's Hospital, University of Barcelona; Pediatric Neurology Unit of Hospital Universitario 12 de Octubre, Complutense University of Madrid (A.C.S.); Pediatric Neurology Unit of Hospital Universitario Donostia (I.M.), Guipuzcoa; Pediatric Neurology Unit of Hospital Universitario Río Hortega (R.C.-C.), Valladolid; and Pediatric Neurology Unit of Cruces University Hospital (M.J.M.-G.), Bilbao, Spain
| | - Thaís Armangué
- From the Pediatric Neuroimmunology Program (G.O.-C.,E.F.,A.S.,T.A.), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clinic, University of Barcelona; Pediatric Neurology Unit of Parc Taulí Hospital of Sabadell (G.O.-C.), Barcelona; Pediatric Neurology Unit of Hospital Infantil Universitario Niño Jesús (V.C.-E.,M.J.-L.), Madrid; Pediatric Neurology Unit of Hospital Gregorio Marañón (M.V.-L.), Madrid; Pediatric Neuroimmunology Unit (V.G.-A.,J.R.-C.,T.A.), Neurology Service, Sant Joan de Déu (SJD) Children's Hospital, University of Barcelona; Pediatric Neurology Unit of Hospital Universitario 12 de Octubre, Complutense University of Madrid (A.C.S.); Pediatric Neurology Unit of Hospital Universitario Donostia (I.M.), Guipuzcoa; Pediatric Neurology Unit of Hospital Universitario Río Hortega (R.C.-C.), Valladolid; and Pediatric Neurology Unit of Cruces University Hospital (M.J.M.-G.), Bilbao, Spain
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