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Bachour K, House AA, Andrade DM, Connolly M, Debicki DB, Desbiens R, Fantaneanu TA, Kyriakopoulos P, Lattouf JB, Suller-Marti A, Marques PT, Keezer MR. Adults with tuberous sclerosis complex: A distinct patient population. Epilepsia 2021; 63:663-671. [PMID: 34967000 DOI: 10.1111/epi.17159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 12/20/2021] [Accepted: 12/20/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES There are few data on adults living with tuberous sclerosis complex (TSC), with most studies focusing on pediatric populations. The objective of our study was to examine a large national cohort of adults with TSC, and to describe the clinical characteristics of these adults and the nature of the multidisciplinary care that they receive. METHODS Six Canadian medical centers collaborated in this study. Data were collected using a standardized form, and descriptive statistics were used for the analyses. RESULTS Our study included 181 adults with definite TSC (mean age = 33.6 years [SD = 13.7]). More than 40% (n = 75) had family members affected by TSC. Forty-six percent (n = 83) of individuals had intellectual disability. Nearly 30% (n = 52) of individuals reported living alone or with a partner/spouse. Seventy-six percent (n = 138) of people had epilepsy, 43% (n = 59) of whom had drug-resistant epilepsy, and 21% (n = 29) had undergone epilepsy surgery. Neuropsychiatric disease (n = 128) and renal angiomyolipomas (n = 130) were both present in approximately 70% of people. Renal imaging was performed in 75.7% (n = 137) of participants within the past 3 years. Renal and pulmonary function tests, as well as electrocardiograms, were recently performed in a minority of individuals. SIGNIFICANCE Our cohort of adults with TSC showed that an important proportion have a milder phenotype, and are more frequently familial, as compared to children with TSC (and differing from prior reports in adult cohorts). Drug-resistant epilepsy, neuropsychiatric comorbidities, and renal angiomyolipoma are challenging factors in adults with TSC. Our participating medical centers generally followed recommended screening strategies, but there remain important gaps in care. Multidisciplinary and structured TSC care centers offering service to adults may help to improve the health of this important patient population.
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Affiliation(s)
- Kenan Bachour
- Research Centre, University of Montreal Hospital Centre, Montreal, Quebec, Canada
| | - Andrew A House
- Department of Nephrology, London Health Science Centre, London, Ontario, Canada
| | - Danielle M Andrade
- Department of Neurology, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Mary Connolly
- Department of Pediatrics, British Columbia's Children Hospital, Vancouver, British Columbia, Canada
| | - Dereck B Debicki
- Department of Clinical Neurological Sciences, London Health Science Centre, Western University, London, Ontario, Canada
| | - Richard Desbiens
- Department of Neurology, Laval University Hospital Centre, Quebec City, Quebec, Canada
| | | | | | - Jean-Baptiste Lattouf
- Department of Urology, University of Montreal Hospital Centre, Montreal, Quebec, Canada
| | - Ana Suller-Marti
- Department of Clinical Neurological Sciences, London Health Science Centre, Western University, London, Ontario, Canada
| | - Paula T Marques
- Department of Neurology, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Mark R Keezer
- Research Centre, University of Montreal Hospital Centre, Montreal, Quebec, Canada.,Department of Neurosciences, University of Montreal, Montreal, Quebec, Canada.,School of Public Health, University of Montreal, Montreal, Quebec, Canada
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Qaiser F, Sadoway T, Yin Y, Zulfiqar Ali Q, Nguyen CM, Shum N, Backstrom I, Marques PT, Tabarestani S, Munhoz RP, Krings T, Pearson CE, Yuen RKC, Andrade DM. Genome sequencing identifies rare tandem repeat expansions and copy number variants in Lennox-Gastaut syndrome. Brain Commun 2021; 3:fcab207. [PMID: 34622207 PMCID: PMC8491034 DOI: 10.1093/braincomms/fcab207] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/23/2021] [Accepted: 07/29/2021] [Indexed: 11/22/2022] Open
Abstract
Epilepsies are a group of common neurological disorders with a substantial
genetic basis. Despite this, the molecular diagnosis of epilepsies remains
challenging due to its heterogeneity. Studies utilizing whole-genome sequencing
may provide additional insights into genetic causes of epilepsies of unknown
aetiology. Whole-genome sequencing was used to evaluate a cohort of adults with
unexplained developmental and epileptic encephalopathies (n
= 30), for whom prior genetic tests, including whole-exome sequencing in
some cases, were negative or inconclusive. Rare single nucleotide variants,
insertions/deletions, copy number variants and tandem repeat expansions were
analysed. Seven pathogenic or likely pathogenic single nucleotide variants, and
two pathogenic deleterious copy number variants were identified in nine patients
(32.1% of the cohort). One of the copy number variants, identified in a
patient with Lennox–Gastaut syndrome, was too small to be detected by
chromosomal microarray techniques. We also identified two tandem repeat
expansions with clinical implications in two other patients with
Lennox–Gastaut syndrome: a CGG repeat expansion in the
5′untranslated region of DIP2B, and a CTG expansion in
ATXN8OS (previously implicated in spinocerebellar ataxia
type 8). Three patients had KCNA2 pathogenic variants. One of
them died of sudden unexpected death in epilepsy. The other two patients had, in
addition to a KCNA2 variant, a second de novo
variant impacting potential epilepsy-relevant genes (KCNIP4 and
UBR5). Overall, whole-genome sequencing provided a genetic
explanation in 32.1% of the total cohort. This is also the first report
of coding and non-coding tandem repeat expansions identified in patients with
Lennox–Gastaut syndrome. This study demonstrates that using whole-genome
sequencing, the examination of multiple types of rare genetic variation,
including those found in the non-coding region of the genome, can help resolve
unexplained epilepsies.
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Affiliation(s)
- Farah Qaiser
- Department of Molecular Genetics, Faculty of Medicine, University of Toronto, Toronto, Canada.,Genetics & Genome Biology Program, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Canada.,Adult Epilepsy Genetics Research Program, Krembil Neurosciences Institute, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - Tara Sadoway
- Adult Epilepsy Genetics Research Program, Krembil Neurosciences Institute, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - Yue Yin
- Genetics & Genome Biology Program, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Canada
| | - Quratulain Zulfiqar Ali
- Adult Epilepsy Genetics Research Program, Krembil Neurosciences Institute, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - Charlotte M Nguyen
- Department of Molecular Genetics, Faculty of Medicine, University of Toronto, Toronto, Canada.,Genetics & Genome Biology Program, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Canada
| | - Natalie Shum
- Department of Molecular Genetics, Faculty of Medicine, University of Toronto, Toronto, Canada.,Genetics & Genome Biology Program, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Canada
| | - Ian Backstrom
- Genetics & Genome Biology Program, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Canada
| | - Paula T Marques
- Adult Epilepsy Genetics Research Program, Krembil Neurosciences Institute, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - Sepideh Tabarestani
- Adult Epilepsy Genetics Research Program, Krembil Neurosciences Institute, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - Renato P Munhoz
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Canada.,Neuromodulation Unit and Ataxia Clinic, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - Timo Krings
- Department of Medical Imaging, University of Toronto, Toronto, Canada.,Division of Neuroradiology, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - Christopher E Pearson
- Department of Molecular Genetics, Faculty of Medicine, University of Toronto, Toronto, Canada.,Genetics & Genome Biology Program, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Canada
| | - Ryan K C Yuen
- Department of Molecular Genetics, Faculty of Medicine, University of Toronto, Toronto, Canada.,Genetics & Genome Biology Program, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Canada
| | - Danielle M Andrade
- Adult Epilepsy Genetics Research Program, Krembil Neurosciences Institute, Toronto Western Hospital, University Health Network, Toronto, Canada.,Division of Neurology, Department of Medicine, University of Toronto, Toronto, Canada.,Epilepsy Program, Krembil Neurosciences Institute, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Canada
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Teive HAG, Marques PT, Oliveira LPD, Germiniani FMB, Paola LD, Camargo CHF. Overcoming bashfulness: how cocaine aided Freud to summon the courage to meet Charcot. Arq Neuropsiquiatr 2019; 77:825-827. [PMID: 31826139 DOI: 10.1590/0004-282x20190052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 02/14/2019] [Indexed: 11/21/2022]
Abstract
Jean-Martin Charcot, the most celebrated neurologist of the 19th century, had a profound influence on Sigmund Freud's career. Freud spent the winter of 1885-1886 working in Charcot's neurology department in Paris. During this period, he went to Charcot's house on several occasions to participate in the very famous Tuesday soirées under the guidance of Gilles de la Tourette. Freud was always very proud to be invited and curious to meet the Parisian intellectual elite. On these occasions, however, he was very apprehensive and made frequent use of cocaine. Due to anxiety and the need to appear creative in front of Charcot, it is possible that Freud used cocaine at other times.
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Affiliation(s)
- Hélio A G Teive
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Medicina Interna, Serviço de Neurologia, Curitiba PR, Brasil.,Universidade Federal do Paraná, Departamento de Medicina Interna, Programa de Pós-Graduação em Medicina Interna, Curitiba PR, Brasil
| | - Paula T Marques
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Medicina Interna, Serviço de Neurologia, Curitiba PR, Brasil
| | - Livia P de Oliveira
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Medicina Interna, Serviço de Neurologia, Curitiba PR, Brasil
| | - Francisco M B Germiniani
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Medicina Interna, Serviço de Neurologia, Curitiba PR, Brasil
| | - Luciano de Paola
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Medicina Interna, Serviço de Neurologia, Curitiba PR, Brasil
| | - Carlos Henrique F Camargo
- Universidade Federal do Paraná, Departamento de Medicina Interna, Programa de Pós-Graduação em Medicina Interna, Curitiba PR, Brasil
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