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Sasaki M, Ishii A, Saito Y, Morisada N, Iijima K, Takada S, Araki A, Tanabe Y, Arai H, Yamashita S, Ohashi T, Oda Y, Ichiseki H, Hirabayashi S, Yasuhara A, Kawawaki H, Kimura S, Shimono M, Narumiya S, Suzuki M, Yoshida T, Oyazato Y, Tsuneishi S, Ozasa S, Yokochi K, Dejima S, Akiyama T, Kishi N, Kira R, Ikeda T, Oguni H, Zhang B, Tsuji S, Hirose S. Genotype-phenotype correlations in alternating hemiplegia of childhood. Neurology 2014; 82:482-90. [PMID: 24431296 DOI: 10.1212/wnl.0000000000000102] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Clinical severity of alternating hemiplegia of childhood (AHC) is extremely variable. To investigate genotype-phenotype correlations in AHC, we analyzed the clinical information and ATP1A3 mutations in patients with AHC. METHODS Thirty-five Japanese patients who were clinically diagnosed with AHC participated in this study. ATP1A3 mutations were analyzed using Sanger sequencing. Detailed clinical information was collected from family members of patients with AHC and clinicians responsible for their care. RESULTS Gene analysis revealed 33 patients with de novo heterozygous missense mutations of ATP1A3: Glu815Lys in 12 cases (36%), Asp801Asn in 10 cases (30%), and other missense mutations in 11 cases. Clinical information was compared among the Glu815Lys, Asp801Asn, and other mutation groups. Statistical analysis revealed significant differences in the history of neonatal onset, gross motor level, status epilepticus, and respiratory paralysis in the Glu815Lys group compared with the other groups. In addition, 8 patients who did not receive flunarizine had severe motor deteriorations. CONCLUSIONS The Glu815Lys genotype appears to be associated with the most severe AHC phenotype. Although AHC is not generally seen as a progressive disorder, it should be considered a disorder that deteriorates abruptly or in a stepwise fashion, particularly in patients with the Glu815Lys mutation.
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Affiliation(s)
- Masayuki Sasaki
- From the Department of Child Neurology (M. Sasaki, Y.S.), National Center of Neurology and Psychiatry, Kodaira; Department of Pediatrics and Central Research Institute for the Molecular Pathomechanisms of Epilepsy (A.I., S. Hirose) and Department of Biochemistry (B.Z.), Fukuoka University School of Medicine; Department of Pediatrics (N.M., K.I., S. Takada), Kobe University School of Medicine; Department of Pediatrics (A.A., Y.T.), Kansai Medical University, Osaka; Department of Neurology (H.A.), Chiba Children's Hospital; Division of Neurology (S.Y.), Kanagawa Children's Medical Center, Yokohama; Department of Pediatrics (T.O.), Nishi-Niigata Central Hospital, Niigata; Department of Pediatrics (Y. Oda, H.I.), Chigasaki Municipal Hospital; Department of Neurology (S. Hirabayashi), Nagano Children's Hospital, Azumino; Yasuhara Children's Clinic (A.Y.), Osaka; Department of Pediatrics (H.K.), Osaka City General Hospital; Division of Child Neurology (S.K.), Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi; Department of Pediatrics (M. Shimono), University of Occupational and Environmental Health, Kitakyushu; Department of Pediatrics (S.N.), Nagahama Red Cross Hospital; Department of Child Neurology (M. Suzuki), Aichi Prefectural Colony Central Hospital, Kasugai; Department of Pediatrics (T.Y.), Kyoto University School of Medicine; Department of Pediatrics (Y. Oyazato), Kakogawa-Nishi Municipal Hospital, Kakogawa; Department of Pediatrics (S. Tsuneishi), Medical and Welfare Center Kizuna, Kasai; Department of Child Development (S.O.), Faculty of Life Sciences, Kumamoto University Graduate School, Kumamoto; Department of Pediatric Neurology (K.Y.), Seirei-Mikatahara Hospital, Hamamatsu; Department of Pediatrics (S.D.), Kyoto Min-iren Chuo Hospital, Kyoto; Department of Child Neurology (T.A.), Okayama University Graduate School of Medicine; Department of Psychiatry (N.K.), Kyoto Katsura Hospital, Kyoto; Department of Pediatrics, (R.K.) Fukuo
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Abstract
OBJECTIVE There is little systematic data on early neurodevelopmental functioning of infants with Smith-Magenis syndrome, since early diagnosis is rare. METHODS A boy with cytogenetically confirmed Smith-Magenis syndrome was videotaped at 4 months and 1 week of age. His posture and spontaneous movements were analysed without knowing the diagnosis. RESULTS The motor repertoire appeared significantly reduced; fidgety general movements, which are typical of that age, were missing. Posture was abnormal and overall movements were jerky and monotonous. The findings indicate a severe motor impairment by no more than 4 months of age. CONCLUSION It was concluded that an absence of fidgety movements that goes along with subtle dysmorphic features indicates an increased risk of maldevelopment and justifies the need to refer for genetic evaluation with the potential of facilitating earlier diagnosis.
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Affiliation(s)
- Christa Einspieler
- Institute of Physiology, Center for Physiological Medicine, Medical University of Graz, Austria.
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Ito M, Aiba H, Hashimoto K, Kuroki S, Tomiwa K, Okuno T, Hattori H, Go T, Sejima H, Dejima S, Ikeda H, Yoshioka M, Kanazawa O, Kawamitsu T, Ochi J, Miki N, Noma H, Oguro K, Ozaki N, Tamamoto A, Matsubara T, Miyajima T, Fujii T, Konishi Y, Okuno T, Hojo H. Low-dose ACTH therapy for West syndrome: initial effects and long-term outcome. Neurology 2002; 58:110-4. [PMID: 11781414 DOI: 10.1212/wnl.58.1.110] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Most Japanese pediatric neurologists attempt other treatments before using adrenocorticotropic hormone (ACTH) therapy for West syndrome (WS), and even then, they use only a low-dose synthetic ACTH to avoid serious adverse effects. In this multi-institutional study, the authors analyzed the initial effects, adverse effects, and long-term outcome in patients treated with low-dose synthetic ACTH in Japan. METHODS The medical records of 138 patients with WS, who were treated with low-dose synthetic ACTH therapy for the first time at the authors' institutions between 1989 and 1998, were analyzed. RESULTS At the end of ACTH therapy, excellent effect on seizures was noted in 106 of 138 (76%) patients, good effect in 23 (17%), and poor effect in 9 (7%). Initial effects on EEG were excellent in 53 of 138 (38%) patients, good in 76 (55%), and poor in 9 (7%). As for seizure prognosis at the time of follow-up, 51 of 99 (52%) patients were seizure-free, whereas 48 (48%) patients had seizures. Mental outcome was normal in 6 of 98 (6%) patients, mild mental retardation in 16 (16%), moderate mental retardation in 26 (27%), and severe mental retardation in 50 (51%). The initial effects of ACTH on seizures and long-term outcome were not dose dependent (daily dosage 0.005 to 0.032 mg/kg, 0.2 to 1.28 IU/kg; total dosage 0.1 to 0.87 mg/kg, 4 to 34.8 IU/kg). The severity of adverse effects correlated with total dosage of ACTH, and the severity of brain volume loss due to ACTH correlated well with the daily dosage and total dosage of ACTH. CONCLUSION Low-dose synthetic ACTH therapy is as effective for the treatment of WS as the higher doses used in previous studies. The dosage of synthetic ACTH used in the treatment of WS can be decreased as much as possible to avoid serious adverse effects.
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Affiliation(s)
- M Ito
- Department of Pediatrics, Shiga Medical Center for Children, Moriyama, Japan.
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Abstract
Using a two-site enzyme-linked immunosorbent assay, we measured nerve growth factor (NGF) levels in cerebrospinal fluid (CSF) from 40 patients with or without brain atrophy due to various neurologic disorders. White matter and cortical atrophies were assessed by frontal horn index (FHI) and subarachnoid space area/inner skull space area (SSA/ISSA) ratio, respectively. CT findings of 40 patients were classified into 4 grades: normal (< mean + 2SD), grade I (mean + 2SD < or = or < mean + 4SD), grade II (mean + 4SD < or = < mean + 8SD), and grade III (mean + 8SD < or =). NGF levels in CSF were significantly elevated in 3 of 6 patients with grade III cortical atrophy and normal in 2 with grade II atrophy, 4 with grade I atrophy and 28 without atrophy. Cortical atrophy was progressive in the 3 with NGF elevation in CSF. With respect to white matter atrophy, NGF elevation was observed in none of 3 with grade III white matter atrophy, two of 4 with grade II atrophy, none of 3 with grade I atrophy and one of 30 without atrophy. The symptoms of the two of three with NGF elevation were progressive at the time of obtaining the CSF samples, while those of other patients without NGF elevation were non-progressive. The present study suggests that NGF elevation in CSF may reflect extensive cortical degenerative change.
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Affiliation(s)
- I Suzaki
- Division of Child Neurology, Tottori University of Medicine, Japan
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Abstract
PURPOSE To report a previously undescribed adverse effect, IgA/IgG subclass deficiency associated with zonisamide (ZNS) therapy. METHODS Serum IgA and IgG subclass levels were determined by the turbidimetric immunoassay and enzyme-linked immunosorbent assay, respectively, in a 2-year-old boy with postmeningitis sequelae who was treated by ZNS. RESULTS Four months after initiation of ZNS, combined deficiency of IgA and IgG2 was noted. After cessation of ZNS, serum IgA level was promptly increased. IgG2 level was gradually increased, but remained subnormal after 7 months. CONCLUSIONS This case documents, for the first time, the action of ZNS on IgG immune system as well as IgA system. If patients with ZNS therapy showed IgA deficiency and recurrent infections, it is preferable to check serum IgG subclass concentrations as well.
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Affiliation(s)
- Y Maeoka
- Division of Child Neurology, Tottori University School of Medicine, Yonago, Japan
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Tanabe M, Mizushima M, Anno Y, Kondou S, Dejima S, Hirao DJ, Kamitani H, Watanabe T, Hori T. Intracranial germinoma with Down's syndrome: a case report and review of the literature. Surg Neurol 1997; 47:28-31. [PMID: 8986161 DOI: 10.1016/s0090-3019(96)00152-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Down's syndrome's association with malignancies such as leukemia is well known, but its association with brain tumor appears to be rare. We reviewed such rare cases of Down's syndrome and intracranial germ-cell tumor. CASE REPORT A 10-year-old boy with Down's syndrome and intracranial germinoma located in the left basal ganglia is reported. The patient presented with right hemiparesis and was treated with a combination of surgery, chemotherapy with cisplatin and etoposide, and irradiation. CONCLUSIONS We speculate that the percentage of germ-cell tumors is high among Down syndrome patients with brain tumors and that the most common site is the basal ganglia.
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Affiliation(s)
- M Tanabe
- Division of Neurosurgery, Institute of Neurological Sciences, Faculty of Medicine, Tottori University, Yonago, Japan
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Dejima S, Yamamoto T, Maeoka Y, Maegaki Y, Hara T. [Taste disturbance as an initial manifestation of Guillain-Barré syndrome in a 14-year-old girl]. No To Hattatsu 1995; 27:492-5. [PMID: 8534516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We reported a 14-year-old girl who showed taste disturbance as an initial manifestation of Guillain-Barré syndrome (GBS). After an upper respiratory infection, she initially complained of taste disturbance, diplopia and salivation, followed by weakness in the legs and numbness in the extremities. On admission, she showed taste deficiency for sweet and sour sense, and a decline of salty and bitter taste. Weakness in the legs and disappearance of deep tendon reflexes were also noticed. We considered that the findings of electrophysiological examinations would conform to demyelinating features. Laboratory examinations revealed an increase of memory T cells in the peripheral blood and an elevated level of myelin basic protein in the cerebrospinal fluid. Based on clinical features and laboratory data, the diagnosis of GBS was made. We should keep taste disturbance in mind as one of the signs of GBS.
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Affiliation(s)
- S Dejima
- Division of Child Neurology, Institute of Neurological Sciences, Tottori University Faculty of Medicine
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