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Vill K, Tacke M, König A, Baumann M, Baumgartner M, Steinbach M, Bernert G, Blaschek A, Deschauer M, Flotats-Bastardas M, Friese J, Goldbach S, Gross M, Günther R, Hahn A, Hagenacker T, Hauser E, Horber V, Illsinger S, Johannsen J, Kamm C, Koch JC, Koelbel H, Koehler C, Kolzter K, Lochmüller H, Ludolph A, Mensch A, Meyer Zu Hoerste G, Mueller M, Mueller-Felber W, Neuwirth C, Petri S, Probst-Schendzielorz K, Pühringer M, Steinbach R, Schara-Schmidt U, Schimmel M, Schrank B, Schwartz O, Schlachter K, Schwerin-Nagel A, Schreiber G, Smitka M, Topakian R, Trollmann R, Tuerk M, Theophil M, Rauscher C, Vorgerd M, Walter MC, Weiler M, Weiss C, Wilichowski E, Wurster CD, Wunderlich G, Zeller D, Ziegler A, Kirschner J, Pechmann A. 5qSMA: standardised retrospective natural history assessment in 268 patients with four copies of SMN2. J Neurol 2024; 271:2787-2797. [PMID: 38409538 PMCID: PMC11055798 DOI: 10.1007/s00415-024-12188-5] [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] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/29/2023] [Accepted: 01/05/2024] [Indexed: 02/28/2024]
Abstract
Newborn screening for 5qSMA offers the potential for early, ideally pre-symptomatic, therapeutic intervention. However, limited data exist on the outcomes of individuals with 4 copies of SMN2, and there is no consensus within the SMA treatment community regarding early treatment initiation in this subgroup. To provide evidence-based insights into disease progression, we performed a retrospective analysis of 268 patients with 4 copies of SMN2 from the SMArtCARE registry in Germany, Austria and Switzerland. Inclusion criteria required comprehensive baseline data and diagnosis outside of newborn screening. Only data prior to initiation of disease-modifying treatment were included. The median age at disease onset was 3.0 years, with a mean of 6.4 years. Significantly, 55% of patients experienced symptoms before the age of 36 months. 3% never learned to sit unaided, a further 13% never gained the ability to walk independently and 33% of ambulatory patients lost this ability during the course of the disease. 43% developed scoliosis, 6.3% required non-invasive ventilation and 1.1% required tube feeding. In conclusion, our study, in line with previous observations, highlights the substantial phenotypic heterogeneity in SMA. Importantly, this study provides novel insights: the median age of disease onset in patients with 4 SMN2 copies typically occurs before school age, and in half of the patients even before the age of three years. These findings support a proactive approach, particularly early treatment initiation, in this subset of SMA patients diagnosed pre-symptomatically. However, it is important to recognize that the register will not include asymptomatic individuals.
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Affiliation(s)
- Katharina Vill
- Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children With Medical Complexity, Dr. Von Hauner Children's Hospital, LMU Hospital, Ludwig-Maximilians-University, 80337, Munich, Germany.
- School of Medicine, Klinikum Rechts Der Isar, Department of Human Genetics, Technical University of Munich, Munich, Germany.
| | - Moritz Tacke
- Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children With Medical Complexity, Dr. Von Hauner Children's Hospital, LMU Hospital, Ludwig-Maximilians-University, 80337, Munich, Germany
| | - Anna König
- Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children With Medical Complexity, Dr. Von Hauner Children's Hospital, LMU Hospital, Ludwig-Maximilians-University, 80337, Munich, Germany
| | - Matthias Baumann
- Division of Pediatric Neurology, Department of Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | - Manuela Baumgartner
- Department of Children and Adolescents, Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria
| | - Meike Steinbach
- Department of Neurology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | | | - Astrid Blaschek
- Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children With Medical Complexity, Dr. Von Hauner Children's Hospital, LMU Hospital, Ludwig-Maximilians-University, 80337, Munich, Germany
| | - Marcus Deschauer
- School of Medicine, Klinikum Rechts Der Isar, Department of Neurology, Technical University of Munich, Munich, Germany
| | | | - Johannes Friese
- Department of Neuropediatrics, University Hospital Bonn, Center for Pediatrics, Bonn, Germany
| | | | - Martin Gross
- Department of Neurological Intensive Care and Rehabilitation, Evangelisches Krankenhaus Oldenburg, Oldenburg, Germany
| | - René Günther
- University Hospital Carl Gustav Carus Dresden at Technische Universität Dresden, Dresden, Germany
| | - Andreas Hahn
- Department of Child Neurology, Justus-Liebig-University Gießen, Gießen, Germany
| | - Tim Hagenacker
- Department of Neurology, and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Medicine Essen, Essen, Germany
| | - Erwin Hauser
- Department for Neuropädiatrie, Landeskrankenhaus Mödling, Mödling, Austria
| | - Veronka Horber
- Department of Paediatric Neurology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Sabine Illsinger
- Hannover Medical School, Clinic for Pediatric Kidney-, Liver- and Metabolic Diseases, Hannover, Germany
| | - Jessika Johannsen
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Kamm
- Department of Neurology, University of Rostock, Rostock, Germany
| | - Jan C Koch
- Klinik Für Neurologie Universitätsmedizin Göttingen, Göttingen, Germany
| | - Heike Koelbel
- Department of Pediatric Neurology, Centre for Neuromuscular Disorders, Centre for Translational Neuro- and Behavioral Sciences, University Duisburg-Essen, Essen, Germany
| | - Cornelia Koehler
- Klinik Für Kinder-Und Jugendmedizin der Ruhr-Universität Bochum Im St. Josef-Hospital, Bochum, Germany
| | - Kirsten Kolzter
- Kliniken Köln, Sozialpädiatrisches Zentrum, Cologne, Germany
| | - Hanns Lochmüller
- Division of Neurology, Department of Medicine, Children's Hospital of Eastern Ontario Research Institute, The Ottawa Hospital and Brain and Mind Research Institute, University of Ottawa, Ottawa, Canada
- Department of Neuropediatrics and Muscle Disorders, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Albert Ludolph
- Department for Neurology, University of Ulm, Ulm, Germany
- Department of Neurology, Ulm University, Ulm, Germany
| | - Alexander Mensch
- Department of Neurology, University Medicine Halle, Halle, Saale, Germany
| | | | - Monika Mueller
- Department for Neuropediatrics, University of Wuerzburg, Würzburg, Germany
| | - Wolfgang Mueller-Felber
- Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children With Medical Complexity, Dr. Von Hauner Children's Hospital, LMU Hospital, Ludwig-Maximilians-University, 80337, Munich, Germany
| | - Christoph Neuwirth
- Neuromuscular Diseases Unit/ALS Clinic, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Susanne Petri
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | | | - Manuel Pühringer
- Department of Pediatrics and Adolescent Medicine, Kepler University Hospital Linz, Linz, Austria
| | - Robert Steinbach
- Department of Neurology, University Hospital Jena, Jena, Germany
| | - Ulrike Schara-Schmidt
- Department of Pediatric Neurology, Centre for Neuromuscular Disorders, Centre for Translational Neuro- and Behavioral Sciences, University Duisburg-Essen, Essen, Germany
| | - Mareike Schimmel
- Pediatric Neurology, Pediatrics and Adolescent Medicine, University Medical Center Augsburg, Augsburg, Germany
| | - Bertold Schrank
- Department of Neurology, DKD Helios Klinik Wiesbaden, Wiesbaden, Germany
| | - Oliver Schwartz
- Universitätsklinikum Münster Klinik Für Kinder- Und Jugendpädiatrie- Neuropädiatrie, Albert-Schweitzer-Campus 1, Münster, Germany
| | - Kurt Schlachter
- Department of Neuropediatrics, Landeskrankenhaus Bregenz, Bregenz, Austria
| | | | | | - Martin Smitka
- Department of Neuropediatrics, Medical Faculty Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Raffi Topakian
- Department of Neurology, Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria
| | - Regina Trollmann
- Department of Pediatrics, Friedrich-Alexander Universität Erlangen-Nürnberg Pediatric Neurology, Erlangen, Germany
| | - Matthias Tuerk
- Department of Neurology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
- Centre for Rare Diseases Erlangen (ZSEER), University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | | | - Christian Rauscher
- Department for Neuropediatrics, University of Salzburg, Salzburg, Austria
| | - Mathias Vorgerd
- Department of Neurology, BG-University Hospital Bergmannsheil gGmbH, Heimer Institute for Muscle Research, Ruhr-University Bochum, Bochum, Germany
| | - Maggie C Walter
- Friedrich Baur Institute at the Department of Neurology, LMU University Hospital, Ludwig Maximilians University, Munich, Germany
| | - Markus Weiler
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Claudia Weiss
- Charité - University Medicine Berlin, Center for Chronically Sick Children, Berlin, Germany
| | | | | | - Gilbert Wunderlich
- German Center for Neurodegenerative Diseases, DZNE, Site Ulm, Ulm, Germany
- Faculty of Medicine and University Hospital, Department of Neurology and Center for Rare Diseases, University of Cologne, Cologne, Germany
| | - Daniel Zeller
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Andreas Ziegler
- Center for Childhood and Adolescent Medicine, Department of Metabolic Medicine and Pediatric Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Janbernd Kirschner
- Klinik Für Kinder-Und Jugendmedizin der Ruhr-Universität Bochum Im St. Josef-Hospital, Bochum, Germany
| | - Astrid Pechmann
- Klinik Für Kinder-Und Jugendmedizin der Ruhr-Universität Bochum Im St. Josef-Hospital, Bochum, Germany
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2
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Albuainain F, Shi Y, Lor-Zade S, Hüffmeier U, Pauly M, Reis A, Faivre L, Maraval J, Bruel AL, Them FTM, Haack TB, Grasshoff U, Horber V, Schot R, van Slegtenhorst M, Wilke M, Barakat TS. Confirmation and expansion of the phenotype of the TCEAL1-related neurodevelopmental disorder. Eur J Hum Genet 2024; 32:350-356. [PMID: 38200082 PMCID: PMC10923854 DOI: 10.1038/s41431-023-01530-6] [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] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/30/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
Numerous contiguous gene deletion syndromes causing neurodevelopmental disorders have previously been defined using cytogenetics for which only in the current genomic era the disease-causing genes have become elucidated. One such example is deletion at Xq22.2, previously associated with a neurodevelopmental disorder which has more recently been found to be caused by de novo loss-of-function variants in TCEAL1. So far, a single study reported six unrelated individuals with this monogenetic disorder, presenting with syndromic features including developmental delay especially affecting expressive speech, intellectual disability, autistic-like behaviors, hypotonia, gait abnormalities and mild facial dysmorphism, in addition to ocular, gastrointestinal, and immunologic abnormalities. Here we report on four previously undescribed individuals, including two adults, with de novo truncating variants in TCEAL1, identified through trio exome or genome sequencing, further delineating the phenotype of the TCEAL1-related disorder. Whereas overall we identify similar features compared to the original report, we also highlight features in our adult individuals including hyperphagia, obesity, and endocrine abnormalities including hyperinsulinemia, hyperandrogenemia, and polycystic ovarian syndrome. X chromosome inactivation and RNA-seq studies further provide functional insights in the molecular mechanisms. Together this report expands the phenotypic and molecular spectrum of the TCEAL1-related disorder which will be useful for counseling of newly identified individuals and their families.
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Affiliation(s)
- Fatimah Albuainain
- Department of Clinical Genetics, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Yuwei Shi
- Department of Clinical Genetics, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Sarah Lor-Zade
- Department of Clinical Genetics, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Ulrike Hüffmeier
- Institute of Human Genetics, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054, Erlangen, Germany
| | - Melissa Pauly
- Institute of Human Genetics, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054, Erlangen, Germany
| | - André Reis
- Institute of Human Genetics, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054, Erlangen, Germany
- Centre for Rare Diseases Erlangen (ZSEER), Erlangen, Germany
| | - Laurence Faivre
- Centre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs, Fédération Hospitalo-Universitaire TRANSLAD et Institut GIMI, Dijon Bourgogne University Hospital, F-21000, Dijon, France
- Inserm UMR1231 team GAD, University of Burgundy and Franche-Comté, F-21000, Dijon, France
| | - Julien Maraval
- Inserm UMR1231 team GAD, University of Burgundy and Franche-Comté, F-21000, Dijon, France
- Centre de Référence Déficiences Intellectuelles de causes rares, Dijon Bourgogne University Hospital, F-21000, Dijon, France
| | - Ange-Line Bruel
- Inserm UMR1231 team GAD, University of Burgundy and Franche-Comté, F-21000, Dijon, France
- Functional Unit of Innovative Diagnosis for Rare Diseases, Dijon Bourgogne University Hospital, F-21000, Dijon, France
| | - Frédéric Tran Mau Them
- Inserm UMR1231 team GAD, University of Burgundy and Franche-Comté, F-21000, Dijon, France
- Functional Unit of Innovative Diagnosis for Rare Diseases, Dijon Bourgogne University Hospital, F-21000, Dijon, France
| | - Tobias B Haack
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
- Centre for Rare Diseases, University of Tübingen, Tübingen, Germany
| | - Ute Grasshoff
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
| | - Veronka Horber
- Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital Tübingen, Tübingen, Germany
| | - Rachel Schot
- Department of Clinical Genetics, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Discovery Unit, Department of Clinical Genetics, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Marjon van Slegtenhorst
- Department of Clinical Genetics, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Martina Wilke
- Department of Clinical Genetics, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Tahsin Stefan Barakat
- Department of Clinical Genetics, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
- Discovery Unit, Department of Clinical Genetics, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center, Rotterdam, The Netherlands.
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3
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Horber V, Andersen GL, Arnaud C, De La Cruz J, Dakovic I, Greitane A, Hensey O, Himmelmann K, Hollody K, Horridge K, Künzle CT, Marcelli M, Ortibus E, Papavasiliou A, Perra O, Platt MJ, Rackauskaite G, Sigurdardottir S, Troha Gergeli A, Virella D, Krägeloh-Mann I, Sellier E. Prevalence, Clinical Features, Neuroimaging, and Genetic Findings in Children With Ataxic Cerebral Palsy in Europe. Neurology 2023; 101:e2509-e2521. [PMID: 37857495 PMCID: PMC10791054 DOI: 10.1212/wnl.0000000000207851] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 09/06/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND AND OBJECTIVES To report on prevalence, associated impairments, severity, and neuroimaging findings in children with ataxic cerebral palsy (CP). METHODS In children coded as having ataxic CP in the Central database of Joint Research Center-Surveillance of Cerebral Palsy in Europe (JRC-SCPE) and born during 1980-2010, birth characteristics, severity profiles including associated impairments, neuroimaging patterns, and the presence of syndromes were analyzed. Definitions were according to validated SCPE guidelines. Prevalence over time was estimated using Poisson regression. RESULTS In total, 679 children with ataxic CP were identified in 20 European CP registers. The proportion with ataxic CP was 3.8% and varied from 0% to 12.9%. Prevalence over time showed no significant trend. Approximately 70% of children with ataxic CP were able to walk, and 40% had severe intellectual impairment and a high impairment index. Children with ataxic CP were mostly born at term (79%) and with normal birth weight (77%). Neuroimaging patterns revealed normal findings in 29%, brain maldevelopments in 28.5%, miscellaneous findings in 23.5%, and brain injuries in 19%, according to the SCPE classification. Genetic syndromes were described in 9%. DISCUSSION This register-based multicenter study on children with ataxic CP provides a large sample size for the analysis of prevalence, severity, and origin of this rare CP subtype. Even with strict inclusion and classification criteria, there is variation between registers on how to deal with this subtype, and diagnosis of ataxic CP remains a challenge. Ataxic cerebral palsy differs from other CP subtypes: children with ataxic CP have a disability profile that is more pronounced in terms of cognitive than gross motor dysfunction. They are mostly term born and the origin rarely suggests acquired injuries. In addition to neuroimaging, a comprehensive genetic workup is particularly recommended for children with this CP type.
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Affiliation(s)
- Veronka Horber
- From the Department of Paediatric Neurology (V.H., I.K.-M.), University Children's Hospital Tübingen, Germany; Norwegian Quality and Surveillance Registry for Cerebral Palsy (G.L.A.), Vestfold Hospital Trust, Tønsberg, Norway; CERPOP (C.A.), UMR 1295 Toulouse University, Inserm, Paul Sabatier University, Toulouse; Clinical Epidemiology Unit (C.A.), University Hospital of Toulouse, France; Imas12 (J.D.L.C.), Hospital Universitario 12 de Octubre, RedSAMID, Madrid Spain; Department of Pediatrics (I.D.), Children's Hospital, University of Zagreb Croatia; Association Rehabilitation Center (A.G.), Riga, Latvia; The Central Remedial Clinic (O.H.), Dublin, Ireland; Department of Pediatrics (K. Himmelmann), Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; Regional Rehabilitation Centre (K. Himmelmann), Queen Silvia Children's Hospital, Gothenburg, Sweden; Department of Pediatrics (K. Hollody), Faculty of Medicine, University of Pecs, Hungary; Childhood Disability and Development (K. Horridge), University of Sunderland, UK; Zentrum für Kinderneurologie (C.T.K.), Entwicklung und Rehabilitation, Ostschweizer Kinderspital, St. Gallen, Switzerland; Developmental Age Mental Health and Rehabilitation Unit (M.M.), ASL (local Health Institution Viterbo), Viterbo, Italy; Department of Development and Regeneration (E.O.), KU Leuven, Belgium; Iaso Children's Hospital (A.P.), Athens, Greece; Queen's University Belfast (O.P.), UK; Norwich Medical School (M.J.P.), University of East Anglia, Norwich, UK; Department of Pediatrics and Adolescent Medicine (G.R.), Aarhus University Hospital, Denmark; Counselling and Diagnostic Centre (S.S.), Iceland Department of Child and Adolescent & Developmental Neurology (A.T.G.), Children´s Hospital, University Medical Centre Ljubljana, Slovenia; PVNPC (D.V.), Programa de Vigilância Nacional da Paralisia Cerebral, Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal; Grenoble Alpes University (E.S.), CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC-IMAG; and Registre des Handicaps de l'Enfant et Observatoire Périnatal (E.S.), Grenoble, France
| | - Guro L Andersen
- From the Department of Paediatric Neurology (V.H., I.K.-M.), University Children's Hospital Tübingen, Germany; Norwegian Quality and Surveillance Registry for Cerebral Palsy (G.L.A.), Vestfold Hospital Trust, Tønsberg, Norway; CERPOP (C.A.), UMR 1295 Toulouse University, Inserm, Paul Sabatier University, Toulouse; Clinical Epidemiology Unit (C.A.), University Hospital of Toulouse, France; Imas12 (J.D.L.C.), Hospital Universitario 12 de Octubre, RedSAMID, Madrid Spain; Department of Pediatrics (I.D.), Children's Hospital, University of Zagreb Croatia; Association Rehabilitation Center (A.G.), Riga, Latvia; The Central Remedial Clinic (O.H.), Dublin, Ireland; Department of Pediatrics (K. Himmelmann), Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; Regional Rehabilitation Centre (K. Himmelmann), Queen Silvia Children's Hospital, Gothenburg, Sweden; Department of Pediatrics (K. Hollody), Faculty of Medicine, University of Pecs, Hungary; Childhood Disability and Development (K. Horridge), University of Sunderland, UK; Zentrum für Kinderneurologie (C.T.K.), Entwicklung und Rehabilitation, Ostschweizer Kinderspital, St. Gallen, Switzerland; Developmental Age Mental Health and Rehabilitation Unit (M.M.), ASL (local Health Institution Viterbo), Viterbo, Italy; Department of Development and Regeneration (E.O.), KU Leuven, Belgium; Iaso Children's Hospital (A.P.), Athens, Greece; Queen's University Belfast (O.P.), UK; Norwich Medical School (M.J.P.), University of East Anglia, Norwich, UK; Department of Pediatrics and Adolescent Medicine (G.R.), Aarhus University Hospital, Denmark; Counselling and Diagnostic Centre (S.S.), Iceland Department of Child and Adolescent & Developmental Neurology (A.T.G.), Children´s Hospital, University Medical Centre Ljubljana, Slovenia; PVNPC (D.V.), Programa de Vigilância Nacional da Paralisia Cerebral, Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal; Grenoble Alpes University (E.S.), CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC-IMAG; and Registre des Handicaps de l'Enfant et Observatoire Périnatal (E.S.), Grenoble, France
| | - Catherine Arnaud
- From the Department of Paediatric Neurology (V.H., I.K.-M.), University Children's Hospital Tübingen, Germany; Norwegian Quality and Surveillance Registry for Cerebral Palsy (G.L.A.), Vestfold Hospital Trust, Tønsberg, Norway; CERPOP (C.A.), UMR 1295 Toulouse University, Inserm, Paul Sabatier University, Toulouse; Clinical Epidemiology Unit (C.A.), University Hospital of Toulouse, France; Imas12 (J.D.L.C.), Hospital Universitario 12 de Octubre, RedSAMID, Madrid Spain; Department of Pediatrics (I.D.), Children's Hospital, University of Zagreb Croatia; Association Rehabilitation Center (A.G.), Riga, Latvia; The Central Remedial Clinic (O.H.), Dublin, Ireland; Department of Pediatrics (K. Himmelmann), Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; Regional Rehabilitation Centre (K. Himmelmann), Queen Silvia Children's Hospital, Gothenburg, Sweden; Department of Pediatrics (K. Hollody), Faculty of Medicine, University of Pecs, Hungary; Childhood Disability and Development (K. Horridge), University of Sunderland, UK; Zentrum für Kinderneurologie (C.T.K.), Entwicklung und Rehabilitation, Ostschweizer Kinderspital, St. Gallen, Switzerland; Developmental Age Mental Health and Rehabilitation Unit (M.M.), ASL (local Health Institution Viterbo), Viterbo, Italy; Department of Development and Regeneration (E.O.), KU Leuven, Belgium; Iaso Children's Hospital (A.P.), Athens, Greece; Queen's University Belfast (O.P.), UK; Norwich Medical School (M.J.P.), University of East Anglia, Norwich, UK; Department of Pediatrics and Adolescent Medicine (G.R.), Aarhus University Hospital, Denmark; Counselling and Diagnostic Centre (S.S.), Iceland Department of Child and Adolescent & Developmental Neurology (A.T.G.), Children´s Hospital, University Medical Centre Ljubljana, Slovenia; PVNPC (D.V.), Programa de Vigilância Nacional da Paralisia Cerebral, Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal; Grenoble Alpes University (E.S.), CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC-IMAG; and Registre des Handicaps de l'Enfant et Observatoire Périnatal (E.S.), Grenoble, France
| | - Javier De La Cruz
- From the Department of Paediatric Neurology (V.H., I.K.-M.), University Children's Hospital Tübingen, Germany; Norwegian Quality and Surveillance Registry for Cerebral Palsy (G.L.A.), Vestfold Hospital Trust, Tønsberg, Norway; CERPOP (C.A.), UMR 1295 Toulouse University, Inserm, Paul Sabatier University, Toulouse; Clinical Epidemiology Unit (C.A.), University Hospital of Toulouse, France; Imas12 (J.D.L.C.), Hospital Universitario 12 de Octubre, RedSAMID, Madrid Spain; Department of Pediatrics (I.D.), Children's Hospital, University of Zagreb Croatia; Association Rehabilitation Center (A.G.), Riga, Latvia; The Central Remedial Clinic (O.H.), Dublin, Ireland; Department of Pediatrics (K. Himmelmann), Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; Regional Rehabilitation Centre (K. Himmelmann), Queen Silvia Children's Hospital, Gothenburg, Sweden; Department of Pediatrics (K. Hollody), Faculty of Medicine, University of Pecs, Hungary; Childhood Disability and Development (K. Horridge), University of Sunderland, UK; Zentrum für Kinderneurologie (C.T.K.), Entwicklung und Rehabilitation, Ostschweizer Kinderspital, St. Gallen, Switzerland; Developmental Age Mental Health and Rehabilitation Unit (M.M.), ASL (local Health Institution Viterbo), Viterbo, Italy; Department of Development and Regeneration (E.O.), KU Leuven, Belgium; Iaso Children's Hospital (A.P.), Athens, Greece; Queen's University Belfast (O.P.), UK; Norwich Medical School (M.J.P.), University of East Anglia, Norwich, UK; Department of Pediatrics and Adolescent Medicine (G.R.), Aarhus University Hospital, Denmark; Counselling and Diagnostic Centre (S.S.), Iceland Department of Child and Adolescent & Developmental Neurology (A.T.G.), Children´s Hospital, University Medical Centre Ljubljana, Slovenia; PVNPC (D.V.), Programa de Vigilância Nacional da Paralisia Cerebral, Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal; Grenoble Alpes University (E.S.), CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC-IMAG; and Registre des Handicaps de l'Enfant et Observatoire Périnatal (E.S.), Grenoble, France
| | - Ivana Dakovic
- From the Department of Paediatric Neurology (V.H., I.K.-M.), University Children's Hospital Tübingen, Germany; Norwegian Quality and Surveillance Registry for Cerebral Palsy (G.L.A.), Vestfold Hospital Trust, Tønsberg, Norway; CERPOP (C.A.), UMR 1295 Toulouse University, Inserm, Paul Sabatier University, Toulouse; Clinical Epidemiology Unit (C.A.), University Hospital of Toulouse, France; Imas12 (J.D.L.C.), Hospital Universitario 12 de Octubre, RedSAMID, Madrid Spain; Department of Pediatrics (I.D.), Children's Hospital, University of Zagreb Croatia; Association Rehabilitation Center (A.G.), Riga, Latvia; The Central Remedial Clinic (O.H.), Dublin, Ireland; Department of Pediatrics (K. Himmelmann), Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; Regional Rehabilitation Centre (K. Himmelmann), Queen Silvia Children's Hospital, Gothenburg, Sweden; Department of Pediatrics (K. Hollody), Faculty of Medicine, University of Pecs, Hungary; Childhood Disability and Development (K. Horridge), University of Sunderland, UK; Zentrum für Kinderneurologie (C.T.K.), Entwicklung und Rehabilitation, Ostschweizer Kinderspital, St. Gallen, Switzerland; Developmental Age Mental Health and Rehabilitation Unit (M.M.), ASL (local Health Institution Viterbo), Viterbo, Italy; Department of Development and Regeneration (E.O.), KU Leuven, Belgium; Iaso Children's Hospital (A.P.), Athens, Greece; Queen's University Belfast (O.P.), UK; Norwich Medical School (M.J.P.), University of East Anglia, Norwich, UK; Department of Pediatrics and Adolescent Medicine (G.R.), Aarhus University Hospital, Denmark; Counselling and Diagnostic Centre (S.S.), Iceland Department of Child and Adolescent & Developmental Neurology (A.T.G.), Children´s Hospital, University Medical Centre Ljubljana, Slovenia; PVNPC (D.V.), Programa de Vigilância Nacional da Paralisia Cerebral, Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal; Grenoble Alpes University (E.S.), CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC-IMAG; and Registre des Handicaps de l'Enfant et Observatoire Périnatal (E.S.), Grenoble, France
| | - Andra Greitane
- From the Department of Paediatric Neurology (V.H., I.K.-M.), University Children's Hospital Tübingen, Germany; Norwegian Quality and Surveillance Registry for Cerebral Palsy (G.L.A.), Vestfold Hospital Trust, Tønsberg, Norway; CERPOP (C.A.), UMR 1295 Toulouse University, Inserm, Paul Sabatier University, Toulouse; Clinical Epidemiology Unit (C.A.), University Hospital of Toulouse, France; Imas12 (J.D.L.C.), Hospital Universitario 12 de Octubre, RedSAMID, Madrid Spain; Department of Pediatrics (I.D.), Children's Hospital, University of Zagreb Croatia; Association Rehabilitation Center (A.G.), Riga, Latvia; The Central Remedial Clinic (O.H.), Dublin, Ireland; Department of Pediatrics (K. Himmelmann), Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; Regional Rehabilitation Centre (K. Himmelmann), Queen Silvia Children's Hospital, Gothenburg, Sweden; Department of Pediatrics (K. Hollody), Faculty of Medicine, University of Pecs, Hungary; Childhood Disability and Development (K. Horridge), University of Sunderland, UK; Zentrum für Kinderneurologie (C.T.K.), Entwicklung und Rehabilitation, Ostschweizer Kinderspital, St. Gallen, Switzerland; Developmental Age Mental Health and Rehabilitation Unit (M.M.), ASL (local Health Institution Viterbo), Viterbo, Italy; Department of Development and Regeneration (E.O.), KU Leuven, Belgium; Iaso Children's Hospital (A.P.), Athens, Greece; Queen's University Belfast (O.P.), UK; Norwich Medical School (M.J.P.), University of East Anglia, Norwich, UK; Department of Pediatrics and Adolescent Medicine (G.R.), Aarhus University Hospital, Denmark; Counselling and Diagnostic Centre (S.S.), Iceland Department of Child and Adolescent & Developmental Neurology (A.T.G.), Children´s Hospital, University Medical Centre Ljubljana, Slovenia; PVNPC (D.V.), Programa de Vigilância Nacional da Paralisia Cerebral, Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal; Grenoble Alpes University (E.S.), CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC-IMAG; and Registre des Handicaps de l'Enfant et Observatoire Périnatal (E.S.), Grenoble, France
| | - Owen Hensey
- From the Department of Paediatric Neurology (V.H., I.K.-M.), University Children's Hospital Tübingen, Germany; Norwegian Quality and Surveillance Registry for Cerebral Palsy (G.L.A.), Vestfold Hospital Trust, Tønsberg, Norway; CERPOP (C.A.), UMR 1295 Toulouse University, Inserm, Paul Sabatier University, Toulouse; Clinical Epidemiology Unit (C.A.), University Hospital of Toulouse, France; Imas12 (J.D.L.C.), Hospital Universitario 12 de Octubre, RedSAMID, Madrid Spain; Department of Pediatrics (I.D.), Children's Hospital, University of Zagreb Croatia; Association Rehabilitation Center (A.G.), Riga, Latvia; The Central Remedial Clinic (O.H.), Dublin, Ireland; Department of Pediatrics (K. Himmelmann), Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; Regional Rehabilitation Centre (K. Himmelmann), Queen Silvia Children's Hospital, Gothenburg, Sweden; Department of Pediatrics (K. Hollody), Faculty of Medicine, University of Pecs, Hungary; Childhood Disability and Development (K. Horridge), University of Sunderland, UK; Zentrum für Kinderneurologie (C.T.K.), Entwicklung und Rehabilitation, Ostschweizer Kinderspital, St. Gallen, Switzerland; Developmental Age Mental Health and Rehabilitation Unit (M.M.), ASL (local Health Institution Viterbo), Viterbo, Italy; Department of Development and Regeneration (E.O.), KU Leuven, Belgium; Iaso Children's Hospital (A.P.), Athens, Greece; Queen's University Belfast (O.P.), UK; Norwich Medical School (M.J.P.), University of East Anglia, Norwich, UK; Department of Pediatrics and Adolescent Medicine (G.R.), Aarhus University Hospital, Denmark; Counselling and Diagnostic Centre (S.S.), Iceland Department of Child and Adolescent & Developmental Neurology (A.T.G.), Children´s Hospital, University Medical Centre Ljubljana, Slovenia; PVNPC (D.V.), Programa de Vigilância Nacional da Paralisia Cerebral, Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal; Grenoble Alpes University (E.S.), CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC-IMAG; and Registre des Handicaps de l'Enfant et Observatoire Périnatal (E.S.), Grenoble, France
| | - Kate Himmelmann
- From the Department of Paediatric Neurology (V.H., I.K.-M.), University Children's Hospital Tübingen, Germany; Norwegian Quality and Surveillance Registry for Cerebral Palsy (G.L.A.), Vestfold Hospital Trust, Tønsberg, Norway; CERPOP (C.A.), UMR 1295 Toulouse University, Inserm, Paul Sabatier University, Toulouse; Clinical Epidemiology Unit (C.A.), University Hospital of Toulouse, France; Imas12 (J.D.L.C.), Hospital Universitario 12 de Octubre, RedSAMID, Madrid Spain; Department of Pediatrics (I.D.), Children's Hospital, University of Zagreb Croatia; Association Rehabilitation Center (A.G.), Riga, Latvia; The Central Remedial Clinic (O.H.), Dublin, Ireland; Department of Pediatrics (K. Himmelmann), Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; Regional Rehabilitation Centre (K. Himmelmann), Queen Silvia Children's Hospital, Gothenburg, Sweden; Department of Pediatrics (K. Hollody), Faculty of Medicine, University of Pecs, Hungary; Childhood Disability and Development (K. Horridge), University of Sunderland, UK; Zentrum für Kinderneurologie (C.T.K.), Entwicklung und Rehabilitation, Ostschweizer Kinderspital, St. Gallen, Switzerland; Developmental Age Mental Health and Rehabilitation Unit (M.M.), ASL (local Health Institution Viterbo), Viterbo, Italy; Department of Development and Regeneration (E.O.), KU Leuven, Belgium; Iaso Children's Hospital (A.P.), Athens, Greece; Queen's University Belfast (O.P.), UK; Norwich Medical School (M.J.P.), University of East Anglia, Norwich, UK; Department of Pediatrics and Adolescent Medicine (G.R.), Aarhus University Hospital, Denmark; Counselling and Diagnostic Centre (S.S.), Iceland Department of Child and Adolescent & Developmental Neurology (A.T.G.), Children´s Hospital, University Medical Centre Ljubljana, Slovenia; PVNPC (D.V.), Programa de Vigilância Nacional da Paralisia Cerebral, Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal; Grenoble Alpes University (E.S.), CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC-IMAG; and Registre des Handicaps de l'Enfant et Observatoire Périnatal (E.S.), Grenoble, France
| | - Katalin Hollody
- From the Department of Paediatric Neurology (V.H., I.K.-M.), University Children's Hospital Tübingen, Germany; Norwegian Quality and Surveillance Registry for Cerebral Palsy (G.L.A.), Vestfold Hospital Trust, Tønsberg, Norway; CERPOP (C.A.), UMR 1295 Toulouse University, Inserm, Paul Sabatier University, Toulouse; Clinical Epidemiology Unit (C.A.), University Hospital of Toulouse, France; Imas12 (J.D.L.C.), Hospital Universitario 12 de Octubre, RedSAMID, Madrid Spain; Department of Pediatrics (I.D.), Children's Hospital, University of Zagreb Croatia; Association Rehabilitation Center (A.G.), Riga, Latvia; The Central Remedial Clinic (O.H.), Dublin, Ireland; Department of Pediatrics (K. Himmelmann), Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; Regional Rehabilitation Centre (K. Himmelmann), Queen Silvia Children's Hospital, Gothenburg, Sweden; Department of Pediatrics (K. Hollody), Faculty of Medicine, University of Pecs, Hungary; Childhood Disability and Development (K. Horridge), University of Sunderland, UK; Zentrum für Kinderneurologie (C.T.K.), Entwicklung und Rehabilitation, Ostschweizer Kinderspital, St. Gallen, Switzerland; Developmental Age Mental Health and Rehabilitation Unit (M.M.), ASL (local Health Institution Viterbo), Viterbo, Italy; Department of Development and Regeneration (E.O.), KU Leuven, Belgium; Iaso Children's Hospital (A.P.), Athens, Greece; Queen's University Belfast (O.P.), UK; Norwich Medical School (M.J.P.), University of East Anglia, Norwich, UK; Department of Pediatrics and Adolescent Medicine (G.R.), Aarhus University Hospital, Denmark; Counselling and Diagnostic Centre (S.S.), Iceland Department of Child and Adolescent & Developmental Neurology (A.T.G.), Children´s Hospital, University Medical Centre Ljubljana, Slovenia; PVNPC (D.V.), Programa de Vigilância Nacional da Paralisia Cerebral, Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal; Grenoble Alpes University (E.S.), CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC-IMAG; and Registre des Handicaps de l'Enfant et Observatoire Périnatal (E.S.), Grenoble, France
| | - Karen Horridge
- From the Department of Paediatric Neurology (V.H., I.K.-M.), University Children's Hospital Tübingen, Germany; Norwegian Quality and Surveillance Registry for Cerebral Palsy (G.L.A.), Vestfold Hospital Trust, Tønsberg, Norway; CERPOP (C.A.), UMR 1295 Toulouse University, Inserm, Paul Sabatier University, Toulouse; Clinical Epidemiology Unit (C.A.), University Hospital of Toulouse, France; Imas12 (J.D.L.C.), Hospital Universitario 12 de Octubre, RedSAMID, Madrid Spain; Department of Pediatrics (I.D.), Children's Hospital, University of Zagreb Croatia; Association Rehabilitation Center (A.G.), Riga, Latvia; The Central Remedial Clinic (O.H.), Dublin, Ireland; Department of Pediatrics (K. Himmelmann), Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; Regional Rehabilitation Centre (K. Himmelmann), Queen Silvia Children's Hospital, Gothenburg, Sweden; Department of Pediatrics (K. Hollody), Faculty of Medicine, University of Pecs, Hungary; Childhood Disability and Development (K. Horridge), University of Sunderland, UK; Zentrum für Kinderneurologie (C.T.K.), Entwicklung und Rehabilitation, Ostschweizer Kinderspital, St. Gallen, Switzerland; Developmental Age Mental Health and Rehabilitation Unit (M.M.), ASL (local Health Institution Viterbo), Viterbo, Italy; Department of Development and Regeneration (E.O.), KU Leuven, Belgium; Iaso Children's Hospital (A.P.), Athens, Greece; Queen's University Belfast (O.P.), UK; Norwich Medical School (M.J.P.), University of East Anglia, Norwich, UK; Department of Pediatrics and Adolescent Medicine (G.R.), Aarhus University Hospital, Denmark; Counselling and Diagnostic Centre (S.S.), Iceland Department of Child and Adolescent & Developmental Neurology (A.T.G.), Children´s Hospital, University Medical Centre Ljubljana, Slovenia; PVNPC (D.V.), Programa de Vigilância Nacional da Paralisia Cerebral, Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal; Grenoble Alpes University (E.S.), CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC-IMAG; and Registre des Handicaps de l'Enfant et Observatoire Périnatal (E.S.), Grenoble, France
| | - Christoph T Künzle
- From the Department of Paediatric Neurology (V.H., I.K.-M.), University Children's Hospital Tübingen, Germany; Norwegian Quality and Surveillance Registry for Cerebral Palsy (G.L.A.), Vestfold Hospital Trust, Tønsberg, Norway; CERPOP (C.A.), UMR 1295 Toulouse University, Inserm, Paul Sabatier University, Toulouse; Clinical Epidemiology Unit (C.A.), University Hospital of Toulouse, France; Imas12 (J.D.L.C.), Hospital Universitario 12 de Octubre, RedSAMID, Madrid Spain; Department of Pediatrics (I.D.), Children's Hospital, University of Zagreb Croatia; Association Rehabilitation Center (A.G.), Riga, Latvia; The Central Remedial Clinic (O.H.), Dublin, Ireland; Department of Pediatrics (K. Himmelmann), Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; Regional Rehabilitation Centre (K. Himmelmann), Queen Silvia Children's Hospital, Gothenburg, Sweden; Department of Pediatrics (K. Hollody), Faculty of Medicine, University of Pecs, Hungary; Childhood Disability and Development (K. Horridge), University of Sunderland, UK; Zentrum für Kinderneurologie (C.T.K.), Entwicklung und Rehabilitation, Ostschweizer Kinderspital, St. Gallen, Switzerland; Developmental Age Mental Health and Rehabilitation Unit (M.M.), ASL (local Health Institution Viterbo), Viterbo, Italy; Department of Development and Regeneration (E.O.), KU Leuven, Belgium; Iaso Children's Hospital (A.P.), Athens, Greece; Queen's University Belfast (O.P.), UK; Norwich Medical School (M.J.P.), University of East Anglia, Norwich, UK; Department of Pediatrics and Adolescent Medicine (G.R.), Aarhus University Hospital, Denmark; Counselling and Diagnostic Centre (S.S.), Iceland Department of Child and Adolescent & Developmental Neurology (A.T.G.), Children´s Hospital, University Medical Centre Ljubljana, Slovenia; PVNPC (D.V.), Programa de Vigilância Nacional da Paralisia Cerebral, Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal; Grenoble Alpes University (E.S.), CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC-IMAG; and Registre des Handicaps de l'Enfant et Observatoire Périnatal (E.S.), Grenoble, France
| | - Marco Marcelli
- From the Department of Paediatric Neurology (V.H., I.K.-M.), University Children's Hospital Tübingen, Germany; Norwegian Quality and Surveillance Registry for Cerebral Palsy (G.L.A.), Vestfold Hospital Trust, Tønsberg, Norway; CERPOP (C.A.), UMR 1295 Toulouse University, Inserm, Paul Sabatier University, Toulouse; Clinical Epidemiology Unit (C.A.), University Hospital of Toulouse, France; Imas12 (J.D.L.C.), Hospital Universitario 12 de Octubre, RedSAMID, Madrid Spain; Department of Pediatrics (I.D.), Children's Hospital, University of Zagreb Croatia; Association Rehabilitation Center (A.G.), Riga, Latvia; The Central Remedial Clinic (O.H.), Dublin, Ireland; Department of Pediatrics (K. Himmelmann), Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; Regional Rehabilitation Centre (K. Himmelmann), Queen Silvia Children's Hospital, Gothenburg, Sweden; Department of Pediatrics (K. Hollody), Faculty of Medicine, University of Pecs, Hungary; Childhood Disability and Development (K. Horridge), University of Sunderland, UK; Zentrum für Kinderneurologie (C.T.K.), Entwicklung und Rehabilitation, Ostschweizer Kinderspital, St. Gallen, Switzerland; Developmental Age Mental Health and Rehabilitation Unit (M.M.), ASL (local Health Institution Viterbo), Viterbo, Italy; Department of Development and Regeneration (E.O.), KU Leuven, Belgium; Iaso Children's Hospital (A.P.), Athens, Greece; Queen's University Belfast (O.P.), UK; Norwich Medical School (M.J.P.), University of East Anglia, Norwich, UK; Department of Pediatrics and Adolescent Medicine (G.R.), Aarhus University Hospital, Denmark; Counselling and Diagnostic Centre (S.S.), Iceland Department of Child and Adolescent & Developmental Neurology (A.T.G.), Children´s Hospital, University Medical Centre Ljubljana, Slovenia; PVNPC (D.V.), Programa de Vigilância Nacional da Paralisia Cerebral, Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal; Grenoble Alpes University (E.S.), CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC-IMAG; and Registre des Handicaps de l'Enfant et Observatoire Périnatal (E.S.), Grenoble, France
| | - Els Ortibus
- From the Department of Paediatric Neurology (V.H., I.K.-M.), University Children's Hospital Tübingen, Germany; Norwegian Quality and Surveillance Registry for Cerebral Palsy (G.L.A.), Vestfold Hospital Trust, Tønsberg, Norway; CERPOP (C.A.), UMR 1295 Toulouse University, Inserm, Paul Sabatier University, Toulouse; Clinical Epidemiology Unit (C.A.), University Hospital of Toulouse, France; Imas12 (J.D.L.C.), Hospital Universitario 12 de Octubre, RedSAMID, Madrid Spain; Department of Pediatrics (I.D.), Children's Hospital, University of Zagreb Croatia; Association Rehabilitation Center (A.G.), Riga, Latvia; The Central Remedial Clinic (O.H.), Dublin, Ireland; Department of Pediatrics (K. Himmelmann), Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; Regional Rehabilitation Centre (K. Himmelmann), Queen Silvia Children's Hospital, Gothenburg, Sweden; Department of Pediatrics (K. Hollody), Faculty of Medicine, University of Pecs, Hungary; Childhood Disability and Development (K. Horridge), University of Sunderland, UK; Zentrum für Kinderneurologie (C.T.K.), Entwicklung und Rehabilitation, Ostschweizer Kinderspital, St. Gallen, Switzerland; Developmental Age Mental Health and Rehabilitation Unit (M.M.), ASL (local Health Institution Viterbo), Viterbo, Italy; Department of Development and Regeneration (E.O.), KU Leuven, Belgium; Iaso Children's Hospital (A.P.), Athens, Greece; Queen's University Belfast (O.P.), UK; Norwich Medical School (M.J.P.), University of East Anglia, Norwich, UK; Department of Pediatrics and Adolescent Medicine (G.R.), Aarhus University Hospital, Denmark; Counselling and Diagnostic Centre (S.S.), Iceland Department of Child and Adolescent & Developmental Neurology (A.T.G.), Children´s Hospital, University Medical Centre Ljubljana, Slovenia; PVNPC (D.V.), Programa de Vigilância Nacional da Paralisia Cerebral, Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal; Grenoble Alpes University (E.S.), CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC-IMAG; and Registre des Handicaps de l'Enfant et Observatoire Périnatal (E.S.), Grenoble, France
| | - Antigone Papavasiliou
- From the Department of Paediatric Neurology (V.H., I.K.-M.), University Children's Hospital Tübingen, Germany; Norwegian Quality and Surveillance Registry for Cerebral Palsy (G.L.A.), Vestfold Hospital Trust, Tønsberg, Norway; CERPOP (C.A.), UMR 1295 Toulouse University, Inserm, Paul Sabatier University, Toulouse; Clinical Epidemiology Unit (C.A.), University Hospital of Toulouse, France; Imas12 (J.D.L.C.), Hospital Universitario 12 de Octubre, RedSAMID, Madrid Spain; Department of Pediatrics (I.D.), Children's Hospital, University of Zagreb Croatia; Association Rehabilitation Center (A.G.), Riga, Latvia; The Central Remedial Clinic (O.H.), Dublin, Ireland; Department of Pediatrics (K. Himmelmann), Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; Regional Rehabilitation Centre (K. Himmelmann), Queen Silvia Children's Hospital, Gothenburg, Sweden; Department of Pediatrics (K. Hollody), Faculty of Medicine, University of Pecs, Hungary; Childhood Disability and Development (K. Horridge), University of Sunderland, UK; Zentrum für Kinderneurologie (C.T.K.), Entwicklung und Rehabilitation, Ostschweizer Kinderspital, St. Gallen, Switzerland; Developmental Age Mental Health and Rehabilitation Unit (M.M.), ASL (local Health Institution Viterbo), Viterbo, Italy; Department of Development and Regeneration (E.O.), KU Leuven, Belgium; Iaso Children's Hospital (A.P.), Athens, Greece; Queen's University Belfast (O.P.), UK; Norwich Medical School (M.J.P.), University of East Anglia, Norwich, UK; Department of Pediatrics and Adolescent Medicine (G.R.), Aarhus University Hospital, Denmark; Counselling and Diagnostic Centre (S.S.), Iceland Department of Child and Adolescent & Developmental Neurology (A.T.G.), Children´s Hospital, University Medical Centre Ljubljana, Slovenia; PVNPC (D.V.), Programa de Vigilância Nacional da Paralisia Cerebral, Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal; Grenoble Alpes University (E.S.), CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC-IMAG; and Registre des Handicaps de l'Enfant et Observatoire Périnatal (E.S.), Grenoble, France
| | - Oliver Perra
- From the Department of Paediatric Neurology (V.H., I.K.-M.), University Children's Hospital Tübingen, Germany; Norwegian Quality and Surveillance Registry for Cerebral Palsy (G.L.A.), Vestfold Hospital Trust, Tønsberg, Norway; CERPOP (C.A.), UMR 1295 Toulouse University, Inserm, Paul Sabatier University, Toulouse; Clinical Epidemiology Unit (C.A.), University Hospital of Toulouse, France; Imas12 (J.D.L.C.), Hospital Universitario 12 de Octubre, RedSAMID, Madrid Spain; Department of Pediatrics (I.D.), Children's Hospital, University of Zagreb Croatia; Association Rehabilitation Center (A.G.), Riga, Latvia; The Central Remedial Clinic (O.H.), Dublin, Ireland; Department of Pediatrics (K. Himmelmann), Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; Regional Rehabilitation Centre (K. Himmelmann), Queen Silvia Children's Hospital, Gothenburg, Sweden; Department of Pediatrics (K. Hollody), Faculty of Medicine, University of Pecs, Hungary; Childhood Disability and Development (K. Horridge), University of Sunderland, UK; Zentrum für Kinderneurologie (C.T.K.), Entwicklung und Rehabilitation, Ostschweizer Kinderspital, St. Gallen, Switzerland; Developmental Age Mental Health and Rehabilitation Unit (M.M.), ASL (local Health Institution Viterbo), Viterbo, Italy; Department of Development and Regeneration (E.O.), KU Leuven, Belgium; Iaso Children's Hospital (A.P.), Athens, Greece; Queen's University Belfast (O.P.), UK; Norwich Medical School (M.J.P.), University of East Anglia, Norwich, UK; Department of Pediatrics and Adolescent Medicine (G.R.), Aarhus University Hospital, Denmark; Counselling and Diagnostic Centre (S.S.), Iceland Department of Child and Adolescent & Developmental Neurology (A.T.G.), Children´s Hospital, University Medical Centre Ljubljana, Slovenia; PVNPC (D.V.), Programa de Vigilância Nacional da Paralisia Cerebral, Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal; Grenoble Alpes University (E.S.), CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC-IMAG; and Registre des Handicaps de l'Enfant et Observatoire Périnatal (E.S.), Grenoble, France
| | - Mary J Platt
- From the Department of Paediatric Neurology (V.H., I.K.-M.), University Children's Hospital Tübingen, Germany; Norwegian Quality and Surveillance Registry for Cerebral Palsy (G.L.A.), Vestfold Hospital Trust, Tønsberg, Norway; CERPOP (C.A.), UMR 1295 Toulouse University, Inserm, Paul Sabatier University, Toulouse; Clinical Epidemiology Unit (C.A.), University Hospital of Toulouse, France; Imas12 (J.D.L.C.), Hospital Universitario 12 de Octubre, RedSAMID, Madrid Spain; Department of Pediatrics (I.D.), Children's Hospital, University of Zagreb Croatia; Association Rehabilitation Center (A.G.), Riga, Latvia; The Central Remedial Clinic (O.H.), Dublin, Ireland; Department of Pediatrics (K. Himmelmann), Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; Regional Rehabilitation Centre (K. Himmelmann), Queen Silvia Children's Hospital, Gothenburg, Sweden; Department of Pediatrics (K. Hollody), Faculty of Medicine, University of Pecs, Hungary; Childhood Disability and Development (K. Horridge), University of Sunderland, UK; Zentrum für Kinderneurologie (C.T.K.), Entwicklung und Rehabilitation, Ostschweizer Kinderspital, St. Gallen, Switzerland; Developmental Age Mental Health and Rehabilitation Unit (M.M.), ASL (local Health Institution Viterbo), Viterbo, Italy; Department of Development and Regeneration (E.O.), KU Leuven, Belgium; Iaso Children's Hospital (A.P.), Athens, Greece; Queen's University Belfast (O.P.), UK; Norwich Medical School (M.J.P.), University of East Anglia, Norwich, UK; Department of Pediatrics and Adolescent Medicine (G.R.), Aarhus University Hospital, Denmark; Counselling and Diagnostic Centre (S.S.), Iceland Department of Child and Adolescent & Developmental Neurology (A.T.G.), Children´s Hospital, University Medical Centre Ljubljana, Slovenia; PVNPC (D.V.), Programa de Vigilância Nacional da Paralisia Cerebral, Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal; Grenoble Alpes University (E.S.), CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC-IMAG; and Registre des Handicaps de l'Enfant et Observatoire Périnatal (E.S.), Grenoble, France
| | - Gija Rackauskaite
- From the Department of Paediatric Neurology (V.H., I.K.-M.), University Children's Hospital Tübingen, Germany; Norwegian Quality and Surveillance Registry for Cerebral Palsy (G.L.A.), Vestfold Hospital Trust, Tønsberg, Norway; CERPOP (C.A.), UMR 1295 Toulouse University, Inserm, Paul Sabatier University, Toulouse; Clinical Epidemiology Unit (C.A.), University Hospital of Toulouse, France; Imas12 (J.D.L.C.), Hospital Universitario 12 de Octubre, RedSAMID, Madrid Spain; Department of Pediatrics (I.D.), Children's Hospital, University of Zagreb Croatia; Association Rehabilitation Center (A.G.), Riga, Latvia; The Central Remedial Clinic (O.H.), Dublin, Ireland; Department of Pediatrics (K. Himmelmann), Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; Regional Rehabilitation Centre (K. Himmelmann), Queen Silvia Children's Hospital, Gothenburg, Sweden; Department of Pediatrics (K. Hollody), Faculty of Medicine, University of Pecs, Hungary; Childhood Disability and Development (K. Horridge), University of Sunderland, UK; Zentrum für Kinderneurologie (C.T.K.), Entwicklung und Rehabilitation, Ostschweizer Kinderspital, St. Gallen, Switzerland; Developmental Age Mental Health and Rehabilitation Unit (M.M.), ASL (local Health Institution Viterbo), Viterbo, Italy; Department of Development and Regeneration (E.O.), KU Leuven, Belgium; Iaso Children's Hospital (A.P.), Athens, Greece; Queen's University Belfast (O.P.), UK; Norwich Medical School (M.J.P.), University of East Anglia, Norwich, UK; Department of Pediatrics and Adolescent Medicine (G.R.), Aarhus University Hospital, Denmark; Counselling and Diagnostic Centre (S.S.), Iceland Department of Child and Adolescent & Developmental Neurology (A.T.G.), Children´s Hospital, University Medical Centre Ljubljana, Slovenia; PVNPC (D.V.), Programa de Vigilância Nacional da Paralisia Cerebral, Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal; Grenoble Alpes University (E.S.), CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC-IMAG; and Registre des Handicaps de l'Enfant et Observatoire Périnatal (E.S.), Grenoble, France
| | - Solveig Sigurdardottir
- From the Department of Paediatric Neurology (V.H., I.K.-M.), University Children's Hospital Tübingen, Germany; Norwegian Quality and Surveillance Registry for Cerebral Palsy (G.L.A.), Vestfold Hospital Trust, Tønsberg, Norway; CERPOP (C.A.), UMR 1295 Toulouse University, Inserm, Paul Sabatier University, Toulouse; Clinical Epidemiology Unit (C.A.), University Hospital of Toulouse, France; Imas12 (J.D.L.C.), Hospital Universitario 12 de Octubre, RedSAMID, Madrid Spain; Department of Pediatrics (I.D.), Children's Hospital, University of Zagreb Croatia; Association Rehabilitation Center (A.G.), Riga, Latvia; The Central Remedial Clinic (O.H.), Dublin, Ireland; Department of Pediatrics (K. Himmelmann), Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; Regional Rehabilitation Centre (K. Himmelmann), Queen Silvia Children's Hospital, Gothenburg, Sweden; Department of Pediatrics (K. Hollody), Faculty of Medicine, University of Pecs, Hungary; Childhood Disability and Development (K. Horridge), University of Sunderland, UK; Zentrum für Kinderneurologie (C.T.K.), Entwicklung und Rehabilitation, Ostschweizer Kinderspital, St. Gallen, Switzerland; Developmental Age Mental Health and Rehabilitation Unit (M.M.), ASL (local Health Institution Viterbo), Viterbo, Italy; Department of Development and Regeneration (E.O.), KU Leuven, Belgium; Iaso Children's Hospital (A.P.), Athens, Greece; Queen's University Belfast (O.P.), UK; Norwich Medical School (M.J.P.), University of East Anglia, Norwich, UK; Department of Pediatrics and Adolescent Medicine (G.R.), Aarhus University Hospital, Denmark; Counselling and Diagnostic Centre (S.S.), Iceland Department of Child and Adolescent & Developmental Neurology (A.T.G.), Children´s Hospital, University Medical Centre Ljubljana, Slovenia; PVNPC (D.V.), Programa de Vigilância Nacional da Paralisia Cerebral, Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal; Grenoble Alpes University (E.S.), CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC-IMAG; and Registre des Handicaps de l'Enfant et Observatoire Périnatal (E.S.), Grenoble, France
| | - Anja Troha Gergeli
- From the Department of Paediatric Neurology (V.H., I.K.-M.), University Children's Hospital Tübingen, Germany; Norwegian Quality and Surveillance Registry for Cerebral Palsy (G.L.A.), Vestfold Hospital Trust, Tønsberg, Norway; CERPOP (C.A.), UMR 1295 Toulouse University, Inserm, Paul Sabatier University, Toulouse; Clinical Epidemiology Unit (C.A.), University Hospital of Toulouse, France; Imas12 (J.D.L.C.), Hospital Universitario 12 de Octubre, RedSAMID, Madrid Spain; Department of Pediatrics (I.D.), Children's Hospital, University of Zagreb Croatia; Association Rehabilitation Center (A.G.), Riga, Latvia; The Central Remedial Clinic (O.H.), Dublin, Ireland; Department of Pediatrics (K. Himmelmann), Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; Regional Rehabilitation Centre (K. Himmelmann), Queen Silvia Children's Hospital, Gothenburg, Sweden; Department of Pediatrics (K. Hollody), Faculty of Medicine, University of Pecs, Hungary; Childhood Disability and Development (K. Horridge), University of Sunderland, UK; Zentrum für Kinderneurologie (C.T.K.), Entwicklung und Rehabilitation, Ostschweizer Kinderspital, St. Gallen, Switzerland; Developmental Age Mental Health and Rehabilitation Unit (M.M.), ASL (local Health Institution Viterbo), Viterbo, Italy; Department of Development and Regeneration (E.O.), KU Leuven, Belgium; Iaso Children's Hospital (A.P.), Athens, Greece; Queen's University Belfast (O.P.), UK; Norwich Medical School (M.J.P.), University of East Anglia, Norwich, UK; Department of Pediatrics and Adolescent Medicine (G.R.), Aarhus University Hospital, Denmark; Counselling and Diagnostic Centre (S.S.), Iceland Department of Child and Adolescent & Developmental Neurology (A.T.G.), Children´s Hospital, University Medical Centre Ljubljana, Slovenia; PVNPC (D.V.), Programa de Vigilância Nacional da Paralisia Cerebral, Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal; Grenoble Alpes University (E.S.), CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC-IMAG; and Registre des Handicaps de l'Enfant et Observatoire Périnatal (E.S.), Grenoble, France
| | - Daniel Virella
- From the Department of Paediatric Neurology (V.H., I.K.-M.), University Children's Hospital Tübingen, Germany; Norwegian Quality and Surveillance Registry for Cerebral Palsy (G.L.A.), Vestfold Hospital Trust, Tønsberg, Norway; CERPOP (C.A.), UMR 1295 Toulouse University, Inserm, Paul Sabatier University, Toulouse; Clinical Epidemiology Unit (C.A.), University Hospital of Toulouse, France; Imas12 (J.D.L.C.), Hospital Universitario 12 de Octubre, RedSAMID, Madrid Spain; Department of Pediatrics (I.D.), Children's Hospital, University of Zagreb Croatia; Association Rehabilitation Center (A.G.), Riga, Latvia; The Central Remedial Clinic (O.H.), Dublin, Ireland; Department of Pediatrics (K. Himmelmann), Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; Regional Rehabilitation Centre (K. Himmelmann), Queen Silvia Children's Hospital, Gothenburg, Sweden; Department of Pediatrics (K. Hollody), Faculty of Medicine, University of Pecs, Hungary; Childhood Disability and Development (K. Horridge), University of Sunderland, UK; Zentrum für Kinderneurologie (C.T.K.), Entwicklung und Rehabilitation, Ostschweizer Kinderspital, St. Gallen, Switzerland; Developmental Age Mental Health and Rehabilitation Unit (M.M.), ASL (local Health Institution Viterbo), Viterbo, Italy; Department of Development and Regeneration (E.O.), KU Leuven, Belgium; Iaso Children's Hospital (A.P.), Athens, Greece; Queen's University Belfast (O.P.), UK; Norwich Medical School (M.J.P.), University of East Anglia, Norwich, UK; Department of Pediatrics and Adolescent Medicine (G.R.), Aarhus University Hospital, Denmark; Counselling and Diagnostic Centre (S.S.), Iceland Department of Child and Adolescent & Developmental Neurology (A.T.G.), Children´s Hospital, University Medical Centre Ljubljana, Slovenia; PVNPC (D.V.), Programa de Vigilância Nacional da Paralisia Cerebral, Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal; Grenoble Alpes University (E.S.), CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC-IMAG; and Registre des Handicaps de l'Enfant et Observatoire Périnatal (E.S.), Grenoble, France
| | - Ingeborg Krägeloh-Mann
- From the Department of Paediatric Neurology (V.H., I.K.-M.), University Children's Hospital Tübingen, Germany; Norwegian Quality and Surveillance Registry for Cerebral Palsy (G.L.A.), Vestfold Hospital Trust, Tønsberg, Norway; CERPOP (C.A.), UMR 1295 Toulouse University, Inserm, Paul Sabatier University, Toulouse; Clinical Epidemiology Unit (C.A.), University Hospital of Toulouse, France; Imas12 (J.D.L.C.), Hospital Universitario 12 de Octubre, RedSAMID, Madrid Spain; Department of Pediatrics (I.D.), Children's Hospital, University of Zagreb Croatia; Association Rehabilitation Center (A.G.), Riga, Latvia; The Central Remedial Clinic (O.H.), Dublin, Ireland; Department of Pediatrics (K. Himmelmann), Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; Regional Rehabilitation Centre (K. Himmelmann), Queen Silvia Children's Hospital, Gothenburg, Sweden; Department of Pediatrics (K. Hollody), Faculty of Medicine, University of Pecs, Hungary; Childhood Disability and Development (K. Horridge), University of Sunderland, UK; Zentrum für Kinderneurologie (C.T.K.), Entwicklung und Rehabilitation, Ostschweizer Kinderspital, St. Gallen, Switzerland; Developmental Age Mental Health and Rehabilitation Unit (M.M.), ASL (local Health Institution Viterbo), Viterbo, Italy; Department of Development and Regeneration (E.O.), KU Leuven, Belgium; Iaso Children's Hospital (A.P.), Athens, Greece; Queen's University Belfast (O.P.), UK; Norwich Medical School (M.J.P.), University of East Anglia, Norwich, UK; Department of Pediatrics and Adolescent Medicine (G.R.), Aarhus University Hospital, Denmark; Counselling and Diagnostic Centre (S.S.), Iceland Department of Child and Adolescent & Developmental Neurology (A.T.G.), Children´s Hospital, University Medical Centre Ljubljana, Slovenia; PVNPC (D.V.), Programa de Vigilância Nacional da Paralisia Cerebral, Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal; Grenoble Alpes University (E.S.), CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC-IMAG; and Registre des Handicaps de l'Enfant et Observatoire Périnatal (E.S.), Grenoble, France
| | - Elodie Sellier
- From the Department of Paediatric Neurology (V.H., I.K.-M.), University Children's Hospital Tübingen, Germany; Norwegian Quality and Surveillance Registry for Cerebral Palsy (G.L.A.), Vestfold Hospital Trust, Tønsberg, Norway; CERPOP (C.A.), UMR 1295 Toulouse University, Inserm, Paul Sabatier University, Toulouse; Clinical Epidemiology Unit (C.A.), University Hospital of Toulouse, France; Imas12 (J.D.L.C.), Hospital Universitario 12 de Octubre, RedSAMID, Madrid Spain; Department of Pediatrics (I.D.), Children's Hospital, University of Zagreb Croatia; Association Rehabilitation Center (A.G.), Riga, Latvia; The Central Remedial Clinic (O.H.), Dublin, Ireland; Department of Pediatrics (K. Himmelmann), Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; Regional Rehabilitation Centre (K. Himmelmann), Queen Silvia Children's Hospital, Gothenburg, Sweden; Department of Pediatrics (K. Hollody), Faculty of Medicine, University of Pecs, Hungary; Childhood Disability and Development (K. Horridge), University of Sunderland, UK; Zentrum für Kinderneurologie (C.T.K.), Entwicklung und Rehabilitation, Ostschweizer Kinderspital, St. Gallen, Switzerland; Developmental Age Mental Health and Rehabilitation Unit (M.M.), ASL (local Health Institution Viterbo), Viterbo, Italy; Department of Development and Regeneration (E.O.), KU Leuven, Belgium; Iaso Children's Hospital (A.P.), Athens, Greece; Queen's University Belfast (O.P.), UK; Norwich Medical School (M.J.P.), University of East Anglia, Norwich, UK; Department of Pediatrics and Adolescent Medicine (G.R.), Aarhus University Hospital, Denmark; Counselling and Diagnostic Centre (S.S.), Iceland Department of Child and Adolescent & Developmental Neurology (A.T.G.), Children´s Hospital, University Medical Centre Ljubljana, Slovenia; PVNPC (D.V.), Programa de Vigilância Nacional da Paralisia Cerebral, Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal; Grenoble Alpes University (E.S.), CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC-IMAG; and Registre des Handicaps de l'Enfant et Observatoire Périnatal (E.S.), Grenoble, France
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4
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Johannsen J, Weiss D, Driemeyer J, Olfe J, Stute F, Müller F, Schütt M, Trollmann R, Kölbel H, Schara-Schmidt U, Kirschner J, Pechmann A, Blaschek A, Horber V, Denecke J. High-sensitive cardiac troponin I (hs-cTnI) concentrations in newborns diagnosed with spinal muscular atrophy. Front Pediatr 2023; 11:1259293. [PMID: 38034835 PMCID: PMC10687177 DOI: 10.3389/fped.2023.1259293] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 10/26/2023] [Indexed: 12/02/2023] Open
Abstract
Background Spinal muscular atrophy (SMA) is a genetic neurodegenerative disease leading to muscular weakness and premature death. Three therapeutic options are currently available including gene replacement therapy (GRT), which is potentially cardiotoxic. High-sensitive cardiac troponin I (hs-cTnI) is widely used to monitor potential cardiac contraindications or side effects of GRT, but reference data in healthy newborns are limited and lacking in neonates with SMA. The aim of this study is to determine the range of pre-therapeutic hs-cTnI concentrations in neonates with SMA and to provide guidance for the assessment of these values. Methods Hs-cTnI levels, genetic and clinical data of 30 newborns (age range 2-26 days) with SMA were retrospectively collected from 6 German neuromuscular centers. In addition, hs-cTnI levels were measured in 16 neonates without SMA. Results The median hs-cTnI concentration in neonates with SMA was 39.5 ng/L (range: 4-1205). In 16 newborns with SMA, hs-cTnI levels were above the test-specific upper reference limit (URL). Exploratory statistical analysis revealed no relevant correlation between hs-cTnI levels and gender, gestational age, mode of delivery, SMN2 copy number, symptoms of SMA or abnormal cardiac findings. Discussion Our results suggest higher hs-cTnI plasma levels in newborns with and without SMA compared to assay-specific reference values generated in adults. Given the wide range of hs-cTnI values in neonates with SMA, hs-cTnI levels must be determined before treatment in each patient and post-treatment elevations should be interpreted in the context of the course rather than as individual values.
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Affiliation(s)
- Jessika Johannsen
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Deike Weiss
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Joenna Driemeyer
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jakob Olfe
- Clinic for Children’s Heart Medicine and Adult Congenital Heart Disease, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Fridrike Stute
- Clinic for Children’s Heart Medicine and Adult Congenital Heart Disease, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ferdinand Müller
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marion Schütt
- Department of Neonatology and Pediatric Intensive Care Medicine, University Children's Hospital, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Regina Trollmann
- Department of Pediatrics, Division of Pediatric Neurology, University Hospital Erlangen, Erlangen, Germany
| | - Heike Kölbel
- Department of Pediatric Neurology, Centre for Neuromuscular Disorders, Center for Translational Neuro and Behavioral Sciences, University of Duisburg-Essen, Duisburg, Germany
| | - Ulrike Schara-Schmidt
- Department of Pediatric Neurology, Centre for Neuromuscular Disorders, Center for Translational Neuro and Behavioral Sciences, University of Duisburg-Essen, Duisburg, Germany
| | - Janbernd Kirschner
- Department of Neuropediatrics and Muscle Disorders, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Astrid Pechmann
- Department of Neuropediatrics and Muscle Disorders, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Astrid Blaschek
- Dr. v. Hauner Children’s Hospital, Department of Pediatric Neurology and Developmental Medicine, LMU Munich University Hospital, Munich, Germany
| | - Veronka Horber
- Department of Paediatric Neurology, University Children’s Hospital Tübingen, Tübingen, Germany
| | - Jonas Denecke
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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5
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Pechmann A, Behrens M, Dörnbrack K, Tassoni A, Stein S, Vogt S, Zöller D, Bernert G, Hagenacker T, Schara-Schmidt U, Schwersenz I, Walter MC, Baumann M, Baumgartner M, Deschauer M, Eisenkölbl A, Flotats-Bastardas M, Hahn A, Horber V, Husain RA, Illsinger S, Johannsen J, Köhler C, Kölbel H, Müller M, von Moers A, Schlachter K, Schreiber G, Schwartz O, Smitka M, Steiner E, Stögmann E, Trollmann R, Vill K, Weiß C, Wiegand G, Ziegler A, Lochmüller H, Kirschner J. Effect of nusinersen on motor, respiratory and bulbar function in early-onset spinal muscular atrophy. Brain 2023; 146:668-677. [PMID: 35857854 DOI: 10.1093/brain/awac252] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [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: 02/23/2022] [Revised: 05/22/2022] [Accepted: 06/20/2022] [Indexed: 11/12/2022] Open
Abstract
5q-associated spinal muscular atrophy is a rare neuromuscular disorder with the leading symptom of a proximal muscle weakness. Three different drugs have been approved by the European Medicines Agency and Food and Drug Administration for the treatment of spinal muscular atrophy patients, however, long-term experience is still scarce. In contrast to clinical trial data with restricted patient populations and short observation periods, we report here real-world evidence on a broad spectrum of patients with early-onset spinal muscular atrophy treated with nusinersen focusing on effects regarding motor milestones, and respiratory and bulbar insufficiency during the first years of treatment. Within the SMArtCARE registry, all patients under treatment with nusinersen who never had the ability to sit independently before the start of treatment were identified for data analysis. The primary outcome of this analysis was the change in motor function evaluated with the Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders and motor milestones considering World Health Organization criteria. Further, we evaluated data on the need for ventilator support and tube feeding, and mortality. In total, 143 patients with early-onset spinal muscular atrophy were included in the data analysis with a follow-up period of up to 38 months. We observed major improvements in motor function evaluated with the Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders. Improvements were greater in children >2 years of age at start of treatment than in older children. 24.5% of children gained the ability to sit independently. Major improvements were observed during the first 14 months of treatment. The need for intermittent ventilator support and tube feeding increased despite treatment with nusinersen. Our findings confirm the increasing real-world evidence that treatment with nusinersen has a dramatic influence on disease progression and survival in patients with early-onset spinal muscular atrophy. Major improvements in motor function are seen in children younger than 2 years at the start of treatment. Bulbar and respiratory function needs to be closely monitored, as these functions do not improve equivalent to motor function.
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Affiliation(s)
- Astrid Pechmann
- Department of Neuropediatrics and Muscle Disorders, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, D-79106 Freiburg, Germany
| | - Max Behrens
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center-University of Freiburg, D-70196 Freiburg, Germany
| | - Katharina Dörnbrack
- Clinical Trials Unit, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, D-79106 Freiburg, Germany
| | - Adrian Tassoni
- Clinical Trials Unit, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, D-79106 Freiburg, Germany
| | - Sabine Stein
- Department of Neuropediatrics and Muscle Disorders, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, D-79106 Freiburg, Germany
| | - Sibylle Vogt
- Department of Neuropediatrics and Muscle Disorders, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, D-79106 Freiburg, Germany
| | - Daniela Zöller
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center-University of Freiburg, D-70196 Freiburg, Germany
| | - Günther Bernert
- Clinic Favoriten, Department of Pediatrics, A-1100 Vienna, Austria
| | - Tim Hagenacker
- Department of Neurology, and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Medicine Essen, Hufelands.tr 55, 45147 Essen, Germany
| | - Ulrike Schara-Schmidt
- Department of Neuropediatrics and Neuromuscular Centre for children and Adolescents, Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, D-45147 Essen, Germany
| | - Inge Schwersenz
- Deutsche Gesellschaft für Muskelkranke, D-79112 Freiburg, Germany
| | - Maggie C Walter
- Friedrich-Baur-Institute, Department of Neurology, Ludwig-Maximilians-University of Munich, D-80336 Munich, Germany
| | - Matthias Baumann
- Department of Pediatrics I, Division of Pediatric Neurology, Medical University of Innsbruck, A-6020 Innsbruck, Austria
| | - Manuela Baumgartner
- Ordensklinikum Linz, Barmherzige Schwestern, Department of Pediatrics and Adolescent medicine, A-4020 Linz, Austria
| | - Marcus Deschauer
- Department of Neurology, Technical University of Munich, School of Medicine, D-81675 Munich, Germany
| | - Astrid Eisenkölbl
- Department of Paediatrics and Adolescent Medicine, Johannes Kepler University Linz, Kepler University Hospital, 4020 Linz, Austria
| | | | - Andreas Hahn
- Department of Child Neurology, Justus-Liebig University, D-35392 Giessen, Germany
| | - Veronka Horber
- Department of Paediatric Neurology, University Children's Hospital, D-72076 Tübingen, Germany
| | - Ralf A Husain
- Department of Neuropediatrics, Jena University Hospital, D-07747 Jena, Germany
| | - Sabine Illsinger
- Clinic for Pediatric Kidney-, Liver- and Metabolic Diseases, Hannover Medical School, D-30625 Hannover, Germany
| | - Jessika Johannsen
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, D-20246 Hamburg, Germany
| | - Cornelia Köhler
- Ruhr-Universität Bochum, St. Josef-Hospital, Universitätsklinik für Kinder- und Jugendmedizin, Abteilung für Neuropädiatrie und Sozialpädiatrie, D-44791 Bochum, Germany
| | - Heike Kölbel
- Department of Neuropediatrics and Neuromuscular Centre for children and Adolescents, Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, D-45147 Essen, Germany
| | - Monika Müller
- Department of Neuropediatrics, University Children's Hospital Würzburg, D-97080 Würzburg, Germany
| | - Arpad von Moers
- Department of Pediatrics und Neuropediatrics, DRK Kliniken Berlin, D-14050 Berlin, Germany
| | - Kurt Schlachter
- Department of Pediatrics, State Hospital of Bregenz (LKH Bregenz), A-6900 Bregenz, Austria
| | - Gudrun Schreiber
- Department of Pediatric Neurology, Klinikum Kassel, D-34125 Kassel, Germany
| | - Oliver Schwartz
- Department of Pediatric Neurology, Münster University Hospital, D-48149 Münster, Germany
| | - Martin Smitka
- Abteilung Neuropaediatrie, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, D-01307 Dresden, Germany
| | - Elisabeth Steiner
- Department of Pediatrics, Klinikum Wels-Grieskirchen, A-4600 Wels, Austria
| | - Eva Stögmann
- Department of Pediatrics, LK-Banden-Mödling, A-2340 Mödling, Austria
| | - Regina Trollmann
- Department of Pediatrics, Division of Pediatric Neurology, Friedrich-Alexander-University of Erlangen-Nürnberg, D-91054 Erlangen, Germany
| | - Katharina Vill
- Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, Dr. von Hauner Children's Hospital, LMU Hospital, Ludwig-Maximilians-University, D-80337 Munich, Germany
| | - Claudia Weiß
- Department of Pediatric Neurology and Center for Chronically Sick Children, Charité-University Medicine Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany
| | - Gert Wiegand
- Neuropediatrics Section of the Department of Pediatrics, Asklepios Clinic Hamburg Nord-Heidberg, D-22417 Hamburg, Germany
| | - Andreas Ziegler
- Department of Neuropediatrics and Metabolic Medicine, University Hospital Heidelberg, D-69120 Heidelberg, Germany
| | - Hanns Lochmüller
- Department of Neuropediatrics and Muscle Disorders, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, D-79106 Freiburg, Germany.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada.,Division of Neurology, Department of Medicine, The Ottawa Hospital, Ottawa, ON K1H 8L6, Canada.,Brain and Mind Research Institute, University of Ottawa, Ottawa, ON K1H 8M5, Canada
| | - Janbernd Kirschner
- Department of Neuropediatrics and Muscle Disorders, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, D-79106 Freiburg, Germany.,Department of Neuropediatrics, University Hospital Bonn, Faculty of Medicine, D-53127 Bonn, Germany
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Müller-Felber W, Blaschek A, Schwartz O, Gläser D, Nennstiel U, Brockow I, Wirth B, Burggraf S, Röschinger W, Becker M, Durner J, Eggermann K, Kölbel H, Müller C, Hannibal I, Olgemöller B, Schara U, von Moers A, Trollmann R, Johannssen J, Ziegler A, Cirak S, Hahn A, von der Hagen M, Weiss C, Schreiber G, Flotats-Bastardas M, Hartmann H, Illsinger S, Pechmann A, Horber V, Kirschner J, Köhler C, Winter B, Friese J, Vill K. Newbornscreening SMA - From Pilot Project to Nationwide Screening in Germany. J Neuromuscul Dis 2023; 10:55-65. [PMID: 36463459 PMCID: PMC9881029 DOI: 10.3233/jnd-221577] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Now that targeted therapies for spinal muscular atrophy are available, attempts are being made worldwide to include screening for spinal muscular atrophy in general newborn screening. In Germany, after pilot projects from 2018-2021, it was included in the general newborn screening from October 2021. To ensure a smooth transition, criteria for follow-up were developed together with key stakeholders. At the beginning of the transition to nationwide screening, false positive findings were reported in 3 patients. After optimization of the screening method in the laboratories concerned, all findings have been subsequently confirmed. On average, the first presentation to a neuromuscular center occurred on day 12 of life, and in patients with 2 or 3 SMN2 copies, therapy started on day 26 of life. Compared with the pilot project, there was no significant delay in timing.
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Affiliation(s)
- Wolfgang Müller-Felber
- Dr. v. Hauner Children’s Hospital, Department of Pediatric Neurology and Developmental Medicine, LMU – University of Munich, Munich, Germany,Correspondence to: Prof. Dr. med. Wolfgang Müller-Felber, Department of Pediatrics, Dr. von Hauner Children’s Hospital, University Hospital, LMU Munich, Lindwurmstr. 4, 80337 Munich, Germany. E-mail:
| | - Astrid Blaschek
- Dr. v. Hauner Children’s Hospital, Department of Pediatric Neurology and Developmental Medicine, LMU – University of Munich, Munich, Germany
| | - Oliver Schwartz
- Department of Pediatric Neurology, Muenster University Hospital, Münster, Germany
| | - Dieter Gläser
- MVZ Genetikum GmbH, Center for Human Genetics, Neu-Ulm, Germany
| | - Uta Nennstiel
- Screening Center of the Bavarian Health and Food Safety Authority, Oberschleissheim, Germany
| | - Inken Brockow
- Screening Center of the Bavarian Health and Food Safety Authority, Oberschleissheim, Germany
| | - Brunhilde Wirth
- Institute of Human Genetics, Center for Molecular Genetics Cologne and Center for Rare Diseases Cologne, University of Cologne, Cologne, Germany
| | | | | | | | - Jürgen Durner
- Labor Becker und Kollegen, Munich, Germany,Department of Operative/Restorative Dentistry, Periodontology and Pedodontics, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Katja Eggermann
- Institute of Human Genetics, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Heike Kölbel
- Department of Pediatric Neurology, Developmental Neurology and Social Pediatrics, University of Essen, Germany
| | - Christine Müller
- Dr. v. Hauner Children’s Hospital, Department of Pediatric Neurology and Developmental Medicine, LMU – University of Munich, Munich, Germany
| | - Iris Hannibal
- Dr. v. Hauner Children’s Hospital, Department of Pediatric Neurology and Developmental Medicine, LMU – University of Munich, Munich, Germany
| | | | - Ulrike Schara
- Department of Pediatric Neurology, Developmental Neurology and Social Pediatrics, University of Essen, Germany
| | - Arpad von Moers
- Klinik für Kinder- und Jugendmedizin, Neuropädiatrie, DRK Klinikum Westend, Berlin, Germany
| | - Regina Trollmann
- Department of Pediatrics, Division of Pediatric Neurology, Friedrich-Alexander University ofErlangen-Nürnberg, Erlangen, Germany
| | - Jessika Johannssen
- University Medical Center Hamburg-Eppendorf, Department of Pediatrics, Hamburg, Germany
| | - Andreas Ziegler
- Division of Child Neurology and Metabolic Medicine, Center for Child and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Andreas Hahn
- Department of Child Neurology, University Hospital, Gießen, Germany
| | - Maja von der Hagen
- Abteilung Neuropädiatrie, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Claudia Weiss
- Department of Pediatric Neurology, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Gudrun Schreiber
- Department of Pediatric Neurology, Klinikum Kassel, Kassel, Germany
| | | | - Hans Hartmann
- Hannover Medical School, Clinic for Pediatric Kidney-, Liver- and Metabolic Diseases, OE, Hannover, Germany
| | - Sabine Illsinger
- Hannover Medical School, Clinic for Pediatric Kidney-, Liver- and Metabolic Diseases, OE, Hannover, Germany
| | - Astrid Pechmann
- Department of Neuropediatrics and Muscle Disorders, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Veronka Horber
- Department of Paediatric Neurology, University Children’s Hospital, Tübingen, Germany
| | - Jan Kirschner
- Department of Neuropediatrics and Muscle Disorders, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Cornelia Köhler
- Department of Pediatric Neurology, University of Bochum, Bochum, Germany
| | - Benedikt Winter
- Department of Paediatric Neurology, University hospital Mannheim, Mannheim, Germany
| | - Johannes Friese
- Department of Paediatric Neurology, University hospital Bonn, Bonn, Germany
| | - Katharina Vill
- Dr. v. Hauner Children’s Hospital, Department of Pediatric Neurology and Developmental Medicine, LMU – University of Munich, Munich, Germany
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Pechmann A, Behrens M, Dörnbrack K, Tassoni A, Wenzel F, Stein S, Vogt S, Zöller D, Bernert G, Hagenacker T, Schara-Schmidt U, Walter MC, Bertsche A, Vill K, Baumann M, Baumgartner M, Cordts I, Eisenkölbl A, Flotats-Bastardas M, Friese J, Günther R, Hahn A, Horber V, Husain RA, Illsinger S, Jahnel J, Johannsen J, Köhler C, Kölbel H, Müller M, von Moers A, Schwerin-Nagel A, Reihle C, Schlachter K, Schreiber G, Schwartz O, Smitka M, Steiner E, Trollmann R, Weiler M, Weiß C, Wiegand G, Wilichowski E, Ziegler A, Lochmüller H, Kirschner J, Ameshofer L, Andres B, Angelova-Toshkina D, Banholzer D, Bant C, Baum P, Baumann S, Baur U, Becker B, Behring B, Bellut J, Bevot A, Bischofberger J, Bitzan L, Bjelica B, Blankenburg M, Böger S, Bonetti F, Bongartz A, Brakemeier S, Bratka L, Braun N, Braun S, Brauner B, Bretschneider C, Burgenmeister N, Burke B, Cirak S, Dall A, de Vries H, Marina AD, Denecke J, Deschauer M, Dibrani Z, Diebold U, Dondit L, Drebes J, Driemeyer J, Dukic V, Eckenweiler M, Eminger M, Fischer M, Fischer C, Freigang M, Gaiser P, Gangfuß A, Geitmann S, George A, Gosk-Tomek M, Grinzinger S, Gröning K, Groß M, Güttsches AK, Hagenmeyer A, Hartmann H, Haverkamp J, Hiebeler M, Hoevel A, Hoffmann GF, Holtkamp B, Holzwarth D, Homma A, Horneff V, Hörnig C, Hotter A, Hubert A, Huppke P, Jansen E, Jung L, Kaiser N, Kappel S, Katharina B, Koch J, Kölke S, Korschinsky B, Kostede F, Krause K, Küpper H, Lang A, Lange I, Langer T, Lechner Y, Lehmann H, Leypold C, Lingor P, Lipka J, Löscher W, Luiking A, Machetanz G, Malm E, Martakis K, Menzen B, Metelmann M, zu Hörste GM, Montagnese F, Mörtlbauer K, Müller P, Müller A, Müller A, Müschen L, Neuwirth C, Niesert M, Pauschek J, Pernegger E, Petri S, Pilshofer V, Plecko B, Pollok J, Preisel M, Pühringer M, Quinten AL, Raffler S, Ramadan B, Rappold M, Rauscher C, Reckmann K, Reinhardt T, Röder M, Roland-Schäfer D, Roth E, Ruß L, Saffari A, Schimmel M, Schlag M, Schlotter-Weigel B, Schneider J, Schöne-Bake JC, Schorling D, Schreiner I, Schüssler S, Schwarzbach M, Schwippert M, Semmler L, Smuda K, Sprenger-Svacina A, Stadler T, Steffens P, Steuernagel D, Stolte B, Stoltenburg C, Tasch G, Thimm A, Tiefenthaler E, Topakian R, Türk M, van der Stam L, Vettori K, Vollmann P, Vorgerd M, Weiss D, Wenninger S, Werring S, Wessel M, Weyen U, Wider S, Wiebe NO, Wiesenhofer A, Wiethoff S, Wirner C, Wohnrade C, Wunderlich G, Zeller D, Zemlin M, Zobel J. Improved upper limb function in non-ambulant children with SMA type 2 and 3 during nusinersen treatment: a prospective 3-years SMArtCARE registry study. Orphanet J Rare Dis 2022; 17:384. [PMID: 36274155 PMCID: PMC9589836 DOI: 10.1186/s13023-022-02547-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 10/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background The development and approval of disease modifying treatments have dramatically changed disease progression in patients with spinal muscular atrophy (SMA). Nusinersen was approved in Europe in 2017 for the treatment of SMA patients irrespective of age and disease severity. Most data on therapeutic efficacy are available for the infantile-onset SMA. For patients with SMA type 2 and type 3, there is still a lack of sufficient evidence and long-term experience for nusinersen treatment. Here, we report data from the SMArtCARE registry of non-ambulant children with SMA type 2 and typen 3 under nusinersen treatment with a follow-up period of up to 38 months. Methods SMArtCARE is a disease-specific registry with data on patients with SMA irrespective of age, treatment regime or disease severity. Data are collected during routine patient visits as real-world outcome data. This analysis included all non-ambulant patients with SMA type 2 or 3 below 18 years of age before initiation of treatment. Primary outcomes were changes in motor function evaluated with the Hammersmith Functional Motor Scale Expanded (HFMSE) and the Revised Upper Limb Module (RULM). Results Data from 256 non-ambulant, pediatric patients with SMA were included in the data analysis. Improvements in motor function were more prominent in upper limb: 32.4% of patients experienced clinically meaningful improvements in RULM and 24.6% in HFMSE. 8.6% of patients gained a new motor milestone, whereas no motor milestones were lost. Only 4.3% of patients showed a clinically meaningful worsening in HFMSE and 1.2% in RULM score. Conclusion Our results demonstrate clinically meaningful improvements or stabilization of disease progression in non-ambulant, pediatric patients with SMA under nusinersen treatment. Changes were most evident in upper limb function and were observed continuously over the follow-up period. Our data confirm clinical trial data, while providing longer follow-up, an increased number of treated patients, and a wider range of age and disease severity.
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Weiß C, Ziegler A, Becker LL, Johannsen J, Brennenstuhl H, Schreiber G, Flotats-Bastardas M, Stoltenburg C, Hartmann H, Illsinger S, Denecke J, Pechmann A, Müller-Felber W, Vill K, Blaschek A, Smitka M, van der Stam L, Weiss K, Winter B, Goldhahn K, Plecko B, Horber V, Bernert G, Husain RA, Rauscher C, Trollmann R, Garbade SF, Hahn A, von der Hagen M, Kaindl AM. Gene replacement therapy with onasemnogene abeparvovec in children with spinal muscular atrophy aged 24 months or younger and bodyweight up to 15 kg: an observational cohort study. Lancet Child Adolesc Health 2021; 6:17-27. [PMID: 34756190 DOI: 10.1016/s2352-4642(21)00287-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/25/2021] [Accepted: 09/01/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Given the novelty of gene replacement therapy with onasemnogene abeparvovec in spinal muscular atrophy, efficacy and safety data are limited, especially for children older than 24 months, those weighing more than 8·5 kg, and those who have received nusinersen. We aimed to provide real-world data on motor function and safety after gene replacement therapy in different patient subgroups. METHODS We did a protocol-based, multicentre prospective observational study between Sept 21, 2019, and April 20, 2021, in 18 paediatric neuromuscular centres in Germany and Austria. All children with spinal muscular atrophy types 1 and 2 receiving onasemnogene abeparvovec were included in our cohort, and there were no specific exclusion criteria. Motor function was assessed at the time of gene replacement therapy and 6 months afterwards, using the Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP INTEND) and Hammersmith Functional Motor Scale-Expanded (HFMSE) scores. Additionally, in children pretreated with nusinersen, motor function was assessed before and after treatment switch. Off-target adverse events were analysed with a focus on liver function, thrombocytopaenia, and potential cardiotoxicity. FINDINGS 76 children (58 pretreated with nusinersen and 18 who were nusinersen naive) with spinal muscular atrophy were treated with onasemnogene abeparvovec at a mean age of 16·8 months (range 0·8-59·0, IQR 9-23) and a mean weight of 9·1 kg (range 4·0-15·0, IQR 7·4-10·6). In 60 patients with available data, 49 had a significant improvement on the CHOP-INTEND score (≥4 points) and HFMSE score (≥3 points). Mean CHOP INTEND scores increased significantly in the 6 months after therapy in children younger than 8 months (n=16; mean change 13·8 [SD 8·5]; p<0·0001) and children aged between 8 and 24 months (n=34; 7·7 [SD 5·2]; p<0·0001), but not in children older than 24 months (n=6; 2·5 [SD 5·2]; p=1·00). In the 45 children pretreated with nusinersen and had available data, CHOP INTEND score increased by 8·8 points (p=0·0003) at 6 months after gene replacement therapy. No acute complications occurred during infusion of onasemnogene abeparvovec, but 56 (74%) patients had treatment-related side-effects. Serious adverse events occurred in eight (11%) children. Liver enzyme elevation significantly increased with age and weight at treatment. Six (8%) patients developed acute liver dysfunction. Other adverse events included pyrexia (n=47 [62%]), vomiting or loss of appetite (41 [54%]), and thrombocytopenia (n=59 [78%]). Prednisolone treatment was significantly prolonged with a mean duration of 15·7 weeks (IQR 9-19), mainly due to liver enzyme elevation. Cardiac adverse events were rare; only two patients had abnormal echocardiogram and echocardiography findings. INTERPRETATION This study provides class IV evidence that children with spinal muscular atrophy aged 24 months or younger and patients pretreated with nusinersen significantly benefit from gene replacement therapy, but adverse events can be severe and need to be closely monitored. FUNDING None. TRANSLATION For the German translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Claudia Weiß
- Department of Pediatric Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany; Center for Chronically Sick Children, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Ziegler
- Division of Child Neurology and Metabolic Medicine, Center for Child and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Lena-Luise Becker
- Department of Pediatric Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany; Center for Chronically Sick Children, Charité-Universitätsmedizin Berlin, Berlin, Germany; Institute of Cell Biology and Neurobiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jessika Johannsen
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Heiko Brennenstuhl
- Division of Child Neurology and Metabolic Medicine, Center for Child and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Gudrun Schreiber
- Department of Pediatric Neurology, Klinikum Kassel, Kassel, Germany
| | | | - Corinna Stoltenburg
- Department of Pediatric Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany; Center for Chronically Sick Children, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Hans Hartmann
- Hannover Medical School, Clinic for Pediatric Kidney, Liver, and Metabolic Diseases, Hannover, Germany
| | - Sabine Illsinger
- Hannover Medical School, Clinic for Pediatric Kidney, Liver, and Metabolic Diseases, Hannover, Germany
| | - Jonas Denecke
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Astrid Pechmann
- Department of Neuropediatrics and Muscle Disorders, Medical Center, University of Freiburg, Freiburg, Germany
| | - Wolfgang Müller-Felber
- Department of Paediatric Neurology and Developmental Medicine, Hauner Children's Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Katharina Vill
- Department of Paediatric Neurology and Developmental Medicine, Hauner Children's Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Astrid Blaschek
- Department of Paediatric Neurology and Developmental Medicine, Hauner Children's Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Martin Smitka
- Department of Neuropediatrics, Medical Faculty Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Lieske van der Stam
- Department of Pediatric Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany; Center for Chronically Sick Children, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Katja Weiss
- Department of Pediatric Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Klaus Goldhahn
- Department of Pediatrics and Neuropediatrics, DRK Klinikum Westend, Berlin, Germany
| | - Barbara Plecko
- Department of Pediatrics and Adolescent Medicine, Division of General Pediatrics, Medical University Graz, Graz, Austria
| | - Veronka Horber
- Department of Paediatric Neurology, University Children's Hospital, Tübingen, Germany
| | | | - Ralf A Husain
- Department of Neuropediatrics, Jena University Hospital, Jena, Germany
| | - Christian Rauscher
- Department of Pediatrics, Paracelsus Medical University, Salzburg, Austria
| | - Regina Trollmann
- Department of Pediatrics, Division of Pediatric Neurology, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Sven F Garbade
- Division of Child Neurology and Metabolic Medicine, Center for Child and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Andreas Hahn
- Department of Child Neurology, University Hospital, Gießen, Germany
| | - Maja von der Hagen
- Department of Neuropediatrics, Medical Faculty Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Angela M Kaindl
- Department of Pediatric Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany; Center for Chronically Sick Children, Charité-Universitätsmedizin Berlin, Berlin, Germany; Institute of Cell Biology and Neurobiology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
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Horber V, Grasshoff U, Sellier E, Arnaud C, Krägeloh-Mann I, Himmelmann K. The Role of Neuroimaging and Genetic Analysis in the Diagnosis of Children With Cerebral Palsy. Front Neurol 2021; 11:628075. [PMID: 33633660 PMCID: PMC7900404 DOI: 10.3389/fneur.2020.628075] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 11/11/2020] [Accepted: 12/30/2020] [Indexed: 11/13/2022] Open
Abstract
Cerebral magnetic resonance imaging (MRI) is considered an important tool in the assessment of a child with cerebral palsy (CP), as it is abnormal in more than 80% of children with CP, disclosing the pathogenic pattern responsible for the neurological condition. MRI, therefore, is recommended as the first diagnostic step after medical history taking and neurological examination. With the advances in genetic diagnostics, the genetic contribution to CP is increasingly discussed, and the question arises about the role of genetic testing in the diagnosis of cerebral palsy. The paper gives an overview on genetic findings reported in CP, which are discussed with respect to the underlying brain pathology according to neuroimaging findings. Surveillance of Cerebral Palsy in Europe (SCPE) classifies neuroimaging findings in CP into five categories, which help to stratify decisions concerning genetic testing. Predominant white and gray matter injuries are by far predominant (accounting for around 50 and 20% of the findings). They are considered to be acquired. Here, predisposing genetic factors may play a role to increase vulnerability (and should especially be considered, when family history is positive and/or causative external factors are missing). In maldevelopments and normal findings (around 11% each), monogenic causes are more likely, and thus, genetic testing is clearly recommended. In the miscellaneous category, the precise nature of the MRI finding has to be considered as it could indicate a genetic origin.
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Affiliation(s)
- Veronka Horber
- Department of Paediatric Neurology, University Children's Hospital, Tübingen, Germany
| | - Ute Grasshoff
- Institute of Medical Genetics and Applied Genomics, University Hospital, Tübingen, Germany
| | - Elodie Sellier
- Grenoble Alpes University, CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC-IMAG, Grenoble, France.,Registre des Handicaps de l'Enfant et Observatoire Périnatal, Grenoble, France
| | - Catherine Arnaud
- CERPOP, SPHERE Team, University of Toulouse, Inserm, UPS, Toulouse, France.,Clinical Epidemiology Unit, Toulouse University Hospital, Toulouse, France
| | | | - Kate Himmelmann
- Department of Pediatrics, Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Himmelmann K, Horber V, Sellier E, De la Cruz J, Papavasiliou A, Krägeloh-Mann I. Neuroimaging Patterns and Function in Cerebral Palsy-Application of an MRI Classification. Front Neurol 2021; 11:617740. [PMID: 33613420 PMCID: PMC7887285 DOI: 10.3389/fneur.2020.617740] [Citation(s) in RCA: 21] [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] [Received: 10/15/2020] [Accepted: 12/17/2020] [Indexed: 01/02/2023] Open
Abstract
Background: Cerebral palsy (CP) is a disorder of movement and posture and every child with CP has a unique composition of neurological symptoms, motor severity, and associated impairments, constituting the functional profile. Although not part of the CP definition, magnetic resonance imaging (MRI) sheds light on the localization, nature, and severity of brain compromise. The MRI classification system (MRICS), developed by the Surveillance of Cerebral Palsy in Europe (SCPE), describes typical MRI patterns associated with specific timing of vulnerability in different areas of the brain. The classification has proven to be reliable and easy to use. Aims: The aim of this study is to apply the MRICS on a large dataset and describe the functional profile associated with the different MRI patterns of the MRICS. Materials and Methods: Data on children with CP born in 1999-2009 with a post-neonatal MRI from 20 European registers in the JRC-SCPE Central Registry was included. The CP classification and the MRICS was applied, and The Gross Motor Function Classification (GMFCS) and the Bimanual Fine Motor Function (BFMF) classification were used. The following associated impairments were documented: intellectual impairment, active epilepsy, visual impairment, and hearing impairment. An impairment index was used to characterize severity of impairment load. Results: The study included 3,818 children with post-neonatal MRI. Distribution of CP type, motor, and associated impairments differed by neuroimaging patterns. Functional profiles associated with neuroimaging patterns were described, and the impairment index showed that bilateral findings were associated with a more severe outcome both regarding motor impairment and associated impairments than unilateral compromise. The results from this study, particularly the differences in functional severity regarding uni- and bilateral brain compromise, may support counseling and service planning of support of children with CP.
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Affiliation(s)
- Kate Himmelmann
- Department of Pediatrics, Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Veronka Horber
- Department of Paediatric Neurology, University Children's Hospital, Tübingen, Germany
| | - Elodie Sellier
- Univ. Grenoble Alpes, CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC-IMAG, Grenoble, France.,RHEOP, Grenoble, France
| | - Javier De la Cruz
- Research Institute (i+12), SAMID, University Hospital "12 Octubre", Madrid, Spain
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Ziegler A, Wilichowski E, Schara U, Hahn A, Müller-Felber W, Johannsen J, von der Hagen M, von Moers A, Stoltenburg C, Saffari A, Walter MC, Husain RA, Pechmann A, Köhler C, Horber V, Schwartz O, Kirschner J. [Recommendations for gene therapy of spinal muscular atrophy with onasemnogene abeparvovec-AVXS-101 : Consensus paper of the German representatives of the Society for Pediatric Neurology (GNP) and the German treatment centers with collaboration of the medical scientific advisory board of the German Society for Muscular Diseases (DGM)]. Nervenarzt 2020; 91:518-529. [PMID: 32394004 DOI: 10.1007/s00115-020-00919-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Spinal muscular atrophy (SMA) is a severe, life-limiting neurodegenerative disease. A disease-modifying and approved therapy with nusinersen has been available in Germany since July 2017. Gene therapies offer another promising treatment option through a once in a lifetime administration. In May 2019 a gene replacement therapy for the treatment of SMA was approved for the first time by the U.S. Food and Drug Administration (FDA). An application for approval in Europe has been submitted and is currently pending. OBJECTIVE This consensus paper was compiled at the invitation of the German Society for Muscular Diseases (DGM) with the participation of all potential German neuromuscular treatment centers, the German section of the Society for Pediatric Neurology (GNP) and with the involvement of the medical scientific advisory board of the DGM. The aim was to define and establish the necessary prerequisites for a safe and successful application of the new gene replacement therapy in clinical practice. CONCLUSION Gene replacement therapy with onasemnogene abeparvovec has the potential to significantly influence the course of SMA. Long-term data on sustainability of effects and possible adverse effects of gene replacement therapy are not yet available. The application of this innovative therapy must be carried out in specialized and appropriately qualified treatment centers under strict safety conditions. This article makes suggestions for the necessary framework conditions and gives recommendations for a systematic pretreatment and posttreatment assessment schedule under gene therapy. The effectiveness and safety of the therapy should be systematically documented in an industry-independent and disease-specific register.
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Affiliation(s)
- Andreas Ziegler
- Zentrum für Kinder- und Jugendmedizin Heidelberg, Sektion Neuropädiatrie und Stoffwechselmedizin, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 430, 69120, Heidelberg, Deutschland.
| | - Ekkehard Wilichowski
- Abteilung Neuropädiatrie und Sozialpädiatrie, Klinik für Kinder- und Jugendmedizin, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Ulrike Schara
- Abteilung für Neuropädiatrie, Zentrum für neuromuskuläre Erkrankungen des Kindes- und Jugendalters, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland
| | - Andreas Hahn
- Abteilung Kinderneurologie, Sozialpädiatrie und Epileptologie, Zentrum Kinderheilkunde, Justus-Liebig-Universität, Gießen, Deutschland
| | - Wolfgang Müller-Felber
- Dr. v. Hauner'sche Kinderklinik, Universitätskinderklinik, Ludwig-Maximilians-Universität, München, Deutschland
| | - Jessika Johannsen
- Neuropädiatrie, Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Maja von der Hagen
- Abteilung Neuropädiatrie, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland
| | - Arpad von Moers
- Klinik für Kinder- und Jugendmedizin, DRK Kliniken Berlin, Berlin, Deutschland
| | - Corinna Stoltenburg
- Sozialpädiatrisches Zentrum, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Afshin Saffari
- Zentrum für Kinder- und Jugendmedizin Heidelberg, Sektion Neuropädiatrie und Stoffwechselmedizin, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 430, 69120, Heidelberg, Deutschland
| | - Maggie C Walter
- Friedrich-Baur-Institut, Neurologische Klinik und Poliklinik, Ludwig-Maximilians-Universität, München, Deutschland
| | - Ralf A Husain
- Klinik für Neuropädiatrie, Universitätsklinikum Jena, Jena, Deutschland
| | - Astrid Pechmann
- Klinik für Neuropädiatrie und Muskelerkrankungen, Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| | - Cornelia Köhler
- Abteilung für Neuropädiatrie mit Sozialpädiatrie, Klinik für Kinder- und Jugendmedizin, Ruhr-Universität Bochum, Bochum, Deutschland
| | - Veronka Horber
- Abteilung Neuropädiatrie, Entwicklungsneurologie und Sozialpädiatrie, Universitätsklinik für Kinder- und Jugendmedizin, Tübingen, Deutschland
| | - Oliver Schwartz
- Abteilung für Allgemeine Pädiatrie - Neuropädiatrie, Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Münster, Münster, Deutschland
| | - Janbernd Kirschner
- Abteilung Neuropädiatrie und Sozialpädiatrisches Zentrum, Zentrum für Kinderheilkunde, Universitätsklinikum Bonn, Bonn, Deutschland
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12
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Pechmann A, Baumann M, Bernert G, Flotats-Bastardas M, Gruber-Sedlmayr U, von der Hagen M, Hasselmann O, Hobbiebrunken E, Horber V, Johannsen J, Kellersmann A, Köhler C, von Moers A, Müller-Felber W, Plecko B, Reihle C, Schlachter K, Schreiber G, Schwartz O, Smitka M, Steiner E, Stoltenburg C, Stüve B, Theophil M, Weiß C, Wiegand G, Wilichowski E, Winter B, Wittmann W, Schara U, Kirschner J. Treatment with Nusinersen - Challenges Regarding the Indication for Children with SMA Type 1. J Neuromuscul Dis 2020; 7:41-46. [PMID: 31744015 DOI: 10.3233/jnd-190441] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The natural history of patients with spinal muscular atrophy (SMA) has changed due to advances in standard care and development of targeted treatments. Nusinersen was the first drug approved for the treatment of all SMA patients. The transfer of clinical trial data into a real-life environment is challenging, especially regarding the advice of patients and families to what extent they can expect a benefit from the novel treatment. We report the results of a modified Delphi consensus process among child neurologists from Germany, Austria and Switzerland about the indication or continuation of nusinersen treatment in children with SMA type 1 based on different clinical case scenarios.
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Affiliation(s)
- Astrid Pechmann
- Department of Neuropediatrics and Muscle Disorders, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Matthias Baumann
- Department of Pediatrics I, Division of Pediatric Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Günther Bernert
- Department of Pediatrics, Neuropediatrics, Kaiser Franz Josef Krankenhaus mit Gottfried von Preyer Children Hospital, Vienna, Austria
| | | | - Ursula Gruber-Sedlmayr
- Department of Pediatrics and Adolescent Medicine, Division of General Pediatrics, Medical University of Graz, Graz, Austria
| | - Maja von der Hagen
- Abteilung Neuropädiatrie, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Germany
| | | | - Elke Hobbiebrunken
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Neurology, University Medical Center Göttingen, Georg August University, Robert Koch Strasse 40, Göttingen, 37075, Germany
| | - Veronka Horber
- Department of Paediatric Neurology, University Children's Hospital, Tübingen, Germany
| | - Jessika Johannsen
- Department of Pediatrics, Neuropediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anna Kellersmann
- Department of Pediatrics, Neuropediatrics, Kaiser Franz Josef Krankenhaus mit Gottfried von Preyer Children Hospital, Vienna, Austria
| | - Cornelia Köhler
- Department of Neuropaediatrics, University Children's Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Arpad von Moers
- Department of Pediatrics and Neuropediatrics, DRK Klinikum Westend, Berlin, Germany
| | - Wolfgang Müller-Felber
- Department of Neuropediatrics, Dr. v. Haunersche Kinderklinik, University Children's Hospital, LMU, München, Germany
| | - Barbara Plecko
- Department of Pediatrics and Adolescent Medicine, Division of General Pediatrics, Medical University of Graz, Graz, Austria
| | - Christof Reihle
- Department for Pediatric Neurology, Center for Child and Adolescent Medicine Olgahospital, Psychosomatic and Pain Medicine, Child Pain Center Baden-Württemberg, Klinikum Stuttgart, Stuttgart, Germany
| | - Kurt Schlachter
- Department of Pediatrics, State Hospital of Bregenz (LKH Bregenz), Bregenz, Austria
| | | | - Oliver Schwartz
- Department of Neuropediatrics, University Children's Hospital Muenster, Muenster, Germany
| | - Martin Smitka
- Abteilung Neuropädiatrie, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Germany
| | | | - Corinna Stoltenburg
- Department of Neuropediatrics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Burkhard Stüve
- Department of Neuropediatrics, Kliniken der Stadt Köln, Children's Hospital, Cologne, Germany
| | - Manuela Theophil
- Department of Pediatrics and Neuropediatrics, DRK Klinikum Westend, Berlin, Germany
| | - Claudia Weiß
- Department of Neuropediatrics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Gert Wiegand
- Neuropediatrics Section of the Department of Pediatrics, Asklepios Clinic Hamburg, Nord-Heidberg, Hamburg, Germany
| | - Ekkehard Wilichowski
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Neurology, University Medical Center Göttingen, Georg August University, Robert Koch Strasse 40, Göttingen, 37075, Germany
| | | | - Wolfgang Wittmann
- Kinderzentrum St. Martin - Social Paediatric Centre Regensburg, Regensburg, Germany
| | - Ulrike Schara
- Department of Neuropediatrics, Children's Hospital 1, University of Duisburg-Essen, Essen, Germany
| | - Janbernd Kirschner
- Department of Neuropediatrics and Muscle Disorders, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.,Department of Neuropediatrics, University Hospital Bonn, Bonn, Germany
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13
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Donkervoort S, Mohassel P, Laugwitz L, Zaki MS, Kamsteeg EJ, Maroofian R, Chao KR, Verschuuren-Bemelmans CC, Horber V, Fock AJM, McCarty RM, Jain MS, Biancavilla V, McMacken G, Nalls M, Voermans NC, Elbendary HM, Snyder M, Cai C, Lehky TJ, Stanley V, Iannaccone ST, Foley AR, Lochmüller H, Gleeson J, Houlden H, Haack TB, Horvath R, Bönnemann CG. Biallelic loss of function variants in SYT2 cause a treatable congenital onset presynaptic myasthenic syndrome. Am J Med Genet A 2020; 182:2272-2283. [PMID: 32776697 DOI: 10.1002/ajmg.a.61765] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 04/19/2020] [Revised: 05/25/2020] [Accepted: 06/13/2020] [Indexed: 12/15/2022]
Abstract
Synaptotagmins are integral synaptic vesicle membrane proteins that function as calcium sensors and regulate neurotransmitter release at the presynaptic nerve terminal. Synaptotagmin-2 (SYT2), is the major isoform expressed at the neuromuscular junction. Recently, dominant missense variants in SYT2 have been reported as a rare cause of distal motor neuropathy and myasthenic syndrome, manifesting with stable or slowly progressive distal weakness of variable severity along with presynaptic NMJ impairment. These variants are thought to have a dominant-negative effect on synaptic vesicle exocytosis, although the precise pathomechanism remains to be elucidated. Here we report seven patients of five families, with biallelic loss of function variants in SYT2, clinically manifesting with a remarkably consistent phenotype of severe congenital onset hypotonia and weakness, with variable degrees of respiratory involvement. Electrodiagnostic findings were consistent with a presynaptic congenital myasthenic syndrome (CMS) in some. Treatment with an acetylcholinesterase inhibitor pursued in three patients showed clinical improvement with increased strength and function. This series further establishes SYT2 as a CMS-disease gene and expands its clinical and genetic spectrum to include recessive loss-of-function variants, manifesting as a severe congenital onset presynaptic CMS with potential treatment implications.
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Affiliation(s)
- Sandra Donkervoort
- Neuromuscular and Neurogenetic Disorders of Childhood Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Payam Mohassel
- Neuromuscular and Neurogenetic Disorders of Childhood Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Lucia Laugwitz
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany.,Department of Paediatric Neurology, University Children's Hospital, Tübingen, Germany
| | - Maha S Zaki
- Clinical Genetics Department, Human Genetics and Genome Research Division, National Research Centre, Cairo, Egypt
| | - Erik-Jan Kamsteeg
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Reza Maroofian
- Department of Neuromuscular Disorders, University College London Institute of Neurology, London, UK
| | - Katherine R Chao
- Center for Mendelian Genomics, Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | | | - Veronka Horber
- Department of Paediatric Neurology, University Children's Hospital, Tübingen, Germany
| | - Annemarie J M Fock
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Riley M McCarty
- Neuromuscular and Neurogenetic Disorders of Childhood Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Minal S Jain
- Rehabilitation Medicine Department, Clinical Research Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Victoria Biancavilla
- Rehabilitation Medicine Department, Clinical Research Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Grace McMacken
- Department of Neurosciences, Royal Victoria Hospital, Belfast, UK
| | - Matthew Nalls
- Neuromuscular and Neurogenetic Disorders of Childhood Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Nicol C Voermans
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Hasnaa M Elbendary
- Clinical Genetics Department, Human Genetics and Genome Research Division, National Research Centre, Cairo, Egypt
| | - Molly Snyder
- Department of Neurology, Children's Health, Dallas, Texas, USA
| | - Chunyu Cai
- Department of Pathology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Tanya J Lehky
- EMG Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Valentina Stanley
- Laboratory for Pediatric Brain Disease, Howard Hughes Medical Institute, University of California, San Diego, California, USA.,Rady Children's Institute for Genomic Medicine, Rady Children's Hospital, San Diego, California, USA
| | - Susan T Iannaccone
- Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas, USA
| | - A Reghan Foley
- Neuromuscular and Neurogenetic Disorders of Childhood Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Hanns Lochmüller
- Department of Neuropediatrics and Muscle Disorders, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany.,Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada.,Division of Neurology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Joseph Gleeson
- Laboratory for Pediatric Brain Disease, Howard Hughes Medical Institute, University of California, San Diego, California, USA.,Rady Children's Institute for Genomic Medicine, Rady Children's Hospital, San Diego, California, USA
| | - Henry Houlden
- Department of Neuromuscular Disorders, University College London Institute of Neurology, London, UK
| | - Tobias B Haack
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
| | - Rita Horvath
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Carsten G Bönnemann
- Neuromuscular and Neurogenetic Disorders of Childhood Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
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14
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Grimm AS, Schubert C, Grimm A, Stahl JH, Küpper H, Horber V, Kegele J, Willikens S, Wittlinger J, Serna-Higuita L, Winter N, Groeschel S. Normative Observational Nerve Ultrasound Values in School-Age Children and Adolescents and Their Application to Hereditary Neuropathies. Front Neurol 2020; 11:303. [PMID: 32411079 PMCID: PMC7198742 DOI: 10.3389/fneur.2020.00303] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 12/03/2019] [Accepted: 03/30/2020] [Indexed: 12/31/2022] Open
Abstract
Backgrounds: We have aimed to establish nerve ultrasound reference data in 8 to 17-year-old children and adolescents and to compare those data to younger children, adults, and age-matched children with polyneuropathies. Methods: High-resolution ultrasounds of the nerves were performed in 117 healthy children and adolescents at 20 predefined landmarks in the neck and the extremities of both sides. Mean values, side-to-side differences and intraneural ratios, as well as upper limits have been calculated. In a second step, a comparison between 25 children and adolescents of the same age range with proven hereditary and acquired neuropathies and lysosomal storage diseases has been carried out. Results: Nerve growth correlates significantly with age and reaches adult values at the age of around 15 years. The influence of body mass index and gender is negligible at most segments. By the use of age-specific upper limits, nerve enlargement could be seen in distinct types of neuropathies, particularly in demyelinating hereditary and inflammatory types, which is comparable to findings in adults, but also in rare lysosomal storage diseases. Conclusion: Nerve size correlates with age during childhood and reaches a climax in younger adults. Age-matched reference data are inevitable to differ between hypertrophic and non-hypertrophic nerve damage, e.g., in neuropathies.
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Affiliation(s)
- Anna-Sophie Grimm
- Department of Pediatric Neurology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Charlotte Schubert
- Department of Neurology and Hertie Institute for Clinical Brain Research (HIH), University of Tübingen, Tübingen, Germany
| | - Alexander Grimm
- Department of Neurology and Hertie Institute for Clinical Brain Research (HIH), University of Tübingen, Tübingen, Germany
| | - Jan-Hendrik Stahl
- Department of Neurology and Hertie Institute for Clinical Brain Research (HIH), University of Tübingen, Tübingen, Germany.,Center of Neurology and Hertie Institute for Clinical Brain Research (HIH), University of Tübingen, Tübingen, Germany
| | - Hanna Küpper
- Department of Pediatric Neurology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Veronka Horber
- Department of Pediatric Neurology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Josua Kegele
- Department of Neurology and Hertie Institute for Clinical Brain Research (HIH), University of Tübingen, Tübingen, Germany.,Center of Neurology and Hertie Institute for Clinical Brain Research (HIH), University of Tübingen, Tübingen, Germany.,University Hospital Tübingen, Neurology, Tübingen, Germany
| | - Sophia Willikens
- Department of Neurology and Hertie Institute for Clinical Brain Research (HIH), University of Tübingen, Tübingen, Germany.,University Hospital Tübingen, Neurology, Tübingen, Germany
| | | | - Lina Serna-Higuita
- Department of Clinical Epidemiology and Applied Biostatistics, Tübingen University, Tübingen, Germany
| | - Natalie Winter
- Department of Neurology and Hertie Institute for Clinical Brain Research (HIH), University of Tübingen, Tübingen, Germany.,Center of Neurology and Hertie Institute for Clinical Brain Research (HIH), University of Tübingen, Tübingen, Germany
| | - Samuel Groeschel
- Department of Pediatric Neurology, University Children's Hospital Tübingen, Tübingen, Germany
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15
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Abstract
OBJECTIVE This article describes associated impairments in children with cerebral palsy (CP) and its subtypes. METHOD Children born between 1990 and 2006 recorded in the Surveillance of Cerebral Palsy in Europe common database were studied. An "impairment index" characterized severity of impairments and their combinations. RESULTS Amongst the 11,015 children analyzed, 56% (n = 5,968) could walk unaided, 54% (4,972) had normal or near-normal intellect (intelligence quotient ≥ 70). Except for ataxic CP, associated impairments were less frequent when walking ability was preserved. The impairment index was low (walking unaided and normal or near-normal intellect) in 30% of cases; 54% (n = 1,637) in unilateral spastic, 24% (n = 79) in ataxic, 18% (n = 913) in bilateral spastic, and 7% (n = 50) in dyskinetic CP. Around 40% had a high impairment index (inability to walk and/or severe intellectual impairment ± additional impairments)-highest in dyskinetic (77%, n = 549) and bilateral spastic CP (54%, n = 2,680). The impairment index varied little in birth weight and gestational age groups. However, significantly fewer cases in the birth weight group ≤ 1,000 g or gestational age group ≤ 27 weeks had a low impairment index compared to the other birth weight and gestational age groups (23 and 24% vs. between 27 and 32%). CONCLUSION Thirty percent of the children with CP had a low impairment index (they were able to walk unaided and had a normal or near-normal intellect). Severity in CP was strongly associated to subtype, whereas the association was weak with birth weight or gestational age.
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Affiliation(s)
- Veronka Horber
- Department of Paediatric Neurology, University Children's Hospital, Tübingen, Germany
| | - Asma Fares
- Public Health Department, University Hospital of Lyon, Lyon, France
| | - Mary Jane Platt
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Catherine Arnaud
- UMR Inserm U1027, team SPHERE University Toulouse III Paul Sabatier, Toulouse, France.,Clinical Epidemiology Unit, Toulouse University Hospital, Toulouse, France
| | | | - Elodie Sellier
- University Grenoble Alpes, CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC-IMAG, Grenoble, France
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16
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Horber V, Sellier E, Horridge K, Rackauskaite G, Andersen GL, Virella D, Ortibus E, Dakovic I, Hensey O, Radsel A, Papavasiliou A, Cruz De la J, Arnaud C, Krägeloh-Mann I, Himmelmann K. The Origin of the Cerebral Palsies: Contribution of Population-Based Neuroimaging Data. Neuropediatrics 2020; 51:113-119. [PMID: 32120429 DOI: 10.1055/s-0039-3402007] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Surveillance of cerebral palsy in Europe (SCPE) presents the first population-based results on neuroimaging findings in children with cerebral palsy (CP) using a magnetic resonance imaging classification system (MRICS). METHOD MRIs of children with CP born between 1999 and 2009 from 18 European countries were analyzed. MRICS identifies patterns of brain pathology according to timing during brain development which was analyzed with respect to CP subtypes and gestational age. RESULTS MRIs or written reports from 3,818 children were available. The main clinical characteristics were similar to the 5,415 without such data. Most frequent was predominant white matter injury (49%), followed by predominant gray matter injury (21%). Maldevelopments were found in 11% of cases. Miscellaneous findings were present in 8.5% and normal findings in 10.6%. MRI patterns of children with unilateral spastic, bilateral spastic, and dyskinetic CP were mainly lesional (77, 71, and 59%, respectively), whereas children with ataxic CP had more maldevelopments, miscellaneous, and normal findings (25, 21, and 32%, respectively). In children born preterm, predominant white matter injury was most prevalent (80% in children born <32 weeks of gestation). CONCLUSION Analysis of MRI in the European CP database identified CP as a mainly lesional condition on a large population basis, maldevelopments were relatively uncommon. An exception was ataxic CP. Children born preterm mostly presented with a lesion typical for their gestational age (GA) at birth. The decreasing prevalence of CP in this group suggests that progress in perinatal and neonatal medicine may lead to a reduction of these lesions.
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Affiliation(s)
- Veronka Horber
- Department of Paediatric Neurology, University Children's Hospital, Tübingen, Germany
| | - Elodie Sellier
- CNRS, Grenoble INP, CHU Grenoble Alpes, Univ. Grenoble Alpes, TIMC-IMAG, Grenoble, France
| | - Karen Horridge
- Department of Paediatrics, Sunderland Royal Hospital, Sunderland, United Kingdom
| | - Gija Rackauskaite
- Child and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Guro L Andersen
- Vestfold Hospital Trust, Cerebral Palsy Registry of Norway, Tønsberg, Norway
| | - Daniel Virella
- Neonatology Intensive Care Unit/Research Centre, Lisbon, Central Lisbon Hospital, Portugal
| | - Els Ortibus
- Department of Development and Regeneration, KULeuven and University Hospitals Leuven, Belgium
| | - Ivana Dakovic
- Department of Neuropediatrics, Children's Hospital Zagreb, University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Owen Hensey
- Central Remedial Clinic, Clontarf, Dublin, Ireland
| | - Anja Radsel
- Community Health Centre Medvode, Paediatric Medical Office, Slovenia
| | | | - Javier Cruz De la
- Research Institute (i + 12), SAMID, University Hospital "12 Octubre," Madrid, Spain
| | - Catherine Arnaud
- UMR Inserm U1027, team SPHERE University Toulouse III Paul Sabatier, Toulouse, France.,Clinical Epidemiology Unit, Toulouse University Hospital, Toulouse, France
| | | | - Kate Himmelmann
- Department of Pediatrics, Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Regional Rehabilitation Centre, Queen Silvia Children's Hospital, Gothenburg, Sweden
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17
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Donkervoort S, Mohassel P, Laugwitz L, Kamsteeg E, Chao K, Verschuuren-Bemelmans C, Horber V, Fock J, Voermans N, Hu Y, Snyder M, Iannaccone S, Lochmüller H, Haack T, Foley A, Horvath R, Bönnemann C. P.380. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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18
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Himmelmann K, Horber V, De La Cruz J, Horridge K, Mejaski-Bosnjak V, Hollody K, Krägeloh-Mann I. MRI classification system (MRICS) for children with cerebral palsy: development, reliability, and recommendations. Dev Med Child Neurol 2017; 59:57-64. [PMID: 27325153 DOI: 10.1111/dmcn.13166] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2016] [Indexed: 11/29/2022]
Abstract
AIM To develop and evaluate a classification system for magnetic resonance imaging (MRI) findings of children with cerebral palsy (CP) that can be used in CP registers. METHOD The classification system was based on pathogenic patterns occurring in different periods of brain development. The MRI classification system (MRICS) consists of five main groups: maldevelopments, predominant white matter injury, predominant grey matter injury, miscellaneous, and normal findings. A detailed manual for the descriptions of these patterns was developed, including test cases (www.scpenetwork.eu/en/my-scpe/rtm/neuroimaging/cp-neuroimaging/). A literature review was performed and MRICS was compared with other classification systems. An exercise was carried out to check applicability and interrater reliability. Professionals working with children with CP or in CP registers were invited to participate in the exercise and chose to classify either 18 MRIs or MRI reports of children with CP. RESULTS Classification systems in the literature were compatible with MRICS and harmonization possible. Interrater reliability was found to be good overall (k=0.69; 0.54-0.82) among the 41 participants and very good (k=0.81; 0.74-0.92) using the classification based on imaging reports. INTERPRETATION Surveillance of Cerebral Palsy in Europe (SCPE) proposes the MRICS as a reliable tool. Together with its manual it is simple to apply for CP registers.
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Affiliation(s)
- Kate Himmelmann
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Göteborg, Sweden
| | - Veronka Horber
- Department of Child Neurology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Javier De La Cruz
- Biomedical Research Institute Imas12-Ciberesp, 12 Octubre University Hospital, Madrid, Spain
| | - Karen Horridge
- City Hospitals Sunderland NHS Foundation Trust, Sunderland Royal Hospital, Sunderland, UK
| | - Vlatka Mejaski-Bosnjak
- Department of Neuropediatrics, Children's Hospital Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Katalin Hollody
- Department of Paediatrics, University of Pecs, Pecs, Hungary
| | - Ingeborg Krägeloh-Mann
- Department of Paediatric Neurology, University Children's Hospital Tübingen, Tübingen, Germany
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19
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Dakovic I, da Graça Andrada M, Folha T, Neubauer D, Hollody K, Honold M, Horber V, Duranovic V, Bosnjak VM. Clinical features of cerebral palsy in children with symptomatic congenital cytomegalovirus infection. Eur J Paediatr Neurol 2014; 18:618-23. [PMID: 24931914 DOI: 10.1016/j.ejpn.2014.04.007] [Citation(s) in RCA: 10] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 03/09/2014] [Accepted: 04/06/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Human cytomegalovirus is the most common cause of vertically transmitted viral infection, affecting around 1% of liveborns. Infection is symptomatic in nearly 10% of infected children who are at higher risk of development of severe neurological disorders, including cerebral palsy. AIMS To study the clinical profile of children with cerebral palsy caused by symptomatic congenital cytomegalovirus infection in a multicenter study involving six countries from the Surveillance of Cerebral Palsy in Europe (SCPE) Network. METHODS Data on 35 children (13 males, 22 females; mean age at last assessment 12y 6mo, age range 14y 6mo, min 4y, max 18y 6mo) on pre/peri/neonatal history and last clinical assessment were collected. Classification of cerebral palsy and associated impairments was performed according to SCPE criteria. RESULTS The majority of children had bilateral spastic cerebral palsy, 85.7%, with a confidence interval (CI) [69.7-95.2], and 71.4% [CI 53.7-85.4] were unable to walk (GMFCS levels IV-V) while fine motor function was severely affected in 62.8% [CI 44.9-78.5] (BFMF levels IV and V). Most of the children with severe CP had severe associated impairments. 11.4% of children had severe visual and 42.8% severe hearing impairment, 77.1% [CI 59.9-89.6] suffered from epilepsy, also 77.1% had severe intellectual impairment, and speech was undeveloped in 71.4%. Female:male ratio was 1.69:1 and 80% of children were term born. CONCLUSIONS Cerebral palsy following symptomatic congenital cytomegalovirus infection seems to be in most cases a severe condition and associated impairments are overrepresented.
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Affiliation(s)
- Ivana Dakovic
- Children's Hospital Zagreb, University of Zagreb, School of Medicine, Department of Neuropediatrics, Klaiceva 16, 10000 Zagreb, Croatia
| | - Maria da Graça Andrada
- Federação das Associações Portuguesas de Paralisia Cerebral FAPPC/National Epidemiological Program for Cerebral Palsy, Lisbon, Portugal
| | - Teresa Folha
- Centro de Reabilitação de Paralisia Cerebral Calouste Gulbenkian Santa, Casa da Misericordia de Lisboa/National Epidemiological Program for Cerebral Palsy, Lisbon, Portugal
| | - David Neubauer
- University Medical Centre Ljubljana, Division of Paediatrics, Department of Child, Adolescent and Developmental Neurology, Ljubljana, Slovenia
| | - Katalin Hollody
- University of Pecs, Department of Paediatrics, Pecs, Hungary
| | - Michaela Honold
- Medical University Innsbruck, Division of Pediatric Neurology, Department of Pediatrics I, Innsbruck, Austria
| | - Veronka Horber
- University Children's Hospital Tübingen, Department of Child Neurology, Tübingen, Germany
| | - Vlasta Duranovic
- Children's Hospital Zagreb, University of Zagreb, School of Medicine, Department of Neuropediatrics, Klaiceva 16, 10000 Zagreb, Croatia
| | - Vlatka Mejaski Bosnjak
- Children's Hospital Zagreb, University of Zagreb, School of Medicine, Department of Neuropediatrics, Klaiceva 16, 10000 Zagreb, Croatia.
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Riess A, Grasshoff U, Schäferhoff K, Bonin M, Riess O, Horber V, Tzschach A. Interstitial 3p25.3-p26.1 deletion in a patient with intellectual disability. Am J Med Genet A 2012; 158A:2587-90. [PMID: 22965684 DOI: 10.1002/ajmg.a.35562] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Accepted: 06/21/2012] [Indexed: 11/08/2022]
Abstract
Interstitial deletions of the short arm of chromosome 3 are rare. We report on a 3-year-old girl with intellectual disability, muscular hypotonia, strabismus, and facial anomalies in whom an interstitial 1.24 Mb deletion in 3p25.3-p26.1 was detected by SNP array analysis. The deleted region harbors 11 RefSeq genes including CAV3 and SRGAP3/MEGAP, which had been associated with muscle disorders and intellectual disability, respectively. The deletion overlaps with a slightly larger deletion in a girl with a more complex phenotype including congenital heart defect and epilepsy, which indicates that haploinsufficiency of one or several of the genes in the deleted interval causes intellectual deficits, but not heart defects or epilepsy. Thus, the patient broadens our knowledge of the phenotypic consequences of deletions in 3p25.3-p26.1 and facilitates genotype-phenotype correlations for chromosome aberrations of this region.
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Affiliation(s)
- Angelika Riess
- Institute of Human Genetics, University of Tuebingen, Germany
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Sellier E, Horber V, Krägeloh-Mann I, De La Cruz J, Cans C. Interrater reliability study of cerebral palsy diagnosis, neurological subtype, and gross motor function. Dev Med Child Neurol 2012; 54:815-21. [PMID: 22809361 DOI: 10.1111/j.1469-8749.2012.04359.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM To evaluate the interrater reliability of the inclusion in registries and classification of children with cerebral palsy (CP). METHOD Two studies were conducted. In study 1, 12 paediatricians from 11 countries viewed video sequences of 12 children with or without CP (nine males, three females; median age 6y; range 2-16). In study 2, 19 professionals from eight countries participated in an online exercise. They had to classify the same children but based on written vignettes. All participants had to evaluate whether the child had CP, the neurological subtype (Surveillance of Cerebral Palsy in Europe classification system), and gross motor function level (Gross Motor Function Classification System [GMFCS]). Kappa (κ) coefficients were calculated for categorical variables and intraclass correlation coefficients (ICCs) for ordinal data. RESULTS Reliability was excellent in assessing whether or not a child had CP in study 1 (κ=1.00) and substantial in study 2 (κ=0.73); 95% confidence interval [CI] 0.58-0.87). For the neurological subtype, overall κ between paediatricians was 0.85 (95% CI 0.68-0.98), with full agreement observed for eight children. In study 2, overall κ was 0.78 (95% CI 0.61-0.91) with full agreement seen for five children. For the GMFCS, the ICC was 0.88 (95% CI 0.78-0.95) in study 1 and 0.80 (95% CI 0.64-0.91) in study 2. INTERPRETATION Reliability was excellent for all characteristics classified by paediatricians viewing the videos and substantial for professionals reading vignettes.
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Affiliation(s)
- Elodie Sellier
- TIMC-Techniques de l'Ingénierie Médicale et de la Complexité- Université Joseph Fourier-Grenoble 1, Grenoble, France.
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Riess A, Rossier E, Krüger R, Dufke A, Beck-Woedl S, Horber V, Alber M, Gläser D, Riess O, Tzschach A. Novel SLC9A6 mutations in two families with Christianson syndrome. Clin Genet 2012; 83:596-7. [PMID: 22931061 DOI: 10.1111/j.1399-0004.2012.01948.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 07/24/2012] [Accepted: 08/02/2012] [Indexed: 11/28/2022]
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Abstract
OBJECTIVES To develop subjective (visual) and objective (morphometric) rating scales for the classification of MRI in infants who had microcephaly with a simplified gyral pattern (MSGP) and to validate the first by the latter. METHODS We compared the MRI of 12 patients with MSGP and of 5 term-born control infants. Visual rating and morphometric analysis was performed for gyration and associated brain abnormalities of basal ganglia, lateral ventricles, pons, cerebellum, and corpus callosum. RESULTS Gyral pattern was rated reliably as normal in the control infants, simplified in 6 patients, and severely simplified in the other 6 patients. Associated brain abnormalities were reported in 10 of 12 patients. Visual rating correlated well with the morphometric measures. CONCLUSIONS Our visual rating scale for a simplified gyral pattern proved to be sensitive and reliable. Associated brain abnormalities are frequent, which underlines the need for a consistent scoring in these patients.
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Affiliation(s)
- R Jeroen Vermeulen
- Department of Child Neurology, VU University Medical Center, De Boelelaan 1117, 1081HV, Amsterdam, the Netherlands.
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Beschorner R, Wehrmann M, Ernemann U, Bonin M, Horber V, Oehl-Jaschkowitz B, Meyermann R, Dufke A. Extradural ependymal tumor with myxopapillary and ependymoblastic differentiation in a case of Schinzel-Giedion syndrome. Acta Neuropathol 2007; 113:339-46. [PMID: 17165030 DOI: 10.1007/s00401-006-0179-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2006] [Revised: 11/02/2006] [Accepted: 11/24/2006] [Indexed: 12/28/2022]
Abstract
Primary extradural ependymomas are rare neoplasms usually of the myxopapillary type. Reports on malignant primary extradural ependymal tumors are exceptionally rare. We here report on a 3-year-old boy with Schinzel-Giedion syndrome (SGS), who presented with lumbar spina bifida occulta and a progressive extraspinal lesion in the subcutaneous sacrococcygeal region. Microscopic examinations revealed an uncommon ependymal tumor with well-differentiated regions reflecting myxopapillary ependymoma and highly anaplastic regions with numerous mitoses, necroses, ependymal rosettes and ependymoblastic rosettes. Final neuropathologic diagnosis was an extraspinal anaplastic ependymal tumor with myxopapillary and ependymoblastic differentiation, corresponding to WHO grade IV. SGS is a very rare disorder with a likely autosomal recessive pattern of inheritance. So far, 42 cases have been reported, among them 7 were diagnosed to have malignant neoplasms, including three malignant sacrococcygeal teratomas, two sacrococcygeal primitive neuroectodermal tumors (PNET), one hepatoblastoma and one malignant kidney tumor. The present case is the first report on an ependymal tumor with a mixture of myxopapillary, anaplastic and ependymoblastic features and the first report on an ependymal tumor arising on the genetic background of SGS.
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Affiliation(s)
- Rudi Beschorner
- Institute of Brain Research, Eberhard-Karls University, Medical School, Tuebingen, Germany.
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Abstract
The aim of this study was to show the role of magnetic resonance imaging (MRI) in elucidating the aetiology, or at least pathogenesis, of cerebral palsy (CP). A systematic review of studies using MRI in children with CP was performed according to pathogenetic patterns characterizing different timing periods of occurence of the lesions, and with respect to gestational age (term vs preterm) and CP subtypes. Out of the studies published since 1990 in English, six met all the inclusion criteria; they involved children with spastic and dyskinetic CP. Abnormal MRI was reported in 334 out of 388 (86%) patients and gave clues to pathogenesis in 83%. Fourteen studies met only part of the inclusion criteria and abnormal MRIs were reported even more frequently in these (91%; 930/1022). Periventricular white matter lesions were most frequent (56%) followed by cortical and deep grey matter lesions (18%); brain maldevelopments were rather rare, described in 9%. Brain maldevelopments and grey matter lesions were more often seen in term than in preterm-born children with CP (brain maldevelopments: 16% vs 2.5%; grey matter lesions: 33% vs 3.5%); periventricular white matter lesions occurred significantly more often in preterm than in term-born children (90% vs 20%). CP is mainly characterized by brain lesions which can be identified by MRI in around 75% of preterm infants; brain maldevelopments occur in around 10%.
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Asmus F, Horber V, Pohlenz J, Schwabe D, Zimprich A, Munz M, Schöning M, Gasser T. A novel TITF-1 mutation causes benign hereditary chorea with response to levodopa. Neurology 2005; 64:1952-4. [PMID: 15955952 DOI: 10.1212/01.wnl.0000164000.75046.cc] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.9] [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
Presented is a pedigree with infancy-onset benign hereditary chorea (BHC) caused by a novel nonsense mutation in exon 3 (523G-->T, E175X) of the TITF-1 (Nkx2.1) gene. Four confirmed mutation carriers showed the typical movement disorder of BHC and congenital hypothyroidism. Surprisingly, treatment with levodopa improved gait dramatically and reduced chorea in two patients. Dopaminergic drugs should be considered a useful therapeutic option in BHC.
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Affiliation(s)
- F Asmus
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, Tuebingen, Germany.
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