Improved upper limb function in non-ambulant children with SMA type 2 and 3 during nusinersen treatment: a prospective 3-years SMArtCARE registry study

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.

BDV Syndrome: An Emerging Syndrome With Profound Obesity and Neurodevelopmental Delay Resembling Prader-Willi Syndrome

CONTEXT

CPE encodes carboxypeptidase E, an enzyme that converts proneuropeptides and propeptide hormones to bioactive forms. It is widely expressed in the endocrine and central nervous system. To date, 4 individuals from 2 families with core clinical features including morbid obesity, neurodevelopmental delay, and hypogonadotropic hypogonadism, harboring biallelic loss-of-function (LoF) CPE variants, have been reported.

OBJECTIVE

We describe 4 affected individuals from 3 unrelated consanguineous families, 2 siblings of Syrian, 1 of Egyptian, and 1 of Pakistani descent, all harboring novel homozygous CPE LoF variants.

METHODS

After excluding Prader-Willi syndrome (PWS), exome sequencing was performed in both Syrian siblings. The variants identified in the other 2 individuals were reported as research variants in a large-scale exome study and in the ClinVar database. Computational modeling of all possible missense alterations allowed assessing CPE tolerance to missense variants.

RESULTS

All affected individuals were severely obese with neurodevelopmental delay and other endocrine anomalies. Three individuals from 2 families shared the same CPE homozygous truncating variant c.361C > T, p.(Arg121*), while the fourth carried the c.994del, p.(Ser333Alafs*22) variant. Comparison of clinical features with previously described cases and standardization according to the Human Phenotype Ontology terms indicated a recognizable clinical phenotype, which we termed Blakemore-Durmaz-Vasileiou (BDV) syndrome. Computational analysis indicated high conservation of CPE domains and intolerance to missense changes.

CONCLUSION

Biallelic truncating CPE variants are associated with BDV syndrome, a clinically recognizable monogenic recessive syndrome with childhood-onset obesity, neurodevelopmental delay, hypogonadotropic hypogonadism, and hypothyroidism. BDV syndrome resembles PWS. Our findings suggest missense variants may also be clinically relevant.

Treatment of primary malignant rhabdoid tumor of the brain: report of three cases and review of the literature

PURPOSE

Primary malignant rhabdoid tumor (MRT) of the central nervous system is an extremely aggressive tumor predominantly related to early childhood, with characteristic histopathological findings but unclear histogenesis. Owing to its low incidence, little knowledge exists concerning the best therapeutic strategy.

METHODS AND MATERIALS

Three children of our hospital with MRT of the brain underwent a maximum tumor resection followed by multidrug chemotherapy and radiation therapy to the craniospinal axis.

RESULTS

Relapse was disseminated along the spinal subarachnoid spaces in one child and occurred at the primary tumor site in the other two patients. Maximum survival was 15 months from diagnosis.

CONCLUSION

A review of patients reported in the literature and a comparison to our patients reveals a high propensity to early local relapse and meningeal dissemination. In the absence of more effective therapeutic options, we recommend multidisciplinary treatment of patients in good general condition and with resectable disease. In particular, following radiation therapy, tumor remissions and delay of tumor regrowth have been observed.

Progressive dementia with parkinsonism in corticobasal and brainstem degeneration with neuronal inclusions

Pathologic findings are presented in a case of neurodegenerative disease with a 5-year course of progressive presenile dementia and parkinsonism. At autopsy, atrophy of the cerebral cortex, caudate nucleus, and substantia nigra were observed. Homogeneous eosinophilic intracytoplasmic neuronal inclusions were found, predominantly in the brainstem and cerebellar nuclei. These inclusions were nonargyrophilic and did not stain with antibodies against tau and ubiquitin.

Immunohistochemistry of primary central nervous system malignant rhabdoid tumors: report of five cases and review of the literature

Malignant rhabdoid tumors (MRT) are characterized by a typical light microscopic morphology with uniformly round tumor cells, vacuolated cytoplasm with occasional round, hyaline intracytoplasmic, periodic acid-Schiff-positive inclusions, vesicular nuclei with prominent nucleoli and positive immunoreactivity for vimentin. The histogenesis of MRT is controversial. Five cases of primary central nervous system (CNS) rhabdoid tumors in children are presented. Immunohistochemical, light and electron microscopic features are compared with primary CNS malignant rhabdoid tumors reported in the literature. Expression of various neurofilaments in our cases of primary CNS rhabdoid tumors was prominent and we therefore favor a neural differentiation of extrarenal intracerebral rhabdoid tumors.

Detection of Trace Amounts of Fetal RhD-Positive Red Cells with Flow Cytometry after Multiple Rh-Negative Intrauterine Transfusions and RhD-Gene Determination with PCR

In 2 cases of RhD-sensitized women, hemolytic disease of the newborns (hdn) was mitigated by intrauterine transfusions of·Rh-negative donor blood during pregnancy. In both cases preterm delivery was performed by cesarean section in week 32 of pregnancy. With cord blood the direct antiglobulin test (DAT) was negative using the gel test. The blood groups corresponded to the transfused donor blood. With flow cytometry (FC), 2% of IgG-coated red cells were found in the cord blood in case I and 5% in case 2. Using FC, these cells were RhD positive. Polymerase chain reaction (PCR) analyses showed the presence of RhD-gene sequences in both cases. Therefore, FC and PCR seem to be suitable methods for the diagnosis and the monitoring in cases of imminent hemolytic disease due to anti-D alloimmunization. With further transfusions, both children developed well after delivery.

[Hereditary motor and sensory neuropathy type III. Case report and review of the literature]

We report on a 6 years old girl, who was first presented at the age of 3 1/2 years with progressive ataxia, coordination disturbance and distal motoric weakness (especially hand-weakness). Diagnostic procedure revealed heredomotorsensoric neuropathy type III (syn. Dejerine-Sottas Disease).