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Saracino A, Totaro M, Politano D, DE Giorgis V, Gana S, Papalia G, Pichiecchio A, Plumari M, Rognone E, Varesio C, Orcesi S. PGAP2-Related Hyperphosphatasia-Mental Retardation Syndrome: Report of a Novel Patient, Toward a Broadening of Phenotypic Spectrum and Therapeutic Perspectives. Neuropediatrics 2024; 55:129-134. [PMID: 38365198 DOI: 10.1055/s-0044-1779613] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
PGAP2 gene has been known to be the cause of "hyperphosphatasia, mental retardation syndrome-3" (HPMRS3). To date, 14 pathogenic variants in PGAP2 have been identified as the cause of this syndrome in 24 patients described in single-case reports or small clinical series with pan-ethnic distribution. We aim to present a pediatric PGAP2-mutated case, intending to further expand the clinical phenotype of the syndrome and to report our experience on a therapeutic approach to drug-resistant epilepsy.We present the clinical, neuroradiological, and genetic characterization of a Caucasian pediatric subject with biallelic pathogenic variants in the PGAP2 gene revealed by next generation sequencing analysis.We identified a subject who presented with global developmental delay and visual impairment. Brain magnetic resonance imaging showed mild hypoplasia of the inferior cerebellar vermis and corpus callosum and mild white matter reduction. Laboratory investigations detected an increase in alkaline phosphatase. At the age of 13 months, he began to present epileptic focal seizures with impaired awareness, which did not respond to various antiseizure medications. Electroencephalogram (EEG) showed progressive background activity disorganization and multifocal epileptic abnormalities. Treatment with high-dose pyridoxine showed partial benefit, but the persistence of seizures and the lack of EEG amelioration prompted us to introduce ketogenic diet treatment.Our case provides a further phenotypical expansion of HPMRS3 to include developmental and epileptic encephalopathy. Due to the limited number of patients reported so far, the full delineation of the clinical spectrum of HPMRS3 and indications for precision medicine would benefit from the description of new cases and their follow-up evaluations.
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Affiliation(s)
- Annalisa Saracino
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Member of ERN-Epicare, Pavia, Italy
| | - Martina Totaro
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Member of ERN-Epicare, Pavia, Italy
| | - Davide Politano
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Member of ERN-Epicare, Pavia, Italy
| | - Valentina DE Giorgis
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Member of ERN-Epicare, Pavia, Italy
| | - Simone Gana
- Neurogenetics Research Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Grazia Papalia
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Member of ERN-Epicare, Pavia, Italy
| | - Anna Pichiecchio
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Neuroradiology Department, Advanced Imaging and Radiomics Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Massimo Plumari
- Neurogenetics Research Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Elisa Rognone
- Neuroradiology Department, Advanced Imaging and Radiomics Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Costanza Varesio
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Member of ERN-Epicare, Pavia, Italy
| | - Simona Orcesi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Member of ERN-Epicare, Pavia, Italy
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Varesio C, Zanaboni MP, Pasca L, Provenzi L, Ferraris C, Tagliabue A, Pezzotti E, Carpani A, Veggiotti P, DE Giorgis V. Novel insight into GLUT1 deficiency syndrome: screening for emotional and behavioral problems in youths following ketogenic diet. Minerva Pediatr (Torino) 2024; 76:189-196. [PMID: 33820407 DOI: 10.23736/s2724-5276.21.05923-1] [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] [Indexed: 11/08/2022]
Abstract
BACKGROUND Glucose transporter type 1 deficiency syndrome (GLUT1DS) is a rare disorder with a broad spectrum of neurological manifestations. The ketogenic diet (KD) is, to date, the gold standard treatment. Behavioral problems, well recognized in patients with chronic conditions, have not been, so far, deeply investigated in GLUT1DS patients. We performed an exploratory study to assess the risk of emotional and behavioral problems and investigated the potential role of influencing factors related to the pathology itself or KD treatment. METHODS This was a mono-center retrospective study involving youths with GLUT1Ds treated with KD and a group of migraine patients age- and gender-matched. Patients were included if the main caregiver completed the Child Behavior Check List 6-18 (CBCL). Descriptive statistics for demographic and clinical data and questionnaire scores were computed. Correlational analyses were used to assess the potential associations of clinical variables and age and time from KD introduction with CBCL scores in GLUT1DS patients. RESULTS We enrolled nine youths with GLUT1DS and 9 with migraine. In the GLUT1DS group, none of the mean scores of the CBCL items fell within the borderline/clinical range, except for social problems located in the borderline range. Investigation for influencing factors revealed the patient's age related to withdrawn/depressive (r=0.709, P=0.032) and social problems (r=.684, P=0.042). Time from the introduction of KD was related to social problems (r=.827, P=0.006). From the comparison with the scores obtained from migraine patients, significantly higher scores emerged in the latter group in internalizing problems (Z=-2.48, P=0.01), externalizing problems (Z=-3.49, P<0.001), anxious/depressed subscale (Z=-2.37, P=0.014), somatic complaints subscale (Z=-2.624, P=0.008), aggressive behavior subscale (Z=-2.539, P=0.011). CONCLUSIONS Although highly exploratory in its nature, this study provides a novel insight into GLUT1DS. Our data suggested that the risk for internalizing problems in GLUT1DS youths was related to higher age and higher time elapsed from KD introduction. They occurred at a sub-clinical level, making them difficult to detect, if not expressly and systematically investigated.
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Affiliation(s)
- Costanza Varesio
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy -
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy -
| | - Martina P Zanaboni
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy
| | - Ludovica Pasca
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Livio Provenzi
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy
| | - Cinzia Ferraris
- Nutrition and Eating Disorder Research Center, Department of Public Health, Experimental and Forensic Medicine University of Pavia, Pavia, Italy
| | - Anna Tagliabue
- Nutrition and Eating Disorder Research Center, Department of Public Health, Experimental and Forensic Medicine University of Pavia, Pavia, Italy
| | - Elena Pezzotti
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Adriana Carpani
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy
| | - Pierangelo Veggiotti
- Unit of Pediatric Neurology, Vittore Buzzi Hospital, Milan, Italy
- Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Valentina DE Giorgis
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy
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Zanaboni MP, Pasca L, Bergamoni S, Bova SM, Celario M, Freri E, Grumi S, Filippini M, Leonardi V, Micheletti S, Operto FF, Papa A, Pastorino GMG, Peruzzi C, Pruna D, Ragona F, Raviglione F, Totaro M, Varesio C, De Giorgis V. The effect of executive function on health related quality of life in children with self-limited epilepsy with centrotemporal spikes. Epilepsy Behav 2024; 152:109607. [PMID: 38277852 DOI: 10.1016/j.yebeh.2023.109607] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/11/2023] [Accepted: 12/21/2023] [Indexed: 01/28/2024]
Abstract
AIM The current study aims to investigate the effect of Executive Functions (EFs) on Health Related Quality of Life (HRQoL) in a cohort of children with self-limited epilepsy with centrotemporal spikes (SeLECTS) and to identify possible factors that impact HRQoL specifically related to epilepsy-related variables and EFs skills. MATERIAL AND METHOD The Pediatric Quality of Life Inventory 4.0 Generic Core Scales (PedsQL) and The Behavior Rating Inventory of Executive Function (BRIEF-2 and BRIEF-P) were completed by the parents of 129 patients with SeLECTS. Demographic variables and epilepsy-related variables were collected. RESULTS Our sample performed in the average range across all the subscales and summary scores of the PedsQL and performed in the normal range of the BRIEF questionnaire. We observed that a lower functioning in EFs was associated with lower overall HRQoL scores. We explored the relationship between epilepsy characteristics and scores on the PedsQL. We found that the use of antiseizure medications (ASMs), longer duration of the treatment, and a higher seizure frequency were associated with a lower HRQoL. Moreover, we observed that executive dysfunction was a significant predictor of reduced HRQoL. CONCLUSION Our results suggest the importance of the identification of patients with SeLECTS with a high level of risk for a poor HRQoL. We may now add executive dysfunction to the list of known risk factors for poor HRQoL in children with SeLECTS, along with such factors as seizure frequency, recent seizures, use of ASMs and longer duration of therapy. The early identification of children with SeLECTS at risk of a poor HRQoL could allow the activation of adequate interventions.
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Affiliation(s)
| | - Ludovica Pasca
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
| | - Stefania Bergamoni
- Childhood and Adolescence Neurology and Psychiatry Unit, ASST GOM Niguarda, Milan, Italy
| | | | - Massimiliano Celario
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy
| | - Elena Freri
- Department of Pediatric Neuroscience, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Serena Grumi
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy
| | | | - Valeria Leonardi
- Department of Biomedical and Clinical Sciences "L.Sacco", University of Milan, Italy
| | - Serena Micheletti
- Unit of Child Neurology and Psychiatry, ASST-Spedali Civili of Brescia, Brescia, Italy
| | | | - Amanda Papa
- Department of Child Neuropsychiatry, University Hospital Maggiore della Carità, Novara, Italy
| | - Grazia Maria Giovanna Pastorino
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno, Italy
| | - Cinzia Peruzzi
- Child and Adolescent Neuropsychiatry Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Dario Pruna
- Pediatric Neurology and Epileptology Unit, Pediatric Department, ARNAS Brotzu, Cagliari, Italy
| | - Francesca Ragona
- Department of Pediatric Neuroscience, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | | | - Martina Totaro
- Hospital Neuropsychiatry Service, ASST Rhodense, Rho, Milan, Italy
| | - Costanza Varesio
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Valentina De Giorgis
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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Vitali H, Campus C, Signorini S, De Giorgis V, Morelli F, Varesio C, Pasca L, Sammartano A, Gori M. Blindness affects the developmental trajectory of the sleeping brain. Neuroimage 2024; 286:120508. [PMID: 38181867 DOI: 10.1016/j.neuroimage.2024.120508] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 12/12/2023] [Accepted: 01/03/2024] [Indexed: 01/07/2024] Open
Abstract
Sleep plays a crucial role in brain development, sensory information processing, and consolidation. Sleep spindles are markers of these mechanisms as they mirror the activity of the thalamocortical circuits. Spindles can be subdivided into two groups, slow (10-13 Hz) and fast (13-16 Hz), which are each associated with different functions. Specifically, fast spindles oscillate in the high-sigma band and are associated with sensorimotor processing, which is affected by visual deprivation. However, how blindness influences spindle development has not yet been investigated. We recorded nap video-EEG of 50 blind/severely visually impaired (BSI) and 64 sighted children aged 5 months to 6 years old. We considered aspects of both macro- and micro-structural spindles. The BSI children lacked the evolution of developmental spindles within the central area. Specifically, young BSI children presented low central high-sigma and high-beta (25-30 Hz) event-related spectral perturbation and showed no signs of maturational decrease. High-sigma and high-beta activity in the BSI group correlated with clinical indices predicting perceptual and motor disorders. Our findings suggest that fast spindles are pivotal biomarkers for identifying an early developmental deviation in BSI children. These findings are critical for initial therapeutic intervention.
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Affiliation(s)
- Helene Vitali
- Unit for Visually Impaired People, Center for Human Technologies, Fondazione Istituto Italiano di Tecnologia, Istituto Italiano di Tecnologia, Via Enrico Melen 83, Building B, Genoa 16152, Italy; DIBRIS, University of Genova, Genoa 16145, Italy
| | - Claudio Campus
- Unit for Visually Impaired People, Center for Human Technologies, Fondazione Istituto Italiano di Tecnologia, Istituto Italiano di Tecnologia, Via Enrico Melen 83, Building B, Genoa 16152, Italy
| | - Sabrina Signorini
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia 27100, Italy
| | - Valentina De Giorgis
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia 27100, Italy; Department of Brain and Behavioural Sciences, University of Pavia, Pavia 27100, Italy; Member of European Reference Network for Rare and Complex Epilepsies, EpiCARE, Italy
| | - Federica Morelli
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia 27100, Italy; Department of Brain and Behavioural Sciences, University of Pavia, Pavia 27100, Italy
| | - Costanza Varesio
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia 27100, Italy; Department of Brain and Behavioural Sciences, University of Pavia, Pavia 27100, Italy; Member of European Reference Network for Rare and Complex Epilepsies, EpiCARE, Italy
| | - Ludovica Pasca
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia 27100, Italy; Department of Brain and Behavioural Sciences, University of Pavia, Pavia 27100, Italy; Member of European Reference Network for Rare and Complex Epilepsies, EpiCARE, Italy
| | - Alessia Sammartano
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia 27100, Italy; Member of European Reference Network for Rare and Complex Epilepsies, EpiCARE, Italy
| | - Monica Gori
- Unit for Visually Impaired People, Center for Human Technologies, Fondazione Istituto Italiano di Tecnologia, Istituto Italiano di Tecnologia, Via Enrico Melen 83, Building B, Genoa 16152, Italy.
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Cavirani B, Spagnoli C, Caraffi SG, Cavalli A, Cesaroni CA, Cutillo G, De Giorgis V, Frattini D, Marchetti GB, Masnada S, Peron A, Rizzi S, Varesio C, Spaccini L, Vignoli A, Canevini MP, Veggiotti P, Garavelli L, Fusco C. Genetic Epilepsies and Developmental Epileptic Encephalopathies with Early Onset: A Multicenter Study. Int J Mol Sci 2024; 25:1248. [PMID: 38279250 PMCID: PMC10816990 DOI: 10.3390/ijms25021248] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/15/2024] [Accepted: 01/17/2024] [Indexed: 01/28/2024] Open
Abstract
The genetic causes of epilepsies and developmental and epileptic encephalopathies (DEE) with onset in early childhood are increasingly recognized. Their outcomes vary from benign to severe disability. In this paper, we wished to retrospectively review the clinical, genetic, EEG, neuroimaging, and outcome data of patients experiencing the onset of epilepsy in the first three years of life, diagnosed and followed up in four Italian epilepsy centres (Epilepsy Centre of San Paolo University Hospital in Milan, Child Neurology and Psychiatry Unit of AUSL-IRCCS di Reggio Emilia, Pediatric Neurology Unit of Vittore Buzzi Children's Hospital, Milan, and Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia). We included 168 patients (104 with monogenic conditions, 45 with copy number variations (CNVs) or chromosomal abnormalities, and 19 with variants of unknown significance), who had been followed up for a mean of 14.75 years. We found a high occurrence of generalized seizures at onset, drug resistance, abnormal neurological examination, global developmental delay and intellectual disability, and behavioural and psychiatric comorbidities. We also documented differing presentations between monogenic issues versus CNVs and chromosomal conditions, as well as atypical/rare phenotypes. Genetic early-childhood-onset epilepsies and DEE show a very wide phenotypic and genotypic spectrum, with a high risk of complex neurological and neuropsychiatric phenotypes.
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Affiliation(s)
- Benedetta Cavirani
- Child Neuropsychiatry Unit, Azienda USL di Parma, 43121 Parma, Italy;
- Child Neurology and Psychiatry Unit, Department of Pediatrics, Presidio Ospedaliero Santa Maria Nuova, AUSL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (A.C.); (C.A.C.); (D.F.); (S.R.); (C.F.)
| | - Carlotta Spagnoli
- Child Neurology and Psychiatry Unit, Department of Pediatrics, Presidio Ospedaliero Santa Maria Nuova, AUSL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (A.C.); (C.A.C.); (D.F.); (S.R.); (C.F.)
| | - Stefano Giuseppe Caraffi
- Medical Genetics Unit, Presidio Ospedaliero Santa Maria Nuova, AUSL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy (L.G.)
| | - Anna Cavalli
- Child Neurology and Psychiatry Unit, Department of Pediatrics, Presidio Ospedaliero Santa Maria Nuova, AUSL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (A.C.); (C.A.C.); (D.F.); (S.R.); (C.F.)
| | - Carlo Alberto Cesaroni
- Child Neurology and Psychiatry Unit, Department of Pediatrics, Presidio Ospedaliero Santa Maria Nuova, AUSL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (A.C.); (C.A.C.); (D.F.); (S.R.); (C.F.)
| | - Gianni Cutillo
- Pediatric Neurology Unit, Department of Pediatric Neurology, Buzzi Children’s Hospital, 20154 Milan, Italy; (G.C.); (S.M.); (P.V.)
| | - Valentina De Giorgis
- Department of Brain and Behavioural Sciences, University of Pavia, 27100 Pavia, Italy; (V.D.G.); (C.V.)
- Department of Child Neurology and Psychiatriy, IRCCS Mondino Foundation, ERN-Epicare, 27100 Pavia, Italy
| | - Daniele Frattini
- Child Neurology and Psychiatry Unit, Department of Pediatrics, Presidio Ospedaliero Santa Maria Nuova, AUSL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (A.C.); (C.A.C.); (D.F.); (S.R.); (C.F.)
| | - Giulia Bruna Marchetti
- Medical Genetics Unit, Woman-Child-Newborn Department, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Silvia Masnada
- Pediatric Neurology Unit, Department of Pediatric Neurology, Buzzi Children’s Hospital, 20154 Milan, Italy; (G.C.); (S.M.); (P.V.)
| | - Angela Peron
- Medical Genetics, Meyer Children’s Hospital IRCCS, 50139 Florence, Italy;
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, Università degli Studi di Firenze, 50121 Florence, Italy
- Medical Genetics, ASST Santi Paolo e Carlo, San Paolo Hospital, 20142 Milan, Italy
| | - Susanna Rizzi
- Child Neurology and Psychiatry Unit, Department of Pediatrics, Presidio Ospedaliero Santa Maria Nuova, AUSL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (A.C.); (C.A.C.); (D.F.); (S.R.); (C.F.)
| | - Costanza Varesio
- Department of Brain and Behavioural Sciences, University of Pavia, 27100 Pavia, Italy; (V.D.G.); (C.V.)
- Department of Child Neurology and Psychiatriy, IRCCS Mondino Foundation, ERN-Epicare, 27100 Pavia, Italy
| | - Luigina Spaccini
- Clinical Genetics Unit, Department of Obstetrics and Gynecology, V. Buzzi Children’s Hospital, University of Milan, 20157 Milan, Italy;
| | - Aglaia Vignoli
- Child Neuropsychiatry Unit-Epilepsy Center, ASST Santi Paolo e Carlo, San Paolo Hospital, 20142 Milan, Italy; (A.V.); (M.P.C.)
- Department of Health Sciences, University of Milan, 20157 Milan, Italy
| | - Maria Paola Canevini
- Child Neuropsychiatry Unit-Epilepsy Center, ASST Santi Paolo e Carlo, San Paolo Hospital, 20142 Milan, Italy; (A.V.); (M.P.C.)
- Department of Health Sciences, University of Milan, 20157 Milan, Italy
| | - Pierangelo Veggiotti
- Pediatric Neurology Unit, Department of Pediatric Neurology, Buzzi Children’s Hospital, 20154 Milan, Italy; (G.C.); (S.M.); (P.V.)
- Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy
| | - Livia Garavelli
- Medical Genetics Unit, Presidio Ospedaliero Santa Maria Nuova, AUSL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy (L.G.)
| | - Carlo Fusco
- Child Neurology and Psychiatry Unit, Department of Pediatrics, Presidio Ospedaliero Santa Maria Nuova, AUSL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (A.C.); (C.A.C.); (D.F.); (S.R.); (C.F.)
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Pasca L, Quaranta CA, Grumi S, Zanaboni MP, Tagliabue A, Guglielmetti M, Vitali H, Capriglia E, Varesio C, Toni F, Nobili L, Terzaghi M, De Giorgis V. The effects of ketogenic dietary therapies on sleep: A scoping review. J Sleep Res 2023:e14073. [PMID: 37932966 DOI: 10.1111/jsr.14073] [Citation(s) in RCA: 3] [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: 08/08/2023] [Revised: 09/29/2023] [Accepted: 10/04/2023] [Indexed: 11/08/2023]
Abstract
Sleep problems are common in neurological conditions for which ketogenic dietary therapies (KDTs) are recognised as an effective intervention (drug-resistant epilepsy, autism spectrum disorder, and migraine). Given the composite framework of action of ketogenic dietary therapies, the prevalence of sleep disturbance, and the importance of sleep regulation, the present scoping review aimed at identifying and mapping available evidence of the effects of ketogenic dietary therapies on sleep. A comprehensive web-based literature search was performed retrieving publications published to June 2023 using PubMed and Scopus, yielding to 277 records. Twenty papers were finally selected and included in the review. Data were abstracted by independent coders. High variability was identified in study design and sleep outcome evaluation among the selected studies. Several changes in sleep quality and sleep structure under ketogenic dietary therapies were found, namely an improvement of overall sleep quality, improvement in the difficulty falling asleep and nighttime awakenings, improvement in daytime sleepiness and an increase of REM sleep. The relevance and possible physiological explanations of these changes, clinical recommendations, and future directions in the field are discussed.
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Affiliation(s)
- Ludovica Pasca
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Carlo Alberto Quaranta
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Serena Grumi
- Developmental Psychobiology Lab, IRCCS Mondino Foundation, Pavia, Italy
| | | | - Anna Tagliabue
- Human Nutrition and Eating Disorder Research Centre, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Monica Guglielmetti
- Human Nutrition and Eating Disorder Research Centre, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Helene Vitali
- U-VIP: Unit for Visually Impaired People, Istituto Italiano di Tecnologia, Genova, Italy
| | - Elena Capriglia
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Unit of Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Pavia, Italy
| | - Costanza Varesio
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Federico Toni
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Lino Nobili
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Child and Maternal Health, University of Genova, Genova, Italy
- Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Michele Terzaghi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Unit of Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Pavia, Italy
| | - Valentina De Giorgis
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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7
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Politano D, Catalano G, Pezzotti E, Varesio C, Sirchia F, Casella A, Rognone E, Pichiecchio A, Borgatti R, Orcesi S. Expanding the Natural History of SNORD118-Related Ribosomopathy: Hints from an Early-Diagnosed Patient with Leukoencephalopathy with Calcifications and Cysts and Overview of the Literature. Genes (Basel) 2023; 14:1817. [PMID: 37761957 PMCID: PMC10531261 DOI: 10.3390/genes14091817] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/11/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
Leukoencephalopathy with calcifications and cysts (LCC) is a rare autosomal recessive disorder showing a pediatric or adult onset. First described in 1996 by Labrune and colleagues, it was only in 2016 that bi-allelic variants in a non-protein coding gene, SNORD118, were found as the cause for LCC, differentiating this syndrome from coats plus (CP). SNORD118 transcribes for a small nucleolar RNA, which is necessary for correct ribosome biogenesis, hence the classification of LCC among ribosomopathies. The syndrome is characterized by a combination of white matter hyperintensities, calcifications, and cysts on brain MRI with varying neurological signs. Corticosteroids, surgery, and recently bevacizumab, have been tried with unclear results since the natural history of the disease remains elusive. To date, 67 patients with a pediatric onset of disease have been described in the literature, with a clinical-radiological follow-up carried out in only eleven of them. We described the clinical-radiological follow-up from birth to almost five years of age of a late-preterm patient diagnosed with LCC and carried out a thorough overview of pediatric patients described in the literature. It is important to gather serial clinical-radiological data from other patients to depict the natural history of this disease, aiming to deeply depict genotype-phenotype correlations and make the role of new therapeutics clearer.
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Affiliation(s)
- Davide Politano
- Department of Brain and Behavior Neuroscience, University of Pavia, 27100 Pavia, Italy
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy
| | - Guido Catalano
- Department of Brain and Behavior Neuroscience, University of Pavia, 27100 Pavia, Italy
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy
| | - Elena Pezzotti
- Department of Brain and Behavior Neuroscience, University of Pavia, 27100 Pavia, Italy
- U.O. Neuropsichiatria Infanzia e Adolescenza, ASST Bergamo Est, 24068 Seriate, Italy
| | - Costanza Varesio
- Department of Brain and Behavior Neuroscience, University of Pavia, 27100 Pavia, Italy
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy
| | - Fabio Sirchia
- Department of Molecular Medicine, University of Pavia, 27100 Pavia, Italy
- Medical Genetics Unit, IRCCS San Matteo Foundation, 27100 Pavia, Italy
| | - Antonella Casella
- Department of Molecular Medicine, University of Pavia, 27100 Pavia, Italy
- Neurogenetics Research Center, IRCCS Mondino Foundation, 27100 Pavia, Italy
| | - Elisa Rognone
- Neuroradiology Department, IRCCS Mondino Foundation, 27100 Pavia, Italy
| | - Anna Pichiecchio
- Department of Brain and Behavior Neuroscience, University of Pavia, 27100 Pavia, Italy
- Neuroradiology Department, IRCCS Mondino Foundation, 27100 Pavia, Italy
| | - Renato Borgatti
- Department of Brain and Behavior Neuroscience, University of Pavia, 27100 Pavia, Italy
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy
| | - Simona Orcesi
- Department of Brain and Behavior Neuroscience, University of Pavia, 27100 Pavia, Italy
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy
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8
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Parravicini S, Pasca L, Zanaboni MP, Varesio C, Rognone E, Totaro M, Gana S, Rossi E, De Giorgis V. Electroclinical Improvement in a Patient with Ring Chromosome 20 Syndrome Treated with Zonisamide: A Case Report. J Pediatr Genet 2023; 12:219-223. [PMID: 37575645 PMCID: PMC10421690 DOI: 10.1055/s-0041-1726281] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 02/06/2021] [Indexed: 10/21/2022]
Abstract
Ring chromosome 20 or r(20) syndrome is a rare chromosomal disorder, mainly characterized by childhood-onset drug-resistant epilepsy with typical electroencephalographic findings, followed by mild to severe cognitive-behavioral decline. Recent studies support a possible role of the dopaminergic system in the epileptogenesis of this syndrome. We report the case of a 13-year-old female with mosaic r(20) who showed typical disease onset and evolution and a remarkable electroclinical improvement with zonisamide. Epilepsy related to r(20) is often medically intractable. When valproate and lamotrigine are not effective, zonisamide could be further investigated as a therapeutic option, since it acts as antifocal and it has a potential role in the prevention of dopamine depletion.
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Affiliation(s)
- Stefano Parravicini
- Department of Child Neurology and Psychiatry, IRCSS Mondino Foundation, European Reference Network for Rare and Complex Epilepsies, EpiCARE, Pavia, Italy
- Brain and Behaviour Department, University of Pavia, Pavia, Italy
| | - Ludovica Pasca
- Department of Child Neurology and Psychiatry, IRCSS Mondino Foundation, European Reference Network for Rare and Complex Epilepsies, EpiCARE, Pavia, Italy
- Brain and Behaviour Department, University of Pavia, Pavia, Italy
| | - Martina Paola Zanaboni
- Department of Child Neurology and Psychiatry, IRCSS Mondino Foundation, European Reference Network for Rare and Complex Epilepsies, EpiCARE, Pavia, Italy
| | - Costanza Varesio
- Department of Child Neurology and Psychiatry, IRCSS Mondino Foundation, European Reference Network for Rare and Complex Epilepsies, EpiCARE, Pavia, Italy
- Brain and Behaviour Department, University of Pavia, Pavia, Italy
| | - Elisa Rognone
- Department of Neuroradiology, IRCSS Mondino Foundation, Pavia, Italy
| | - Martina Totaro
- Department of Child Neurology and Psychiatry, IRCSS Mondino Foundation, European Reference Network for Rare and Complex Epilepsies, EpiCARE, Pavia, Italy
- Brain and Behaviour Department, University of Pavia, Pavia, Italy
| | - Simone Gana
- Medical Genetics, IRCCS Mondino Foundation, Pavia, Italy
| | - Elena Rossi
- Medical Genetics, IRCCS Mondino Foundation, Pavia, Italy
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Valentina De Giorgis
- Department of Child Neurology and Psychiatry, IRCSS Mondino Foundation, European Reference Network for Rare and Complex Epilepsies, EpiCARE, Pavia, Italy
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9
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Pasca L, Ferraris C, Guglielmetti M, Varesio C, Totaro M, Trentani C, Marazzi C, Brambilla I, Ballante E, Armeno M, Valenzuela GR, Caraballo RH, Veggiotti P, Tagliabue A, De Giorgis V. Ketonemia variability through menstrual cycle in patients undergoing classic ketogenic diet. Front Nutr 2023; 10:1188055. [PMID: 37575326 PMCID: PMC10413101 DOI: 10.3389/fnut.2023.1188055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/13/2023] [Indexed: 08/15/2023] Open
Abstract
Introduction Ketogenic dietary therapies (KDT) are well-established, safe, non-pharmacologic treatments used for children and adults with drug-resistant epilepsy and other neurological disorders. Ketone bodies (KBs) levels are recognized as helpful to check compliance to the KDT and to attempt titration of the diet according to the individualized needs. KBs might undergo inter-individual and intra-individual variability and can be affected by several factors. Possible variations in glycemia and ketone bodies blood levels according to the menstrual cycle have not been systematically assessed yet, but this time window deserves special attention because of hormonal and metabolic related changes. Methods This study aims at searching for subtle changes in KBs blood level during menstrual cycle in female patients undergoing a stable ketogenic diet, by analyzing 3-months daily measurement of ketone bodies blood levels and glucose blood levels throughout the menstrual cycle. Results We report the preliminary results on six female patients affected by GLUT1DS or drug resistant epilepsy, undergoing a stable classic ketogenic diet. A significant increase in glucose blood levels during menstruation was found in the entire cohort. As far as the ketone bodies blood levels, an inversely proportional trend compared to glycemia was noted. Conclusion Exploring whether ketonemia variations might occur according to the menstrual cycle is relevant to determine the feasibility of transient preventive diet adjustments to assure a continuative treatment efficacy and to enhance dietary behavior support. Clinical trial registration clinicaltrials.gov, identifier NCT05234411.
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Affiliation(s)
- Ludovica Pasca
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Cinzia Ferraris
- Department of Public Health, Experimental and Forensic Medicine, Human Nutrition and Eating Disorder Research Center, University of Pavia, Pavia, Italy
- Department of Public Health, Experimental and Forensic Medicine, Ketogenic Metabolic Therapy Laboratory, University of Pavia, Pavia, Italy
| | - Monica Guglielmetti
- Department of Public Health, Experimental and Forensic Medicine, Human Nutrition and Eating Disorder Research Center, University of Pavia, Pavia, Italy
- Department of Public Health, Experimental and Forensic Medicine, Ketogenic Metabolic Therapy Laboratory, University of Pavia, Pavia, Italy
| | - Costanza Varesio
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Martina Totaro
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Claudia Trentani
- Department of Public Health, Experimental and Forensic Medicine, Human Nutrition and Eating Disorder Research Center, University of Pavia, Pavia, Italy
- Department of Public Health, Experimental and Forensic Medicine, Ketogenic Metabolic Therapy Laboratory, University of Pavia, Pavia, Italy
| | - Claudia Marazzi
- Department of Public Health, Experimental and Forensic Medicine, Human Nutrition and Eating Disorder Research Center, University of Pavia, Pavia, Italy
- Department of Public Health, Experimental and Forensic Medicine, Ketogenic Metabolic Therapy Laboratory, University of Pavia, Pavia, Italy
| | - Ilaria Brambilla
- Department of Pediatrics, Pediatric Clinic, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Elena Ballante
- Department of Political and Social Sciences, University of Pavia, Pavia, Italy
- BioData Science Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Marisa Armeno
- Department of Nutrition, Ketogenic Therapy Program Coordinator at Hospital Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | | | - Roberto H. Caraballo
- Department of Neurology, Hospital Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Pierangelo Veggiotti
- Children Hospital Department Scienze biomediche e cliniche, University of Milan, Milan, Italy
| | - Anna Tagliabue
- Department of Public Health, Experimental and Forensic Medicine, Human Nutrition and Eating Disorder Research Center, University of Pavia, Pavia, Italy
- Department of Public Health, Experimental and Forensic Medicine, Ketogenic Metabolic Therapy Laboratory, University of Pavia, Pavia, Italy
| | - Valentina De Giorgis
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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10
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Palmisani M, Tartara E, Johannessen Landmark C, Crema F, De Giorgis V, Varesio C, Fattore C, Rota P, Russo E, Franco V. Therapeutic Salivary Monitoring of Perampanel in Patients with Epilepsy Using a Volumetric Absorptive Microsampling Technique. Pharmaceutics 2023; 15:2030. [PMID: 37631244 PMCID: PMC10458119 DOI: 10.3390/pharmaceutics15082030] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/21/2023] [Accepted: 07/22/2023] [Indexed: 08/27/2023] Open
Abstract
The objective of this study was to validate a novel assay using the volumetric absorptive microsampling (VAMS) technique combined with liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS) for the determination of the antiseizure medication perampanel in saliva and its clinical applicability in patients with epilepsy. VAMS tips were loaded with 30 μL of saliva and dried for 60 min. Analytes were extracted with methanol. The supernatant was evaporated under a gentle stream of nitrogen and reconstituted with 60 μL of methanol. Separation and quantification were achieved on a monolithic column connected to a mass spectrometer. Calibration curves were linear between 0.5 and 300 ng/mL. Intra- and inter-day accuracy was within 85.6-103.2% and intra-day and inter-day precision did not exceed 12.1%. Perampanel was stable in samples collected by VAMS and stored under different storage conditions. The VAMS-LC-MS/MS method was validated according to internationally accepted criteria and tested in patients with epilepsy who were receiving a combination of perampanel and other antiseizure medications. The method showed adequate bioanalytical performances, holding great potential as an alternative strategy to support domiciliary TDM in patients with epilepsy treated with perampanel according to the simplicity of sample collection.
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Affiliation(s)
- Michela Palmisani
- Clinical and Experimental Pharmacology Unit, Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia, Italy; (M.P.); (F.C.)
- IRCCS Mondino Foundation, 27100 Pavia, Italy;
| | - Elena Tartara
- Epilepsy Center, ERN Network EpiCare, IRCCS Mondino Foundation, 27100 Pavia, Italy;
| | - Cecilie Johannessen Landmark
- Department of Pharmacy, Faculty of Health Sciences, Oslo Metropolitan University, 0316 Oslo, Norway;
- The National Center for Epilepsy, Sandvika, ERN Network EpiCare, Oslo University Hospital, 0372 Oslo, Norway
- Section for Clinical Pharmacology, Department of Pharmacology, Oslo University Hospital, 0372 Oslo, Norway
| | - Francesca Crema
- Clinical and Experimental Pharmacology Unit, Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia, Italy; (M.P.); (F.C.)
| | - Valentina De Giorgis
- Department of Child Neurology and Psychiatry, ERN Network EpiCare, IRCCS Mondino Foundation, 27100 Pavia, Italy; (V.D.G.); (C.V.)
| | - Costanza Varesio
- Department of Child Neurology and Psychiatry, ERN Network EpiCare, IRCCS Mondino Foundation, 27100 Pavia, Italy; (V.D.G.); (C.V.)
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
| | | | - Paola Rota
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20100 Milan, Italy;
- Institute for Molecular and Translational Cardiology (IMTC), San Donato Milanese, 20097 Milan, Italy
| | - Emilio Russo
- Science of Health Department, School of Medicine and Surgery, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy;
| | - Valentina Franco
- Clinical and Experimental Pharmacology Unit, Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia, Italy; (M.P.); (F.C.)
- IRCCS Mondino Foundation, 27100 Pavia, Italy;
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11
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De Giorgis V, Tagliabue A, Bisulli F, Brambilla I, Camerini A, Cusmai R, Darra F, Dianin A, Domenica E, Lodi MAM, Matricardi S, Messana T, Operto F, Ragona F, Russo E, Varesio C, Volpi L, Zanaboni MP, Pasca L, Veggiotti P. Ketogenic dietary therapies in epilepsy: recommendations of the Italian League against Epilepsy Dietary Therapy Study Group. Front Neurol 2023; 14:1215618. [PMID: 37497012 PMCID: PMC10368245 DOI: 10.3389/fneur.2023.1215618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 05/24/2023] [Indexed: 07/28/2023] Open
Abstract
A stepwise increase in the utilization of ketogenic dietary therapies for drug-resistant epilepsy has been observed in Italy in the last decade, although it is still considered often underused in many centers when compared to other countries. The Dietary Therapy Study Group of the Italian League against Epilepsy proposes practical recommendations to improve shared knowledge and facilitate the application of ketogenic dietary therapies, optimizing its efficacy and tolerability. The experts involved (11 child neuropsychiatrists, two adult neurologists, one psychologist, one pharmacologist, one pediatric endocrinologist, one representative of patients' associations, and three dietitians and clinical nutritionists) responded to a survey on current clinical practice issues and were asked to discuss controversial topics related to supplementation, long-term maintenance, transition, and a multidisciplinary approach to ketogenic dietary therapies. Practical indications for patient selection, diet initiation, management, side effects prevention, and follow-up are provided.
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Affiliation(s)
- Valentina De Giorgis
- Department of Brain and Behaviour Neuroscience, University of Pavia, Pavia, Italy
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Anna Tagliabue
- Department of Public Health, Human Nutrition and Eating Disorder Research Center and Ketogenic Metabolic Therapy Laboratory—Experimental and Forensic Medicine University of Pavia, Pavia, Italy
| | - Francesca Bisulli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Full Member of the European Reference Network for Rare and Complex Epilepsies (EpiCARE), Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Ilaria Brambilla
- Endocrinologia, Diabetologia e Ginecologia Pediatrica, Fondazione IRCCS Policlinico San Matteo di Pavia, Università degli Studi di Pavia, Pavia, Italy
| | | | - Raffaella Cusmai
- Child Neurology Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Research Hospital, IRCCS, Rome, Italy
| | - Francesca Darra
- Child Neuropsychiatry Unit, Department of Engineering for Innovation Medicine, University of Verona, Full Member of European Reference Network EpiCARE, Verona, Italy
| | - Alice Dianin
- Inherited Metabolic Diseases Unit and Regional Centre for Newborn Screening, Diagnosis and Treatment of Inherited Metabolic Diseases and Congenital Endocrine Diseases, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Elia Domenica
- Artificial Nutrition Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Monica Anna Maria Lodi
- Department of Child Neuropsychiatry, Epilepsy Center, Fatebenefratelli Hospital, Milan, Italy
| | - Sara Matricardi
- Department of Pediatrics, University of Chieti, Chieti, Italy
| | - Tullio Messana
- Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria dell'etá pediatrica, Member of the ERN Epicare, Bologna, Italy
| | - Francesca Operto
- Department of Science of Health, School of Medicine, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Francesca Ragona
- Department of Pediatric Neurology, IRCCS Foundation Carlo Besta Neurological Institute, Milan, Italy
| | - Emilio Russo
- Science of Health Department, University of Catanzaro, Catanzaro, Italy
| | - Costanza Varesio
- Department of Brain and Behaviour Neuroscience, University of Pavia, Pavia, Italy
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Lilia Volpi
- UOC Neurologia, IRCCS Istituto delle Scienze Neurologiche, Azienda USL di Bologna, Ospedale Bellaria Bologna, Bologna, Italy
| | | | - Ludovica Pasca
- Department of Brain and Behaviour Neuroscience, University of Pavia, Pavia, Italy
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Pierangelo Veggiotti
- Vittore Buzzi Children's Hospital, Pediatric Neurology Unit, Milan, Italy
- Department of Biomedical and Clinical Sciences, L. Sacco, University of Milan, Milan, Italy
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12
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Zanaboni MP, Pasca L, Geraci MA, Varesio C, Guglielmetti M, Tagliabue A, Grumi S, De Giorgis V. Case report: KETOLAND the psychoeducation program for ketogenic diet. Front Psychiatry 2023; 14:1155717. [PMID: 37363168 PMCID: PMC10285047 DOI: 10.3389/fpsyt.2023.1155717] [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: 02/21/2023] [Accepted: 05/16/2023] [Indexed: 06/28/2023] Open
Abstract
Glucose transporter type 1 deficiency syndrome (GLUT1DS) is a rare neurological disorder characterized by a wide spectrum of symptoms: epilepsy, movement disorders and neurocognitive impairment. The gold standard treatment for GLUT1DS are ketogenic dietary therapies (KDTs), specifically classical ketogenic diet (CKD). Despite the benefits, CKD often represents a challenge for patients and their families since meal preparation is extremely demanding and deviates a lot from normal diet. To assure an optimal compliance to CKD a psychological support for parents and patients with GLUT1DS is highly recommended. Specifically, a psychoeducational intervention that ameliorates the knowledge about the illness and its therapy improves treatment' s adherence and efficacy. The aim of this case report is to investigate the effectiveness of a psychoeducational program, partially implemented through telepsychology, based on the theoretical model of Cognitive Behavioral Play Therapy (CBPT) to support KDT knowledge and adherence in a patient with GLUT1DS who presented a worsening of her clinical picture due to a sparse knowledge of KDTs principles which determined a low adherence. Thus, with this case report we propose a model of intervention with psychoeducation in a patient with a complex chronic disease.
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Affiliation(s)
| | - Ludovica Pasca
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | | | - Costanza Varesio
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Monica Guglielmetti
- Department of Public Health, Experimental and Forensic Medicine, Human Nutrition and Eating Disorder Research Center, University of Pavia, Pavia, Italy
- Laboratory of Food Education and Sport Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Anna Tagliabue
- Department of Public Health, Experimental and Forensic Medicine, Human Nutrition and Eating Disorder Research Center, University of Pavia, Pavia, Italy
| | - Serena Grumi
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy
| | - Valentina De Giorgis
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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13
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Garau J, Charras A, Varesio C, Orcesi S, Dragoni F, Galli J, Fazzi E, Gagliardi S, Pansarasa O, Cereda C, Hedrich CM. Altered DNA methylation and gene expression predict disease severity in patients with Aicardi-Goutières syndrome. Clin Immunol 2023; 249:109299. [PMID: 36963449 DOI: 10.1016/j.clim.2023.109299] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/06/2023] [Accepted: 03/15/2023] [Indexed: 03/26/2023]
Abstract
Aicardi-Goutières Syndrome (AGS) is a rare neuro-inflammatory disease characterized by increased expression of interferon-stimulated genes (ISGs). Disease-causing mutations are present in genes associated with innate antiviral responses. Disease presentation and severity vary, even between patients with identical mutations from the same family. This study investigated DNA methylation signatures in PBMCs to understand phenotypic heterogeneity in AGS patients with mutations in RNASEH2B. AGS patients presented hypomethylation of ISGs and differential methylation patterns (DMPs) in genes involved in "neutrophil and platelet activation". Patients with "mild" phenotypes exhibited DMPs in genes involved in "DNA damage and repair", whereas patients with "severe" phenotypes had DMPs in "cell fate commitment" and "organ development" associated genes. DMPs in two ISGs (IFI44L, RSAD2) associated with increased gene expression in patients with "severe" when compared to "mild" phenotypes. In conclusion, altered DNA methylation and ISG expression as biomarkers and potential future treatment targets in AGS.
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Affiliation(s)
- Jessica Garau
- Neurogenetics Research Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - Amandine Charras
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Costanza Varesio
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy
| | - Simona Orcesi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy
| | - Francesca Dragoni
- Department of Biology and Biotechnology, University of Pavia, Pavia, Italy; Molecular Biology and Transcriptomics, IRCCS Mondino Foundation, Pavia, Italy
| | - Jessica Galli
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Unit of Child Neurology and Psychiatry, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Elisa Fazzi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Unit of Child Neurology and Psychiatry, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Stella Gagliardi
- Molecular Biology and Transcriptomics, IRCCS Mondino Foundation, Pavia, Italy
| | - Orietta Pansarasa
- Cellular Model and Neuroepigenetics, IRCCS Mondino Foundation, Pavia, Italy
| | - Cristina Cereda
- Genomic and post-Genomic Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Christian M Hedrich
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, United Kingdom.
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14
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Varesio C, De Giorgis V, Veggiotti P, Nardocci N, Granata T, Ragona F, Pasca L, Mensi MM, Borgatti R, Olivotto S, Previtali R, Riva A, Mancardi MM, Striano P, Cavallin M, Guerrini R, Operto FF, Pizzolato A, Di Maulo R, Martino F, Lodi A, Marini C. GLUT1-DS Italian registry: past, present, and future: a useful tool for rare disorders. Orphanet J Rare Dis 2023; 18:63. [PMID: 36944981 PMCID: PMC10029278 DOI: 10.1186/s13023-023-02628-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 02/06/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND GLUT1 deficiency syndrome is a rare, genetically determined neurological disorder for which Ketogenic Dietary Treatment represents the gold standard and lifelong treatment. Patient registries are powerful tools providing insights and real-world data on rare diseases. OBJECTIVE To describe the implementation of a national web-based registry for GLUT1-DS. METHODS This is a retrospective and prospective, multicenter, observational registry developed in collaboration with the Italian GLUT1-DS association and based on an innovative, flexible and configurable cloud computing technology platform, structured according to the most rigorous requirements for the management of patient's sensitive data. The Glut1 Registry collects baseline and follow-up data on the patient's demographics, history, symptoms, genotype, clinical, and instrumental evaluations and therapies. RESULTS Five Centers in Italy joined the registry, and two more Centers are currently joining. In the first two years of running, data from 67 patients (40 females and 27 males) have been collected. Age at symptom onset was within the first year of life in most (40, 60%) patients. The diagnosis was formulated in infancy in almost half of the cases (34, 51%). Symptoms at onset were mainly paroxysmal (mostly epileptic seizure and paroxysmal ocular movement disorder) or mixed paroxysmal and fixed symptoms (mostly psychomotor delay). Most patients (53, 79%) are currently under Ketogenic dietary treatments. CONCLUSIONS We describe the principles behind the design, development, and deployment of the web-based nationwide GLUT1-DS registry. It represents a stepping stone towards a more comprehensive understanding of the disease from onset to adulthood. It also represents a virtuous model from a technical, legal, and organizational point of view, thus representing a possible paradigmatic example for other rare disease registry implementation.
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Affiliation(s)
- Costanza Varesio
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation (Member of ERN-Epicare), Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Valentina De Giorgis
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation (Member of ERN-Epicare), Pavia, Italy.
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
| | - Pierangelo Veggiotti
- Pediatric Neurology Unit, Vittore Buzzi Hospital, Milan, Italy
- Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Nardo Nardocci
- Department of Pediatric Neuroscience Fondazione, IRCCS Istituto Neurologico Carlo Besta (Member of ERN-Epicare), Milan, Italy
| | - Tiziana Granata
- Department of Pediatric Neuroscience Fondazione, IRCCS Istituto Neurologico Carlo Besta (Member of ERN-Epicare), Milan, Italy
| | - Francesca Ragona
- Department of Pediatric Neuroscience Fondazione, IRCCS Istituto Neurologico Carlo Besta (Member of ERN-Epicare), Milan, Italy
| | - Ludovica Pasca
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation (Member of ERN-Epicare), Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Martina Maria Mensi
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation (Member of ERN-Epicare), Pavia, Italy
| | - Renato Borgatti
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation (Member of ERN-Epicare), Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Sara Olivotto
- Pediatric Neurology Unit, Vittore Buzzi Hospital, Milan, Italy
| | - Roberto Previtali
- Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Antonella Riva
- IRCCS Istituto Giannina Gaslini (Member of ERN-Epicare), Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Università Degli Studi di Genova, Genoa, Italy
| | | | - Pasquale Striano
- IRCCS Istituto Giannina Gaslini (Member of ERN-Epicare), Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Università Degli Studi di Genova, Genoa, Italy
| | - Mara Cavallin
- Neuroscience Department, Meyer Children's University Hospital (Member of ERN-Epicare), Florence, Italy
| | - Renzo Guerrini
- Neuroscience Department, Meyer Children's University Hospital (Member of ERN-Epicare), Florence, Italy
| | - Francesca Felicia Operto
- Child Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | | | | | | | - Andrea Lodi
- Associazione Italiana Glut1 aps, Milan, Italy
| | - Carla Marini
- Child Neurology and Psychiatric Unit, Salesi Children's Hospital, Ancona, Italy
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15
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Zanaboni MP, Pasca L, Bova SM, Chiappedi MA, Filippini M, Giordano L, Grumi S, Micheletti S, Operto FF, Pruna D, Ragona F, Raviglione F, Totaro M, Varesio C, Vignoli A, De Giorgis V. WISC‐IV
intellectual profiles in Italian children with self‐limited epilepsy with centrotemporal spikes. Epileptic Disord 2023. [DOI: 10.1002/epd2.20003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Affiliation(s)
| | - Ludovica Pasca
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation Pavia Italy
- Department of Brain and Behavioral Sciences University of Pavia Pavia Italy
| | | | | | | | - Lucio Giordano
- Child Neurology and Psychiatry Unit, ASST Spedali Civili of Brescia Brescia Italy
| | - Serena Grumi
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation Pavia Italy
| | - Serena Micheletti
- Child Neurology and Psychiatry Unit, ASST Spedali Civili of Brescia Brescia Italy
| | - Francesca F. Operto
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry University of Salerno Salerno Italy
| | - Dario Pruna
- Department of Pediatric Neurology and Epileptology, Pediatric, ARNAS Brotzu Cagliari Italy
| | - Francesca Ragona
- Department of Paediatric Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta Milano Italy
| | | | - Martina Totaro
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation Pavia Italy
- Department of Brain and Behavioral Sciences University of Pavia Pavia Italy
| | - Costanza Varesio
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation Pavia Italy
- Department of Brain and Behavioral Sciences University of Pavia Pavia Italy
| | - Aglaia Vignoli
- Child Neuropsychiatry Unit, Department of Health Sciences, ASST Grande Ospedale Metropolitano Niguarda Milan Italy
| | - Valentina De Giorgis
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation Pavia Italy
- Department of Brain and Behavioral Sciences University of Pavia Pavia Italy
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16
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De Giorgis V, Ferraris C, Brena ML, Farris G, Gentilino V, Guglielmetti M, Marazzi C, Pasca L, Trentani C, Tagliabue A, Varesio C. Classic ketogenic diet in parenteral nutrition in a GLUT1DS patient: Doing more with less in an acute surgical setting. Front Nutr 2023; 10:1114386. [PMID: 36875855 PMCID: PMC9975382 DOI: 10.3389/fnut.2023.1114386] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 01/24/2023] [Indexed: 02/17/2023] Open
Abstract
Ketogenic Dietary Treatments (KDTs) are to date the gold-standard treatment for glucose transporter type 1 (GLUT1) deficiency syndrome. Administration of KDTs is generally per os; however, in some conditions including the acute gastro-enteric post-surgical setting, short-term parenteral (PN) administration might be needed. We report the case of a 14-year-old GLUT1DS patient, following classic KDT for many years, who underwent urgent laparoscopic appendectomy. PN-KDT was required, after 1 day of fasting. No ad hoc PN-KDTs products were available and the patient received infusions of OLIMEL N4 (Baxter). On the sixth day postoperatively enteral nutrition was progressively reintroduced. The outcome was optimal with rapid recovery and no exacerbation of neurological manifestations. Our patient is the first pediatric patient with GLUT1DS in chronic treatment with KDT efficiently treated with exclusive PN for five days. This case reports on real-word management and the ideal recommendations for PN-KDT in an acute surgical setting.
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Affiliation(s)
- Valentina De Giorgis
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Member of ERN-EpiCARE, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Cinzia Ferraris
- Human Nutrition and Eating Disorder Research Center, Department of Public Health, Experimental and Forensic Medicine University of Pavia, Pavia, Italy
| | - Mario Leo Brena
- Unit of Pediatric Surgery, Woman and Child Department, Filippo Del Ponte Hospital - ASST Sette Laghi, Varese, Italy
| | - Giorgio Farris
- Unit of Pediatric Surgery, Woman and Child Department, Filippo Del Ponte Hospital - ASST Sette Laghi, Varese, Italy
| | - Valerio Gentilino
- Unit of Pediatric Surgery, Woman and Child Department, Filippo Del Ponte Hospital - ASST Sette Laghi, Varese, Italy
| | - Monica Guglielmetti
- Human Nutrition and Eating Disorder Research Center, Department of Public Health, Experimental and Forensic Medicine University of Pavia, Pavia, Italy
| | - Claudia Marazzi
- Human Nutrition and Eating Disorder Research Center, Department of Public Health, Experimental and Forensic Medicine University of Pavia, Pavia, Italy
| | - Ludovica Pasca
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Member of ERN-EpiCARE, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Claudia Trentani
- Human Nutrition and Eating Disorder Research Center, Department of Public Health, Experimental and Forensic Medicine University of Pavia, Pavia, Italy
| | - Anna Tagliabue
- Human Nutrition and Eating Disorder Research Center, Department of Public Health, Experimental and Forensic Medicine University of Pavia, Pavia, Italy
| | - Costanza Varesio
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Member of ERN-EpiCARE, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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17
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Dragoni F, Garau J, Orcesi S, Varesio C, Bordoni M, Scarian E, Di Gerlando R, Fazzi E, Battini R, Gjurgjaj A, Rizzo B, Pansarasa O, Gagliardi S. Comparison between D-loop methylation and mtDNA copy number in patients with Aicardi-Goutières Syndrome. Front Endocrinol (Lausanne) 2023; 14:1152237. [PMID: 36998476 PMCID: PMC10043473 DOI: 10.3389/fendo.2023.1152237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 02/28/2023] [Indexed: 03/16/2023] Open
Abstract
INTRODUCTION Aicardi-Goutières Syndrome (AGS) is a rare encephalopathy with early onset that can be transmitted in both dominant and recessive forms. Its phenotypic covers a wide range of neurological and extraneurological symptoms. Nine genes that are all involved in nucleic acids (NAs) metabolism or signaling have so far been linked to the AGS phenotype. Recently, a link between autoimmune or neurodegenerative conditions and mitochondrial dysfunctions has been found. As part of the intricate system of epigenetic control, the mtDNA goes through various alterations. The displacement (D-loop) region represents one of the most methylated sites in the mtDNA. The term "mitoepigenetics" has been introduced as a result of increasing data suggesting that epigenetic processes may play a critical role in the control of mtDNA transcription and replication. Since we showed that RNASEH2B and RNASEH2A-mutated Lymphoblastoid Cell Lines (LCLs) derived from AGS patients had mitochondrial alterations, highlighting changes in the mtDNA content, the main objective of this study was to examine any potential methylation changes in the D-loop regulatory region of mitochondria and their relationship to the mtDNA copy number in peripheral blood cells of AGS patients with mutations in various AGS genes and healthy controls. MATERIALS AND METHODS We collected blood samples from 25 AGS patients and we performed RT-qPCR to assess the mtDNA copy number and pyrosequencing to measure DNA methylation levels in the D-loop region. RESULTS Comparing AGS patients to healthy controls, D-loop methylation levels and mtDNA copy number increased significantly. We also observed that in AGS patients, the mtDNA copy number increased with age at sampling, but not the D-loop methylation levels, and there was no relationship between sex and mtDNA copy number. In addition, the D-loop methylation levels and mtDNA copy number in the AGS group showed a non-statistically significant positive relation. CONCLUSION These findings, which contradict the evidence for an inverse relationship between D-loop methylation levels and mtDNA copy number, show that AGS patients have higher D-loop methylation levels than healthy control subjects. Additional research is needed to identify the function of these features in the etiology and course of AGS.
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Affiliation(s)
- Francesca Dragoni
- Department of Biology and Biotechnology “L. Spallanzani”, University of Pavia, Pavia, Italy
- Molecular Biology and Transcriptomics Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Jessica Garau
- Neurogenetics Research Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - Simona Orcesi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy
| | - Costanza Varesio
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy
| | - Matteo Bordoni
- Cellular Model and Neuroepigenetics Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Eveljn Scarian
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Cellular Model and Neuroepigenetics Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Rosalinda Di Gerlando
- Department of Biology and Biotechnology “L. Spallanzani”, University of Pavia, Pavia, Italy
- Molecular Biology and Transcriptomics Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Elisa Fazzi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili, Brescia, Italy
| | - Roberta Battini
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Altea Gjurgjaj
- Department of Biology and Biotechnology “L. Spallanzani”, University of Pavia, Pavia, Italy
| | - Bartolo Rizzo
- Department of Biology and Biotechnology “L. Spallanzani”, University of Pavia, Pavia, Italy
| | - Orietta Pansarasa
- Cellular Model and Neuroepigenetics Unit, IRCCS Mondino Foundation, Pavia, Italy
- *Correspondence: Orietta Pansarasa,
| | - Stella Gagliardi
- Molecular Biology and Transcriptomics Unit, IRCCS Mondino Foundation, Pavia, Italy
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18
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Masnada S, Alfei E, Formica M, Previtali R, Accorsi P, Arrigoni F, Bonanni P, Borgatti R, Darra F, Fusco C, De Giorgis V, Giordano L, La Briola F, Orcesi S, Osanni E, Parazzini C, Pinelli L, Rebessi E, Romaniello R, Romeo A, Spagnoli C, Uebler C, Varesio C, MaurizioViri, Zucca C, Pichiecchio A, Veggiotti P. EEG at onset and MRI predict long-term clinical outcome in Aicardi syndrome. Clin Neurophysiol 2022; 142:112-124. [DOI: 10.1016/j.clinph.2022.07.496] [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] [Received: 12/30/2021] [Revised: 06/29/2022] [Accepted: 07/17/2022] [Indexed: 11/03/2022]
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19
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Franco V, Palmisani M, Marchiselli R, Crema F, Fattore C, De Giorgis V, Varesio C, Rota P, Dibari VF, Perucca E. On-Line Solid Phase Extraction High Performance Liquid Chromatography Method Coupled With Tandem Mass Spectrometry for the Therapeutic Monitoring of Cannabidiol and 7-Hydroxy-cannabidiol in Human Serum and Saliva. Front Pharmacol 2022; 13:915004. [PMID: 35814197 PMCID: PMC9258944 DOI: 10.3389/fphar.2022.915004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 04/29/2022] [Indexed: 11/17/2022] Open
Abstract
Cannabidiol is a novel antiseizure medication approved in Europe and the US for the treatment of seizures associated with Lennox-Gastaut syndrome, Dravet syndrome and tuberous sclerosis complex. We describe in this article a new and simple liquid chromatography-mass spectrometry method (LC-MS/MS) for the determination of cannabidiol and its active metabolite 7-hydroxy-cannabidiol in microvolumes of serum and saliva (50 μl), to be used as a tool for therapeutic drug monitoring (TDM) and pharmacokinetic studies. After on-line solid phase extraction cannabidiol, 7-hydroxy-cannabidiol and the internal standard cannabidiol-d3 are separated on a monolithic C18 column under gradient conditions. Calibration curves are linear within the validated concentration range (10–1,000 ng/ml for cannabidiol and 5–500 ng/ml for 7-hydroxy-cannabidiol). The method is accurate (intraday and interday accuracy within 94–112% for cannabidiol, 91–109% for 7-hydroxy-cannabidiol), precise (intraday and interday precision <11.6% for cannabidiol and <11.7% for 7- hydroxy-cannabidiol) and sensitive, with a LOQ of 2.5 ng/ml for cannabidiol and 5 ng/ml for 7-hydroxy-cannabidiol. The stability of the analytes was confirmed under different storage conditions. Extraction recoveries were in the range of 81–129% for cannabidiol and 100–113% for 7-hydroxy-cannabidiol. The applicability of the method to TDM was demonstrated by analysis of human serum and saliva samples obtained from patients with epilepsy treated with cannabidiol.
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Affiliation(s)
- Valentina Franco
- Department of Internal Medicine and Therapeutics, Clinical and Experimental Pharmacology Unit, University of Pavia, Pavia, Italy
- IRCCS Mondino Foundation, Pavia, Italy
- *Correspondence: Valentina Franco,
| | | | - Roberto Marchiselli
- Department of Internal Medicine and Therapeutics, Clinical and Experimental Pharmacology Unit, University of Pavia, Pavia, Italy
| | - Francesca Crema
- Department of Internal Medicine and Therapeutics, Clinical and Experimental Pharmacology Unit, University of Pavia, Pavia, Italy
| | | | | | - Costanza Varesio
- IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Paola Rota
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | | | - Emilio Perucca
- Department of Medicine, Austin Health, The University of Melbourne, Melbourne, VIC, Australia
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia
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20
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Varesio C, Ferraris C, Gentilino V, Brena ML, Farris G, Guglielmetti M, Marazzi C, Pasca L, Trentani C, Tagliabue A, De Giorgis V. PARENTERAL NUTRITION IN A GLUT1DS PATIENT FOLLOWING CLASSIC KETOGENIC DIET: IDEAL VERSUS REAL-WORLD MANAGEMENT IN AN ACUTE SURGICAL SETTING. JPEN J Parenter Enteral Nutr 2022; 46:1951. [PMID: 35233775 DOI: 10.1002/jpen.2361] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 02/28/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND GLUT1 deficiency syndrome is a rare neurometabolic disorder, whose current gold standard treatment is represented by ketogenic dietary treatments (KDTs). KDTs are generally administered per os; however, in an immediate gastro-enteric post-surgical setting, short-term parenteral (PN) administration might be required. CASE REPORT a 14-year-old boy diagnosed with GLUT1DS and in chronic treatment for many years with KDTs underwent urgent laparoscopic appendectomy. Subsequently, after one day of fasting, PN-KDT was started as the boy was unable to tolerate enteral nutrition postoperatively. On the sixth day, enteral nutrition was progressively reintroduced. Since ad hoc PN-KDTs products were unavailable, the patient received infusion of OLIMEL N4 (Baxter). Outcome was characterized by prompt recovery and no exacerbation of neurological symptoms was observed. CONCLUSION we described the first pediatric patient with GLUT1DS in chronic treatment with KDT efficiently treated with exclusive PN for five days. We presented our real word management and the ideal recommendations for PN-KDT in acute surgical setting. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- C Varesio
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, 27100, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, 27100, Pavia, Italy
| | - C Ferraris
- Human Nutrition and Eating Disorder Research Center, Department of Public Health, Experimental and Forensic Medicine University of Pavia, 27100, Pavia, Italy
| | - V Gentilino
- Unit of Pediatric Surgery, Woman and Child Department, Filippo Del Ponte Hospital - ASST Sette Laghi, 21100, Varese, Italy
| | - M L Brena
- Unit of Pediatric Surgery, Woman and Child Department, Filippo Del Ponte Hospital - ASST Sette Laghi, 21100, Varese, Italy
| | - G Farris
- Unit of Pediatric Surgery, Woman and Child Department, Filippo Del Ponte Hospital - ASST Sette Laghi, 21100, Varese, Italy
| | - M Guglielmetti
- Human Nutrition and Eating Disorder Research Center, Department of Public Health, Experimental and Forensic Medicine University of Pavia, 27100, Pavia, Italy
| | - C Marazzi
- Human Nutrition and Eating Disorder Research Center, Department of Public Health, Experimental and Forensic Medicine University of Pavia, 27100, Pavia, Italy
| | - L Pasca
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, 27100, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, 27100, Pavia, Italy
| | - C Trentani
- Human Nutrition and Eating Disorder Research Center, Department of Public Health, Experimental and Forensic Medicine University of Pavia, 27100, Pavia, Italy
| | - A Tagliabue
- Human Nutrition and Eating Disorder Research Center, Department of Public Health, Experimental and Forensic Medicine University of Pavia, 27100, Pavia, Italy
| | - V De Giorgis
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, 27100, Pavia, Italy
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21
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Pasca L, Sanvito F, Ballante E, Totaro M, Paoletti M, Bergui A, Varesio C, Rognone E, De Giorgis V, Pichiecchio A. Arterial spin labelling qualitative assessment in paediatric patients with MRI-negative epilepsy. Clin Radiol 2021. [PMID: 34645570 DOI: 10.1016/j.crad.2021.09.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
AIM To evaluate the usefulness of arterial spin labelling (ASL) qualitative analysis for the localisation of seizure-related perfusion abnormalities in paediatric patients with negative brain magnetic resonance imaging (MRI) epilepsy. MATERIALS AND METHODS Forty-two patients with a diagnosis of MRI-negative focal or generalised epilepsy, who underwent electroencephalogram (EEG) and MRI with ASL in the interictal phase were included. Perfusion abnormalities were evaluated through a qualitative assessment and then compared to EEG seizure focus. RESULTS Among the 42 patients, 26 had focal epilepsy and 16 had generalised epilepsy. Thirty-three patients (79%) showed a perfusion abnormality, mainly hypoperfusion (74.5% of all ASL alterations), whereas hyperperfused alterations were more represented in patients who experienced the last seizure either less than 48 hours prior to ASL acquisition or in the time interval from 1 week to 1 month prior to ASL acquisition (p=0.034). Concordance of ASL abnormality and EEG focus was found in 33 patients (78.5%), as complete in 17 (40.5%) and as partial in 16 (38%). A trend of higher concordance was found in focal epilepsies compared to generalised epilepsies (p=0.059). The concordance between ASL and EEG major alterations was higher for hyperperfused anomalies than for hypoperfused ones (p=0.009). Variables such as age, sedation, and time from last seizure were not significant contributors for concordance. CONCLUSIONS The combined use of qualitative ASL and brain MRI and scalp EEG could be a potential tool in daily clinical practice.
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Affiliation(s)
- L Pasca
- Department of Child Neurology and Psychiatry, IRCSS Mondino Foundation, Pavia, Italy; Department of Brain and Behaviour Neuroscience, University of Pavia, Pavia, Italy
| | - F Sanvito
- Unit of Radiology, Department of Clinical, Surgical, Diagnostic, and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - E Ballante
- Department of Mathematics, University of Pavia, Pavia, Italy; BioData Science Center, IRCCS Mondino Foundation, Pavia, Italy
| | - M Totaro
- Department of Child Neurology and Psychiatry, IRCSS Mondino Foundation, Pavia, Italy; Department of Brain and Behaviour Neuroscience, University of Pavia, Pavia, Italy
| | - M Paoletti
- Advanced Imaging and Radiomics, Department of Neuroradiology, IRCCS Mondino Foundation, Pavia, Italy
| | - A Bergui
- Unit of Radiology, Department of Clinical, Surgical, Diagnostic, and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - C Varesio
- Department of Child Neurology and Psychiatry, IRCSS Mondino Foundation, Pavia, Italy
| | - E Rognone
- Advanced Imaging and Radiomics, Department of Neuroradiology, IRCCS Mondino Foundation, Pavia, Italy
| | - V De Giorgis
- Department of Child Neurology and Psychiatry, IRCSS Mondino Foundation, Pavia, Italy.
| | - A Pichiecchio
- Department of Brain and Behaviour Neuroscience, University of Pavia, Pavia, Italy; Advanced Imaging and Radiomics, Department of Neuroradiology, IRCCS Mondino Foundation, Pavia, Italy
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22
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Pasca L, Sanvito F, Ballante E, Totaro M, Paoletti M, Bergui A, Varesio C, Rognone E, De Giorgis V, Pichiecchio A. Arterial spin labelling qualitative assessment in paediatric patients with MRI-negative epilepsy. Clin Radiol 2021; 76:942.e15-942.e23. [PMID: 34645570 DOI: 10.1016/j.crad.2021.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 09/10/2021] [Indexed: 11/29/2022]
Abstract
AIM To evaluate the usefulness of arterial spin labelling (ASL) qualitative analysis for the localisation of seizure-related perfusion abnormalities in paediatric patients with negative brain magnetic resonance imaging (MRI) epilepsy. MATERIALS AND METHODS Forty-two patients with a diagnosis of MRI-negative focal or generalised epilepsy, who underwent electroencephalogram (EEG) and MRI with ASL in the interictal phase were included. Perfusion abnormalities were evaluated through a qualitative assessment and then compared to EEG seizure focus. RESULTS Among the 42 patients, 26 had focal epilepsy and 16 had generalised epilepsy. Thirty-three patients (79%) showed a perfusion abnormality, mainly hypoperfusion (74.5% of all ASL alterations), whereas hyperperfused alterations were more represented in patients who experienced the last seizure either less than 48 hours prior to ASL acquisition or in the time interval from 1 week to 1 month prior to ASL acquisition (p=0.034). Concordance of ASL abnormality and EEG focus was found in 33 patients (78.5%), as complete in 17 (40.5%) and as partial in 16 (38%). A trend of higher concordance was found in focal epilepsies compared to generalised epilepsies (p=0.059). The concordance between ASL and EEG major alterations was higher for hyperperfused anomalies than for hypoperfused ones (p=0.009). Variables such as age, sedation, and time from last seizure were not significant contributors for concordance. CONCLUSIONS The combined use of qualitative ASL and brain MRI and scalp EEG could be a potential tool in daily clinical practice.
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Affiliation(s)
- L Pasca
- Department of Child Neurology and Psychiatry, IRCSS Mondino Foundation, Pavia, Italy; Department of Brain and Behaviour Neuroscience, University of Pavia, Pavia, Italy
| | - F Sanvito
- Unit of Radiology, Department of Clinical, Surgical, Diagnostic, and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - E Ballante
- Department of Mathematics, University of Pavia, Pavia, Italy; BioData Science Center, IRCCS Mondino Foundation, Pavia, Italy
| | - M Totaro
- Department of Child Neurology and Psychiatry, IRCSS Mondino Foundation, Pavia, Italy; Department of Brain and Behaviour Neuroscience, University of Pavia, Pavia, Italy
| | - M Paoletti
- Advanced Imaging and Radiomics, Department of Neuroradiology, IRCCS Mondino Foundation, Pavia, Italy
| | - A Bergui
- Unit of Radiology, Department of Clinical, Surgical, Diagnostic, and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - C Varesio
- Department of Child Neurology and Psychiatry, IRCSS Mondino Foundation, Pavia, Italy
| | - E Rognone
- Advanced Imaging and Radiomics, Department of Neuroradiology, IRCCS Mondino Foundation, Pavia, Italy
| | - V De Giorgis
- Department of Child Neurology and Psychiatry, IRCSS Mondino Foundation, Pavia, Italy.
| | - A Pichiecchio
- Department of Brain and Behaviour Neuroscience, University of Pavia, Pavia, Italy; Advanced Imaging and Radiomics, Department of Neuroradiology, IRCCS Mondino Foundation, Pavia, Italy
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Zanaboni MP, Varesio C, Pasca L, Foti A, Totaro M, Celario M, Provenzi L, De Giorgis V. Systematic review of executive functions in children with self-limited epilepsy with centrotemporal spikes. Epilepsy Behav 2021; 123:108254. [PMID: 34428616 DOI: 10.1016/j.yebeh.2021.108254] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/28/2021] [Accepted: 07/28/2021] [Indexed: 12/01/2022]
Abstract
Self-limited Epilepsy with Centrotemporal Spikes (ECTS) is a self-limiting childhood epilepsy with an overall good prognosis. The neurocognitive profile of ECTS shows various degrees of neuropsychological impairment, with speech impairment and executive dysfunction being the most prominent. This review aimed to clarify the executive function (EF) profile of children with ECTS and the clinical variables' impact on these abilities. We conducted a systematic review of the relevant literature for articles published up to January 2021. Demographic and clinical characteristics were abstracted from the original records. EF tasks used in the studies were classified according to Diamond's model, which identified four components: working memory, inhibitory control, cognitive flexibility, and higher order EFs. Twenty-three studies were included. Among the included records, 14 studies examined working memory, 15 inhibitory control, 15 flexibility, 4 higher order EFs, and 2 general EFs. Results confirmed the presence of a specific impairment in two abilities: inhibitory control and cognitive flexibility. This review confirms the need to assess each EF both in verbal and visual-spatial tasks. The early detection of children with ECTS at risk of developing neuropsychological impairment could activate interventions and prevent worse school achievement, social functioning, and a poor quality of life. Systematic review registration: PROSPERO: CRD42021245959.
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Affiliation(s)
| | - Costanza Varesio
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
| | - Ludovica Pasca
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Annalisa Foti
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy
| | - Martina Totaro
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Massimiliano Celario
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Livio Provenzi
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy
| | - Valentina De Giorgis
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy
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24
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De Giorgis V, Paoletti M, Varesio C, Gana S, Rognone E, Dallavalle G, Papalia G, Pichiecchio A. Novel insights into the clinico-radiological spectrum of phenotypes associated to PIGN mutations. Eur J Paediatr Neurol 2021; 33:21-28. [PMID: 34051595 DOI: 10.1016/j.ejpn.2021.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 01/21/2021] [Revised: 04/19/2021] [Accepted: 05/14/2021] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Autosomic recessive mutations in the PIGN gene have been described in less than 30 subjects to date, in whom multiple congenital anomalies combined with severe developmental delay, hypotonia, epileptic encephalopathy, and cerebellar atrophy have been described as crucial features. A clear-cut neuroradiological characterization of this entity, however, is still lacking. We aim to present three pediatric PIGN mutated cases with an in-depth evaluation of their brain abnormalities. METHODS We present the neuroradiological, clinical, and genetic characterization of three Caucasian pediatric subjects with pathogenic/likely pathogenic variants in the PIGN gene revealed by Next Generation Sequencing analysis. RESULTS We identified three subjects (two siblings, one unrelated case) presenting with encephalopathy with early-onset epilepsy, hypotonia, and severe global developmental delay. No additional severe multiple congenital anomalies were detected. Neuroradiological evaluation showed extensive quantitative reduction of white matter, severe and progressive cortical atrophy, with frontal predominance and an anteroposterior gradient, combined with cerebellar and brainstem atrophy. CONCLUSIONS Our findings broaden and systematize the neuroradiological spectrum of abnormalities in PIGN related encephalopathy. Furthermore, our dataset confirms that mutations in PIGN gene appear to be pan-ethnic and represent an underestimated cause of early-onset encephalopathy.
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Affiliation(s)
- Valentina De Giorgis
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy
| | - Matteo Paoletti
- Advanced Imaging and Radiomics Center, Neuroradiology Department, IRCCS Mondino Foundation, Pavia, Italy
| | - Costanza Varesio
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy.
| | - Simone Gana
- Medical Genetics Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Elisa Rognone
- Advanced Imaging and Radiomics Center, Neuroradiology Department, IRCCS Mondino Foundation, Pavia, Italy
| | - Gianfranco Dallavalle
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Grazia Papalia
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Anna Pichiecchio
- Advanced Imaging and Radiomics Center, Neuroradiology Department, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
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25
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Siri B, Varesio C, Freri E, Darra F, Gana S, Mei D, Porta F, Fontana E, Galati G, Solazzi R, Niceta M, Veggiotti P, Alfei E. CDKL5 deficiency disorder in males: Five new variants and review of the literature. Eur J Paediatr Neurol 2021; 33:9-20. [PMID: 33989939 DOI: 10.1016/j.ejpn.2021.04.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 05/01/2020] [Revised: 04/18/2021] [Accepted: 04/24/2021] [Indexed: 11/30/2022]
Abstract
The X-linked Cyclin-Dependent Kinase-Like 5 (CDKL5) gene encodes a serine-threonine kinase highly expressed in the developing brain. Loss of function of CDKL5 is pointed out to underlie the CDKL5 Deficiency Disorder (CDD), an X-linked dominant disease characterized by early-onset epileptic encephalopathy and developmental delay, usually affecting females more than males. To the best to our knowledge, only 45 males with CDD have been reported so far. Type and position of CDKL5 variants with different impact on the protein are reported to influence the clinical presentation. X-chromosome inactivation occurring in females and post-zygotic mosaicism in males are also believed to contribute to this variability. Based on these issues, genotype-phenotype correlations are still challenging. Here, we describe clinical features of five additional affected males with unreported CDKL5 variants, expanding the molecular spectrum of the disorder. We also reviewed the clinical profile of the previously reported 45 males with molecularly confirmed CDD. Severe developmental delay, cortical visual impairment, and early-onset refractory epilepsy characterize the CDD picture in males. By assessing the molecular spectrum, we confirm that germ-line truncating CDKL5 variants, equally distributed across the coding sequence, are the most recurrent mutations in CDD, and cause the worsen phenotype. While recurrence and relevance of missense substitutions within C-terminal remain still debated, disease-causing missense changes affecting the N-terminal catalytic domain correlate to a severe clinical phenotype. Finally, our data provide evidence that post-zygotic CDKL5 mosaicism may result in milder phenotypes and, at least in a subset of subjects, in variable response to antiepileptic treatments.
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Affiliation(s)
- Barbara Siri
- Department of Paediatrics, Ospedale Infantile Regina Margherita, University of Torino, Italy; Division of Metabolism, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - Costanza Varesio
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Italy.
| | - Elena Freri
- Department of Paediatric Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Francesca Darra
- Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynecology and Paediatrics, University of Verona, AOUI Verona, Verona, Italy
| | - Simone Gana
- Medical Genetics Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Davide Mei
- Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, Children's Hospital A. Meyer-University of Florence, Italy
| | - Francesco Porta
- Department of Paediatrics, AOU Città della Salute e della Scienza di Torino, University of Torino, Italy
| | - Elena Fontana
- Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynecology and Paediatrics, University of Verona, AOUI Verona, Verona, Italy
| | - Giulia Galati
- Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynecology and Paediatrics, University of Verona, AOUI Verona, Verona, Italy
| | - Roberta Solazzi
- Department of Paediatric Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Marcello Niceta
- Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - Pierangelo Veggiotti
- L. Sacco Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy; Paediatric Neurology Unit V. Buzzi Children's Hospital Milan, Italy
| | - Enrico Alfei
- Paediatric Neurology Unit V. Buzzi Children's Hospital Milan, Italy
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26
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Varesio C, Gana S, Asaro A, Ballante E, Cabini RF, Tartara E, Bagnaschi M, Pasca L, Valente M, Orcesi S, Cereda C, Veggiotti P, Borgatti R, Valente EM, De Giorgis V. Diagnostic Yield and Cost-Effectiveness of "Dynamic" Exome Analysis in Epilepsy with Neurodevelopmental Disorders: A Tertiary-Center Experience in Northern Italy. Diagnostics (Basel) 2021; 11:diagnostics11060948. [PMID: 34070668 PMCID: PMC8228291 DOI: 10.3390/diagnostics11060948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/18/2021] [Accepted: 05/24/2021] [Indexed: 02/02/2023] Open
Abstract
Background: The advent of next-generation sequencing (NGS) techniques in clinical practice led to a significant advance in gene discovery. We aimed to describe diagnostic yields of a “dynamic” exome-based approach in a cohort of patients with epilepsy associated with neurodevelopmental disorders. Methods: We conducted a retrospective, observational study on 72 probands. All patients underwent a first diagnostic level of a 135 gene panel, a second of 297 genes for inconclusive cases, and finally, a whole-exome sequencing for negative cases. Diagnostic yields at each step and cost-effectiveness were the objects of statistical analysis. Results: Overall diagnostic yield in our cohort was 37.5%: 29% of diagnoses derived from the first step analysis, 5.5% from the second step, and 3% from the third. A significant difference emerged between the three diagnostic steps (p < 0.01), between the first and second (p = 0.001), and the first and third (p << 0.001). The cost-effectiveness plane indicated that our exome-based “dynamic” approach was better in terms of cost savings and higher diagnostic rate. Conclusions: Our findings suggested that “dynamic” NGS techniques applied to well-phenotyped individuals can save both time and resources. In patients with unexplained epilepsy comorbid with NDDs, our approach might maximize the number of diagnoses achieved.
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Affiliation(s)
- Costanza Varesio
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, 27100 Pavia, Italy; (L.P.); (S.O.); (R.B.); (V.D.G.)
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy;
- Correspondence: ; Tel.: +39-0382-380289
| | - Simone Gana
- Medical Genetics Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy; (S.G.); (A.A.); (M.V.); (E.M.V.)
| | - Alessia Asaro
- Medical Genetics Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy; (S.G.); (A.A.); (M.V.); (E.M.V.)
| | - Elena Ballante
- BioData Science Center, IRCCS Mondino Foundation, 27100 Pavia, Italy;
- Department of Mathematics, University of Pavia, 27100 Pavia, Italy;
| | - Raffaella Fiamma Cabini
- Department of Mathematics, University of Pavia, 27100 Pavia, Italy;
- Istituto Nazionale di Fisica Nucleare Section of Pavia, 27100 Pavia, Italy
| | - Elena Tartara
- Epilepsy Center, IRCCS Mondino Foundation, 27100 Pavia, Italy;
| | - Michela Bagnaschi
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy;
| | - Ludovica Pasca
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, 27100 Pavia, Italy; (L.P.); (S.O.); (R.B.); (V.D.G.)
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy;
| | - Marialuisa Valente
- Medical Genetics Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy; (S.G.); (A.A.); (M.V.); (E.M.V.)
- Laboratory of Clinical Pathology Microbiology and Genetics, SS. Annunziata, 74100 Taranto, Italy
| | - Simona Orcesi
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, 27100 Pavia, Italy; (L.P.); (S.O.); (R.B.); (V.D.G.)
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy;
| | - Cristina Cereda
- Molecular Genetics and Cytogenetics Section, IRCCS Mondino Foundation, 27100 Pavia, Italy;
- Genomic and Post-Genomic Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy
| | - Pierangelo Veggiotti
- Pediatric Neurology Unit, Vittore Buzzi Hospital, 20100 Milano, Italy;
- Biomedical and Clinical Sciences Department, Luigi Sacco Hospital, University of Milan, 20100 Milano, Italy
| | - Renato Borgatti
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, 27100 Pavia, Italy; (L.P.); (S.O.); (R.B.); (V.D.G.)
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy;
| | - Enza Maria Valente
- Medical Genetics Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy; (S.G.); (A.A.); (M.V.); (E.M.V.)
- Department of Molecular Medicine, University of Pavia, 27100 Pavia, Italy
| | - Valentina De Giorgis
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, 27100 Pavia, Italy; (L.P.); (S.O.); (R.B.); (V.D.G.)
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Zanaboni MP, Pasca L, Villa BV, Faggio A, Grumi S, Provenzi L, Varesio C, De Giorgis V. Characterization of Speech and Language Phenotype in GLUT1DS. Children (Basel) 2021; 8:children8050344. [PMID: 33925679 PMCID: PMC8146076 DOI: 10.3390/children8050344] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/23/2021] [Accepted: 04/23/2021] [Indexed: 12/02/2022]
Abstract
Background: To analyze the oral motor, speech and language phenotype in a sample of pediatric patients with GLUT 1 transporter deficiency syndrome (GLUT1DS). Methods: eight Italian-speaking children with GLUT1DS (aged 4.6–15.4 years) in stable treatment with ketogenic diet from a variable time underwent a specific and standardized speech and language assessment battery. Results: All patients showed deficits with different degrees of impairment in multiple speech and language areas. In particular, orofacial praxis, parallel and total movements were the most impaired in the oromotor domain; in the speech domain patients obtained a poor performance in the diadochokinesis rate and in the repetition of words that resulted as severely deficient in seven out of eight patients; in the language domain the most affected abilities were semantic/phonological fluency and receptive grammar. Conclusions: GLUT1DS is associated to different levels of speech and language impairment, which should guide diagnostic and therapeutic intervention. Larger population data are needed to identify more precisely a speech and language profile in GLUT1DS patients.
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Affiliation(s)
- Martina Paola Zanaboni
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, 27100 Pavia, Italy; (M.P.Z.); (B.V.V.); (A.F.); (S.G.); (L.P.); (C.V.); (V.D.G.)
| | - Ludovica Pasca
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, 27100 Pavia, Italy; (M.P.Z.); (B.V.V.); (A.F.); (S.G.); (L.P.); (C.V.); (V.D.G.)
- Department of Brain and Behaviour Neuroscience, University of Pavia, 27100 Pavia, Italy
- Correspondence: ; Tel.: +39-0382-380289
| | - Barbara Valeria Villa
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, 27100 Pavia, Italy; (M.P.Z.); (B.V.V.); (A.F.); (S.G.); (L.P.); (C.V.); (V.D.G.)
| | - Antonella Faggio
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, 27100 Pavia, Italy; (M.P.Z.); (B.V.V.); (A.F.); (S.G.); (L.P.); (C.V.); (V.D.G.)
| | - Serena Grumi
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, 27100 Pavia, Italy; (M.P.Z.); (B.V.V.); (A.F.); (S.G.); (L.P.); (C.V.); (V.D.G.)
| | - Livio Provenzi
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, 27100 Pavia, Italy; (M.P.Z.); (B.V.V.); (A.F.); (S.G.); (L.P.); (C.V.); (V.D.G.)
| | - Costanza Varesio
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, 27100 Pavia, Italy; (M.P.Z.); (B.V.V.); (A.F.); (S.G.); (L.P.); (C.V.); (V.D.G.)
- Department of Brain and Behaviour Neuroscience, University of Pavia, 27100 Pavia, Italy
| | - Valentina De Giorgis
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, 27100 Pavia, Italy; (M.P.Z.); (B.V.V.); (A.F.); (S.G.); (L.P.); (C.V.); (V.D.G.)
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Garau J, Masnada S, Dragoni F, Sproviero D, Fogolari F, Gagliardi S, Izzo G, Varesio C, Orcesi S, Veggiotti P, Zuccotti GV, Pansarasa O, Tonduti D, Cereda C. Case Report: Novel Compound Heterozygous RNASEH2B Mutations Cause Aicardi-Goutières Syndrome. Front Immunol 2021; 12:672952. [PMID: 33981319 PMCID: PMC8107470 DOI: 10.3389/fimmu.2021.672952] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 04/06/2021] [Indexed: 11/21/2022] Open
Abstract
Aicardi–Goutières Syndrome (AGS) is a rare disorder characterized by neurological and immunological signs. In this study we have described a child with a phenotype consistent with AGS carrying a novel compound heterozygous mutation in RNASEH2B gene. Next Generation Sequencing revealed two heterozygous variants in RNASEH2B gene. We also highlighted a reduction of RNase H2B transcript and protein levels in all the family members. Lower protein levels of RNase H2A have been observed in all the members of the family as well, whereas a deep depletion of RNase H2C has only been identified in the affected child. The structural analysis showed that both mutations remove many intramolecular contacts, possibly introducing conformational rearrangements with a decrease of the stability of RNase H2B and strongly destabilizing the RNase H2 complex. Taken together, these results highlight the importance of an integrated diagnostic approach which takes into consideration clinical, genetic, and molecular analyses.
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Affiliation(s)
- Jessica Garau
- Genomic and Post-Genomic Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Silvia Masnada
- Unit of Pediatric Neurology, V. Buzzi Children's Hospital, Milan, Italy.,C.O.A.L.A (Center for Diagnosis and Treatment of Leukodystrophies), V. Buzzi Children's Hospital, Milan, Italy
| | - Francesca Dragoni
- Genomic and Post-Genomic Unit, IRCCS Mondino Foundation, Pavia, Italy.,Department of Biology and Biotechnology "L. Spallanzani", University of Pavia, Pavia, Italy
| | - Daisy Sproviero
- Genomic and Post-Genomic Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Federico Fogolari
- Department of Mathematics, Computer Science and Physics, University of Udine, Udine, Italy
| | - Stella Gagliardi
- Genomic and Post-Genomic Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Giana Izzo
- C.O.A.L.A (Center for Diagnosis and Treatment of Leukodystrophies), V. Buzzi Children's Hospital, Milan, Italy.,Department of Pediatric Radiology and Neuroradiology, V. Buzzi Children's Hospital, Milan, Italy
| | - Costanza Varesio
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Simona Orcesi
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Pierangelo Veggiotti
- Unit of Pediatric Neurology, V. Buzzi Children's Hospital, Milan, Italy.,C.O.A.L.A (Center for Diagnosis and Treatment of Leukodystrophies), V. Buzzi Children's Hospital, Milan, Italy.,Department of Biomedical and Clinical Science "L. Sacco, University of Milan, Milan, Italy
| | - Gian Vincenzo Zuccotti
- C.O.A.L.A (Center for Diagnosis and Treatment of Leukodystrophies), V. Buzzi Children's Hospital, Milan, Italy.,Department of Biomedical and Clinical Science "L. Sacco, University of Milan, Milan, Italy.,Department of Pediatrics, V. Buzzi Children's Hospital, Milan, Italy
| | - Orietta Pansarasa
- Genomic and Post-Genomic Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Davide Tonduti
- Unit of Pediatric Neurology, V. Buzzi Children's Hospital, Milan, Italy.,C.O.A.L.A (Center for Diagnosis and Treatment of Leukodystrophies), V. Buzzi Children's Hospital, Milan, Italy
| | - Cristina Cereda
- Genomic and Post-Genomic Unit, IRCCS Mondino Foundation, Pavia, Italy
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29
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De Giorgis V, Varesio C, Viri M, Giordano L, La Piana R, Tonduti D, Roncarolo F, Masnada S, Pichiecchio A, Veggiotti P, Fazzi E, Orcesi S. The epileptology of Aicardi-Goutières syndrome: electro-clinical-radiological findings. Seizure 2021; 86:197-209. [PMID: 33589296 DOI: 10.1016/j.seizure.2020.11.019] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/24/2020] [Accepted: 11/26/2020] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE Although epileptic seizures occur in approximately a quarter of patients with Aicardi-Goutières syndrome (AGS), their phenotypic and electrophysiological characterization remains elusive. The aim of our study was to characterize epilepsy phenotypes and electroencephalographic (EEG) patterns in AGS and look for possible correlations with clinical, genetic and neuroradiological features. METHODS We selected patients with an established AGS diagnosis followed at three Italian reference centers. Medical records, EEGs and MRI/CT findings were reviewed. EEGs were independently and blindly reviewed by three board-certified pediatric epileptologists. Chi square and Fisher's exact tests were used to test associations between epilepsy and EEG feature categories and clinical, radiological and genetic variables. RESULTS Twenty-seven patients were enrolled. We reviewed 63 EEGs and at least one brain MRI scan per patient. Epilepsy, mainly in the form of epileptic spasms and focal seizures, was present in 37 % of the cohort; mean age at epilepsy onset was 9.5 months (range 1-36). The presence of epilepsy was associated with calcification severity (p = 0.016) and startle reactions (p = 0.05). Organization of EEG electrical activity appeared to be disrupted or markedly disrupted in 73 % of cases. Severe EEG disorganization correlated with microcephaly (p < 0.001) and highly abnormal MRI T2-weighted signal intensity in white matter (p = 0.022). Physiological organization of the EEG was found to be better preserved during sleep (87 %) than wakefulness (38 %). Focal slow activity was recorded in more than one third of cases. Fast activity, either diffuse or with frontal location, was more frequent in the awake state (78 %) than in sleep (50 %). Interictal epileptiform discharges (IEDs) were present in 33 % of awake and 45 % of sleep recordings. IEDs during sleep were associated with a higher risk of a epileptic seizures (p = 0.008). SIGNIFICANCE The hallmarks of EEG recordings in AGS were found to be: disruption of electrical organization, the presence of focal slow and fast activity, and the presence of IEDs, both in patients with and in those without epilepsy. The associations between epilepsy and calcification and between EEG pattern and the finding of a highly abnormal white matter T2 signal intensity suggest a common anatomical correlate. However, the complex anatomical-electroclinical basis of AGS-related epilepsy still requires further elucidation.
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Affiliation(s)
- Valentina De Giorgis
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy
| | - Costanza Varesio
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy.
| | - Maurizio Viri
- Department of Child Neurology and Psychiatry, AOU Maggiore della Carità Novara, Novara, Italy
| | - Lucio Giordano
- Child Neurology and Psychiatry Unit, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Roberta La Piana
- Department of Neuroradiology and Laboratory of Neurogenetics of Motion, Neurological Institute and Hospital, McGill University, Montreal, QC H3A2B4, Canada
| | - Davide Tonduti
- Pediatric Neurology Unit - COALA (Center for Diagnosis and Treatment of Leukodystrophies) -V. Buzzi Children's Hospital, Milan, Italy
| | - Federico Roncarolo
- Institute of Public Health Research of University of Montreal (IRSPUM), University of Montreal, Montreal, QC, Canada
| | - Silvia Masnada
- Pediatric Neurology Unit - COALA (Center for Diagnosis and Treatment of Leukodystrophies) -V. Buzzi Children's Hospital, Milan, Italy
| | - Anna Pichiecchio
- Neuroradiology Unit, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Pierangelo Veggiotti
- Pediatric Neurology Unit - COALA (Center for Diagnosis and Treatment of Leukodystrophies) -V. Buzzi Children's Hospital, Milan, Italy; Biomedical and Clinical Sciences Department, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Elisa Fazzi
- Child Neurology and Psychiatry Unit, ASST Spedali Civili di Brescia, Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Simona Orcesi
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
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30
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Piccoli C, Bronner N, Gavazzi F, Dubbs H, De Simone M, De Giorgis V, Orcesi S, Fazzi E, Galli J, Masnada S, Tonduti D, Varesio C, Vanderver A, Vossough A, Adang L. Late-Onset Aicardi-Goutières Syndrome: A Characterization of Presenting Clinical Features. Pediatr Neurol 2021; 115:1-6. [PMID: 33307271 PMCID: PMC7856674 DOI: 10.1016/j.pediatrneurol.2020.10.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 09/08/2020] [Revised: 10/23/2020] [Accepted: 10/27/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Aicardi-Goutières syndrome (AGS) is a genetic interferonopathy characterized by early onset of severe neurological injury with intracranial calcifications, leukoencephalopathy, and systemic inflammation. Increasingly, a spectrum of neurological dysfunction and presentation beyond the infantile period is being recognized in AGS. The aim of this study was to characterize late-infantile and juvenile-onset AGS. METHODS We conducted a multi-institution review of individuals with AGS who were older than one year at the time of presentation, including medical history, imaging characteristics, and suspected diagnoses at presentation. RESULTS Thirty-four individuals were identified, all with pathogenic variants in RNASEH2B, SAMHD1, ADAR1, or IFIH1. Most individuals had a history of developmental delay and/or systemic symptoms, such as sterile pyrexias and chilblains, followed by a prodromal period associated with increasing symptoms. This was followed by an abrupt onset of neurological decline (fulminant phase), with a median onset at 1.33 years (range 1.00 to 17.68 years). Most individuals presented with a change in gross motor skills (97.0%), typically with increased tone (78.8%). Leukodystrophy was the most common magnetic resonance imaging finding (40.0%). Calcifications were less common (12.9%). CONCLUSIONS This is the first study to characterize the presentation of late-infantile and juvenile onset AGS and its phenotypic spectrum. Late-onset AGS can present insidiously and lacks classical clinical and neuroimaging findings. Signs of early systemic dysfunction before fulminant disease onset and loss of motor symptoms were common. We strongly recommend genetic testing when there is concern for sustained inflammation of unknown origins or changes in motor skills in children older than one year.
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Affiliation(s)
- Cara Piccoli
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Nowa Bronner
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Holly Dubbs
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Micaela De Simone
- ASST Spedali Civili di Brescia, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, Brescia, Italy
| | | | | | - Elisa Fazzi
- ASST Spedali Civili di Brescia, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, Brescia, Italy
| | - Jessica Galli
- ASST Spedali Civili di Brescia, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, Brescia, Italy
| | - Silvia Masnada
- Vittore Buzzi Children’s Hospital, Ospedale dei Bambini Vittore Buzzi, Milan, Italy
| | - Davide Tonduti
- Vittore Buzzi Children’s Hospital, Ospedale dei Bambini Vittore Buzzi, Milan, Italy
| | | | | | | | - Laura Adang
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
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31
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Ferraris C, Pasca L, Guglielmetti M, Marazzi C, Trentani C, Varesio C, Tagliabue A, De Giorgis V. Comment on: Ketogenic diet therapy provision in the COVID-19 pandemic: Dual-center experience and recommendations. Epilepsy Behav 2020; 112:107399. [PMID: 32861023 PMCID: PMC7425539 DOI: 10.1016/j.yebeh.2020.107399] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 08/11/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Cinzia Ferraris
- Human Nutrition and Eating Disorder Research Center, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Via Agostino Bassi, 21, 27100 Pavia, Italy.
| | - Ludovica Pasca
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Via Mondino, 2, 27100 Pavia, Italy.
| | - Monica Guglielmetti
- Human Nutrition and Eating Disorder Research Center, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Via Agostino Bassi, 21, 27100 Pavia, Italy.
| | - Claudia Marazzi
- Human Nutrition and Eating Disorder Research Center, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Via Agostino Bassi, 21, 27100 Pavia, Italy.
| | - Claudia Trentani
- Human Nutrition and Eating Disorder Research Center, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Via Agostino Bassi, 21, 27100 Pavia, Italy.
| | - Costanza Varesio
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Via Mondino, 2, 27100 Pavia, Italy.
| | - Anna Tagliabue
- Human Nutrition and Eating Disorder Research Center, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Via Agostino Bassi, 21, 27100 Pavia, Italy.
| | - Valentina De Giorgis
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Via Mondino, 2, 27100 Pavia, Italy.
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32
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Varesio C, De Giorgis V, Fazzi E, Orcesi S. Commentary on "Catatonia in a Patient with Aicardi-Goutières Syndrome Efficiently Treated with Immunoadsorption". Schizophr Res 2020; 224:188-189. [PMID: 32928619 DOI: 10.1016/j.schres.2020.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/17/2020] [Accepted: 08/27/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Costanza Varesio
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy.
| | - Valentina De Giorgis
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy
| | - Elisa Fazzi
- Child Neurology and Psychiatry Unit, ASST Spedali Civili di Brescia, Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Simona Orcesi
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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Johannesen KM, Gardella E, Encinas AC, Lehesjoki A, Linnankivi T, Petersen MB, Lund ICB, Blichfeldt S, Miranda MJ, Pal DK, Lascelles K, Procopis P, Orsini A, Bonuccelli A, Giacomini T, Helbig I, Fenger CD, Sisodiya SM, Hernandez‐Hernandez L, Krithika S, Rumple M, Masnada S, Valente M, Cereda C, Giordano L, Accorsi P, Bürki SE, Mancardi M, Korff C, Guerrini R, Spiczak S, Hoffman‐Zacharska D, Mazurczak T, Coppola A, Buono S, Vecchi M, Hammer MF, Varesio C, Veggiotti P, Lal D, Brünger T, Zara F, Striano P, Rubboli G, Møller RS. The spectrum of intermediate
SCN
8A
‐related epilepsy. Epilepsia 2019; 60:830-844. [DOI: 10.1111/epi.14705] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 03/07/2019] [Accepted: 03/07/2019] [Indexed: 01/06/2023]
Affiliation(s)
- Katrine M. Johannesen
- Department of Epilepsy Genetics and Personalized TreatmentDanish Epilepsy Center Filadelfia Dianalund Denmark
- Institute for Regional Health ServicesUniversity of Southern Denmark Odense Denmark
| | - Elena Gardella
- Department of Epilepsy Genetics and Personalized TreatmentDanish Epilepsy Center Filadelfia Dianalund Denmark
- Institute for Regional Health ServicesUniversity of Southern Denmark Odense Denmark
| | - Alejandra C. Encinas
- Graduate Interdisciplinary Program of GeneticsUniversity of Arizona Tucson Arizona
| | - Anna‐Elina Lehesjoki
- Folkhälsan Research Center Helsinki Finland
- Research Programs Unit, Molecular Neurology and MedicumUniversity of Helsinki Helsinki Finland
| | - Tarja Linnankivi
- Department of Child NeurologyChildren's HospitalUniversity of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Michael B. Petersen
- Department of Clinical GeneticsAalborg University Hospital Aalborg Denmark
- Department of Clinical MedicineAalborg University Aalborg Denmark
| | | | | | | | - Deb K. Pal
- Department of Basic and Clinical NeuroscienceInstitute of Psychiatry, Psychology, and NeuroscienceKing's College London London UK
- King's College Hospital London UK
- Evelina London Children's Hospital London UK
- Medical Research Council Centre for Neurodevelopmental DisordersKing's College London UK
| | - Karine Lascelles
- Department of Basic and Clinical NeuroscienceInstitute of Psychiatry, Psychology, and NeuroscienceKing's College London London UK
| | - Peter Procopis
- Children's Hospital Westmead, Sydney New South Wales Australia
- Discipline of Child and Adolescent HealthSydney Medical SchoolUniversity of Sydney Sydney New South Wales Australia
| | | | - Alice Bonuccelli
- Pediatric NeurologyPediatric ClinicUniversity of Pisa Pisa Italy
| | - Thea Giacomini
- Child Neuropsychiatry UnitDepartment of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Children's SciencesGiannina Gaslini InstituteUniversity of Genoa Genoa Italy
| | - Ingo Helbig
- Department of NeuropediatricsUniversity Medical Center Schleswig Holstein Kiel Germany
- Division of NeurologyChildren's Hospital of Philadelphia Philadelphia Pennsylvania
| | - Christina D. Fenger
- Department of Epilepsy Genetics and Personalized TreatmentDanish Epilepsy Center Filadelfia Dianalund Denmark
| | - Sanjay M. Sisodiya
- Department of Clinical and Experimental EpilepsyUniversity College London Institute of Neurology London UK
- Chalfont Centre for Epilepsy Bucks UK
| | - Laura Hernandez‐Hernandez
- Department of Clinical and Experimental EpilepsyUniversity College London Institute of Neurology London UK
- Chalfont Centre for Epilepsy Bucks UK
| | - Sundararaman Krithika
- Department of Clinical and Experimental EpilepsyUniversity College London Institute of Neurology London UK
- Chalfont Centre for Epilepsy Bucks UK
| | - Melissa Rumple
- Pediatric NeurologyBanner Children's Specialists Glendale Arizona
| | - Silvia Masnada
- Department of Brain and Behavioral SciencesUniversity of Pavia Pavia Italy
| | - Marialuisa Valente
- Genomic and Postgenomic CenterScientific Institute for Research and Healthcare (IRCCS) Mondino Foundation Pavia Italy
| | - Cristina Cereda
- Genomic and Postgenomic CenterScientific Institute for Research and Healthcare (IRCCS) Mondino Foundation Pavia Italy
| | - Lucio Giordano
- Child Neurology and Psychiatry UnitCivilian Hospital Brescia Italy
| | - Patrizia Accorsi
- Child Neurology and Psychiatry UnitCivilian Hospital Brescia Italy
| | - Sarah E. Bürki
- Department of PediatricsDivision of Child NeurologyUniversity Children's Hospital BernUniversity of Bern Bern Switzerland
| | - Margherita Mancardi
- Unit of Child NeuropsychiatryEpilepsy CenterDepartment of Clinical and Surgical Neuroscience and RehabilitationGiannina Gaslini Institute Genoa Italy
| | - Christian Korff
- Child Neurology UnitUniversity Children's Hospital Geneva Switzerland
| | - Renzo Guerrini
- Neuroscience DepartmentChildren's Hospital Anna Meyer, University of Florence Florence Italy
| | - Sarah Spiczak
- Department of NeuropediatricsChristian Albrecht University Kiel Germany
- Northern German Epilepsy Center for Children and Adolescents Schwentinental Germany
| | | | - Tomasz Mazurczak
- Department of Neurology of Children and AdolescentsInstitute of Mother and Child Warsaw Poland
| | - Antonietta Coppola
- Department of Neuroscience and Reproductive and Odontostomatological SciencesFederico II University Naples Italy
| | - Salvatore Buono
- Neurology DivisionHospital of National Relevance (AORN), Santobono Pausilipon Naples Italy
| | - Marilena Vecchi
- Pediatric Clinic, Hospital CompanyUniversity of Padua Padua Italy
| | - Michael F. Hammer
- University of Arizona Genetic CoreUniversity of Arizona Tucson Arizona
| | - Costanza Varesio
- Brain and Behavior DepartmentUniversity of Pavia Pavia Italy
- Child and Adolescence Neurology DepartmentIRCCS C. Mondino National Neurological Institute Pavia Italy
| | - Pierangelo Veggiotti
- Department of Child NeurologyV. Buzzi Children's Hospital Milan Italy
- L. Sacco Department of Biomedical and Clinical SciencesUniversity of Milan Milan Italy
| | - Dennis Lal
- Epilepsy CenterNeurological InstituteCleveland Clinic Cleveland Ohio
- Genomic Medicine InstituteLerner Research Institute Cleveland Clinic Cleveland Ohio
- Stanley Center for Psychiatric ResearchBroad Institute of Massachusetts Institute of Technology and Harvard Cambridge Massachusetts
- Analytic and Translational Genetics UnitMassachusetts General Hospital Boston Massachusetts
- Cologne Center for GenomicsUniversity of Cologne Cologne Germany
| | - Tobias Brünger
- Cologne Center for GenomicsUniversity of Cologne Cologne Germany
| | - Federico Zara
- Laboratory of Neurogenetics and NeuroscienceDepartment of Head‐Neck and NeuroscienceGiannina Gaslini Institute Genoa Italy
| | - Pasquale Striano
- Pediatric NeurologyPediatric ClinicUniversity of Studies of Pisa Pisa Italy
| | - Guido Rubboli
- Department of Epilepsy Genetics and Personalized TreatmentDanish Epilepsy Center Filadelfia Dianalund Denmark
- University of Copenhagen Copenhagen Denmark
| | - Rikke S. Møller
- Department of Epilepsy Genetics and Personalized TreatmentDanish Epilepsy Center Filadelfia Dianalund Denmark
- Institute for Regional Health ServicesUniversity of Southern Denmark Odense Denmark
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De Giorgis V, Masnada S, Varesio C, Chiappedi MA, Zanaboni M, Pasca L, Filippini M, Macasaet JA, Valente M, Ferraris C, Tagliabue A, Veggiotti P. Overall cognitive profiles in patients with GLUT1 Deficiency Syndrome. Brain Behav 2019; 9:e01224. [PMID: 30714351 PMCID: PMC6422708 DOI: 10.1002/brb3.1224] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 11/13/2018] [Accepted: 12/05/2018] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Glucose Transporter Type I Deficiency Syndrome (GLUT1DS) classical symptoms are seizures, involuntary movements, and cognitive impairment but so far the literature has not devoted much attention to the last. METHODS In our retrospective study involving 25 patients with established GLUT1DS diagnosis, we describe the cognitive impairment of these patients in detail and their response to the ketogenic diet in terms of cognitive improvement. RESULTS We outlined a specific cognitive profile where performance skills were more affected than verbal ones, with prominent deficiencies in visuospatial and visuomotor abilities. We demonstrated the efficacy of ketogenic diet (KD) on cognitive outcome, with particular improvement tin total and verbal IQ; we found that timing of KD introduction was inversely related to IQ outcome: the later the starting of KD, the lower the IQ, more notable nonverbal scale (verbal IQ correlation coefficient -0.634, p-value = 0.015). We found a significant direct correlation between cognition and CSF/blood glucose ratio values: the higher the ratio, the better the cognitive improvement in response to diet (from T0-baseline evaluation to T1 on average 18 months after introduction of KD-: TIQ correlation coefficient 0.592, p-value = 0.26; VIQ correlation coefficient 0.555, p-value = 0.039). Finally, we demonstrated that a longer duration of treatment is necessary to find an improvement in patients with "severely low ratio." CONCLUSION Our results were consistent with the hypothesis that timing of the diet introduction is a predictive factor of cognitive outcome in these patients, confirming that earlier initiation of the diet may prevent the onset of all GLUT1DS symptoms: epilepsy, movement disorders, and cognitive impairment.
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Affiliation(s)
- Valentina De Giorgis
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy
| | - Silvia Masnada
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Costanza Varesio
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy.,Brain and Behavior Department, University of Pavia, Pavia, Italy
| | - Matteo A Chiappedi
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy
| | - Martina Zanaboni
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy
| | - Ludovica Pasca
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy.,Brain and Behavior Department, University of Pavia, Pavia, Italy
| | - Melissa Filippini
- Child Neurology Unit, IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
| | - Joyce A Macasaet
- Department of Neurosciences, Makati Medical Center, Manila, Philippines
| | - Marialuisa Valente
- Genomic and post-Genomic Center, IRCCS ''C. Mondino'' National Neurological Institute, Pavia, Italy
| | - Cinzia Ferraris
- Human Nutrition and Eating Disorder Research Center, Department of Public Health, Experimental and Forensic Medicine University of Pavia, Pavia, Italy
| | - Anna Tagliabue
- Human Nutrition and Eating Disorder Research Center, Department of Public Health, Experimental and Forensic Medicine University of Pavia, Pavia, Italy
| | - Pierangelo Veggiotti
- Pediatric Neurology Unit, "V. Buzzi" Hospital, Milan, Italy.,Biomedical and Clinical Sciences Department, L Sacco, University of Milan, Milan, Italy
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35
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Dilena R, DiFrancesco JC, Soldovieri MV, Giacobbe A, Ambrosino P, Mosca I, Galli MA, Guez S, Fumagalli M, Miceli F, Cattaneo D, Darra F, Gennaro E, Zara F, Striano P, Castellotti B, Gellera C, Varesio C, Veggiotti P, Taglialatela M. Early Treatment with Quinidine in 2 Patients with Epilepsy of Infancy with Migrating Focal Seizures (EIMFS) Due to Gain-of-Function KCNT1 Mutations: Functional Studies, Clinical Responses, and Critical Issues for Personalized Therapy. Neurotherapeutics 2018; 15:1112-1126. [PMID: 30112700 PMCID: PMC6277296 DOI: 10.1007/s13311-018-0657-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [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] [Indexed: 10/28/2022] Open
Abstract
Epilepsy of infancy with migrating focal seizures (EIMFS) is a rare early-onset developmental epileptic encephalopathy resistant to anti-epileptic drugs. The most common cause for EIMFS is a gain-of-function mutation in the KCNT1 potassium channel gene, and treatment with the KCNT1 blocker quinidine has been suggested as a rational approach for seizure control in EIMFS patients. However, variable results on the clinical efficacy of quinidine have been reported. In the present study, we provide a detailed description of the clinical, genetic, in vitro, and in vivo electrophysiological profile and pharmacological responses to quinidine of 2 EIMFS unrelated patients with a heterozygous de novo KCNT1 mutation: c.2849G>A (p.R950Q) in patient 1 and c.2677G>A (p.E893K) in patient 2. When expressed heterologously in CHO cells, KCNT1 channels carrying each variant showed gain-of-function effects, and were more effectively blocked by quinidine when compared to wild-type KCNT1 channels. On the basis of these in vitro results, add-on quinidine treatment was started at 3 and 16 months of age in patients 1 and 2, respectively. The results obtained reveal that quinidine significantly reduced seizure burden (by about 90%) and improved quality of life in both patients, but failed to normalize developmental milestones, which persisted as severely delayed. Based on the present experience, early quinidine intervention associated with heart monitoring and control of blood levels is among the critical factors for therapy effectiveness in EIMFS patients with KCNT1 gain-of-function mutations. Multicenter studies are needed to establish a consensus protocol for patient recruitment, quinidine treatment modalities, and outcome evaluation, to optimize clinical efficacy and reduce risks as well as variability associated to quinidine use in such severe developmental encephalopathy.
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Affiliation(s)
- Robertino Dilena
- Pediatric Epileptology and Neurophysiology (RD), Infantile Neuropsichiatry (AG), Cardiology (MAG), High Intensity Pediatric Care (SG), Neonatology (MF), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
| | - Jacopo C DiFrancesco
- Clinical Neurophysiology and Epilepsy Center, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133, Milan, Italy
- Department of Neurology, San Gerardo Hospital, School of Medicine and Surgery, Milan Center for Neuroscience (NeuroMi), University of Milano-Bicocca, 20900, Monza, Italy
| | | | - Antonella Giacobbe
- Pediatric Epileptology and Neurophysiology (RD), Infantile Neuropsichiatry (AG), Cardiology (MAG), High Intensity Pediatric Care (SG), Neonatology (MF), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
| | - Paolo Ambrosino
- Department of Medicine and Health Science, University of Molise, 86100, Campobasso, Italy
| | - Ilaria Mosca
- Department of Medicine and Health Science, University of Molise, 86100, Campobasso, Italy
| | - Maria Albina Galli
- Pediatric Epileptology and Neurophysiology (RD), Infantile Neuropsichiatry (AG), Cardiology (MAG), High Intensity Pediatric Care (SG), Neonatology (MF), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
| | - Sophie Guez
- Pediatric Epileptology and Neurophysiology (RD), Infantile Neuropsichiatry (AG), Cardiology (MAG), High Intensity Pediatric Care (SG), Neonatology (MF), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
| | - Monica Fumagalli
- Pediatric Epileptology and Neurophysiology (RD), Infantile Neuropsichiatry (AG), Cardiology (MAG), High Intensity Pediatric Care (SG), Neonatology (MF), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
| | - Francesco Miceli
- Division of Pharmacology, Department of Neuroscience, University of Naples "Federico II", 80131, Naples, Italy
| | - Dario Cattaneo
- Unit of Clinical Pharmacology, ASST Fatebenefratelli Sacco, 20157, Milan, Italy
| | - Francesca Darra
- Department of Surgical, Odontostomatological, and Maternal-Infantile Sciences, University of Verona, 37134, Verona, Italy
| | - Elena Gennaro
- Laboratory of Genetics, E.O. Ospedali Galliera, 16128, Genoa, Italy
| | - Federico Zara
- Laboratory of Genetics, E.O. Ospedali Galliera, 16128, Genoa, Italy
| | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, "G. Gaslini" Institute, 16147, Genoa, Italy
| | - Barbara Castellotti
- Unit of Genetics of Neurodegenerative and Metabolic Diseases, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133, Milan, Italy
| | - Cinzia Gellera
- Unit of Genetics of Neurodegenerative and Metabolic Diseases, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133, Milan, Italy
| | - Costanza Varesio
- Department of Child Neurology and Psychiatry, "C. Mondino" National Neurological Institute, 27100, Pavia, Italy
| | - Pierangelo Veggiotti
- Department of Biomedical and Clinical Sciences, Children's Hospital Vittore Buzzi, University of Milan, and Pediatric Neurology, 20154, Milan, Italy
| | - Maurizio Taglialatela
- Department of Medicine and Health Science, University of Molise, 86100, Campobasso, Italy.
- Division of Pharmacology, Department of Neuroscience, University of Naples "Federico II", 80131, Naples, Italy.
- Department of Neuroscience, University of Naples "Federico II", Via Pansini 5, 80131, Naples, Italy.
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De Giorgis V, Varesio C, Baldassari C, Piazza E, Olivotto S, Macasaet J, Balottin U, Veggiotti P. Atypical Manifestations in Glut1 Deficiency Syndrome. J Child Neurol 2016; 31:1174-80. [PMID: 27250207 DOI: 10.1177/0883073816650033] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [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: 09/30/2015] [Accepted: 03/27/2016] [Indexed: 11/17/2022]
Abstract
Glucose transporter type 1 deficiency syndrome is a genetically determined, treatable, neurologic disorder that is caused by an insufficient transport of glucose into the brain. It is caused by a mutation in the SCL2A1 gene, which is so far the only known to be associated with this condition. Glucose transporter type 1 deficiency syndrome consists of a wide clinical spectrum that usually presents with cognitive impairment, epilepsy, paroxysmal exercise-induced dyskinesia, acquired microcephaly, hemolytic anemia, gait disturbance, and dyspraxia in different combinations. However, there are other clinical manifestations that we consider equally peculiar but that have so far been poorly described in literature. In this review, supported by a video contribution, we will accurately describe this type of clinical manifestation such as oculogyric crises, weakness, paroxysmal kinesigenic and nonkinesigenic dyskinesia in order to provide an additional instrument for a correct, rapid diagnosis.
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Affiliation(s)
- V De Giorgis
- Brain and Behaviour Department, University of Pavia, Pavia, Italy
| | - C Varesio
- Department of Child Neurology and Psychiatry, "C. Mondino" National Neurological Institute, Pavia, Italy
| | - C Baldassari
- Department of Child Neurology and Psychiatry, "C. Mondino" National Neurological Institute, Pavia, Italy
| | - E Piazza
- Brain and Behaviour Department, University of Pavia, Pavia, Italy
| | - S Olivotto
- Department of Child Neurology and Psychiatry, "C. Mondino" National Neurological Institute, Pavia, Italy
| | - J Macasaet
- Department of Neurosciences, Makati Medical Center, Manila, Philippines
| | - U Balottin
- Brain and Behaviour Department, University of Pavia, Pavia, Italy Department of Child Neurology and Psychiatry, "C. Mondino" National Neurological Institute, Pavia, Italy
| | - P Veggiotti
- Brain and Behaviour Department, University of Pavia, Pavia, Italy Department of Child Neurology and Psychiatry, "C. Mondino" National Neurological Institute, Pavia, Italy
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