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Gibellato E, Cianci P, Mariani M, Parma B, Huisman S, Śmigiel R, Bisgaard AM, Massa V, Gervasini C, Moretti A, Cattoni A, Biondi A, Selicorni A. SMC1A epilepsy syndrome: clinical data from a large international cohort. Am J Med Genet A 2024:e63577. [PMID: 38421079 DOI: 10.1002/ajmg.a.63577] [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: 11/04/2023] [Revised: 01/24/2024] [Accepted: 02/08/2024] [Indexed: 03/02/2024]
Abstract
SMC1A epilepsy syndrome or developmental and epileptic encephalopathy-85 with or without midline brain defects (DEE85, OMIM #301044) is an X-linked neurologic disorder associated with mutations of the SMC1A gene, which is also responsible for about 5% of patients affected by Cornelia de Lange syndrome spectrum (CdLS). Only described in female patients, SMC1A epilepsy syndrome is characterized by the onset of severe refractory epileptic seizures in the first year of life, global developmental delay, a variable degree of intellectual disability, and dysmorphic facial features not typical of CdLS. This was a descriptive observational study for the largest international cohort with this specific disorder. The main goal of this study was to improve the knowledge of the natural history of this phenotype with particular attention to the psychomotor development and the epilepsy data. The analyzed cohort shows normal prenatal growth with the subsequent development of postnatal microcephaly. The incidence of neonatal problems (seizures and respiratory compromise) is considerable (51.4%). There is a significant prevalence of central nervous system (20%) and cardiovascular malformations (20%). Motor skills are generally delayed. The presence of drug-resistant epilepsy is confirmed; the therapeutic role of a ketogenic diet is still uncertain. The significant regression of previously acquired skills following the onset of seizures has been observed. Facial dysmorphisms are variable and no patient shows a classic CdLS phenotype. To sum up, SMC1A variants caused drug-resistant epilepsy in these patients, more than two-thirds of whom were shown to progress to developmental and epileptic encephalopathy. The SMC1A gene variants are all different from each other (apart from a couple of monozygotic twins), demonstrating the absence of a mutational hotspot in the SMC1A gene. Owing to the absence of phenotypic specificity, whole-exome sequencing is currently the diagnostic gold standard.
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Affiliation(s)
- Elisabetta Gibellato
- Pediatric Department, "Mariani" Center for Fragile Child, ASST Lariana, Sant'Anna Hospital, Como, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Paola Cianci
- Pediatric Department, "Mariani" Center for Fragile Child, ASST Lariana, Sant'Anna Hospital, Como, Italy
| | - Milena Mariani
- Pediatric Department, "Mariani" Center for Fragile Child, ASST Lariana, Sant'Anna Hospital, Como, Italy
| | - Barbara Parma
- Pediatric Department, "Mariani" Center for Fragile Child, ASST Lariana, Sant'Anna Hospital, Como, Italy
| | - Sylvia Huisman
- Pediatric Department, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Robert Śmigiel
- Pediatric Department, Endocrinology, Diabetology and Metabolic Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Anne-Marie Bisgaard
- Pediatric Department and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark
| | - Valentina Massa
- Department of Health Sciences, University of Milan, Milan, Italy
| | | | - Alex Moretti
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Alessandro Cattoni
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Andrea Biondi
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Angelo Selicorni
- Pediatric Department, "Mariani" Center for Fragile Child, ASST Lariana, Sant'Anna Hospital, Como, Italy
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