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Cerebellar Atrophy and Epilepsy in Twins with a Novel SCN8A Mutation 新型SCN8A突变双胞胎的小脑萎缩和癫痫
IF 0.2 Q4 PEDIATRICS Pub Date : 2023-02-10 DOI: 10.1055/s-0043-1768657
I. Aleksandrova, A. Asenova, T. Todorov, S. Atemin, A. Maver, B. Peterlin, V. Mitev, A. Todorova, V. Bojinova
Abstract Purpose  Pathogenic SCN8A variants are associated with a wide spectrum of clinical presentation, ranging from mild to severe epileptic phenotypes, cases of intellectual disability, or movement disorders without epilepsy. Ataxia and cerebellar atrophy are rarely described as components of the disease phenotype. Case Presentation  We present the cases of male twins, born after normal pregnancy and delivery, both with normal neuropsychological but with delayed motor development in the first 2 years of life. Between 8 months and 9 years of age, the boys experienced generalized tonic-clonic seizures, several times per year. When 9 years old, the children suffered an increase in seizure frequency, and the family reported gradual worsening in coordination, speech, communication, and social skills. When 9 and a half years of age, the patients were admitted to the Clinic of Child Neurology for the first time. They both had coordination syndrome (intention tremor, dysmetria, dysdiadochokinesia) that had worsened compared with previous reports, and magnetic resonance imaging of the brain showed cerebellar atrophy. The genetic testing confirmed a mutation c.2617G > T, p.Gly873Cys in SCN8A gene. After adding lamotrigine to valproate and levetiracetam, and adjusting the dosage of valproate and levetiracetam, we observed good seizure control accompanied by improvement in the coordination syndrome. Conclusion  The cerebellar atrophy in our patients is likely due to the underlying sodium channelopathy, as it was presented at the time of the seizure worsening, but we cannot exclude the role of the epileptic seizures as the worsening of the coordination syndrome accompanied the seizure aggravation, and the tendency toward improvement was evident after seizure control.
致病性SCN8A变异与广泛的临床表现相关,从轻度到重度癫痫表型,智力残疾病例或无癫痫的运动障碍。共济失调和小脑萎缩很少被描述为疾病表型的组成部分。我们报告了一对正常怀孕和分娩后出生的男性双胞胎,他们的神经心理正常,但在生命的前2年运动发育迟缓。在8个月至9岁之间,男孩经历全身性强直阵挛发作,每年数次。当孩子9岁时,癫痫发作频率增加,家庭报告在协调、言语、沟通和社交技能方面逐渐恶化。9岁半时,患者第一次住进儿童神经病学诊所。与之前的报道相比,他们都患有协调综合征(意图性震颤、节律障碍、运动障碍),并且大脑磁共振成像显示小脑萎缩。基因检测证实SCN8A基因c.2617G > T, p.Gly873Cys突变。在丙戊酸钠和左乙拉西坦的基础上加入拉莫三嗪,并调整丙戊酸钠和左乙拉西坦的剂量后,我们观察到癫痫发作控制良好,并伴有协调综合征的改善。结论本组患者的小脑萎缩可能是由于潜在的钠通道病变引起的,因为它是在癫痫发作加重时出现的,但我们不能排除癫痫发作的作用,因为协调综合征的恶化伴随着癫痫发作的加重,而癫痫控制后改善的趋势明显。
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引用次数: 0
An Unusual Case of Progressive Myoclonic Epilepsy (PME): Familial Encephalopathy with Neuroserpin Inclusion Body (FENIB) 进行性肌阵挛性癫痫1例:家族性脑病伴神经丝素包涵体(FENIB)
IF 0.2 Q4 PEDIATRICS Pub Date : 2023-02-06 DOI: 10.1055/s-0043-1769116
Debarup Das, U. Chakraborty, S. Dubey, Bhaswar Bhattacharya, A. Pandit
Abstract Progressive myoclonic epilepsy (PME) is a spectrum with epileptic encephalopathy and myoclonus. In this case report authors describe a young patient presenting with refractory multifocal myoclonus with multiple seizure types with dyscognitive features. He was bed-bound with complete dependency on his caregivers. His electroencephalogram had an encephalopathy pattern, and his magnetic resonance imaging showed gross cortical atrophy. In this patient, the working clinical diagnosis of epileptic encephalopathy with PME phenotype had a wide differential list including neuronal ceroid lipofuscinosis, Lafora body disease, sialidosis, myoclonic epilepsy with ragged red fibers, dentatorubro-pallidoluysian atrophy, Unverricht–Lundborg, and other rare disorders such as Gaucher's disease and other genetic causes. Eventually after ruling out all common etiologies, whole-exome sequencing revealed a SERPINI1 gene mutation in exon 9 showing a pathogenic variant c1175G > A (p.Gly392Glu) which associated with PME as a part of familial encephalopathy with neuroserpin inclusion bodies.
进行性肌阵挛性癫痫(PME)是一种癫痫性脑病和肌阵挛的频谱。在这个案例中,报告作者描述了一个年轻的患者,表现为难治性多局灶性肌阵挛,并伴有多种癫痫发作类型和认知障碍特征。他卧床不起,完全依赖照顾他的人。脑电图表现为脑病型,核磁共振显示皮质严重萎缩。本例患者PME表型癫痫性脑病的临床有效诊断鉴别范围很广,包括神经元样脂褐质病、拉福拉体病、唾液增多症、红色纤维粗糙的肌阵挛性癫痫、齿状体-苍白球萎缩症、Unverricht-Lundborg,以及其他罕见疾病如戈谢病和其他遗传原因。最终,在排除了所有常见病因后,全外显子组测序显示,第9外显子serini1基因突变显示致病变异c1175G > a (p.Gly392Glu),该变异与PME作为家族性脑病的一部分与神经丝氨酸蛋白包涵体相关。
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引用次数: 0
Contributing Reviewers in 2022 2022年投稿审稿人
IF 0.2 Q4 PEDIATRICS Pub Date : 2023-01-30 DOI: 10.1055/s-0043-1761401
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引用次数: 0
Study on Effectiveness and Tolerability of Adjunctive Perampanel Treatment in Children with Refractory Epilepsy in a Tertiary Care Center 三级医疗中心辅助Perampanel治疗难治性癫痫患儿的疗效和耐受性研究
IF 0.2 Q4 PEDIATRICS Pub Date : 2023-01-22 DOI: 10.1055/s-0043-1768658
V.K. Gowda, Jincy Thavalenga, R. C. Nanjundappa
Abstract Background  Nearly 30% of patients with epilepsy are refractory to currently available antiseizure drugs (ASDs). Although the U.S. Food and Drug Administration approved perampanel (PER) for patients as young as 4 years, there are limited data on using PER in children. Objective  The aim of this study was to determine the efficacy and tolerability of adjunctive PER treatment in children with refractory epilepsy (RE). Methodology  This prospective intervention study was conducted in the tertiary care center, in Bengaluru, India from December 2020 to May 2022. PER was added after the failure of a minimum of two ASDs and patients with 6 months follow-up. Treatment response was classified as complete, partial, or none with ≥90, ≥50, and <50% reduction in seizure frequency, respectively. Adverse events and discontinuation data were used to assess tolerability. Results  Our cohort consisted of 100 cases, a mean age of 9.3 ± 3.8 years and male:female ratio of 3:1. The predominant seizure type was generalized seizures (74%), and concomitant enzyme-inducing ASD use was noted in 27%. Structural etiology was noted in 57%. A total of 76% of participants responded to PER therapy (46% complete response and 30% partial response), while 23% showed no response and 1% discontinued the treatment. Adverse events were observed in 25% of participants (11/25 [44%] drowsiness/sedation, 10/25 [40%] behavioral problems, and 4 [16%] other side effects). Early PER add-on provided a statistically significant benefit over late PER add-on ( p  = 0.01). Response to PER did not differ significantly with the type of seizure and ASD used ( p  > 0.05). Conclusion  Adjunctive PER therapy is safe and effective for treating children with RE. An early add-on of PER is more beneficial in controlling seizures than a late add-on.
背景近30%的癫痫患者对现有抗癫痫药物(asd)难以治愈。尽管美国食品和药物管理局批准perampanel (PER)用于4岁以下的患者,但在儿童中使用PER的数据有限。目的探讨PER辅助治疗小儿难治性癫痫(RE)的疗效和耐受性。该前瞻性干预研究于2020年12月至2022年5月在印度班加罗尔的三级保健中心进行。在至少两例asd和患者6个月随访失败后添加PER。治疗反应分为完全、部分或无(≥90、≥50和0.05)。结论PER辅助治疗儿童RE安全有效,早期加用比晚期加用更有利于控制癫痫发作。
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引用次数: 0
Special Issue on Minimally Invasive Pediatric Epilepsy Surgery 微创小儿癫痫外科特刊
IF 0.2 Q4 PEDIATRICS Pub Date : 2023-01-05 DOI: 10.1055/s-0042-1760414
J. Riviello, Irfan Ali, D. Curry
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引用次数: 0
Clinical Characteristics and Prognosis of Juvenile Myoclonic Epilepsy: Single-Center Retrospective Study 青少年肌阵挛性癫痫的临床特点及预后:单中心回顾性研究
IF 0.2 Q4 PEDIATRICS Pub Date : 2022-12-21 DOI: 10.1055/s-0043-1764390
T. Çelik, H. Başpınar
Abstract Juvenile myoclonic epilepsy (JME) is one of the most common idiopathic (genetic) generalized epilepsy syndromes. It occurs in healthy adolescents and is characterized by the triad of myoclonic jerks, generalized tonic-clonic seizures (GTCs), and absence seizures. The study's primary aim was to determine the demographic and clinical characteristics, family history of seizure, electroencephalogram findings, treatments, and short-term prognosis of patients diagnosed with JME. Patients diagnosed with JME at the Pediatric Neurology Department of Sağlık Bilimleri University Adana Numune Training and Research Hospitals were enrolled. Thirteen (30%) of 44 patients were male, whereas 31 (70%) were female, with a mean age at diagnosis of 14 ± 1.3 years. In total, 21 patients (48%) had a family history of epilepsy, and 14 patients (32%) had JME in their families. Those having a family history of JME seizures were identified at a younger age. Thirty (68%) patients presented with GTCs, while 14 (32%) presented with myoclonic seizures at the time of diagnosis. In the history, 98% of patients had myoclonus and one patient had an absence seizure. Patients with the first seizure type GTCs were diagnosed later, while patients with myoclonus were diagnosed earlier ( p  < 0,05). The most precipitating factors for seizures were sleep deprivation and stress. Thirty-eight (86%) of the EEGs recorded during the initial admission was abnormal. Valproic acid was administered to 32 patients (73%), while levetiracetam was administered to 12 patients (27%) as the initial treatment. Forty-one (93%) of the patients exhibited a complete response to the initial medication therapy, while forty (91%) of the patients received monotherapy, and only four (9%) received polytherapy. JME may be well-controlled epilepsy with early diagnosis and appropriate treatment. A family history of JME is also common among patients with JME. Patients with the myoclonus as a first seizure type are diagnosed earlier than GTCs because of family awareness. A family history of JME may facilitate the diagnosis of new cases in the family.
青少年肌阵挛性癫痫(JME)是最常见的特发性(遗传性)全身性癫痫综合征之一。它发生在健康青少年中,以肌阵挛抽搐、全身性强直-阵挛发作(GTCs)和失神发作为特征。该研究的主要目的是确定JME患者的人口学和临床特征、癫痫家族史、脑电图结果、治疗方法和短期预后。在Sağlık Bilimleri大学Adana Numune培训和研究医院儿科神经内科诊断为JME的患者被纳入研究。44例患者中男性13例(30%),女性31例(70%),平均诊断年龄14±1.3岁。共有21例患者(48%)有癫痫家族史,14例患者(32%)有家族性癫痫。那些有JME发作家族史的人在更年轻的时候就被发现了。30例(68%)患者表现为gtc, 14例(32%)患者在诊断时表现为肌阵挛性发作。病史中,98%的患者有肌阵挛,1例患者有失神性癫痫发作。首次发作型gtc患者诊断较晚,而肌阵挛型患者诊断较早(p < 0.05)。导致癫痫发作的最主要因素是睡眠不足和压力。初次入院时记录的脑电图中有38例(86%)异常。32例(73%)患者使用丙戊酸,12例(27%)患者使用左乙拉西坦作为初始治疗。41例(93%)患者对初始药物治疗有完全反应,40例(91%)患者接受单一治疗,只有4例(9%)患者接受综合治疗。通过早期诊断和适当治疗,JME可能是一种控制良好的癫痫。JME的家族史在JME患者中也很常见。由于家庭意识的提高,首次发作类型为肌阵挛的患者比gtc更早被诊断出来。JME家族史有助于诊断家族新发病例。
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引用次数: 0
Neuromodulation in Children with Drug-Resistant Epilepsy 儿童耐药癫痫的神经调节
IF 0.2 Q4 PEDIATRICS Pub Date : 2022-11-28 DOI: 10.1055/s-0042-1760293
I. Ali, Kimberly Houck, K. Sully
Abstract The introduction of neuromodulation was a revolutionary advancement in the antiseizure armamentarium for refractory epilepsy. The basic principle of neuromodulation is to deliver an electrical stimulation to the desired neuronal site to modify the neuronal functions not only at the site of delivery but also at distant sites by complex neuronal processes like disrupting the neuronal circuitry and amplifying the functions of marginally functional neurons. The modality is considered open-loop when electrical stimulation is provided at a set time interval or closed-loop when delivered in response to an incipient seizure. Neuromodulation in individuals older than 18 years with epilepsy has proven efficacious and safe. The use of neuromodulation is extended off-label to pediatric patients with epilepsy and the results are promising. Vagus nerve stimulation (VNS), responsive neurostimulation (RNS), and deep brain stimulation (DBS) are Food and Drug Administration-approved therapeutic techniques. The VNS provides retrograde signaling to the central nervous system, whereas DBS and RNS are more target specific in the central nervous system. While DBS is open-loop and approved for stimulation of the anterior nucleus of the thalamus, the RNS is closed-loop and can stimulate any cortical or subcortical structure. We will review different modalities and their clinical efficacy in individuals with epilepsy, with a focus on pediatric patients.
神经调节的引入是治疗难治性癫痫的革命性进展。神经调节的基本原理是通过复杂的神经元过程,如破坏神经回路和放大边缘功能神经元的功能,将电刺激传递到所需的神经元部位,不仅在传递部位,而且在远处改变神经元的功能。当在设定的时间间隔内提供电刺激时,这种模式被认为是开环的;当响应于早期癫痫发作时,这种模式被认为是闭环的。18岁以上癫痫患者的神经调节已被证明是有效和安全的。神经调节的使用被扩展到标签外的儿童癫痫患者,结果是有希望的。迷走神经刺激(VNS),反应性神经刺激(RNS)和脑深部刺激(DBS)是食品和药物管理局批准的治疗技术。VNS向中枢神经系统提供逆行信号,而DBS和RNS在中枢神经系统中更具靶向特异性。DBS是开环的,被批准用于刺激丘脑前核,而RNS是闭环的,可以刺激任何皮层或皮层下结构。我们将回顾不同的治疗方式及其对癫痫患者的临床疗效,重点是儿科患者。
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引用次数: 1
Molecular Neurosurgery: Introduction to Gene Therapy and Clinical Applications 分子神经外科:基因治疗导论及临床应用
IF 0.2 Q4 PEDIATRICS Pub Date : 2022-11-28 DOI: 10.1055/s-0042-1760292
Angela P. Addison, J. P. Mcginnis, Joshua Ortiz-Guzman, Evelyne K. Tantry, Dhruv M. Patel, B. D. Belfort, Snigdha Srivastava, J. M. Romero, B. Arenkiel, D. Curry
Abstract To date, more than 100 clinical trials have used sequence-based therapies to address diseases of the pediatric central nervous system. The first targeted pathologies share common features: the diseases are severe; they are due (mostly) to single variants; the variants are well characterized within the genome; and the interventions are technically feasible. Interventions range from intramuscular and intravenous injection to intrathecal and intraparenchymal infusions. Whether the therapeutic sequence consists of RNA or DNA, and whether the sequence is delivered via simple oligonucleotide, nanoparticle, or viral vector depends on the disease and the involved cell type(s) of the nervous system. While only one active trial targets an epilepsy disorder—Dravet syndrome—experiences with aromatic L-amino acid decarboxylase deficiency, spinal muscular atrophy, and others have taught us several lessons that will undoubtedly apply to the future of gene therapy for epilepsies. Epilepsies, with their diverse underlying mechanisms, will have unique aspects that may influence gene therapy strategies, such as targeting the epileptic zone or nodes in affected circuits, or alternatively finding ways to target nearly every neuron in the brain. This article focuses on the current state of gene therapy and includes its history and premise, the strategy and delivery vehicles most commonly used, and details viral vectors, current trials, and considerations for the future of pediatric intracranial gene therapy.
迄今为止,已有超过100项临床试验使用基于序列的疗法来治疗儿童中枢神经系统疾病。第一类目标病理具有共同特征:疾病严重;它们(主要)是由于单一的变体;这些变异在基因组中有很好的特征;这些干预措施在技术上是可行的。干预措施包括从肌肉和静脉注射到鞘内和肺实质内输注。治疗序列是由RNA还是DNA组成,以及该序列是通过简单的寡核苷酸、纳米颗粒还是病毒载体传递,取决于疾病和涉及的神经系统细胞类型。虽然只有一项正在进行的试验针对癫痫疾病——德拉韦综合征,但芳香l -氨基酸脱羧酶缺乏症、脊髓性肌萎缩症和其他疾病的经验给我们带来了一些教训,这些教训无疑将适用于未来的癫痫基因治疗。癫痫有着不同的潜在机制,将有可能影响基因治疗策略的独特方面,例如靶向受影响回路中的癫痫区或节点,或者找到几乎靶向大脑中每个神经元的方法。本文重点介绍了基因治疗的现状,包括其历史和前提,策略和最常用的递送载体,并详细介绍了病毒载体,目前的试验,以及对儿童颅内基因治疗未来的考虑。
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引用次数: 0
Minimally Invasive Destructive, Ablative, and Disconnective Epilepsy Surgery 微创破坏性,消融性和分离性癫痫手术
IF 0.2 Q4 PEDIATRICS Pub Date : 2022-11-16 DOI: 10.1055/s-0042-1760106
J. Treiber, James C. Bayley, D. Curry
Abstract Conventional epilepsy surgery performed by microsurgical dissection typically requires large cranial working windows created with high-speed drills and lengthy incisions. In the past few decades, minimally invasive techniques have been developed with smaller incisions, comparable efficacy, shorter hospitalizations, and better safety profiles. These minimally invasive alternatives utilize stereotactic, ultrasonic, radiotherapeutic, and endoscopic techniques. Although not able to completely replace conventional surgery for all etiologies of epilepsy, these minimally invasive techniques have revolutionized modern epilepsy surgery and have been an invaluable asset to the neurosurgeon's repertoire. The endoscope has allowed for surgeons to have adequate visualization during resective and disconnective epilepsy surgeries using keyhole or miniature craniotomies. Modern stereotactic techniques such as laser interstitial thermal therapy and radiofrequency ablation can be used as viable alternatives for mesial temporal lobe epilepsy and can destroy lesional tissue deep areas without the approach-related morbidity of microsurgery such as with hypothalamic hamartomas. These stereotactic techniques do not preclude future surgery in the settings of treatment failure and have been used successfully after failed conventional surgery. Multiple ablation corridors can be performed in a single procedure that can be used for lesioning of large targets or to simplify treating multifocal epilepsies. These stereotactic techniques have even been used successfully to perform disconnective procedures such as hemispherotomies and corpus callosotomies. In patients unable to tolerate surgery, stereotactic radiosurgery is a minimally invasive option that can result in improved seizure control with minimal procedural risks. Advances in minimally invasive neurosurgery provide viable treatment options for drug-resistant epilepsy with quicker recovery, less injury to functional brain, and for patients that may otherwise not choose conventional surgery.
通过显微外科解剖进行的常规癫痫手术通常需要使用高速钻头和长切口创建大的颅骨工作窗口。在过去的几十年里,微创技术的发展具有更小的切口、相当的疗效、更短的住院时间和更好的安全性。这些微创替代方法利用立体定向、超声、放射治疗和内窥镜技术。虽然不能完全取代传统手术治疗癫痫的所有病因,这些微创技术已经彻底改变了现代癫痫手术,并已成为神经外科医生曲目的宝贵资产。内窥镜允许外科医生在使用锁孔或微型开颅术进行切除和分离性癫痫手术时有足够的可视化。现代立体定向技术,如激光间质热疗法和射频消融,可以作为内侧颞叶癫痫的可行替代方案,并且可以破坏病变组织的深层区域,而不会引起显微外科手术相关的并发症,如下丘脑错构瘤。这些立体定向技术在治疗失败的情况下不排除未来的手术,并且在常规手术失败后成功使用。多个消融通道可在一次手术中完成,可用于大目标的病变或简化多灶性癫痫的治疗。这些立体定向技术甚至已成功地用于分离手术,如半球切开术和胼胝体切开术。对于无法忍受手术的患者,立体定向放射手术是一种微创选择,可以在最小的手术风险下改善癫痫控制。微创神经外科的进展为耐药癫痫提供了可行的治疗选择,恢复更快,对功能脑的损伤更小,对于那些可能不选择传统手术的患者。
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引用次数: 0
The Noninvasive Evaluation for Minimally Invasive Pediatric Epilepsy Surgery (MIPES): A Multimodal Exploration of the Localization-Based Hypothesis 微创小儿癫痫手术(MIPES)的无创评估:基于定位假设的多模式探索
IF 0.2 Q4 PEDIATRICS Pub Date : 2022-11-15 DOI: 10.1055/s-0042-1760104
Deepankar Mohanty, Michael M. C. Quach
Abstract Minimally invasive pediatric epilepsy surgery (MIPES) is a rising technique in the management of focal-onset drug-refractory epilepsy. Minimally invasive surgical techniques are based on small, focal interventions (such as parenchymal ablation or localized neuromodulation) leading to elimination of the seizure onset zone or interruption of the larger epileptic network. Precise localization of the seizure onset zone, demarcation of eloquent cortex, and mapping of the network leading to seizure propagation are required to achieve optimal outcomes. The toolbox for presurgical, noninvasive evaluation of focal epilepsy continues to expand rapidly, with a variety of options based on advanced imaging and electrophysiology. In this article, we will examine several of these diagnostic modalities from the standpoint of MIPES and discuss how each can contribute to the development of a localization-based hypothesis for potential surgical targets.
微创小儿癫痫手术(MIPES)是一项新兴的治疗局灶性药物难治性癫痫的技术。微创手术技术是基于小范围的局部干预(如实质消融或局部神经调节),从而消除癫痫发作区或中断更大的癫痫网络。精确定位癫痫发作区,划定雄辩皮层,以及绘制导致癫痫发作传播的网络是实现最佳结果所必需的。局灶性癫痫的术前、无创评估工具箱继续迅速扩大,有多种基于先进成像和电生理学的选择。在本文中,我们将从MIPES的角度研究这些诊断模式中的几种,并讨论每种模式如何有助于为潜在手术目标建立基于定位的假设。
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引用次数: 0
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Journal of Pediatric Epilepsy
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