Angelman Syndrome in a Filipino child

@#Angelman syndrome (AS) is a distinct condition that presents with severe developmental delay. This condition also presents with speech impairment, ataxia/tremor, and inappropriate laughter. Some other features in most patients include microcephaly, seizures, tongue protrusion, wide mouth, and hypopigmentation. This case aims to emphasize the value of diagnosis in a patient with developmental delay. The diagnosis allows anticipation of the development of other possible problems and guides appropriate management. This report also aims to increase awareness regarding the condition. Here we present a 71-month-old Filipino male with developmental delay at six months, seizures at 10 months with a note of an overall happy demeanor and frequent inappropriate bouts of laughter at one year old. The patient also presented with severe stunting, microcephaly, wide mouth and ataxic gait. Through pattern recognition and the updated consensus of its diagnostic criteria, and confirmation via fluorescence in situ hybridization (FISH), which revealed a deletion in chromosome 15q11, the diagnosis of AS was made. This case re-emphasizes the role of clinical recognition of this condition and its confirmation via cytogenetic techniques like FISH, which will aid appropriate management and counseling for the patient and their families.

Analysis of clinical phenotype and genetic variants in a Chinese pedigree affected with Angelman syndrome / 中华医学遗传学杂志

OBJECTIVE@#To explore the genetic etiology for a Chinese pedigree affected with Angelman syndrome (AS).@*METHODS@#The proband with phenotypes suggestive of AS was subjected to copy number variation sequencing (CNV-seq), methylation-specific multiplex ligation-dependent probe amplification (MS-MLPA) and high-throughput next generation sequencing (NGS). Variant of the UBE3A gene was verified among family members by Sanger sequencing and bioinformatic analysis.@*RESULTS@#NGS revealed that the proband has carried a heterozygous variant of the UBE3A gene, namely c.1517G>A (p.R506H). The variant has co-segregated with the disease in the pedigree. Multiple amino acid sequence alignment showed that the site of mutant residue is conserved among nine homologous species. The variant was predicted to be deleterious by bioinformatic analysis.@*CONCLUSION@#A novel variant of the UBE3A gene has been identified in a Chinese pedigree affected with AS. Above finding has further expanded the spectrum of UBE3A gene variants and phenotypes of AS, which also facilitated molecular diagnosis and genetic counseling for the family.

Linguagem, neurodesenvolvimento e comportamento na Síndrome de Angelman: relato de caso / Language, neurodevelopment, and behavior in Angelman syndrome: a case report

RESUMO Objetivo O objetivo deste estudo é apresentar achados de linguagem, comportamento e neurodesenvolvimento de uma menina com diagnóstico da Síndrome de Angelman, avaliada aos três e aos oito anos. Método Os instrumentos de avaliação foram Observação do Comportamento Comunicativo, Early Language Milestone Scale (ELM) e Teste de Screening de Desenvolvimento DENVER-II (TSDD-II). Resultados No caso apresentado, verifica-se a presença dos sinais fenotípicos da SA, tais como boca larga, dentes espaçados, língua protuberante, estrabismo, fissuras palpebrais ascendentes e sialorreia. Na avaliação de linguagem, foram verificados déficits expressivos e receptivos, com ausência de oralidade e prejuízos na compreensão. O TSDD-II e a ELMS indicaram grave comprometimento de todas as habilidades avaliadas aos três e aos oito anos. O desempenho encontrado, nas duas avaliações, foi muito semelhante em todas as áreas do desenvolvimento infantil. Ao longo dos anos, verificou-se pouca evolução, apesar do grande investimento terapêutico e educacional. Conclusão A presença de um quadro complexo como a SA demanda necessidades clínicas de alta complexidade, situação agravada frente à escassez de recursos terapêuticos que possam minimizar os impactos deletérios da síndrome, culminando em comprometimento da qualidade de vida da população com a SA, bem como de suas famílias.

ABSTRACT Purpose This study aimed to present findings on language, behavior, and neurodevelopment in a girl diagnosed with Angelman Syndrome, evaluated when she was three and eight years old. Methods The following evaluation instruments were used: Observation of Communication Behavior, Early Language Milestone (ELM) Scale, and Denver Developmental Screening Test, 2nd edition (DDST-II). Results In this case report, presence of AS phenotype signals such as wide mouth and wide-spaced teeth, tongue thrusting, strabismus, up slanting palpebral fissures, and sialorrhea are verified. Expressive and receptive deficits were verified in the language assessment, with the absence of orality and loss of comprehension with very similar performances in both evaluations. The ELM and DDST-II tests indicated severe impairment of all abilities evaluated at both three and eight years of age. Performance was quite similar in both evaluations in all areas of child development. Little progress was observed over time despite the great therapeutic and educational investment. Conclusion The presence of a complex scenario such as AS demands high complexity clinical needs, a situation that is worsened due to scarcity of therapeutic resources that could minimize the harmful impacts of AS and culminate in increased quality of life for the AS population and their families.

Recurrent Angelman syndrome caused by a rare partial deletion of UBE3A gene / 中华医学遗传学杂志

OBJECTIVE@#To provide genetic testing for two brothers with mental retardation and epilepsy.@*METHODS@#Array comparative genomic hybridization (aCGH) was used to detect copy number variations in the two patients, their parents and maternal grandparents. Methylation-specific multiplex ligation-dependent probe amplification (MS-MLPA) was utilized to delineate the deleted region in the pedigree.@*RESULTS@#A 138 kb deletion in 15q11.2 region was detected by aCGH in both patients, which encompassed part of the UBE3A gene. MS-MLPA has narrowed down the region to exons 8 to 14 of the UBE3A gene. The same deletion was also found in their mother and grandfather.@*CONCLUSION@#The pathogenesis of this rare form of recurrent Angelman syndrome may be attributed to the partial deletion of maternal UBE3A gene.

Genetic diagnosis and non-invasive prenatal testing of a fetus with Prader-Willi/Angelman syndrome / 中华医学遗传学杂志

OBJECTIVE@#To explore the genetic basis for a fetus featuring growth restriction and validate the effectiveness of a novel noninvasive prenatal testing (NIPT) technique for the detection of chromosomal microdeletions.@*METHODS@#Next-generation sequencing(NGS) and fluorescence in situ hybridization(FISH) were used to analyze the DNA of the fetus. Conventional G-banding was used to analyze the karyotypes of the fetus and its parents. High-throughput sequencing was used to analyze free fetal DNA.@*RESULTS@#NGS analysis has revealed a 4.88 Mb deletion at 15q11.2-q13.1 region in the fetus, which has a 99% overlap with the critical region of Prader-Willi syndrome (Type 2) and Angelman syndrome (Type 2) and encompassed critical genes including SNRPN and UBE3A. NIPT also revealed a 4.6 Mb deletion at 15q12, which was consistent with the results of fetal cord blood and amniotic DNA testing. FISH assay has confirmed the result of NGS. By karyotying, all subjects showed a normal karyotypes at a level of 320~400 bands.@*CONCLUSION@#It is quite necessary to carry out genetic testing on fetuses showing growth restriction. NIPT for fetal chromosomal microdeletions/microduplication syndromes is highly accurate for the diagnosis of Prader-Willi/Angelman syndrome.

Análisis de variación del número de copias y de patrones de metilación en la región 15q11-q13 / Variation analysis of the number of copies and methylene patterns in region 15q11-q13

La región q11-q13 del cromosoma 15 humano es proclive a sufrir alteraciones genéticas. Algunos genes de la región presentan expresión parental diferencial monoalélica, regulada por imprinting (EI). Errores en la regulación del EI, disomías uniparentales (DSU), así como también el cambio en el número de copias genómicas (CNV) producidos por sitios susceptibles de quiebre cromosómico (BP), producen alteraciones en esta región. Las enfermedades más frecuentes asociadas son el síndrome de Prader-Willi, el síndrome de Angelman y el síndrome de microduplicación 15q11-q13. En el presente trabajo analizamos la región 15q11-q13 por Methyl specific-multiplex ligation-dependent probe amplification (MS-MLPA) en 181 muestras de ADN derivadas a nuestro servicio de análisis genético molecular. En este trabajo mostramos que, de las 181 muestras, 39 presentaron alteraciones detectables por MS-MLPA. El 61.5% (24/39) de esas alteraciones detectadas fueron deleciones, el 5.1% (2/39) duplicaciones y el 33.3%(13/39) DSU/EI. Los CNV fueron 4 veces más frecuentes que las DSU/EI (OR = 4; IC 95%: 1.56-10.25) consistente con la literatura. Entre los CNV, dos casos atípicos permiten postular posibles sitios BP que no han sido informados en la literatura previamente.

Human chromosome 15q11-q13 region is prone to suffer genetic alterations. Some genes of this region have a differential monoallelic imprinting-regulated expression pattern. Defects in imprinting regulation (IE), uniparental disomy (UPD) or copy number variation (CNV) due to chromosomal breakpoints (BP) in 15q11-q13 region, are associated with several diseases. The most frequent are Prader-Willi syndrome, Angelman syndrome and 15q11-q13 microduplication syndrome. In this work, we analyzed DNA samples from 181 patients with phenotypes which were compatible with the above-mentioned diseases, using Methyl specific-multiplex ligation-dependent probe amplification (MS-MLPA). We show that, of the 181 samples, 39 presented alterations detectable by MS-MLPA. Of those alterations, 61.5% (24/39) were deletions, 5.1% (2/39) duplications and 33.3% (13/39) UPD/IE. The CNV cases were 4 times more frequent than UPD/IE (OR= 4; IC 95%: 1.56-10.25), consistent with the literature. Among the CNVs, two atypical cases allow to postulate new possible BP sites that have not been reported previously in the literature.

Report on the External Quality Assessment Scheme for Molecular Diagnostics in Korea (2017)

Quality control for genetic analysis has become more important with a drastic increase in testing volume and clinical demands. The molecular diagnostics division of the Korean Association of Quality Assurance for Clinical Laboratory conducted two trials in 2017 on the basis of molecular diagnostics surveys, involving 53 laboratories. The molecular diagnostics surveys included 37 tests: gene rearrangement tests for leukemia (BCR-ABL1, PML-RARA, AML1-ETO, and TEL-AML1), genetic tests for Janus kinase 2, FMS-like tyrosine kinase 3-internal tandem duplication, FMS-like tyrosine kinase 3-tyrosine kinase domain, nucleophosmin, cancer-associated genes (KRAS, EGFR, KIT, and BRAF), hereditary breast and ovarian cancer genes (BRCA1 and BRCA2), Li-Fraumeni syndrome (TP53), Wilson disease (ATP7B), achondroplasia (FGFR3), hearing loss and deafness (GJB2), Avellino (TGFBI), multiple endocrine neoplasia 2 (RET), Huntington disease, spinocerebellar ataxia, spinal and bulbar muscular atrophy, mitochondrial encephalopathy with lactic acidosis and stroke-like episodes, myoclonic epilepsy ragged red fibre, Leber hereditary optic neuropathy, Prader-raderd Angelman syndrome, Duchenne muscular dystrophy, spinal muscular atrophy, fragile X syndrome, apolipoprotein E genotyping, methylenetetrahydrofolate reductase genotyping, and ABO genotyping. Molecular genetic surveys revealed excellent results for most participants. The external quality assessment program for genetic analysis in 2017 proved useful for continuous education and the evaluation of quality improvement.

Del fenotipo neuropsiquiátrico al cuidado clínico del síndrome de Angelman: descripción de siete casos / Neuropsychiatrie phenotype of Angelman syndrome and clinical care: report of seven cases

El síndrome de Angelman es un trastorno neurogenético debido a la falta o reducción en la expresión del gen UBE3A en el cromosoma 15, el cual codifica la proteína ubiquitina ligasa E3A, que tiene un papel integral en el desarrollo sinóptico y la plasticidad neuronal. Se manifiesta por retraso en el neurodesarrollo o discapacidad intelectual, comportamiento característico y epilepsia. Se describen las características clínicas de siete pacientes con deleción del cromosoma 15q11-13 y su manejo integral. Por la expectativa de vida, es importante conocer y manejar las comorbilidades de forma interdisciplinaria para lograr mejorar la calidad de vida de los afectados. Se realiza una revisión de la literatura sobre la aproximación integral al diagnóstico y cuidado clínico a largo plazo de los pacientes con síndrome de Angelman.

Angelman syndrome is a neurogenetic disorder caused by a lack or reduction of expression of UBE3A located within chromosome 15, which codes for ubiquitin protein ligase E3A, which has a key role in synaptic development and neural plasticity. Its main features are developmental delay/intellectual disability, lack of speech, a characteristic behavioural profile, and epilepsy. We describe clinical features and management of seven cases with 15q11-13 deletion. Due to their life expectancy, knowing and managing its comorbidities is crucial to improve their quality of life. We review the diagnosis and long-term clinical care of patients with Angelman syndrome.

Clinical and genetic analysis of two unrelated patients with Angelman syndrome and novel UBE3A mutations / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To explore the genetic cause for two familial Angelman syndrome cases and correlation between the clinical phenotypes and their genetic basis.</p><p><b>METHODS</b>Karyotyping analysis and microarray assay were carried out to exclude chromosome anomalies and uniparental disomy. The UBE3A gene was analyzed for potential point mutations, deletions, insertions and splice site mutations. Reverse transcription PCR was used to evaluate splicing mutation of the RNA transcripts.</p><p><b>RESULTS</b>DNA sequencing showed the proband of family 1 has carried a novel maternal UBE3A splice acceptor site mutation, resulting in a guanine-to-cytosine transversion (IVS15-1G>C). Reverse transcription PCR revealed the proband and his mother both carried heterozygous mutant transcripts with loss of 54 and 59 nucleotides in exon 16, respectively. The proband displayed severe mental retardation, ataxia, seizures and inappropriate laughter. The siblings of family 2 has carried a novel maternal missense mutation in exon 16 of the UBE3A gene (c.2540C>T). She also presented with mental retardation, absent speech, mild ataxia and inappropriate laughter.</p><p><b>CONCLUSION</b>The novel IVS15-1G>C and c.2540 C>T mutations of the UBE3A gene probably underlie the AS in the two families. Compared with small-scale mutations, larger fragments mutations can produce more severe phenotypes.</p>

Evaluación clínica y tratamiento estomatológico de un caso con aparente Síndrome de Angelman / Stomatologycal clinical evaluation and treatment of an apparent case with Angelman Syndrome

Enfermedad genética desconocida e insanable, producida por una alteración cromosómica de la región 15q11-13; las manifestaciones de orden físico, neurológico y psicológico están relacionadas con la pérdida de funciones como la deambulación, el habla, cognitivos y alimentarios. Según la OMS se ha identificado cerca de 7 mil enfermedades raras o huérfanas que afectan al 7% de la población mundial. Estas personas generalmente son desatendidas y aisladas por lsaociedad y políticas de salud, debido a la incapacidad y falta de autonomía personal, la salud general y particularmente del sistema estomatognático de estos pacientes, merece cuidados especializados y prolongados con participación multidisciplinaria, con el único fin de proporcionar servicios de salud con calidad, seguridad y oportunidad. Presentamos el caso de un paciente de sexo masculino de 21 años de edad, en el que no se pudo realizar diagnóstico genético por falta de medios tecnológicos y económicos, pero la presencia de los signos clínicos indica que adolece del síndrome de Angelman. (AU)

Unknown and incurable genetic disease caused by a chromosomal abnormality in the region 15q11-13; manifestations of physical, neurological and psychological are related to the loss of functions such as walking, speech, cognitive and food. According to WHO has identified about 7,000 rare or orphan diseases that affect 7% of the world population. These people are generally neglected and isolated by society and health policy, due to the inability and lack of personal autonomy overall, health and particularly the stomatognathic system of these patients deserve specialized and long-term care with multidisciplinary participation, with the sole purpose of provide quality health services, security and opportunity. We report the case of a male patient of 21 years, which could not be performed genetic diagnosis for lack of technological and financial resources, but the presence of clinical signs indicating that suffers from Angelman syndrome. (AU)

Sedation with dexmedetomidine for conducting electroencephalogram in a patient with Angelman syndrome: a case report / Sedação com dexmedetomidina para realização de eletroencefalograma em paciente portadora de síndrome de Angelmann: relato de caso

ABSTRACT INTRODUCTION: Angelman syndrome is characterized by severe mental retardation and speech and seizure disorders. This rare genetic condition is associated with changes in GABAA receptor. Patients with Angelman syndrome need to be sedated during an electroencephalogram ordered for diagnostic purposes or evolutionary control. Dexmedetomidine, whose action is independent of GABA receptor, promotes a sleep similar to physiological sleep and can facilitate the performing of this examination in patients with Angelman syndrome. CASE REPORT: Female patient, 14 years old, with Angelman syndrome; electroencephalogram done under sedation with dexmedetomidine. The procedure was uneventful and bradycardia or respiratory depression was not recorded. The examination was successfully interpreted and epileptiform activity was not observed. CONCLUSION: Dexmedetomidine promoted satisfactory sedation, was well tolerated and enabled the interpretation of the electroencephalogram in a patient with Angelman syndrome and seizure disorder.

RESUMO INTRODUÇÃO: a síndrome de Angelman (SA) é caracterizada por retardo mental grave, distúrbio da fala e desordem convulsiva. Essa condição genética rara está associada a alterações do receptor GABA-A. Pacientes portadores de SA necessitam ser sedados durante a feitura de eletroencefalograma (EEG), indicado para fins diagnósticos ou controle evolutivo. A dexmedetomidina, cuja ação independe do receptor GABA, promove sono semelhante ao fisiológico e pode viabilizar a feitura desse exame em pacientes com SA. RELATO DE CASO: paciente feminina, 14 anos, portadora de SA, fez EEG sob sedação com dexmedetomidina. O procedimento transcorreu sem intercorrências e não foi registrada bradicardia ou depressão respiratória. O exame foi interpretado com sucesso e atividade epileptiforme não foi observada. CONCLUSÃO: a dexmedetomidina promoveu sedação satisfatória, foi bem tolerada e possibilitou a interpretação do EEG em paciente com SA e desordem convulsiva.

Accurate detection of a case with Angelman syndrome (type 1) using SNP array / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To analyze a case with Angelman syndrome (AS) using single nucleotide polymorphism array (SNP array) and explore its genotype-phenotype correlation.</p><p><b>METHODS</b>G-banded karyotyping and SNP array were performed on a child featuring congenital malformations, intellectual disability and developmental delay. Mendelian error checking based on the SNP information was used to delineate the parental origin of detected abnormality. Result of the SNP array was validated with fluorescence in situ hybridization (FISH).</p><p><b>RESULTS</b>The SNP array has detected a 6.053 Mb deletion at 15q11.2q13.1 (22,770,421- 28,823,722) which overlapped with the critical region of AS (type 1). The parents of the child showed no abnormal results for G-banded karyotyping, SNP array and FISH analysis, indicating a de novo origin of the deletion. Mendelian error checking based on the SNP information suggested that the 15q11.2q13.1 deletion was of maternal origin.</p><p><b>CONCLUSION</b>SNP array can accurately define the size, location and parental origin of chromosomal microdeletions, which may facilitate the diagnosis of AS due to 15q11q13 deletion and better understanding of its genotype-phenotype correlation.</p>

Etiología del autismo: el continuo idiopático-sindrómico como tentativa explicativa / Etiology of autism: the idiopathic-syndromic continuum as explanatory attempt

Although already none doubt that the autism spectrum disorders (ASD) constitute a myriad of clinical syndromes, linked to neurodevelopment, there are still many questions that need be answered. Thus, researchers focus their efforts in genetic disorders that are in the origin of secondary autism, for to know more aboutprimary autism (or idiopathic), whose concrete cause is ignored. Delving into this, we review here recent findings in the research of such disorders, convinced that there is a primary-secondary autism continuum that rigorous studies in molecular genetics must show. However, there is much pathology with autistic behaviors whose etiology remains still unknown. In this line, aside from books, were selected indexed articles in MEDLINE, published from 2008 to 2015, related to advances in genetic research and diagnosis from autistic spectrum disorder. Like key words were used "autism", and the paired-words combinations of "autism and etiology", "autism and neurodevelopment" and "autism and genetics".

Aunque ya nadie duda que los trastornos del espectro autista (TEA) conformen una miríada de síndromes clínicos, vinculados al neurodesarrollo, aún existen muchos interrogantes por responder. Por ello, distintos investigadores centran sus esfuerzos en los trastornos genéticos causantes del autismo secundario, para así saber más del autismo primario (o idiopático), cuya causa concreta se ignora. Ahondando en esto, se revisan aquí hallazgos recientes obtenidos en la investigación de tales trastornos, al creer que existe un continuo entre el autismo primario y su homólogo secundario, que estudios rigurosos en genética molecular deberán evidenciar. No obstante, hay diversidad de patologías con conductas autistas cuya etiología aún se ignora. En tal línea, además de libros, se seleccionaron artículos indexados en MEDLINE, publicados entre 2008 y 2015, relacionados con avances en la investigación genética y diagnóstico del espectro autista. Como palabras claves se utilizaron "autismo", y las combinaciones "autismo y etiología", "autismo y neurodesarrollo" y "autismo y genética".

Prenatal diagnosis for a women with a suspected birth history of Angelman syndrome / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To verify the diagnosis of Angelman syndrome(AS) in a proband in order to provide prenatal diagnosis for his family.</p><p><b>METHODS</b>Array comparative genome hybridization(array-CGH) and fluorescence in situ hybridization(FISH) on metaphase chromosomes were performed.</p><p><b>RESULTS</b>The karyotype of the proband was normal, and a regional deletion of 15q11.1-11.2 was detected by array-CGH. FISH analysis has confirmed loss of heterozygosity in 15q11.2. No positive results were obtained by array-CGH or karyotype analysis. Amniotic fluid sample was taken from the proband's mother upon her subsequent pregnancy. The karyotype of the fetus was normal, but SNP microarray chip analysis has identified loss of heterozygosity in 8p23.1-p22. As no abnormality was observed by ultrasound and other prenatal examinations, the pregnancy was recommended to continue to full-term, and a healthy infant was born.</p><p><b>CONCLUSION</b>Clinically suspected AS can be diagnosed by array-CGH and FISH. The result may facilitate accurate genetic counseling and prenatal diagnosis for the affected family.</p>

Molecular cytogenetic evaluation of chromosomal microdeletions: the experience of a public hospital in Southern Brazil

Introduction: During the past few decades, the number of diseases identified to be caused by chromosomal microdeletions has increased quickly, bringing a new and crucial role for cytogenetics on the diagnosis of these conditions. The purpose of this study was to identify and characterize chromosomal microdeletions associated with malformation syndromes and intellectual disability. Methods: We retrospectively evaluated a consecutive series of samples from a cohort of 598 subjects with clinical symptoms of a microdeletion syndrome, including the deletion of chromosomes 4p16.3, 5p15.2, 5q35, 7q11.23, 8q24.12, 15q11.2, 16p13.3, 17p13.3, 17p11.2,2, and 22q11.2, as investigated by fluorescence in situ hybridization (FISH). Array-based comparative genomic hybridization (array-CGH) was performed on 25 samples with microdeletions. Results: A total of 598 samples were evaluated from patients whose clinical phenotypes were most indicative of 22q11.2 deletion syndrome (29.10%), Prader-Willi syndrome (23.41%), Angelman syndrome (16.89%), and Williams-Beuren syndrome (14.72%). In 142 of the samples (23.75%), a chromosomal imbalance associated with phenotypic abnormalities was found. The deletion of 7q11.23 was the most frequent (8.03%), followed by del22q11.2 (5.68%) and del15q11.2 (5%). Conclusion: Our study reinforces the idea that the effort to improve the capacity to perform molecular cytogenetic investigations associated with a qualified clinical evaluation is crucial for the detection and precise characterization of submicroscopic chromosome deletions, bringing benefits to patients, relatives, and genetic counselors. It also contributes to the continuing education of cytogeneticists and to the knowledge of chromosomal rearrangements associated with genomic disorders.

Phenotype-genotype correlation analysis of 12 cases with Angelman/Prader-Willi syndrome / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To investigate the genotype-phenotype correlation in patients with Angelman syndrome/Prader-Willi syndrome (AS/PWS) and assess the application value of high-resolution single nucleotide polymorphism microarrays (SNP array) for such diseases.</p><p><b>METHODS</b>Twelve AS/PWS patients were diagnosed through SNP array, fluorescence in situ hybridization (FISH) and karyotype analysis. Clinical characteristics were analyzed.</p><p><b>RESULTS</b>Deletions ranging from 4.8 Mb to 7.0 Mb on chromosome 15q11.2-13 were detected in 11 patients. Uniparental disomy (UPD) was detected in only 1 patient. Patients with deletions could be divided into 2 groups, including 7 cases with class I and 4 with class II. The two groups however had no significant phenotypic difference. The UPD patient had relatively better development and language ability. Deletions of 6 patients were confirmed by FISH to be of de novo in origin. The risk to their sibs was determined to be less than 1%.</p><p><b>CONCLUSION</b>The phenotypic differences between AS/PWS patients with class I and class II deletion need to be further studied. SNP array is useful in detecting and distinguishing of patients with deletion or UPD. This method may be applied for studying the genotype-phenotype association and the mechanism underlying AS/PWS.</p>

Proposta de atuação fisioterapêutica em uma criança com síndrome de Angelman, enfatizando o equilíbrio postural: estudo de caso / Proposal for a physical therapy program in a child with Angelman syndrome, emphasizing postural balance: a case study / Propuesta de actuación fisioterapéutica en un niño con Síndrome de Angelman, enfatizando el equilibrio postural: estudio de caso

A síndrome de Angelman (SA) é caracterizada por alterações neuromotoras como marcha atáxica e atraso na aquisição de habilidades motoras, porém são escassos os estudos investigando o efeito de intervenções aplicadas a essa população. O objetivo do estudo foi verificar o efeito de um treino de equilíbrio em uma criança com SA. Participou do estudo uma criança de nove anos de idade com diagnóstico de SA, sexo feminino. Foi aplicado um protocolo para treino de equilíbrio por oito semanas, com frequência de duas vezes por semana. O treino consistiu em atividades envolvendo equilíbrio estático sob diversas condições de dificuldade. Após o treino, a análise de biofotogrametria computadorizada do equilíbrio estático revelou redução do grau de oscilação, que passou de 38° para 13,78°. A pontuação na escala de Berg passou de 27 pontos, na avaliação, para 37 pontos na reavaliação. No teste Timed Up & Go, a criança realizou a tarefa em 15 segundos, na avaliação, e, na reavaliação, em 12 segundos. Em conjunto, os resultados sugerem que o treino favoreceu melhora no equilíbrio estático e dinâmico, bem como na mobilidade funcional.

The Angelman syndrome is characterized by neuromotor difficulties, such as ataxic gait and delayed acquisition of motor skills. However, there are few studies investigating the effect of interventions directed to this population. This study aimed to investigate the effect of a balance training in a child with Angelman syndrome. The participant was a nine-year-old girl. The training protocol was implemented during an eight-week period, twice a week, and consisted of activities involving static balance under various difficulty levels. After the training, the postural sway measured by biophotogrammetry changed from 38° to 13.78°. The scores in the Berg scale changed from 27 points to 37 points. In the Timed Up & Go test, the child's time to complete the task changed from 15 to 12 seconds. Taken together, the results suggest that the training led to improved static and dynamic balance, as well as functional mobility.

El síndrome de Angelman (SA) es caracterizado por alteraciones neuromotoras como marcha atáxica y atraso en la adquisición de habilidades motoras, pero son escasos los estudios investigando el efecto de intervenciones aplicadas a esta población. El objetivo de este estudio fue verificar el efecto de un entrenamiento del equilibrio en un niño con SA. Participó del estudio un niño de 9 años de edad con diagnóstico de SA, sexo femenino. Fue aplicado un protocolo de entrenamiento para el equilibrio por 8 semanas, con frecuencia de 2 veces por semana. El entrenamiento consistió en actividades involucrando el equilibrio estático sobre diversas condiciones de dificultad. Después del entrenamiento el análisis de biofotogrametría computarizada del equilibrio estático reveló reducción de los grados de oscilación, que pasó de 38° para 13,78°. La puntuación en la escala de Berg pasó de 27 puntos en la evaluación para 37 puntos en la reevaluación. En el test Timed up and go la niña realizó la tarea en 15 segundos en la evaluación y 12 segundos en la reevaluación. En conjunto, los resultados sugieren que el entrenamiento favoreció la mejora en el equilibrio estático y dinámico, así como de la movilidad funcional.

Síndrome de Angelman / Angelman Syndrome

Se realiza la presentacion de un caso de sindrome de Angelman, diagnosticado y confirmado por pruebas geneticas, que realizó su rehabilitación en el centro Senén Casas Regueiro de La Habana Vieja. La paciente fue diagnosticada con una parálisis cerebral y posteriormente, a partir del estudio realizado a personas con retraso mental y otras discapacidades en el año 2001, se determina la coincidencia de los rasgos físicos y mentales del caso, con el síndrome de Angelman. Se hace la revisión y discusión de la literatura al respecto, y se encuentra coincidencia casi total de los rasgos descritos en la bibliografía, con el caso presentado. Se confirma este diagnóstico con la prueba FISH (Fluorescent in situ hybridization), que determinó la delección del cromosoma 15

We report a case of Angelman syndrome, which was diagnosed and confirmed by genetic testing. This patient had rehabilitation at Senén Casas center rehabilitation center in Habana Vieja. This patient was diagnosed with cerebral palsy. Further, from the study of persons with mental retardation and other disabilities in 2001, we determined the coincidence of physical and mental traits in with Angelman syndrome this case. The corresponding review and discussion of the literature was carried out, and it was found almost complete coincidence of the features described in the literature, with this case. This diagnosis was confirmed with FISH test (Fluorescent in situ hybridization), which determined the deletion of chromosome 15

Epilepsy in Korean patients with Angelman syndrome / 소아과

PURPOSE: The aim of this study was to investigate the natural history of epilepsy and response to anti-epileptic drug treatment in patients with Angelman syndrome (AS) in Korea. METHODS: We retrospectively reviewed the clinical records of 14 patients diagnosed with epilepsy out of a total of 17 patients with a genetic diagnosis of AS. These patients were seen at the Department of Pediatric Neurology at Severance Children's Hospital from March 2005 to March 2011. RESULTS: Fourteen (9 males and 5 females) subjects (82.3%) were diagnosed with epilepsy in AS. The most common seizure types were generalized tonic-clonic (n=9, 27%) and myoclonic (n=9, 27%), followed by atonic (n=8, 24%), atypical absence (n=4, 12%) and complex partial seizure (n=3, 9%). The most commonly prescribed antiepileptic drug (AED) was valproic acid (VPA, n=12, 86%), followed by lamotrigine (LTG, n=9, 64%), and topiramate (n=8, 57%). According to questionnaires that determined whether each AED was efficacious or not, VPA had the highest response rate and LTG was associated with the highest rate of seizure exacerbation. Complete control of seizures was achieved in 6 patients. Partial control was achieved in 7 patients, while one patient was not controlled. CONCLUSION: Epilepsy is observed in the great majority of AS patients. It may have early onset and is often refractory to treatment. There are few reports about epilepsy in AS in Korea. This study will be helpful in understanding epilepsy in AS in Korea.