Analysis of one familial hypokalemic periodic paralysis family with R669H variant of SCN4A gene / 临床神经病学杂志

Objective To investigate the clinical and genetic characteristics of a family with hypokalemic periodic paralysis(HOKPP).Methods The clinical data of one HOKPP family were retrospectively analyzed.Results The proband presented with periodic paralysis,limb weakness and decreased serum potassium(1-2 mmol/L).The proband's father and cousin had similar symptoms.A heterozygous missense variant c.2006G＞A(p.R669H)in SCN4A gene was identified in the proband,his father,younger aunt and cousin using gene detection.However,the variant was absent in his elder aunt and younger uncle.Conclusions The family shows irregular dominant inheritance.The severity,frequency and age of onset of male heterozygotes were different,while female heterozygotes had no clinical phenotype.The study first confirms that the R669H variant in SCN4A gene causes complete penetrance in males and carriers in females in Asian populations.

Physical Therapy Interventions and Response to this Treatment in a 13-year-old Female with Paramyotonia Congenita

Background: Paramyotonia Congenita (PMC) is a rare genetic disorder that affects the sodium ion pump at the level of muscles, retarding muscular relaxation after activation. Symptoms may include isolated or global muscle stiffness, with or without pain. The purpose of this case is to describe physical therapy interventions and response to this treatment in a 13-year-old female with paramyotonia congenita. Case Summary: 13-year-old female diagnosed with Paramyotonia Congenita and a 4-month history of increased low back and bilateral hip pain. Treatment consisted of therapeutic heating modalities, aquatic therapy, and stretches. Patient and family education and coordination for an individual education plan were also implemented.Outcome Measures: The patient was treated at an outpatient clinic for 13 sessions. She showed improvements in shoulder, hip, and back range of motion and pain. Goniometric measurements were used to track the range of motion, and a 0-10 visual analog scale and Wong-baker FACES pain rating scale were used to measure pain.Conclusion: Physical therapy intervention may be an effective treatment option in reducing pain in a 13-year-old girl with PMC. Treatment modalities utilizing heat application may have decreased pain for several days at a time, and deeper heating options appear to yield greater effectiveness at reducing pain for longer periods. However, additional research is needed to evaluate the effectiveness of physical therapy treatment with PMC, including the role and application of deep heat and other treatment modalities.

Mutation analysis of SCN4A gene in a family with hypokalemic periodic paralysis / 中国医师杂志

Objective:To analyze the clinical features and SCN4A gentic background of a family with hypokalemic periodic paralysis.Methods:Peripheral blood samples and clinical data were collected from the proband, his brother and parents, and genomic DNA was extracted from these blood samples. Genome-wide exome sequencing was conducted to determine the mutation site in the proband and then allele-specific oligonucleotide primers were designed based on the mutation site. Polymerase chain reaction (PCR) was performed to detect the mutation site to further identify the causative gene in the family.Results:The patient was a 19-years-old male, Han nationality. The patient presented with periodic paralysis while hypokalemia at the same time. His father and grandpa have a similar medical history in the family. A hybrid missense variation (p.R672H) was identified in exon 12 of SCN4A gene in the proband. The same mutation was also detect in the proband's father.Conclusions:The heterozygous missense variation of SCN4A gene (p.R672H) found in this study resulted in familial hypokalemic periodic paralysis. Our research provided reference for the future genetic counseling of this patient and enriched the research data on the relationship between genotype and clinical manifestations.

New phenotype of severe neonatal episodic laryngospasm due to a missense mutation in SCN4A: A case report and literature review / 中南大学学报(医学版)

Severe neonatal episodic laryngospasm (SNEL) is an ion channel disease characterized by recurrent life-threatening myotonia of respiratory muscle due to mutations in the voltage-gated sodium channel genes. Here we reported a newborn manifested as paroxysmal cyanosis and limb myotonia after birth. The neonate also developed muscle hypertrophy and stunted growth during the follow-up. Whole exome sequencing confirmed c.2395G>A, p. Ala799Thr heterozygous mutation of SCN4A. Carbamazepine was found to be effective on treating the disease. This case expands our understanding of the phenotype resulting from SCN4A mutations. By summarizing the characteristics of reported 16 cases in SNEL, we found they were mainly in the p.G1306E mutation. The common symptoms were upper airway muscle stiffness and feeding difficulties during neonates. When grow up, most patients have different degrees of recurrent attacks of myotonia and progressed muscle hypertrophy. Some of them have athlete-like special faces but all showed myotonic discharge in eletromyogram.

A novel in-frame mutation at the boundary between exon 21 and intron 21 of SCN4A in a family with paramyotonia congenita

@#Nondystrophic myotonias and periodic paralyses are an important group of genetic skeletal muscle disorders characterized by dysfunction of ion channels that regulate cell membrane excitability. Mutations in the Sodium Voltage-Gated Channel Alpha Subunit 4 (SCN4A) gene are associated with a spectrum of a heterogeneous group of skeletal muscle such as sodium channel myotonia, paramyotonia congenita, hyperkalemic periodic paralysis, congenital myasthenia, and congenital myopathy. Gain of function mutations in SCN4A cause three muscle disorders with overlapping clinical phenotypes: myotonia, paramyotonia congenita, and hyperkalemic periodic paralysis. Here, we describe the clinical and genetic features of a new family with paramyotonia. The proband, an eight-year-old girl, began to experience muscle stiffness in her hands and limbs on exposure to exercise exercise at the age of four and presented with myotonia. She was initially misdiagnosed with myotonic dystrophy because of worsening weakness with significant elevation of serum creatinine kinase levels. Two other affected family members had paradoxical myotonia in the face and hands on exposure to cold muscle stiffness in her face, hands, and limbs on exposure to cold and showed grip myotonia on physical examination. A novel heterozygous in-frame insertion, c.3911_3912+1dupAGA, at the boundary between exon 21 and intron 21 of SCN4A was identified using whole exome sequencing. Our finding enhances our understanding of the genotype and phenotype of patients with paramyotonia congenita, caused by mutations in the SCN4A gene.

Paramyotonia congenita and hypokalemic periodic paralysis in a family with mutation p.R1448H in α-subunit type Ⅳ of voltage gated sodium channel gene / 中华神经科杂志

Objective Through description of the clinical,electrophysiological,pathological and gene sequencing characteristics of a family diagnosed as paramyotonia congenita and hypokalemic periodic paralysis to broaden the understanding of skeletal muscle channel disease and provide the reference for clinical diagnosis.Methods The clinical manifestation,electromyography,muscle pathology and gene sequencing of a family diagnosed as paramyotonia congenita and hypokalemic periodic paralysis in the First Hospital of Shanxi Medical University in October 2017 were collected.Results The proband represented myotonia and episodic muscle weakness,and the manifestations of different patients of the family were varied,including myotonia,episodic muscle weakness or myotonia and episodic muscle weakness.The electromyography of the proband showed myotonic potential,and the compound muscle action potential decreased by 36％ in 40 minutes after exercise in the long exercise test in cold environment (11 ℃).The gene sequencing showed α-subunit type Ⅳ of voltage gated sodium channel (SCN4A) gene p.R1448H mutation.Conclusions The proband presented with paramyotonia congenita and hypokalemic periodic paralysis.Family clinical manifestations suggested phenotypic heterogeneity.The long exercise text in cold environment (11 ℃) confirmed the diagnosis of the proband as paramyotonia congenita and hypokalemic periodic paralysis.Family gene sequencing showed that the mutation of p.R1448H in SCN4A gene was the pathogenic gene mutation site of paramyotonia congenita and hypokalemic periodic paralysis.

Prevalência da mutação causadora da paralisia periódica hipercalêmica em equinos da raça Quarto de Milha no Brasil / Prevalence of the hypercalemic periodic paralysis mutation in Quarter Horses in Brazil

A paralisia periódica hipercalêmica (HYPP) é uma das principais enfermidades genéticas de caráter dominante que acometem cavalos da raça Quarto de milha (QM). A HYPP é causada por uma mutação pontual no gene SCN4A e, apesar de estar presente nos cavalos QM no Brasil, dados sobre a prevalência da HYPP são escassos. O objetivo deste trabalho foi verificar a prevalência da mutação responsável pela HYPP em cavalos QM, utilizados nas modalidades esportivas de rédeas (n=160), apartação (n=160), tambor e baliza (n=160), corrida (n=160) e conformação (n=101). Foram utilizados DNA sanguíneo dos 741 equinos; o teste genético para enfermidade foi padronizado e as amostras sequenciadas para identificação da mutação no gene alvo. A prevalência de HYPP na população amostrada foi de 4,2%, sendo que somente na linhagem de conformação foram identificados animais positivos (30,7%). Medidas de controle mais efetivas devem ser adotadas para diminuir a prevalência da HYPP.

Hyperkalemic Periodic Paralysis (HYPP) is one of the major dominant genetic diseases which affect Quarter horses (QH). The HYPP is caused by a point mutation in the SCN4A gene and despite the presence of HYPP in Brazilian QH, limited data on the disease prevalence are available. The aim of this study was to investigate the HYPP mutation in QH belonging to reining (n=160), cutting (n=160), barrel racing (n=160), racing (n=160) and halter (n=101) competitive disciplines. Blood DNA from 741 horses were used. Genetic tests were standardized and samples were sequenced to identify the mutation on the target gene. The prevalence of HYPP on the sampled population was 4.2% and the positive animals (30.7%) were only identified in the halter lineage. More effective actions on HYPP control should be done to reduce the disease prevalence. .

Mutation status of gene CACNA1S and SCN4A in the hypokalemic periodic paralysis pedigree in Chinese population / 解放军医学杂志

Objective To investigate the mutation status of gene CACNA1S and SCN4A in hypokalemic periodic paralysis (HPP) pedigree of Chinese population, and compare the status with that in Caucasian populations as reported in previous literature. Methods To define the gene mutation status, the genes CACNA1S and SCN4A were sequenced by PCR and DNA sequencing technology in two familial HPP pedigrees, one hyperthyroid HPP pedigree and four sporadic HPP patients, the findings were then compared with the reference sequences in gene library. A total of nine relevant reports concerning the gene CACNA1S and SCN4A mutation of HPP pedigree published from Jan. 1999 to Dec. 2012 were retrieved from PubMed database. Results All the probands were suffering from paroxysmal muscle weakness with hypokalemia. As a typical symptom of HPP, muscle weakness often involved the extremities. Auxiliary examination confirmed serum hypopotassemia, electrocardiogram (ECG) showed hypokalemic change, and electromyography (EMG) showed shortened motor potential duration and low amplitude. All the findings mentioned above were in accordance with clinical diagnosis of HPP. Gene analysis indicated that no mutation of CACNA1S and SCN4A was found in the probands, the family members of the three HPP pedigrees and the four patients of sporadic HPP. The previous literature presented that mutation rate of gene CACN1AS and SCN4A was much higher in Caucasian HPP patients than in Chinese population. Conclusion The mutation rate of gene CACN1AS and SCN4A is lower in Chinese HPP patients than in Caucasian patients with significant difference.

Hypokalemic periodic paralysis; two different genes responsible for similar clinical manifestations / 소아과

Primary hypokalemic periodic paralysis (HOKPP) is an autosomal dominant disorder manifesting as recurrent periodic flaccid paralysis and concomitant hypokalemia. HOKPP is divided into type 1 and type 2 based on the causative gene. Although 2 different ion channels have been identified as the molecular genetic cause of HOKPP, the clinical manifestations between the 2 groups are similar. We report the cases of 2 patients with HOKPP who both presented with typical clinical manifestations, but with mutations in 2 different genes (CACNA1Sp.Arg528His and SCN4A p.Arg672His). Despite the similar clinical manifestations, there were differences in the response to acetazolamide treatment between certain genotypes of SCN4A mutations and CACNA1S mutations. We identified p.Arg672His in the SCN4A gene of patient 2 immediately after the first attack through a molecular genetic testing strategy. Molecular genetic diagnosis is important for genetic counseling and selecting preventive treatment.

Familial hyperkalemic periodic paralysis caused by a de novo mutation in the sodium channel gene SCN4A / 소아과

Familial hyperkalemic periodic paralysis (HYPP) is an autosomaldominant channelopathy characterized by transient and recurrent episodes of paralysis with concomitant hyperkalemia. Mutations in the skeletal muscle voltage-gated sodium channel gene SCN4A have been reported to be responsible for this disease. Here, we report the case of a 16-year-old girl with HYPP whose mutational analysis revealed a heterozygous c.2111C>T substitution in the SCN4A gene leading to a Thr704Met mutation in the protein sequence. The parents were clinically unaffected and did not have a mutation in the SCN4A gene. A de novo SCN4A mutation for familial HYPP has not previously been reported. The patient did not respond to acetazolamide, but showed a marked improvement in paralytic symptoms upon treatment with hydrochlorothiazide. The findings in this case indicate that a de novo mutation needs to be considered when an isolated family member is found to have a HYPP phenotype.

Hypokalemic periodic paralysis; two different genes responsible for similar clinical manifestations / 소아과

Primary hypokalemic periodic paralysis (HOKPP) is an autosomal dominant disorder manifesting as recurrent periodic flaccid paralysis and concomitant hypokalemia. HOKPP is divided into type 1 and type 2 based on the causative gene. Although 2 different ion channels have been identified as the molecular genetic cause of HOKPP, the clinical manifestations between the 2 groups are similar. We report the cases of 2 patients with HOKPP who both presented with typical clinical manifestations, but with mutations in 2 different genes (CACNA1Sp.Arg528His and SCN4A p.Arg672His). Despite the similar clinical manifestations, there were differences in the response to acetazolamide treatment between certain genotypes of SCN4A mutations and CACNA1S mutations. We identified p.Arg672His in the SCN4A gene of patient 2 immediately after the first attack through a molecular genetic testing strategy. Molecular genetic diagnosis is important for genetic counseling and selecting preventive treatment.

Familial hyperkalemic periodic paralysis caused by a de novo mutation in the sodium channel gene SCN4A / 소아과

Familial hyperkalemic periodic paralysis (HYPP) is an autosomaldominant channelopathy characterized by transient and recurrent episodes of paralysis with concomitant hyperkalemia. Mutations in the skeletal muscle voltage-gated sodium channel gene SCN4A have been reported to be responsible for this disease. Here, we report the case of a 16-year-old girl with HYPP whose mutational analysis revealed a heterozygous c.2111C>T substitution in the SCN4A gene leading to a Thr704Met mutation in the protein sequence. The parents were clinically unaffected and did not have a mutation in the SCN4A gene. A de novo SCN4A mutation for familial HYPP has not previously been reported. The patient did not respond to acetazolamide, but showed a marked improvement in paralytic symptoms upon treatment with hydrochlorothiazide. The findings in this case indicate that a de novo mutation needs to be considered when an isolated family member is found to have a HYPP phenotype.

Clinical Diversity of SCN4A-Mutation-Associated Skeletal Muscle Sodium Channelopathy

BACKGROUND AND PURPOSE: Mutations of the skeletal muscle sodium channel gene SCN4A, which is located on chromosome 17q23-25, are associated with various neuromuscular disorders that are labeled collectively as skeletal muscle sodium channelopathy. These disorders include hyperkalemic periodic paralysis (HYPP), hypokalemic periodic paralysis, paramyotonia congenita (PMC), potassium-aggravated myotonia, and congenital myasthenic syndrome. This study analyzed the clinical and mutational spectra of skeletal muscle sodium channelopathy in Korean subjects. METHODS: Six unrelated Korean patients with periodic paralysis or nondystrophic myotonia associated with SCN4A mutations were included in the study. For the mutational analysis of SCN4A, we performed a full sequence analysis of the gene using the patients' DNA. We also analyzed the patients' clinical history, physical findings, laboratory tests, and responses to treatment. RESULTS: We identified four different mutations (one of which was novel) in all of the patients examined. The novel heterozygous missense mutation, p.R225W, was found in one patient with mild nonpainful myotonia. Our patients exhibited various clinical phenotypes: pure myotonia in four, and PMC in one, and HYPP in one. The four patients with pure myotonia were initially diagnosed as having myotonia congenita (MC), but a previous analysis revealed no CLCN1 mutation. CONCLUSIONS: Clinical differentiating between sodium-channel myotonia (SCM) and MC is not easy, and it is suggested that a mutational analysis of both SCN4A and CLCN1 is essential for the differential diagnosis of SCM and MC.