ABSTRACT
INTRODUCTION: Angelman syndrome is characterised by mental retardation, epilepsy, speech impairment, facial dysmorphism and a characteristic behavioural phenotype. Diagnostic clinical criteria have been defined by consensus since 1995. It is caused by deficiency or inactivation of the UB3A gene. There is a percentage of cases which satisfy these clinical features but have negative genetic testing. We consider it necessary to analyse the patient characteristics and possible phenotype-genotype correlations. MATERIAL AND METHODS: All cases which were treated between 1981 and 2007 in a neurology unit and fulfilled the clinical criteria were included. Genetic diagnosis was made by methylation testing and fluorescent in situ hybridization. RESULTS: Thirteen patients were studied, nine with positive genetic testing and four with negative testing who completed the clinical criteria. The average age at diagnosis was 37 months. Eleven cases showed acquired microcephaly. Flat occiput, mouth and maxillary malformations, hypopigmentation, a happy appearance and hyperactivity were practically constant characteristics. Speech and walking ability were the areas which showed most deficit. Twelve cases had epilepsy. Three of the cases with normal genetic testing showed less microcephaly and better psychomotor development, particularly in walking ability. CONCLUSIONS: The phenotypical characteristics of the syndrome should be known before requesting specific genetic testing and to make a diagnosis even in cases with negative genetic. The phenotype characteristics that describe Angelman syndrome were verified. Deletion cases had a worse outcome.
Subject(s)
Angelman Syndrome/diagnosis , Angelman Syndrome/genetics , Female , Humans , Infant , Male , PhenotypeABSTRACT
Introducción. El síndrome de Angelman se caracteriza por retraso mental, epilepsia, déficit del lenguaje, dismorfia facial y un fenotipo conductual característico. Los criterios clínicos diagnósticos están definidos por consenso desde 1995. Está causado por el déficit o inactivación del gen UB3A. Se describen varios tipos de alteraciones genéticas. Existe un porcentaje de casos que, cumpliendo los criterios diagnósticos, los estudios genéticos son negativos. Consideramos necesario analizar las características de nuestros pacientes y las posibles correlaciones fenotipogenotipo. Material y métodos. Se incluyeron todos los casos tratados en la unidad de neurología que cumplieron los criterios diagnósticos, durante el período 1981-2007. Para el diagnóstico genético, se efectuó un análisis de metilación e hibridación fluorescente in situ. Resultados. Se estudió a 13 pacientes, 9 con estudio genético positivo y 4 con genética negativa que cumplieron criterios clínicos. La edad media de diagnóstico fue de 37 meses. Once casos presentaron microcefalia adquirida. Un occipucio plano, malformaciones bucales y maxilares, hipopigmentación, apariencia feliz e hiperactividad fueron unas características prácticamente constantes. Tanto el lenguaje como la marcha fueron las áreas que presentaron un mayor déficit. Doce casos presentaron epilepsia. Tres de los casos con estudio genético normal presentan menos microcefalia y mejor desarrollo psicomotor, sobre todo en la marcha. Conclusiones. Es necesario conocer las características fenotípicas del síndrome para solicitar un estudio genético específico y para establecer el diagnóstico en los casos con genética negativa. En nuestros pacientes se constató el fenotipo característico que describió Angelman. Los casos de deleciones presentaron una mayor gravedad y una peor evolución
Introduction. Angelman syndrome is characterised by mental retardation, epilepsy, speech impairment, facial dysmorphism and a characteristic behavioural phenotype. Diagnostic clinical criteria have been defined by consensus since 1995. It is caused by deficiency or inactivation of the UB3A gene. There is a percentage of cases which satisfy these clinical features but have negative genetic testing. We consider it necessary to analyse the patient characteristics and possible phenotype-genotype correlations. Material and methods. All cases which were treated between 1981 and 2007 in a neurology unit and fulfilled the clinical criteria were included. Genetic diagnosis was made by methylation testing and fluorescent in situ hybridization. Results. Thirteen patients were studied, nine with positive genetic testing and four with negative testing who completed the clinical criteria. The average age at diagnosis was 37 months. Eleven cases showed acquired microcephaly. Flat occiput, mouth and maxillary malformations, hypopigmentation, a happy appearance and hyperactivity were practically constant characteristics. Speech and walking ability were the areas which showed most deficit. Twelve cases had epilepsy. Three of the cases with normal genetic testing showed less microcephaly and better psychomotor development, particularly in walking ability. Conclusions. The phenotypical characteristics of the syndrome should be known before requesting specific genetic testing and to make a diagnosis even in cases with negative genetic. The phenotype characteristics that describe Angelman syndrome were verified. Deletion cases had a worse outcome
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Angelman Syndrome/diagnosis , Angelman Syndrome/genetics , Phenotype , Prognosis , Retrospective Studies , Epilepsy/drug therapy , Anticonvulsants/therapeutic useSubject(s)
Brain Diseases/congenital , Brain Diseases/pathology , Epilepsy, Complex Partial/diagnosis , Atrophy/pathology , Brain Diseases/complications , Electroencephalography , Epilepsy, Complex Partial/etiology , Epilepsy, Complex Partial/physiopathology , Functional Laterality/physiology , Humans , Infant , MaleABSTRACT
No disponible
Subject(s)
Humans , Male , Infant , Brain Diseases/complications , Psychomotor Disorders/etiology , Microcephaly/diagnosis , Tomography, X-Ray ComputedSubject(s)
Cerebellar Diseases , Cerebellar Neoplasms , Cerebellar Diseases/diagnosis , Cerebellar Diseases/etiology , Cerebellar Diseases/pathology , Cerebellar Diseases/physiopathology , Cerebellar Neoplasms/complications , Cerebellar Neoplasms/diagnosis , Cerebellar Neoplasms/pathology , Cerebellar Neoplasms/physiopathology , Child, Preschool , Female , Humans , Magnetic Resonance ImagingABSTRACT
No disponible
Subject(s)
Female , Child, Preschool , Humans , Encephalitis/complications , Cerebellar Neoplasms/complications , Lymphangioma/pathologyABSTRACT
Clinical presentation of mitochondrial disorders is heterogeneous because the affected organs are those depending on a high rate of aerobic metabolism. They can appear at any age and evolution is progressive. Signs that guide diagnostic suspicion, especially in the pediatric age group, are heterogeneous clinical presentation and multisystem involvement. Within the spectrum of diseases caused by mitochondrial myopathy, there are clearly defined syndromes such as Kearns-Sayre syndrome. Muscle biopsy shows ragged red fibers and approximately 80 % of patients present sporadic deletions in mitochondrial DNA. Imaging studies reveal areas of hypointensity in basal ganglia and midbrain that are not visible after administration of contrast enhancement in computed tomography, and symmetric T2 hyperintensity lesions in these areas in magnetic resonance imaging. We present a patient with Kearns-Sayre syndrome, in whom radiological alterations were helpful in reaching the diagnosis.
Subject(s)
Kearns-Sayre Syndrome/diagnosis , Central Nervous System/diagnostic imaging , Central Nervous System/pathology , Child , Humans , Magnetic Resonance Imaging , Male , Tomography, X-Ray ComputedABSTRACT
Las enfermedades mitocondriales se caracterizan desde el punto de vista clínico por su variabilidad y heterogeneidad, ya que los síntomas más frecuentes son los dependientes de los numerosos tejidos que requieren una alta demanda energética. Pueden aparecer a cualquier edad y su curso es progresivo. La diversibilidad clínica y la afectación multisistémica son signos orientativos para la sospecha diagnóstica, en particular durante la edad pediátrica. Hay entidades claramente identificadas como el síndrome de Kearns-Sayre. En la biopsia muscular muestra fibras rojas rasgadas y aproximadamente el 80% de los casos presentan deleción del ADN mitocondrial de forma esporádica. En el estudio de imagen se observan áreas de baja densidad en núcleos de la base que no se realzan tras la administración de contraste en tomografía computarizada (TC) y focos simétricos hiperintensos a dichos niveles en resonancia magnética (RM) potenciada en T2. Se presenta el caso de un paciente con síndrome de Kearns-Sayre, en el que las alteraciones radiológicas contribuyeron a establecer el diagnóstico (AU)
Subject(s)
Child , Male , Humans , Tomography, X-Ray Computed , Central Nervous System , Magnetic Resonance Imaging , Kearns-Sayre Syndrome , Kearns-Sayre SyndromeABSTRACT
INTRODUCTION: The childhood opsoclonus-myoclonus or Kinsbourne syndrome, is a uncommon process, of acute or subacute beginning, which affects infant and children. It's course is characterized by opsoclonus, polimyoclonias and cerebellar ataxia. The disease is frequently associated to neuroblastoma (46%). MATERIAL AND METHODS: We present a retrospective study on 9 patients, emphasizing the clinical presentation and the evolution aspects. RESULTS AND CONCLUSIONS: We found changes in the EEG in three cases. Most surprising is the scarce incidence of neuroblastoma, which has been found only in a one out of nine patients. We found three cases with relapse during the treatment or on withdrawal and one of them relapsed twice again. The evolution has been variable, since 5/9 patient have presented some type of mild or moderate neuro-psychological sequelae. Out of three patient with relapses, two presented permanent neurological sequelae. A patient which suffered three relapses, is also the one which presents more serious sequelae.
Subject(s)
Cerebellar Ataxia/epidemiology , Myoclonus/epidemiology , Ocular Motility Disorders/epidemiology , Abdominal Neoplasms/complications , Abdominal Neoplasms/epidemiology , Adolescent , Adrenocorticotropic Hormone/therapeutic use , Brain Damage, Chronic/etiology , Cerebellar Ataxia/drug therapy , Cerebellar Ataxia/etiology , Child , Child, Preschool , Electroencephalography , Female , Follow-Up Studies , Ganglioneuroblastoma/complications , Ganglioneuroblastoma/epidemiology , Humans , Male , Myoclonus/drug therapy , Myoclonus/etiology , Ocular Motility Disorders/drug therapy , Ocular Motility Disorders/etiology , Recurrence , Retrospective Studies , Syndrome , Virus Diseases/complicationsABSTRACT
INTRODUCTION AND MATERIAL: Between 369 cases of benign partial epilepsy of the childhood with Rolandic spikes (BECRS) diagnosed in our hospital, we have been able to study three patients that have presented a neurophysiological and clinical presentation that was compatible with the form described by Aicardi and Chevrie in 1982. RESULTS: None of our patients had familial epilepsy precedents. There were no pathological birth or previous neurological disorders. The neurophysiological development was normal until the beginning of the clinical picture. The seizures began when the patients were 3 years and 4 months, and 5 years, with partial seizures of the same characteristic that present patients with BECRS. Two of them had generalized tonic-clonic seizures during sleep. All the patients presented throughout the evolution absences myoclonic and/or atonic seizures. The awake EEG patterns showed normal background activity and paroxysms of focal spike were complexes with diffusion to central areas. During the slow wave sleep, every cases showed paroxysms of diffuse and generalized slow spike and wave complexes practically continuous. The partial seizures were scarce, but the absences and the atonicas seizures presented several times every day, and in one case appeared in the form of a grand mal state. CONCLUSIONS: The evolution of the patients was favourable, as they were free of seizures, with a normal neurophysiological development. At the beginning, the seizures were resistant to treatment with several antiepileptics drugs (AED). The treatment with valproic acid (VPA) and clonazepam (CZP), has been very effective.
