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1.
Am J Hum Genet ; 108(6): 1012-1025, 2021 06 03.
Article in English | MEDLINE | ID: mdl-34015270

ABSTRACT

The human genetic dissection of clinical phenotypes is complicated by genetic heterogeneity. Gene burden approaches that detect genetic signals in case-control studies are underpowered in genetically heterogeneous cohorts. We therefore developed a genome-wide computational method, network-based heterogeneity clustering (NHC), to detect physiological homogeneity in the midst of genetic heterogeneity. Simulation studies showed our method to be capable of systematically converging genes in biological proximity on the background biological interaction network, and capturing gene clusters harboring presumably deleterious variants, in an efficient and unbiased manner. We applied NHC to whole-exome sequencing data from a cohort of 122 individuals with herpes simplex encephalitis (HSE), including 13 individuals with previously published monogenic inborn errors of TLR3-dependent IFN-α/ß immunity. The top gene cluster identified by our approach successfully detected and prioritized all causal variants of five TLR3 pathway genes in the 13 previously reported individuals. This approach also suggested candidate variants of three reported genes and four candidate genes from the same pathway in another ten previously unstudied individuals. TLR3 responsiveness was impaired in dermal fibroblasts from four of the five individuals tested, suggesting that the variants detected were causal for HSE. NHC is, therefore, an effective and unbiased approach for unraveling genetic heterogeneity by detecting physiological homogeneity.


Subject(s)
Computational Biology/methods , Encephalitis, Herpes Simplex/genetics , Encephalitis, Herpes Simplex/pathology , Fibroblasts/immunology , Gene Regulatory Networks , Genetic Heterogeneity , Genetic Predisposition to Disease , Case-Control Studies , Encephalitis, Herpes Simplex/immunology , Fibroblasts/metabolism , Humans , Toll-Like Receptor 3/genetics , Toll-Like Receptor 3/immunology , Toll-Like Receptor 3/metabolism , Exome Sequencing
2.
Cephalalgia ; 38(5): 943-948, 2018 04.
Article in English | MEDLINE | ID: mdl-28728427

ABSTRACT

Background No study dedicated to postdrome symptoms of migraine attacks is available in children and adolescents. Objective To study the resolution phase of the migraine attack in children and adolescents. Methods 100 children and adolescents with ICHD-3 beta migraine without and/or with typical aura were included. Each patient, and one of her/his parents, were interviewed by phone about the postdrome phrase of their last six months' migraine attacks. They were specifically instructed to distinguish symptoms that had begun before and went on after migraine headache cessation (referred to as persistent symptoms), and symptoms whose onset was strictly after headache cessation (referred to as true postdromes). Results 91% of patients reported persistent symptoms, with a mean of 2.9 and a median of 2; asthenia, cognitive difficulties, pallor, cognitive slowing, anorexia, somnolence, and nausea were the most frequently reported. They lasted less than 12 h in 71% of patients. True postdromes were reported by 82% of patients, with a mean of 2.6 and a median of 2; thirst, somnolence, visual disturbances, food craving, paraesthesias, and ocular pain being the most frequently reported. They lasted less than 12 h in 94% of patients. Conclusions This study showed that children and adolescents with migraine had both frequent persistent symptoms and true postdromes. Both were notably different from those reported in adults.


Subject(s)
Interviews as Topic/methods , Migraine Disorders/diagnosis , Migraine Disorders/psychology , Surveys and Questionnaires , Adolescent , Child , Child, Preschool , Databases, Factual/trends , Female , Humans , Male , Migraine Disorders/physiopathology , Random Allocation , Retrospective Studies
3.
Am J Med Genet A ; 164A(6): 1537-44, 2014 Jun.
Article in English | MEDLINE | ID: mdl-24668847

ABSTRACT

The 15q13.3 heterozygous microdeletion is a fairly common microdeletion syndrome with marked clinical variability and incomplete penetrance. The average size of the deletion, which comprises six genes including CHRNA7, is 1.5 Mb. CHRNA7 has been identified as the gene responsible for the neurological phenotype in this microdeletion syndrome. Only seven patients with a homozygous microdeletion that includes at least CHRNA7, and is inherited from both parents have been described in the literature. The aim of this study was to further describe the distinctive eye manifestations from the analysis in the three French patients diagnosed with the classical 1.5 Mb homozygous microdeletion. Patients' ages ranged from 30 months to 9 years, and included one sib pair. They all displayed a remarkably severe identifiable clinical phenotype that included congenital blindness and convulsive encephalopathy with inconstant abnormal movements. The ophthalmological examination revealed a lack of eye tracking, optic nerve pallor, an immature response with increased latencies with no response to the checkerboard stimulations at the visual evoked potential examination, and a distinctive retina dystrophy with a negative electroretinogram in which the "b" wave was smaller than the "a" wave after a dark adapted pupil and bright flash in all patients. Clear genotype-phenotype correlations emerged, showing that this eye phenotype was secondary to homozygous deletion of TRPM1, the gene responsible for autosomal recessive congenital stationary night blindness. The main differential diagnosis is ceroid lipofuscinosis.


Subject(s)
Blindness/genetics , Chromosome Disorders/genetics , Intellectual Disability/genetics , Neuronal Ceroid-Lipofuscinoses/genetics , Seizures/genetics , TRPM Cation Channels/genetics , alpha7 Nicotinic Acetylcholine Receptor/genetics , Child , Child, Preschool , Chromosome Deletion , Chromosome Disorders/pathology , Chromosomes, Human, Pair 15/genetics , Electroretinography , Eye/pathology , Eye Abnormalities/genetics , Eye Diseases, Hereditary/genetics , Female , Genetic Association Studies , Genetic Diseases, X-Linked/genetics , Humans , Intellectual Disability/pathology , Male , Myopia/genetics , Neuronal Ceroid-Lipofuscinoses/pathology , Night Blindness/genetics , Optic Nerve/abnormalities , Retinal Dystrophies/genetics , Seizures/pathology
4.
Epilepsia ; 55(10): 1576-84, 2014 Oct.
Article in English | MEDLINE | ID: mdl-25231724

ABSTRACT

OBJECTIVE: To gain insight into the long-term impact of vagus nerve stimulation (with VNS Therapy) in children with drug-resistant epilepsy, we conducted the largest retrospective multicenter study to date over an extended follow-up period of up to 24 months. METHODS: The primary objective was to assess change in seizure frequency of the predominant seizure type (defined as the most disabling seizure) following VNS device implantation. Treating physicians collected data from patient records from baseline to 6, 12, and 24 months of follow-up. RESULTS: The analysis population included 347 children (aged 6 months to 17.9 years at the time of implant). At 6, 12, and 24 months after implantation, 32.5%, 37.6%, and 43.8%, respectively, of patients had ≥ 50% reduction in baseline seizure frequency of the predominant seizure type. The responder rate was higher in a subgroup of patients who had no change in antiepileptic drugs (AEDs) during the study. Favorable results were also evident for all secondary outcome measures including changes in seizure duration, ictal severity, postictal severity, quality of life, clinical global impression of improvement, and safety. Post hoc analyses demonstrated a statistically significant correlation between VNS total charge delivered per day and an increase in response rate. VNS Therapy is indicated as adjunctive therapy in children with focal, structural epilepsies, who for any reason are not good candidates for surgical treatment following the trial of two or more AEDs. Children with predominantly generalized seizures from genetic, structural epilepsies, like Dravet syndrome or Lennox-Gastaut syndrome, could also benefit from VNS Therapy. SIGNIFICANCE: The results demonstrate that adjunctive VNS Therapy in children with drug-resistant epilepsy reduces seizure frequency and is well tolerated over a 2-year follow-up period. No new safety issues were identified. A post hoc analysis revealed a dose-response correlation for VNS in patients with epilepsy.


Subject(s)
Epilepsy/therapy , Vagus Nerve Stimulation , Adolescent , Anticonvulsants/therapeutic use , Child , Child, Preschool , Drug Resistance , Epilepsy/drug therapy , Female , Humans , Infant , Male , Quality of Life , Retrospective Studies , Treatment Outcome , Vagus Nerve Stimulation/methods
5.
Cerebellum ; 11(1): 280-8, 2012 Mar.
Article in English | MEDLINE | ID: mdl-21833659

ABSTRACT

We aimed to assess brain regional glucose uptake (rGlcU) changes in children with isolated cerebellar cortical dysplasia (CCD) using 18-fluoro-deoxy-glucose positron emission tomography (FDG-PET). Six children aged 9 months to 11 years at the time of diagnosis, carrying isolated CCD (with no other associated posterior fossa or supratentorial malformation) underwent a brain FDG-PET and a subsequent 3DT1-weighted MRI for coregistration. The MRIs acquired previously at the time of diagnosis were reviewed to record the cerebellar dysplastic features and classify the patients as having minor, moderate, or severe CCD. The individual rGlcU was assessed qualitatively on coregistrated FDG maps. Clinical data from birth, including neurological and neuropsychological (verbal and motor skills) disturbances, were recorded. We found rGlcU changes within the cerebellum of four patients matching with the location and extent of structural abnormalities: hypometabolism in three patients with severe CCD involving the vermis and both cerebellar hemispheres and focal hypermetabolism in one patient with moderate CCD associated with a nodular heterotopic gray matter. No obvious rGlcU changes were found in the two patients with minor CCD involving the vermis only. Supratentorial rGlcU changes found commonly involved the basal ganglia bilaterally. Coregistrated FDG-PET/MRI technique is useful in detecting cerebellar cell dysfunction associated with isolated CCD. Our results enhance the need for multimodal and quantitative studies to better evaluate local and remote functional disturbances caused by CCD.


Subject(s)
Cerebellar Cortex/metabolism , Cerebellar Diseases/metabolism , Glucose/metabolism , Magnetic Resonance Imaging/methods , Nervous System Malformations/metabolism , Positron-Emission Tomography/methods , Adolescent , Brain Mapping/methods , Cerebellar Cortex/diagnostic imaging , Cerebellar Cortex/pathology , Cerebellar Diseases/diagnostic imaging , Cerebellar Diseases/pathology , Child , Child, Preschool , Female , Fluorodeoxyglucose F18 , Humans , Infant , Male , Nervous System Malformations/diagnostic imaging , Nervous System Malformations/pathology , Radiopharmaceuticals
7.
Dev Med Child Neurol ; 54(10): 905-11, 2012 Oct.
Article in English | MEDLINE | ID: mdl-22861906

ABSTRACT

AIM: To investigate the psychiatric and cognitive phenotype in young individuals with the childhood form of myotonic dystrophy type 1 (DM1). METHOD: Twenty-eight individuals (15 females, 13 males) with childhood DM1 (mean age 17y, SD 4.6, range 7-24y) were assessed using standardized instruments and cognitive testing of general intelligence, visual attention, and visual-spatial construction abilities. RESULTS: Nineteen patients had repeated a school grade. The mean (SD) Full-scale IQ was 73.6 (17.5) and mean Verbal IQ was significantly higher than the mean Performance IQ: 80.2 (19.22) versus 72.95 (15.58), p=0.01. Fifteen patients had one or more diagnoses on the DSM-IV axis 1, including internalizing disorders (phobia, n=7; mood disorder, n=6; other anxiety disorders, n=5) and attention-deficit-hyperactivity disorder, inattentive subtype (n=8). Twelve out of 22 patients had alexithymia (inability to express feelings with words and to recognize and share emotional states). Cognitive testing found severe impairments in visual attention and visual-spatial construction abilities in four out of 18, and 14 out of 24 patients respectively. No diagnosis was correlated with the transmitting parent's sex or with cytosine-thymine-guanine (CTG) repeat numbers. Patients with severe visual-spatial construction disabilities had a significantly longer CTG expansion size than those with normal visual-spatial abilities (p=0.04). INTERPRETATION: Children and adolescents with childhood DM1 have frequent diagnoses on DSM-IV axis 1, with internalizing disorders being the most common type of disorder. They also have borderline low intelligence and frequent impairments in attention and visual-spatial construction abilities.


Subject(s)
Cognition Disorders/diagnosis , Cognition Disorders/genetics , Mental Disorders/diagnosis , Mental Disorders/genetics , Myotonic Dystrophy/diagnosis , Myotonic Dystrophy/genetics , Phenotype , Adolescent , Attention , Child , Comorbidity , DNA Mutational Analysis , Female , Humans , Intelligence/genetics , Male , Pattern Recognition, Visual , Psychomotor Performance , Trinucleotide Repeat Expansion/genetics , Young Adult
8.
J Med Genet ; 48(12): 810-8, 2011 Dec.
Article in English | MEDLINE | ID: mdl-22003227

ABSTRACT

BACKGROUND: MicroRNAs (miRNAs) are non-coding gene transcripts involved in post-transcriptional regulation of genes. Recent studies identified miRNAs as important regulators of learning and memory in model organisms. So far, no mutations in specific miRNA genes have been associated with impaired cognitive functions. METHODS AND RESULTS: In three sibs and two unrelated patients with intellectual disability (ID), overlapping 1p21.3 deletions were detected by genome-wide array analysis. The shortest region of overlap included dihydropyrimidine dehydrogenase (DPYD) and microRNA 137 (MIR137). DPYD is involved in autosomal recessive dihydropyrimidine dehydrogenase deficiency. Hemizygous DPYD deletions were previously suggested to contribute to a phenotype with autism spectrum disorder and speech delay. Interestingly, the mature microRNA transcript microRNA-137 (miR-137) was recently shown to be involved in modulating neurogenesis in adult murine neuronal stem cells. Therefore, this study investigated the possible involvement of MIR137 in the 1p21.3-deletion phenotype. The patients displayed a significantly decreased expression of both precursor and mature miR-137 levels, as well as significantly increased expression of the validated downstream targets microphthalmia-associated transcription factor (MITF) and Enhancer of Zeste, Drosophila, Homologue 2 (EZH2), and the newly identified target Kruppel-like factor 4 (KLF4). The study also demonstrated significant enrichment of miR-137 at the synapses of cortical and hippocampal neurons, suggesting a role of miR-137 in regulating local synaptic protein synthesis machinery. CONCLUSIONS: This study showed that dosage effects of MIR137 are associated with 1p21.3 microdeletions and may therefore contribute to the ID phenotype in patients with deletions harbouring this miRNA. A local effect at the synapse might be responsible.


Subject(s)
Chromosome Deletion , Intellectual Disability/genetics , MicroRNAs/genetics , Adolescent , Adult , Animals , Chromosomes, Human, Pair 1/genetics , Chromosomes, Human, Pair 1/metabolism , DNA Copy Number Variations , DNA-Binding Proteins/genetics , DNA-Binding Proteins/metabolism , Dihydrouracil Dehydrogenase (NADP)/genetics , Dihydrouracil Dehydrogenase (NADP)/metabolism , Enhancer of Zeste Homolog 2 Protein , Female , Gene Dosage , Gene Expression Regulation , Hippocampus/cytology , Hippocampus/metabolism , Hippocampus/pathology , Humans , Intellectual Disability/metabolism , Intellectual Disability/pathology , Kruppel-Like Factor 4 , Kruppel-Like Transcription Factors/genetics , Kruppel-Like Transcription Factors/metabolism , Male , MicroRNAs/metabolism , Microphthalmia-Associated Transcription Factor/genetics , Microphthalmia-Associated Transcription Factor/metabolism , Neurons/cytology , Neurons/metabolism , Neurons/pathology , Oligonucleotide Array Sequence Analysis , Phenotype , Polycomb Repressive Complex 2 , Polymorphism, Single Nucleotide , Primary Cell Culture , Rats , Transcription Factors/genetics , Transcription Factors/metabolism , Transfection
9.
J Allergy Clin Immunol ; 128(2): 382-9.e1, 2011 Aug.
Article in English | MEDLINE | ID: mdl-21665257

ABSTRACT

BACKGROUND: Ataxia-telangiectasia (A-T) is a rare genetic disease caused by germline biallelic mutations in the ataxia-telangiectasia mutated gene (ATM) that result in partial or complete loss of ATM expression or activity. The course of the disease is characterized by neurologic manifestations, infections, and cancers. OBJECTIVE: We studied A-T progression and investigated whether manifestations were associated with the ATM genotype. METHODS: We performed a retrospective cohort study in France of 240 patients with A-T born from 1954 to 2005 and analyzed ATM mutations in 184 patients, along with neurologic manifestations, infections, and cancers. RESULTS: Among patients with A-T, the Kaplan-Meier 20-year survival rate was 53.4%; the prognosis for these patients has not changed since 1954. Life expectancy was lower among patients with mutations in ATM that caused total loss of expression or function of the gene product (null mutations) compared with that seen in patients with hypomorphic mutations because of earlier onset of cancer (mainly hematologic malignancies). Cancer (hazard ratio, 2.7; 95% CI, 1.6-4.5) and respiratory tract infections (hazard ratio, 2.3; 95% CI, 1.4-3.8) were independently associated with mortality. Cancer (hazard ratio, 5.8; 95% CI, 2.9-11.6) was a major risk factor for mortality among patients with null mutations, whereas respiratory tract infections (hazard ratio, 4.1; 95% CI, 1.8-9.1) were the leading cause of death among patients with hypomorphic mutations. CONCLUSION: Morbidity and mortality among patients with A-T are associated with ATM genotype. This information could improve our prognostic ability and lead to adapted therapeutic strategies.


Subject(s)
Ataxia Telangiectasia/genetics , Ataxia Telangiectasia/mortality , Cell Cycle Proteins/genetics , DNA-Binding Proteins/genetics , Protein Serine-Threonine Kinases/genetics , Tumor Suppressor Proteins/genetics , Adolescent , Adult , Ataxia Telangiectasia/epidemiology , Ataxia Telangiectasia/physiopathology , Ataxia Telangiectasia Mutated Proteins , Child , Child, Preschool , Cohort Studies , Female , France/epidemiology , Genotype , Humans , Infant , Infant, Newborn , Leukemia/genetics , Lymphoma/genetics , Male , Morbidity , Mutation , Respiratory Tract Infections/genetics , Retrospective Studies , Survival Rate , Young Adult
10.
J Headache Pain ; 13(1): 61-5, 2012 Jan.
Article in English | MEDLINE | ID: mdl-22042255

ABSTRACT

The prevalence and characterization of migraine triggers have not been rigorously studied in children and adolescents. Using a questionnaire, we retrospectively studied the prevalence of 15 predefined trigger factors in a clinic-based population. In 102 children and adolescents fulfilling the Second Edition of The International Headache Classification criteria for paediatric migraine, at least one migraine trigger was reported by the patient and/or was the parents' interpretation in 100% of patients. The mean number of migraine triggers reported per subject was 7. Mean time elapsed between exposure to a trigger factor and attack onset was comprised between 0 and 3 h in 88 patients (86%). The most common individual trigger was stress (75.5% of patients), followed by lack of sleep (69.6%), warm climate (68.6%) and video games (64.7%). Stress was also the most frequently reported migraine trigger always associated with attacks (24.5%). In conclusion, trigger factors were frequently reported by children and adolescents with migraine and stress was the most frequent.


Subject(s)
Migraine Disorders/epidemiology , Stress, Psychological/complications , Stress, Psychological/epidemiology , Adolescent , Child , Climate , Female , Hot Temperature/adverse effects , Humans , Male , Prevalence , Retrospective Studies , Sleep Deprivation/complications , Sleep Deprivation/epidemiology , Surveys and Questionnaires , Video Games/adverse effects
11.
Rev Prat ; 62(10): 1406-9, 2012 Dec.
Article in French | MEDLINE | ID: mdl-23424922

ABSTRACT

Neuropsychological consequences of epilepsy will be function of the specific anamnesis of the child, characteristics of epilepsy syndromes, and treatment. The effects of recurrent seizures, iatrogenic effects of medications, and school adaptation are reviewed. The neurodevelopmental origins of comorbidities are detailed, how they develop over time. Despite the good prognosis and the remission of seizures before adulthood with normal neurological and intellectual development, some subtle cognitive and behavioural deficits in children with benign epilepsy seem to occur. Cognition can be impaired leading to long-term intellectual disabilities. One factor that could potentially cause cognitive deficits is the frequent seizures that characterize intractable epilepsy.


Subject(s)
Epilepsy/complications , Epilepsy/psychology , Mental Disorders/etiology , Age of Onset , Child , Cognition/physiology , Epilepsy/epidemiology , Epilepsy/physiopathology , Humans , Mental Disorders/diagnosis , Mental Disorders/epidemiology , Neuropsychology/methods
12.
Muscle Nerve ; 43(1): 26-30, 2011 Jan.
Article in English | MEDLINE | ID: mdl-21171094

ABSTRACT

Spinal muscular atrophy (SMA) is an autosomal recessive disorder associated with homozygous deletion of the survival motor neuron 1 gene (SMN1). Its centromeric copy gene, SMN2, is the major modifying factor. However, the genotype-phenotype correlation is incomplete and is therefore not useful in clinical practice. We studied a cohort of 103 patients in order to refine this correlation. In addition to standard disease severity data, we collected three additional criteria: age at death; brainstem involvement; and loss of ambulation. Gene dosage analysis was conducted by multiplex ligation-dependent probe amplification (MLPA). SMN2 copynumber was highly correlated with survival duration in SMA type I and ambulation conservation or loss in type III. Among SMA severity groups, it was not significantly different in cases with brainstem involvement. Although the SMN2 copynumber could provide prognostic indications, clinical discrepancies still exist among patients, suggesting the existence of unidentified modifying factors.


Subject(s)
Muscular Atrophy, Spinal/genetics , Muscular Atrophy, Spinal/physiopathology , Brain Stem/pathology , Brain Stem/physiopathology , Child , Child, Preschool , Cohort Studies , Female , Genetic Predisposition to Disease/genetics , Genotype , Humans , Infant , Infant, Newborn , Male , Muscular Atrophy, Spinal/pathology , Phenotype , Retrospective Studies
13.
Pediatr Res ; 70(6): 584-8, 2011 Dec.
Article in English | MEDLINE | ID: mdl-21857379

ABSTRACT

Omega-3 and omega-6 poly-unsaturated fatty acids (PUFAs) are dietary fatty acids that are involved in a myriad of physiological processes in the brain. Although experimental data have shown that PUFAs have anticonvulsant properties, the outcomes of clinical trials have been controversial. Docosahexaenoic acid (DHA) is a PUFA which has been reported to exert anticonvulsant effects. Here we studied anticonvulsant potential of a mixture of enriched n-3 PUFA upon their oral administration in rats. We did not observe an anticonvulsant effect of n-3 PUFA in the i.v. pentylentetrazol threshold test. n-3 PUFA component was increased in the plasma of rats treated with the eicosapentaenoic acid (EPA)/DHA mix (275 mg/kg/d/400 mg/kg/d) due to the increase of both DHA and EPA. We also found modification of PUFA composition in the brain. Despite PUFA profiles modified both in plasma and in the brain, we did not find any anticonvulsant effect of orally administered DHA. Further studies are needed to define the type and the amount of fatty acids that would possess anticonvulsant properties. As the existing literature suggests that the route of administration of PUFA may be crucial, future studies should involve oral administration to provide relevant clinical information.


Subject(s)
Anticonvulsants/pharmacology , Docosahexaenoic Acids/pharmacology , Eicosapentaenoic Acid/pharmacology , Administration, Oral , Animals , Anticonvulsants/administration & dosage , Body Composition/drug effects , Dietary Supplements , Docosahexaenoic Acids/administration & dosage , Eicosapentaenoic Acid/administration & dosage , Male , Palm Oil , Pentylenetetrazole , Plant Oils , Rats , Rats, Wistar , Statistics, Nonparametric , Translational Research, Biomedical/methods
14.
Dev Med Child Neurol ; 53(12): 1119-27, 2011 Dec.
Article in English | MEDLINE | ID: mdl-22077727

ABSTRACT

AIM: To describe neuropsychological disturbances and the developmental course associated with cerebellar cortical dysplasia (CCD). METHOD: The neuroimaging findings from 10 children (five males, five females; aged 3-10 y) with CCD were reviewed and classified. These children all underwent clinical neurological examination and neuropsychological assessment (NPA) on admission, then were followed for an average of 6 years using the cognitive Wechsler Scale, Vineland Adaptive Behavior Scales, and Rey-Osterrieth Complex Figure/McCarthy Drawing subtests. RESULTS: Based on magnetic resonance imaging, CCD was categorized as minor (n = 4), moderate (n = 1), and severe (n = 5). The first NPA disclosed mental retardation* in six (profound, three; moderate, one; mild, two) and normal intelligence in four (low, two; average, one; high, one), but with verbal/performance dissociation in three cases. Socio-adaptive functions were altered in all children except one. Visuospatial abilities were delayed in eight children. In the follow-up, no progression was observed in the three cases with profound mental retardation, whereas the remainder showed homogeneous or disharmonic progression, including improvement or deterioration of verbal/performance function. Cognitive impairment and evolution was not associated with the degree of cerebellar involvement. INTERPRETATION: The neuropsychological profile and evolution associated with CCD do not appear to be predictable, and some features might improve over time.


Subject(s)
Cerebellar Diseases/psychology , Developmental Disabilities/psychology , Malformations of Cortical Development/psychology , Cerebellar Diseases/diagnosis , Child , Child, Preschool , Developmental Disabilities/diagnosis , Developmental Disabilities/etiology , Disease Progression , Female , Follow-Up Studies , Humans , Magnetic Resonance Imaging , Male , Malformations of Cortical Development/diagnosis , Neuropsychological Tests , Severity of Illness Index , Wechsler Scales
15.
J Pediatr ; 157(4): 623-9, 629.e1, 2010 Oct.
Article in English | MEDLINE | ID: mdl-20553844

ABSTRACT

OBJECTIVE: To test the hypothesis that predisposition to childhood herpes simplex virus (HSV) type 1 encephalitis (HSE) may be determined in part by human genetic factors. STUDY DESIGN: A genetic epidemiologic survey of childhood HSE (onset at age 3 months to 15 years) over a 20-year period (1985-2004) was conducted throughout France (comprising 29 university hospital neuropediatric centers). A total of 85 children fulfilled the diagnostic criteria for inclusion. Family and personal histories were obtained by face-to-face interview for 51 patients. RESULTS: No familial cases of HSE were identified in our survey; however, a high proportion (20%) of the children interviewed had a relevant family history: parental consanguinity (12% of patients), early-onset herpetic keratitis in a first-degree relative (6%), or both (2%). The narrow window of high susceptibility to HSE before age 3 years (62% of patients) further indicates that predisposition to HSE is tightly age-dependent. CONCLUSIONS: This survey suggests that childhood HSE, although sporadic, may result from Mendelian predisposition (from autosomal recessive susceptibility in particular), at least in some children. There likely is incomplete penetrance, however, which may reflect, at least in part, the impact of age at the time of HSV-1 infection.


Subject(s)
Encephalitis, Herpes Simplex/genetics , Encephalitis, Herpes Simplex/virology , Genetic Variation , Toll-Like Receptor 3/genetics , Acyclovir/therapeutic use , Adolescent , Age Factors , Age of Onset , Antiviral Agents/therapeutic use , Child , Child, Preschool , Encephalitis, Herpes Simplex/drug therapy , Female , Genetic Predisposition to Disease , Genetic Variation/genetics , Humans , Infant , Male , Risk Factors , Simplexvirus , Young Adult
16.
Epilepsia ; 51(7): 1290-6, 2010 Jul.
Article in English | MEDLINE | ID: mdl-20345938

ABSTRACT

PURPOSE: Late-onset spasms (LOS) are epileptic spasms starting after the first year of life. Our aim was to assess the electroclinical features and the follow-up of the patients with this particular type of epileptic seizure. METHODS: We retrospectively included all patients with LOS confirmed by electroencephalography between 1989 and 2008. Clinical and electroencephalographic findings at diagnosis and during follow-up were collected. The Vineland scale was used to evaluate the neuropsychological outcome. RESULTS: We report 19 patients with LOS of 240 patients with recorded epileptic spasms. Eighteen patients had an epileptic encephalopathy with late-onset spasms. The ictal electroencephalography (EEG) showed a focal or generalized discharge of triphasic slow-waves, slow-spikes, or slow spikes-waves with fast activities. The interictal EEG usually showed focal or generalized slow-waves or slow spikes-waves without hypsarhythmia. LOS were controlled in only six patients. Three developed typical Lennox-Gastaut syndrome and 10 had a severe epileptic encephalopathy. Neuropsychological outcome was evaluated in 15 patients with the Vineland scale. Cognitive functions were normal in only one patient, whereas severe cognitive delay was observed in 12 of 15. CONCLUSION: Epileptic spasms may appear after the age of one. They are more frequently observed in patients with epileptic encephalopathy. In few patients this type of seizure was observed before the patients fulfill Lennox-Gastaut syndrome criteria. In one patient, we diagnosed a focal epilepsy with seizures occurring in cluster. When LOS are related to an epileptic encephalopathy, this epileptic syndrome seems to be linked to refractory epilepsy and severe cognitive outcome unrelated to the etiology.


Subject(s)
Spasms, Infantile/epidemiology , Spasms, Infantile/physiopathology , Age of Onset , Child , Child, Preschool , Electroencephalography/methods , Epilepsy/epidemiology , Epilepsy/physiopathology , Female , Follow-Up Studies , Humans , Infant , Male , Retrospective Studies , Spasms, Infantile/diagnosis
17.
J Atten Disord ; 24(1): 52-65, 2020 01.
Article in English | MEDLINE | ID: mdl-26794670

ABSTRACT

Objective: The objective of this study is to retrospectively describe the pathway toward ADHD diagnosis and treatment, and identify potential areas for improvement. Method: Parent-reported questionnaires were collected by a national sample of ADHD specialists. Results: In total, 473 complete questionnaires were analyzed. Initial onset of ADHD symptoms was reported at a mean age of 4.45 years. Mean age at diagnosis was 8.07 years, and half of the families had seen at least three health care professionals previously. Psychiatrists were most commonly consulted. A "combined" (89% boys) and inattentive (49% boys) profile was identified. Diagnosis was made 1 year later for the latter group. Two thirds of patients received pharmacological treatment. The delay in diagnosis was identified as the main source of concern for caregivers. Conclusion: The 4-year delay in diagnosis may represent a loss of opportunity. Training health care professionals in the core symptoms of ADHD may help reduce disparities and improve patient trajectory.


Subject(s)
Attention Deficit Disorder with Hyperactivity , Attention Deficit Disorder with Hyperactivity/epidemiology , Attention Deficit Disorder with Hyperactivity/therapy , Child , Child, Preschool , Cognition , France/epidemiology , Humans , Male , Retrospective Studies , Surveys and Questionnaires
18.
Neurology ; 94(13): e1378-e1385, 2020 03 31.
Article in English | MEDLINE | ID: mdl-32123049

ABSTRACT

OBJECTIVE: To assess nonparoxysmal movement disorders in ATP1A3 mutation-positive patients with alternating hemiplegia of childhood (AHC). METHODS: Twenty-eight patients underwent neurologic examination with particular focus on movement phenomenology by a specialist in movement disorders. Video recordings were reviewed by another movement disorders specialist and data were correlated with patients' characteristics. RESULTS: Ten patients were diagnosed with chorea, 16 with dystonia (nonparoxysmal), 4 with myoclonus, and 2 with ataxia. Nine patients had more than one movement disorder and 8 patients had none. The degree of movement disorder was moderate to severe in 12/28 patients. At inclusion, dystonic patients (n = 16) were older (p = 0.007) than nondystonic patients. Moreover, patients (n = 18) with dystonia or chorea, or both, had earlier disease onset (p = 0.042) and more severe neurologic impairment (p = 0.012), but this did not correlate with genotype. All patients presented with hypotonia, which was characterized as moderate or severe in 16/28. Patients with dystonia or chorea (n = 18) had more pronounced hypotonia (p = 0.011). Bradykinesia (n = 16) was associated with an early age at assessment (p < 0.01). Significant dysarthria was diagnosed in 11/25 cases. A history of acute neurologic deterioration and further regression of motor function, typically after a stressful event, was reported in 7 patients. CONCLUSIONS: Despite the relatively limited number of patients and the cross-sectional nature of the study, this detailed categorization of movement disorders in patients with AHC offers valuable insight into their precise characterization. Further longitudinal studies on this topic are needed.


Subject(s)
Hemiplegia/complications , Movement Disorders/genetics , Adolescent , Adult , Child , Child, Preschool , Cross-Sectional Studies , Female , Humans , Infant , Male , Mutation , Sodium-Potassium-Exchanging ATPase/genetics , Young Adult
19.
Epilepsia ; 50(4): 943-8, 2009 Apr.
Article in English | MEDLINE | ID: mdl-19054409

ABSTRACT

The underlying mechanisms of the ketogenic diet (KD) remain unknown. Involvement of peroxisome proliferator-activated receptor-alpha (PPARalpha) has been suggested. The aim of this study was to assess the anticonvulsant properties of fenofibrate, a PPARalpha agonist. Wistar rats were fed at libitum during 14 days by regular diet, KD, regular diet containing 0.2% fenofibrate (F), or KD containing 0.2% fenofibrate (KD + F). Pentylenetetrazol (PTZ) threshold and latencies to the onset of status epilepticus induced by lithium-pilocarpine were used to assess diet treatments with anticonvulsive effects. Myoclonic and generalized seizure PTZ thresholds were increased in F- and KD-treated animals in comparison to control. No difference was observed between KD + F group and the others groups (control, F, KD). Latencies to the onset of status epilepticus were increased in F and KD groups compared to control. Fenofibrate exerts anticonvulsive properties comparable to KD in adult rats using PTZ and lithium-pilocarpine models. The underlying mechanisms such as PPARalpha activation and others should be investigated. These findings may provide insights into future directions to simplify KD protocols.


Subject(s)
Epilepsy/prevention & control , Fenofibrate/therapeutic use , Hypolipidemic Agents/therapeutic use , PPAR alpha/agonists , 3-Hydroxybutyric Acid/blood , Analysis of Variance , Animals , Body Weight/drug effects , Diet, Ketogenic/methods , Disease Models, Animal , Electroencephalography/methods , Epilepsy/chemically induced , Epilepsy/pathology , Epilepsy/physiopathology , Ketone Bodies/blood , Lithium Chloride , Liver/drug effects , Male , Organ Size/drug effects , Pentylenetetrazole , Pilocarpine , Rats , Rats, Wistar , Reaction Time/drug effects , Reaction Time/physiology
20.
Epilepsia ; 50(1): 65-71, 2009 Jan.
Article in English | MEDLINE | ID: mdl-18657178

ABSTRACT

PURPOSE: Recent studies have revealed that polyunsaturated fatty acids (PUFAs) have anticonvulsive properties. Clinical trials using PUFAs reported conflicting results. It was suggested that PUFAs have anticonvulsant effects via modifications of brain phospholipids. Moreover, some authors suggested that the effect of the ketogenic diet (KD) leads to a high PUFA content. The aim of the study was to evaluate the anticonvulsant properties of a mixture containing alpha-linolenic acid (ALA) and linolenic acid (LA). METHODS: Four-week-old male Wistar rats were fed one of the following diets for 30 days: KD, standard diet, and standard diet with daily LA/ALA oral supplementation. Pentylenetetrazol (PTZ) threshold was used to assess the anticonvulsive effects of the diets. Nutritional status was monitored by body composition evaluation. Fatty acids composition of both plasma and brain phospholipids were also assessed. RESULTS: Animals fed the KD and those who had the daily LA/ALA supplementation exhibited an increase in PTZ threshold. The animals did not show any modification of body composition or brain phospholipid composition. The plasma fatty acids composition was modified by KD and LA/ALA. A decrease in arachidonic acid (AA) concentrations was observed in both the KD and LA/ALA groups, while an increase in eicosapentanoic acid (EPA) and ALA concentrations was only observed in the LA/ALA group. CONCLUSIONS: Our study shows that LA/ALA supplementation exerts anticonvulsive properties comparable to KD. Nutritional status can not explain the anticonvulsive effects of PUFAs supplementation. Brain phospholipids were not different within groups. The anticonvulsive effects of LA supplementation seem to be unrelated to brain phospholipid composition.


Subject(s)
Anticonvulsants/pharmacology , Brain/drug effects , Brain/metabolism , Cell Membrane/drug effects , Cell Membrane/metabolism , Phospholipids/metabolism , alpha-Linolenic Acid/pharmacology , Animals , Anticonvulsants/administration & dosage , Cell Membrane/chemistry , Convulsants/administration & dosage , Convulsants/pharmacology , Diet, Ketogenic , Fatty Acids, Unsaturated/metabolism , Male , Pentylenetetrazole/administration & dosage , Pentylenetetrazole/pharmacology , Phospholipids/analysis , Rats , Rats, Wistar , alpha-Linolenic Acid/administration & dosage
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