Characterization of the Epileptogenic Phenotype and Response to Antiseizure Medications in Lissencephaly Patients.

BACKGROUND: Patients with lissencephaly typically present with severe psychomotor retardation and drug-resistant seizures. The aim of this study was to characterize the epileptic phenotype in a genotypically and radiologically well-defined patient cohort and to evaluate the response to antiseizure medication (ASM). Therefore, we retrospectively evaluated 47 patients of five genetic forms (LIS1/PAFAH1B1, DCX, DYNC1H1, TUBA1A, TUBG1) using family questionnaires, standardized neuropediatric assessments, and patients' medical reports. RESULTS: All but two patients were diagnosed with epilepsy. Median age at seizure onset was 6 months (range: 2.1-42.0), starting with epileptic spasms in 70%. Standard treatment protocols with hormonal therapy (ACTH or corticosteroids) and/or vigabatrin were the most effective approach for epileptic spasms, leading to seizure control in 47%. Seizures later in the disease course were most effectively treated with valproic acid and lamotrigine, followed by vigabatrin and phenobarbital, resulting in seizure freedom in 20%. Regarding psychomotor development, lissencephaly patients presenting without epileptic spasms were significantly more likely to reach various developmental milestones compared to patients with spasms. CONCLUSION: Classic lissencephaly is highly associated with drug-resistant epilepsy starting with epileptic spasms in most patients. The standard treatment protocols for infantile epileptic spasms syndrome lead to freedom from seizures in around half of the patients. Due to the association of epileptic spasms with an unfavorable course of psychomotor development, early and reliable diagnosis and treatment of spasms should be pursued. For epilepsies occurring later in childhood, ASM with valproic acid and lamotrigine, followed by vigabatrin and phenobarbital, appears to be most effective.

Strong induction of the Tis11B gene in myogenic differentiation.

TIS11B is a zinc-finger protein of the tristetraprolin (TTP) family. Using cDNA microarray analysis, we could identify the Tis11B gene based on its differential expression in myogenesis. Here, we demonstrate that expression of the Tis11B gene is strongly induced during differentiation of the murine myoblast cell line C2C12. By contrast, expression of Ttp itself was not induced in myogenesis. Pretreatment of the cells with the translation inhibitor cycloheximide demonstrated that Tis11B was a primary response gene in this process. In addition, pretreatment with the transcription inhibitor actinomycin D demonstrated that gene expression was regulated at the transcriptional level. Since specific inhibitors of p38 MAP kinase completely blocked Tis11B induction, we conclude that expression of the Tis11B gene is regulated at least in part by this signaling pathway which plays a central role in myogenesis. Induction of Tis11B expression was also observed in primary myoblasts isolated from two different mouse strains, indicating physiological relevance of our results. In addition, TIS11B might also be an important player during myogenic differentiation and regeneration in vivo, as we detected a marked decrease in expression in several muscle tissues of the dystrophic mdx mouse, a model for continuous muscle degeneration and regeneration. These data suggest that TIS11B is an important regulator of myogenesis.

Cerebellar-dependent associative learning is preserved in Duchenne muscular dystrophy: a study using delay eyeblink conditioning.

OBJECTIVE: Besides progressive muscle weakness cognitive deficits have been reported in patients with Duchenne muscular dystrophy (DMD). Cerebellar dysfunction has been proposed to explain cognitive deficits at least in part. In animal models of DMD disturbed Purkinje cell function has been shown following loss of dystrophin. Furthermore there is increasing evidence that the lateral cerebellum contributes to cognitive processing. In the present study cerebellar-dependent delay eyeblink conditioning, a form of associative learning, was used to assess cerebellar function in DMD children. METHODS: Delay eyeblink conditioning was examined in eight genetically defined male patients with DMD and in ten age-matched control subjects. Acquisition, timing and extinction of conditioned eyeblink responses (CR) were assessed during a single conditioning session. RESULTS: Both groups showed a significant increase of CRs during the course of learning (block effect p < 0.001). CR acquisition was not impaired in DMD patients (mean total CR incidence 37.4 ± 17.6%) as compared to control subjects (36.2 ± 17.3%; group effect p = 0.89; group by block effect p = 0.38; ANOVA with repeated measures). In addition, CR timing and extinction was not different from controls. CONCLUSIONS: Delay eyeblink conditioning was preserved in the present DMD patients. Because eyeblink conditioning depends on the integrity of the intermediate cerebellum, this older part of the cerebellum may be relatively preserved in DMD. The present findings agree with animal model data showing that the newer, lateral cerebellum is primarily affected in DMD.