Neurodevelopmental disorder with dysmorphic facies and distal limb anomalies (NEDDFL), defined primarily by developmental delay/intellectual disability, speech delay, postnatal microcephaly, and dysmorphic features, is a syndrome resulting from heterozygous variants in the dosage-sensitive bromodomain PHD finger chromatin remodeler transcription factor BPTF gene. To date, only 11 individuals with NEDDFL due to de novo BPTF variants have been described. To expand the NEDDFL phenotypic spectrum, we describe the clinical features in 25 novel individuals with 20 distinct, clinically relevant variants in BPTF, including four individuals with inherited changes in BPTF. In addition to the previously described features, individuals in this cohort exhibited mild brain abnormalities, seizures, scoliosis, and a variety of ophthalmologic complications. These results further support the broad and multi-faceted complications due to haploinsufficiency of BPTF.
Chromatin Assembly and Disassembly/genetics , Epilepsy/genetics , Microcephaly/genetics , Neurodevelopmental Disorders/genetics , Abnormalities, Multiple/genetics , Abnormalities, Multiple/physiopathology , Adolescent , Adult , Child , Child, Preschool , Chromosome Deletion , Developmental Disabilities/genetics , Developmental Disabilities/physiopathology , Epilepsy/physiopathology , Facies , Female , Haploinsufficiency/genetics , Humans , Infant , Intellectual Disability/genetics , Intellectual Disability/physiopathology , Language Development Disorders/genetics , Language Development Disorders/physiopathology , Male , Microcephaly/physiopathology , Middle Aged , Neurodevelopmental Disorders/physiopathology , Phenotype , Transcription Factors/genetics , Young Adult
OBJECTIVE: Autosomal dominant sleep-related hypermotor epilepsy (ADSHE) is characterized by hypermotor seizures and may be caused by gain-of-function mutations affecting the nicotinic acetylcholine receptor (nAChR). Benefit from nicotine consumption has been reported in adult patients with this disorder. For the first time, the effect of transdermal nicotine is evaluated in children. METHODS: Transdermal nicotine was applied to three boys, two aged 10â¯years (7â¯mg/24â¯h) and one six years (3.5â¯mg/24â¯h). Autosomal dominant sleep-related hypermotor epilepsy was caused by the p.S280F-CHRNA4 (cholinergic receptor, nicotinic, alpha polypeptide 4) mutation. The children suffered from frequent, persistent nocturnal seizures and had developed educational and psychosocial problems. Seizure frequency and cognitive and behavioral parameters were assessed before and after treatment. RESULTS: A striking seizure reduction was reported soon after treatment onset. Hypermotor seizures disappeared; only sporadic arousals, sometimes with minor motor elements, were observed. Psychometric testing documented improvement in cognitive domains such as visuospatial ability, processing speed, memory, and some areas of executive functions. SIGNIFICANCE: Nicotine appears to be a mechanistic treatment for this specific disorder, probably because of desensitization of the mutated receptors. It may control seizures resistant to conventional drugs for epilepsy and impact socioeducational function in children. This mode of precision therapy should receive more attention and should be available to more patients with uncontrolled CHRNA4-related ADSHE across the age span.
Epilepsy, Reflex/drug therapy , Epilepsy, Reflex/genetics , Nicotine/administration & dosage , Receptors, Nicotinic/genetics , Sleep/genetics , Tobacco Use Cessation Devices , Adolescent , Child , Epilepsy, Reflex/diagnosis , Humans , Male , Mutation/genetics , Sleep/drug effects , Treatment Outcome
