KCNMA1基因突变致癫痫三例

目的探讨KCNMA1基因不同位点突变致癫痫及阵发性非运动源性运动障碍的临床特点。方法分析2017年10月-2019年2月河北省儿童医院神经内科收治的3例KCNMA1基因不同位点突变致癫痫患儿,进行临床分析。结果本研究收集3例KCNMA1基因突变患儿,均为男童,基因位点均未报到,基因位点为复合杂合突变,先证者症状均为癫痫,无阵发性非运动源性运动障碍表现。例3患儿母亲幼时有PNKD病史。例1患儿2月龄起病,发作形式为强直发作、不典型失神发作,基因型c.2311-3C>T(Splicing),为新生突变,使用丙戊酸后发作控制;例2患儿8月龄起病,发作形式为局灶性强直发作,基因型c.422G>A(p.S141N),为新生突变,使用左乙拉西坦后发作减少,加用托吡酯后发作停止;例3患儿6月龄起病,发作形式为强直发作,基因型c.2399C>A (p.S800X),遗传自母亲,使用左乙拉西坦后发作停止。结论本组病例提示KCNMA1基因应作为婴幼儿期癫痫及智力、运动发育落后症状的候选筛查基因之一。     

KCNT1基因突变导致的婴儿癫痫伴游走性局灶性发作一例

目的探讨KCNT1基因突变所致婴儿癫痫伴游走性局灶性发作(EIMFS)的临床特征、基因诊断、治疗及预后。方法对1例诊断为EIMFS患儿的临床表现、脑电图(EEG)特点及基因测序结果进行分析。结果患儿男性,2月20d,频繁抽搐发作,表现为局灶性发作,伴癫痫持续状态,EEG放电部位不固定,抗癫痫药物治疗效果欠佳,起病后出现发育滞后,头颅MRI及血、尿遗传代谢筛查无明显异常,基因测序结果发现患儿存在KCNT1基因突变,该突变为杂合错义突变(c.1283G> A,p.Arg428Gln),患儿父母该位点未发现突变,即患儿为新生突变。结论 KCNT1是EIMFS主要的相关基因,对于临床病因不明且抗癫痫药物治疗效果欠佳的早发性癫痫脑病患儿需考虑基因检测,协助临床诊断及预后评估。     

巨脑回致癫痫1例报告及临床分析

目的通过1例巨脑回致癫痫手术治疗病例,回顾分析巨脑回致癫痫的原因,通过CT、MRI等检查对巨脑回畸形进行早期诊断并给予手术。方法 1例巨脑回致癫痫患者通过颅脑磁共振给予早期诊断并手术。结果巨脑回致癫痫患者恢复良好。结论颅脑CT、MRI是目前确诊巨脑回患者的主要检查方法,尤其颅脑MRI对巨脑回畸形早期诊断具有重要价值。早期确诊患者,手术效果良好。     

CTNNB1基因突变致神经发育障碍临床表型及基因突变分析

目的探讨CTNNB1基因突变致发育障碍患儿临床表型及基因突变情况。方法收集2017年5月复旦大学附属儿科医院厦门医院收治的1例CTNNB1基因突变患儿的临床资料, 应用全外显子测序技术对该例患儿及其父母进行家系验证, 并对突变位点进行致病性分析。结果患儿男性, 6岁1个月, 临床表型包括智力障碍、运动发育障碍、言语障碍、视觉障碍(内斜视)、小头畸形及行为问题(社交退缩、过分依赖等), 还出现惊恐综合征表现(即在听觉和视觉刺激下发生突发性惊叫、身体伸直性僵直等, 随后短周期出现全身伸直性僵直状态)。全外显子测序结果显示患儿存在CTNNB1基因新发突变c.283(exon4)C>T, 根据美国医学遗传学与基因组学学会变异分类标准与指南, 判读c.283(exon4)C>T突变为致病性突变(PVS1+PS2+PS1+PM2+PM)。父母家系验证未发现相关基因变异。结论 CTNNB1基因突变c.283(exon4)C>T可致神经发育障碍, 包括智力障碍、运动发育障碍、言语障碍、视觉障碍、小头畸形及行为异常。     

PRF1突变致家族性嗜血细胞综合征二例

目的 探讨PRF1基因突变致家族性嗜血细胞淋巴组织细胞增多症2型(FLH2型)临床症状和基因型特点。方法 报道2例河北省儿童医院神经内科住院一家系患儿的临床资料,提取患儿及其父母基因组DNA,采取靶向外显子捕获测序技术检测致病突变,并对检测到的突变进行Sanger测序验证。结果 该家系2例患儿均以共济失调为首发症状,病情反复,查脑脊液白细胞数升高,头颅MRI提示多发脱髓鞘改变。基因检测显示为PRF1基因突变c.1189-1190dupTG (p.H398Afs*23)和c.394G>A(p.G132R)的复合杂合子,前者来自于父亲,后者来自于母亲。妹妹给予干细胞移植治疗,目前病情缓解。结论PRF1基因突变致FLH2型符合基因杂合变异遗传学特点。儿童可以中枢神经系统受累为首发症状,表现为共济失调、周围性面神经瘫痪,基因可早期诊断,干细胞移植治疗是获得长期生存的方法之一。     

2例散发型神经纤维瘤病病人及其家系NF1基因突变的检测

目的 报道2例Ⅰ型神经纤维瘤病（NF1）病人及其家系NF1基因检测结果。方法 应用目标序列捕获高通量测序技术对2例NF1病人及其家系进行NF1基因测序,明确那不然致病基因型,并采用多重连接探针扩增技术和Sanger测序法进行验证。结果 2例均检测到基因突变,1例为33岁孕6周女性,NF1基因整体杂合缺失,其丈夫和胎儿未检测到相同的基因突变;1例3岁男孩,为移码突变,基因型为c.6408delA,为新发突变。结论 我们进行高通量测序检测NF1基因变异,发现1个新发突变位点,扩充了NF1基因的致病性突变位点。另外,对胎儿进行NF1基因检测,可能是避免NF1患儿出生的一个措施。     

CHD2基因突变致癫痫患者九例

目的 探讨CHD2基因突变致癫痫患儿临床表型及基因型特点。方法 分析2017年01月-2022年07月河北省儿童医院神经内科收治的CHD2基因突变相关性癫痫患儿。并查阅万方、中国知网(CNKI)、PubMed、Uptodate等数据库,结合相关文献进行总结。结果 本研究共收集9例CHD2基因突变阳性患儿,其中自发突变5例,母源性突变4例。9例患儿局灶性发作起病6例,全面性发作起病3例,1例患儿符合LGS诊断,1例患儿符合眼睑肌阵挛综合征诊断。7例患儿伴有轻到中度的发育障碍。9例患儿共发现8个基因突变位点,其中错义突变5个,移码突变3个,突变多集中在SNF2相关解旋酶/ATP酶结构域;其中7个突变位点尚未报道。7例患儿应用丙戊酸钠治疗有效。结论(1)CHD2基因突变多以局灶性发作起病,丙戊酸治疗有效;(2)自发突变起病更早,均伴有轻到中度的发育障碍;(3)CHD2基因致病性突变多集中在SNF2相关解旋酶/ATP酶结构域。     

不同类型KCNQ2基因突变所致癫痫五例临床分析

目的探讨KCNQ2基因突变不同基因型与癫痫患儿临床表型之间的关系。方法分析2017年10月-2018年10月河北省儿童医院神经内科收治的5例KCNQ2基因突变相关性癫痫患儿,并查阅万方、中国知网(CNKI)、PubMed、Uptodate等数据库,结合相关文献进行总结。结果本研究共收集5例KCNQ2基因突变阳性患儿,其中自发突变3例:含错义突变2例,截短突变1例;家系遗传2例;错义突变、无义突变各1例。3例自发突变临床表型均为癫痫性脑病,家系遗传中1例为良性家族性新生儿癫痫。家系1同一位点突变呈现3种不同表型。结论①KCNQ2基因突变不仅可以引起良性家族性新生儿癫痫(BFNE),还可引起多种癫痫性脑病;②自发突变更可能导致癫痫性脑病;③同一家系携带同一基因突变位点成员也可能有不同表型。     

血管紧张素Ⅱ受体2型基因突变致癫痫的临床特点(附2例报告)

目的 探讨血管紧张素Ⅱ受体2型(AGTR2)基因突变后致癫痫的临床特点.方法 回顾性分析2例AGTR2基因突变致癫痫患儿的临床资料,并进行文献复习.结果 病例1,男性,婴儿期起病,以癫痫为主要临床表现.其存在AGTR2基因c.571G＞C错义突变,来源于母亲,为X-连锁隐性遗传.服用丙戊酸钠后癫痫完全控制,无明显认知功...     

GATOR1复合体相关癫痫患者16例的临床特点及诊疗分析

目的总结GATOR1复合体相关癫痫患者的临床表现、基因突变特点及治疗效果, 探讨该复合体相关癫痫的诊疗方法。方法对2017年5月至2022年7月在首都儿科研究所附属儿童医院、北京清华长庚医院及上海德济医院就诊的GATOR1复合体相关癫痫患者的病史、脑电图、头颅影像学、遗传学检测结果和治疗随访情况进行回顾性分析。结果共收集GATOR1复合体相关癫痫患者16例, 其中男7例, 女9例;癫痫起病年龄2个月至14岁;癫痫发作形式仅有局灶性发作者10例, 仅有全面性发作者2例, 局灶性发作与全面性发作并存者4例, 其中全面性发作包括全面性强直阵挛发作、痉挛发作及肌阵挛发作;癫痫综合征包括婴儿痉挛症2例、家族性局灶性癫痫伴可变病灶3例及睡眠相关过度运动癫痫1例。发作间期头皮脑电图提示多脑区放电或弥漫性放电。共发现13个DEPDC5基因突变位点, 1个NPRL2基因突变位点, 2个NPRL3基因突变位点;除DEPDC5基因的4个位点为已报道位点, 余均为未报道位点;所有突变均有致病性;无义突变8个, 大片段缺失1个, 移码突变4个, 整码突变1个, 剪切突变2个;突变遗传自亲代13例, 新生突变2例...     

Adult GM1 gangliosidosis--biochemical studies--1]

To address the pathogenesis of GM1 gangliosidosis, especially adult form, intracellular signal transduction pathway of EGF in skin fibroblasts from patients with this disorder was examined. For this purpose, skin fibroblasts from 2 different patients with adult form of the disorder and from 4 different normal controls were used. The results showed that 1) EGF-receptor autophosphorylation was diminished in skin fibroblasts from patients with altered time course of phosphorylation-dephosphorylation reaction. 2) The amount of EGF-receptor protein was decreased in cells from patients compared with that of controls. 3) 125I-EGF binding + internalization studies revealed decreased rate of EGF binding and internalization in patient cells. 4) Ribosomal S6 protein phosphorylation was strongly enhanced in naive cells from patients, but the reactivity to EGF was diminished compared with control cells. These data strongly suggest that patient fibroblasts have abnormalities in the intracellular signal transduction pathway of EGF. This paper is considered to be the first report demonstrating abnormalities in EGF-signal transducing system in human disorders.     

CYP1A1 and GSTM1/T1 Genetic Variation in Predicting Risk for Cerebral Infarction

Cytochrome P450 1A1 (CYP1A1) is involved in the production of arachidonic acid-derived vasoactive substance. We hypothesized that CYP1A1 polymorphism might be related to pathological conditions associated with cerebral infarction (CI). We investigated the effect of genetic polymorphism in the 3′-flanking region (T6235C) of CYP1A1 gene in 353 patients with CI and 376 controls. The distributions of T6235C CYP1A1 genotypes in patients with (TT: 36.0%; TC/CT: 64.0%; n = 353) and without CI (TT: 44.7%; TC/CT: 55.3%; n = 376) indicate that the C allele is associated with CI (P = 0.017, odds ratio (O.R.) = 1.44; 95% confidence interval (C. I.) = 1.07–1.94). Furthermore, we examined whether the glutathione S-transferase (GST) gene, which is one of detoxification enzyme, influence the risk of CI. GST M1 null genotype increased the relative risk for the CI in the subjects with the CYP1A1 C allele (P = 0.015, O.R. = 1.47; C. I. = 1.08–2.00). We conclude that T6235C CYP1A1 polymorphism is a risk factor for the development of CI and suggest that GST polymorphism contribute to the odds of CI.     

DRB1*1502-DQB1*0601-DQA1*0103 and DRB1*04-DQB1*0302 in Jewish hypersomnolent patients

OBJECTIVES: Narcolepsy is a sleep disorder with a genetic association with the haplotype DRB1*1501, DQA1*0102, DQB1*0602. This haplotype has been described in different ethnic groups suffering from narcolepsy (Japanese, Caucasian, African Americans, Jews). In a recent study we have found the haplotype DRB1*1502, DQB1*0601, DQA1*0103 in three patients with hypersomnolence. The similarity of this haplotype to the narcoleptic haplotype DRB1*1501, DQB1*0602 and DQA1*0102 has raised the question of whether this haplotype is a marker for sleepiness, or rather indicates a variant of non-cataplectic narcolepsy. This study was conducted to further investigate this question. METHODS: HLA-DNA analysis was carried out in 20 healthy Jewish patients (age 23.9+/-6.3 years; 13 Ashkenazi, seven non-Ashkenazi) who had objective measures of hypersomnolence. All underwent whole-night polysomnography, multiple sleep latency test and tissue typing. RESULTS: HLA-DNA analysis revealed HLA-DR2 in eight patients of whom five (25%) carried the haplotype DRB1*1502, DQB1*0601, DQA1*0103 (vs. 1.4% in the Israeli population, P<0.0001). Six patients were diagnosed as non-cataplectic narcoleptics. Five of them carried the haplotype DRB1*1502, DQB1*0601, DQA1*0103. Forty percent of the patients carried the haplotype DRB1*04, DQB1*0302, which was not statistically different from its prevalence in the healthy Israeli population (25%). CONCLUSIONS: This is the first report describing the haplotype DRB1*1502, DQB1*0601, DQA1*0103 in narcoleptic patients (non-cataplectic). This haplotype is close but different from the already known narcoleptic haplotype DRB1*1501, DQA1*0102, DQB1*0602. We assume that this haplotype represents a variant of non-cataplectic narcolepsy rather than association with hypersomnolence. However, in order to conclude whether this haplotype is a marker for the lack of cataplexy, or represents a variant of non-cataplectic narcolepsy, a larger group of patients should be investigated.     

IL-1Rrp2 expression and IL-1F9 (IL-1H1) actions in brain cells

The recently discovered IL-1F9 (IL-1H1) is a putative member of the interleukin (IL)-1 family of cytokines that has been shown to activate nuclear factor-kappa B (NFkappaB) in Jurkat cells transfected with the orphan receptor IL-1 receptor-related protein (IL-1Rrp)2. The aim of the present study was therefore to investigate expression of IL-1Rrp2 and to determine if IL-1F9 induces known IL-1 signaling pathways in the different cell types of the mouse brain in culture. Messenger RNA for IL-1Rrp2 was not detected in primary neurones by RT-PCR, but significant constitutive expression was found in mixed glial cells, particularly in astrocytes and microglia, which was strongly decreased by exposure to bacterial lipopolysaccharide (LPS). LPS induced the release of IL-6, and activated NFkappaB and the mitogen-activated protein kinases (MAPKs) p38, extracellular signal-regulated protein kinase (ERK1/2) and c-Jun N-terminal kinase (JNK) in microglial cultures. IL-1beta induced release of IL-6 and activated NFkappaB, p38, JNK and ERK1/2 in mixed glial cultures, which was completely abolished in the presence of IL-1 receptor antagonist (IL-1ra). When injected intracerebroventrically in the rat, IL-1beta increased core body temperature, and reduced body weight and food intake. In contrast, IL-1F9 failed to induce any of these responses either in vivo or in vitro. These results demonstrate that glial cells may be a target for the new ligand IL-1F9, since high expression of IL-1Rrp2 mRNA was detected in these cells. However, IL-1F9 failed to induce any of the classical IL-1beta responses, suggesting that it may trigger alternative pathway(s).     

Polycystin-1 can interact with homer 1/Vesl-1 in postnatal hippocampal neurons

Polycystin-1 (PC-1) has been identified as critical to development of the nervous system, but the significance of PC-1 expression in neurons remains undefined, and little is known of its roles outside the kidney, where mutation results in autosomal dominant polycystic kidney disease (ADPKD). In kidney, PC-1 interacts with cadherins, catenins, and its cognate calcium channel polycystin-2 (PC-2), which in turn interacts with a number of actin-regulatory proteins. Because some of the proteins that interact with PC-1 in kidney also participate in synaptic remodeling and plasticity in the hippocampus, we decided to test PC-1's potential to interact with a recently discovered type of plasticity-associated protein (homer 1a/Vesl-1S) in postnatal mouse hippocampus. Homer 1a/Vesl-1S is an activity-induced protein believed to participate in synaptic remodeling/plasticity responses to temporal lobe seizure and learning. Here we report the following. 1) PC-1 contains a homer-binding motif (PPxxF), which lies within its purported cytoplasmic domain. 2) Immunoreactivity for PC-1 (PC-1-ir) is highly colocalized with homer 1a immunoreactivity (H1a-ir) in primary cultured hippocampal neurons. 3) PC-1-ir and H1a-ir are present and appear to be colocalized in mouse hippocampus but not cortex on postnatal day 2 (P2), when higher frequencies of spontaneous activity are normal for hippocampus compared with cortex. 4) An endogenous PC-1-ir band with the correct size for the reported C-terminal G-protein-sensitive domain cleavage product of PC-1 (approximately 150 kDa) coimmunoprecipitates with endogenous homer 1/Vesl-1 proteins from mouse brain, suggesting that PC-1 can interact with homer 1/Vesl-1 proteins in postnatal hippocampal neurons.