GRIN2B基因错义变异致早发性癫痫性脑病27型1例报告

早发性癫痫性脑病(EOEE)是新生儿期或婴儿早期出现的的一种癫痫综合征,具有遗传异质性,表现为早发性、难治性和多种发作类型及全面发育迟滞或倒退等特征.文章回顾分析1例确诊GRIN 2 B基因变异致EOEE 27型患儿的临床资料.患儿为12月龄女童,生后第2天起病,表现为难治性癫痫、精神运动发育迟缓、肌张力低下.头颅磁共...     

PHACTR1基因新发变异导致发育性癫痫性脑病一例并文献复习

目的总结PHACTR1基因新发变异导致发育性癫痫性脑病(DEE)的临床特征及基因变异特点。方法回顾性分析泉州市儿童医院神经内科收治的1例PHACTR1基因新发变异导致DEE患儿的临床资料及基因检测结果;以"PHACTR1" "epileptic encephalopathy" "developmental encephalopathy" "癫痫性脑病" "发育性脑病"为关键词, 对PubMed数据库、中国知网及万方医学网从建库至2022年7月收录的文献进行检索并进行文献资料总结。结果男性患儿, 6个月27 d, 2月龄发现发育落后, 6月龄始出现癫痫性痉挛发作, 经ACTH、托吡酯治疗后癫痫发作控制, 但发育落后未改善, 肌张力低下, 基因检测发现PHACTR1基因c.1553T>A(p.Ile518Asn)新发杂合变异。文献复习共检索到外文文献5篇(共6例), 患儿均存在严重发育迟滞, 癫痫发作形式主要为癫痫性痉挛, 部分可有局灶性发作、强直发作, 多数患儿肌张力低下, 少数伴有注意缺陷多动障碍、孤独症谱系障碍表现或特殊外观, 头颅MRI可表现为髓鞘发育延迟、脑萎缩、胼胝体发育...     

SYNGAP1 基因变异致癫痫伴认知发育障碍3 例临床分析

目的探讨SYNGAP1基因变异致儿童癫痫伴认知发育障碍的临床特点。方法收集并分析2017—2019年确诊的3例SYNGAP1变异相关癫痫患儿的临床资料以及对患儿及父母的全外显子二代测序及Sanger验证结果。结果 3例患儿中,男2例、女1例,均为儿童期起病。癫痫发作分别表现为眼睑肌阵挛伴失神,肌阵挛、失张力,局灶性发作。3例患儿均有认知异常,其中1例有刻板、攻击行为,缺少眼神交流和社会性交往。患儿父母及家系成员无惊厥及发育障碍。3例患儿均检测到SYNGAP1基因存在新发杂合变异,均为常染色体显性遗传,分别为6号外显子c.623delC(p.P208Qfs*15)、1号外显子c.67+1GA(splicing)、13号外显子c.2158GA(p.Asp720Asn),其中13号外显子错义变异患儿为局灶性发作。结论 SYNGAP1基因变异可导致癫痫伴认知发育障碍,癫痫发作具有临床多样性。     

SYNGAP1基因相关神经系统表型谱及基因变异特点

目的 总结SYNGAP1基因变异患儿神经系统表型谱及基因变异特点。方法 回顾性收集2015年5月至2022年3月在北京大学第一医院儿科门诊就诊的23例SYNGAP1基因变异患儿临床资料,对其临床表型、基因变异特点及治疗预后进行分析。结果 23例SYNGAP1基因变异患儿中,男7例、女16例,23例均为新生变异,其中错义变异9例,无义变异7例,移码变异6例,剪切位点变异1例。23例均有发育落后,其中21例（91.3%,21/23）患儿有癫痫发作,癫痫发作起病年龄为8个月～5岁（中位起病年龄2岁1月）。发作类型包括不典型失神8例,眼睑肌阵挛伴或不伴失神6例,肌阵挛发作6例,失张力发作3例,痉挛发作2例,全面强直阵挛发作1例。脑电图提示背景活动慢于同龄儿,发作间期广泛性放电22例,无异常放电1例。23例头颅磁共振成像均未见异常。癫痫综合征表型诊断为眼睑肌阵挛伴失神4例,婴儿痉挛症1例,Doose综合征1例,热性惊厥1例。3例（13%,3/23）有孤独症样表现。21例有癫痫发作的患儿中,20例口服抗癫痫发作药物（ASM）,7例发作控制1年以上,其中用丙戊酸6例,左乙拉西坦3例,拉莫三嗪2例,托...     

CHD2基因相关癫痫的临床特点和遗传学分析

目的 研究CHD2基因变异相关癫痫患者的临床表型及基因型特点。方法 对6例CHD2基因变异相关癫痫患者的临床表现、脑电图、基因特点及抗癫痫发作药物疗效等进行回顾性总结分析。结果 6例患儿中男5例、女1例,癫痫起病年龄为1岁8个月至12岁。癫痫发作类型包括局灶性发作及全面性强直阵挛发作各3例次,眼睑肌阵挛伴或不伴失神发作2例次,不典型失神发作、痉挛发作、肌阵挛发作及强直发作各1例次。3例诊断为癫痫综合征,其中2例为Jeavons综合征,1例为Lennox-Gastaut综合征;2例具有光敏性。共患病中智力障碍6例,注意力缺陷多动障碍3例,孤独症谱系疾病2例,精神障碍1例。6例CHD2基因变异中4例为新发突变,2例为母源;其中无义突变3例,错义突变2例,片段缺失1例。末次随访年龄5岁至15岁10月龄,5例患儿抗癫痫药物规律治疗,4例有效,其中2例癫痫发作控制超2年,1例控制1年8月。结论 癫痫发作是CHD2基因变异的常见表型,癫痫起病年龄差别较大,表型为Jeavons综合征者预后不良,丙戊酸钠对CHD2基因变异相关癫痫疗效相对较好。精神障碍为罕见临床表型。     

RARS2 基因变异一家系报告并文献复习

目的探讨RARS2基因变异的临床特点。方法回顾分析一家系2例RARS2基因变异患儿的临床资料,并复习相关文献。结果 2例患儿为姐妹,均于4月龄起病,表现为喂养困难、顽固性局灶性癫痫发作、四肢肌张力减低、小头畸形,血乳酸一过性升高;头颅磁共振示双侧大脑半球萎缩,右侧颅板下出血,右侧基底节区异常信号。先证者检测到RARS2基因复合杂合变异,NM_020320 c.1157GT(p.R386L),NM_020320 c.1210AG(p.M404V)。先证者姐姐首次基因检测无发现,再次分析发现RARS2基因同样变异,并于1岁4月龄死亡。检索到相关文献19篇,包括本家系2例共37例患儿。其中男37.2%、女62.8%,大多在6月龄内起病;临床表现有癫痫发作,精神运动发育停滞或倒退,喂养困难,肌张力减低,小头畸形;大部分患儿血、脑脊液乳酸增高及脑桥小脑发育不良。共发现RARS2基因33个变异位点。结论 RARS2基因变异的临床表现有顽固性癫痫发作、喂养困难、精神运动发育迟滞或倒退、小头畸形、肌张力减低,部分患儿无桥脑小脑发育不良,预后差。     

IQSEC2基因变异相关癫痫基因型与临床表型特点

目的分析IQSEC2基因变异相关癫痫患儿的基因型与临床表型特点。方法收集2019年7月至2021年10月在北京大学第一医院儿科就诊的6例IQSEC2基因变异癫痫患儿的临床资料, 对其基因型特点和癫痫发作表现、脑电图、头颅影像学等结果进行回顾性分析。结果 6例患儿中男5例、女1例。6例IQSEC2基因变异均为新生变异, 其中移码变异2例(c.3801₃808dup/p.Q1270Rfs*130、c.1459₁460delAT/p.M487Vfs*2), 无义变异2例(c.3163C>T/p.R1055*、c.1417G>T/p.E473*), 框内缺失变异1例(c.2295₂297del/p.N765del)、错义变异1例(c.2293A>G/p.N765D)。癫痫起病年龄为3月龄至2岁5月龄。癫痫发作类型多样, 包括癫痫性痉挛、局灶性发作各5例, 强直发作、肌阵挛发作各3例, 不典型失神发作、失张力发作各2例。6例患儿癫痫起病前均有全面发育迟缓, 其他临床表现有孤独症样表现3例, 小头畸形3例, 肌张力...     

GABRA1基因变异相关癫痫的临床表型特点

目的探讨GABRA1基因变异相关癫痫患儿的临床表型特点.方法收集2016年3月至2019年7月在北京大学第一医院儿科就诊的癫痫患儿,并通过靶向捕获二代测序发现GABRA1基因变异的11例患儿(男4例、女7例),回顾性总结其临床表现、脑电图及头颅影像学特点.结果11例患儿中,10例为新生变异,1例为遗传性变异.2例患儿携带相同的变异,6例患儿携带国际未报道的新变异.癫痫起病年龄8(3~14)月龄,其中1岁内起病10例,1岁后起病1例.癫痫发作类型多样,其中局灶性发作10例,全面性强直-阵挛发作3例,肌阵挛发作3例,痉挛发作2例.有5例患儿具有多种发作类型.9例发作有热敏感特点,其中6例因发热诱发癫痫持续状态.2例具有光敏感特点.11例患儿脑电图显示背景异常5例,发作间期有异常放电6例.所有患儿的头颅磁共振成像均未见明显异常.9例患儿有不同程度的发育落后.临床诊断为Dravet综合征5例,婴儿痉挛症2例,不能分类的早发癫痫性脑病1例,其余3例为局灶性癫痫.11例患儿末次随访年龄为8月龄~12岁,8例癫痫发作已缓解6个月~8年,其中1例已停用抗癫痫药物.结论GABRA1基因变异中新生变异较遗传变异常见,其导致的癫痫多数在婴儿期起病,癫痫发作类型多样,局灶性发作最为常见.多数患儿发作预后好,但普遍发育落后.     

先天性糖基化障碍Ie 型合并先天性肌营养不良表型患儿临床和基因分析

目的探讨多萜醇磷酸甘露糖基转移酶1(DMP1)基因变异致先天性糖基化障碍Ie型(CDG-Ie)合并先天性肌营养不良表型的临床表现及基因变异。方法回顾分析1例CDG-Ie型合并先天性肌营养不良表型患儿的临床资料及基因检测结果。结果男性患儿,1月龄即发现头围小,随后有智力、运动发育迟缓、小头畸形、癫痫性脑病、肌力和肌张力减弱、双足挛缩、扁鼻梁、小下颌、双眼上斜、追光差等表现,血清肌酸肌酶升高。头颅磁共振示脑萎缩,脑外间隙弥漫性增宽,脑内髓鞘化明显偏弱。脑电图为暴发-抑制改变。基因测序显示患儿DPM1基因存在复合杂合变异,c.669-3CG和c.677GT;家系分析提示c.669-3CG来自母亲,c.677GT来自父亲。确诊为CDG-Ie。结论 CDG-Ie是CDG的罕见类型,常合并先天性肌营养不良表型,早期基因检测有助明确诊断。     

CACNA1E基因变异致儿童难治性癫痫1例报告

目的报道CACNA1E基因变异所致难治性癫痫的临床特征。方法回顾分析1例CACNA1E基因变异所致难治性癫痫患儿的临床资料。结果患儿,男,1岁6个月,因难治性癫痫伴智力运动发育落后就诊。患儿四肢肌张力降低,有严重的癫痫脑病表现,基因检测提示患儿携带CACNA1E基因c.4258(exon 30)G>A(NM_001205293)新发杂合变异,而其父母该位点均为野生型。根据ACMG(The American College of Medical Genetics and Genomics)标准与指南(2015),该变异为可能致病性变异。结论对难治性癫痫伴有智力运动发育落后、四肢肌张力低下的患儿应尽早完善基因检测,以明确诊断。     

长效确杜先联合拉莫三嗪及维生素B6治疗婴儿痉挛

目的探讨长效确杜先联合拉莫三嗪及维生素B6治疗婴儿痉挛的安全性.方法在应用大剂量维生素B6[20～50mg/(kg·d)]基础上,加用小剂量人工合成的ACTH-长效确杜先[0.010～0.015mg/(kg·     

重组人白细胞介素-6对脂肪细胞蛋白质酪氨酸磷酸酶1B、白细胞介素-6及抵抗素基因表达的影响

目的观察重组人白细胞介素-6(rhIL-6)对SW872脂肪细胞蛋白质酪氨酸磷酸酶1B(PTP1B)、抵抗素及IL-6基因表达的影响,探讨rhIL-6对脂肪细胞分泌功能的调节作用。方法体外培养,油酸诱导SW872前脂肪细胞分化为成熟的脂肪细胞,在培养液中加入不同水平rhIL-6(0、1、5、10、20、50μg/L)作用24 h,加入20μg/L rhIL-6后分别作用不同时间(0、4、8、12、24 h)。收集细胞提取总RNA,采用半定量反转录酶聚合酶链反应方法检测SW872脂肪细胞PTP1B、抵抗素、IL-6 mRNA水平。结果rhIL-6 1μg/L作用24 h,对SW872脂肪细胞IL-6 mRNA的表达无影响;随着rhIL-6水平的增加,SW872脂肪细胞IL-6 mRNA的表达水平逐渐增加,但以20μg/L rhIL-6的作用最强(F=233.9 P<0.01);20μg/L rhIL-6作用4 h即可促进SW872脂肪细胞IL-6 mRNA的表达,随着作用时间的延长,其促进作用更加明显(F=247.8 P<0.01)。1μg/L rhIL-6作用24 h,对SW872脂肪细胞PTP1B mRNA的表达无影响;5μg/L rhIL-6即可促进SW872脂肪细胞PTP1B mRNA表达,50μg/L rhIL-6作用24 h,对PTP1B mRNA的表达促进作用更明显(F=515.58 P<0.01);20μg/L rhIL-6作用4 h对脂肪细胞PTP1B mRNA的表达无影响,作用8 h即可促进PTP1BmRNA的表达,随着作用时间的延长其作用更加明显(F=498.62 P<0.01)。不同水平、不同作用时间下,rhIL-6对SW872脂肪细胞抵抗素mRNA的表达无明显影响(F=9.6,10.5 Pa>0.05)。结论rhIL-6以剂量和时间相关的方式促进SW872脂肪细胞PTP1B及IL-6 mRNA表达,对抵抗素mRNA的表达无影响。     

Vitamin B6 Intake and Plasma Pyridoxal Phosphate Concentrations in the First 2 Weeks of Life

ABSTRACT. Plasma pyridoxal phosphate concentrations were measured in 178 hospitalised neonates. A reference interval for neonates less than 7 day old, of 25 to 78 nmol/l has been established. Vitamin B₆ intakes did not correlate well with plasma pyridoxal concentrations despite 26 neonates receiving less than the Recommended Allowance (0.3 mg/d) and 19 receiving amounts below which convulsions have been associated (0.1 mg/d). Ten percent of those infants fed breast milk had plasma pyridoxal phosphate levels below the reference interval compared with only 4 % of those fed milk formulae. Breast milk from mothers with babies less than 14 days old had a total vitamin B₆ contents reference interval of 5 to 40 μg/l. Twenty percent of breast milk samples had virtually no vitamin B₆ detected.     

Pyridoxine-dependent seizures: a case report and a critical review of the literature

Pyridoxine-dependent seizures are a recognized, although rare, cause of intractable seizures in neonates. Patients with this autosomal recessive disorder have recurrent seizures that are resistant to conventional anticonvulsants but respond dramatically to intravenous administration of pyridoxine. Life-long supplementation with pyridoxine is required to prevent seizure recurrence. In the absence of a biological marker for the disease, clinical diagnosis is often delayed and severe neurological sequelae are common. Herein, we report on the clinical course of a neonate with pyridoxine-dependent seizures. Delayed normalization of the electroencephalogram and a normal developmental outcome (at 15 months of age) on a dose of 10 mg/kg pyridoxine are distinctive features of the present case. We also review recent clinical observations and neurochemical studies that have added to our knowledge of this disorder.     

Homocysteine,folate, vitamin B12 and B6 in mothers of children with neural tube defects in Xinjiang,China

Aim: To investigate the maternal homocysteine (Hcy), folate, vitamin B₁₂ and B₆, and their relations to neural tube defects (NTDs). Methods: Thirty mothers of NTDs offspring and another 60 mothers of normal children were enrolled as the patient and control groups from Xinjiang, China, from January 2008 to May 2011. The plasma levels of Hcy, folate, vitamin B₁₂ and B₆ were measured and compared between the two groups. Results: The morbidity of NTDs was 2.44% in Xinjiang. The Hcy was significantly higher in patient group than in control group (15.1 ± 7.8 vs. 8.5 ± 4.0 μmol/L, p < 0.001). The folate in patient group (9.7 ± 8.1 μg/L) was lower than in control group (15.0 ± 8.1 μg/L, p < 0.001). The vitamin B₁₂ was 181.3 ± 107.7 and 394.3 ± 386.3 ng/L in patient and control groups, respectively, with a significant difference (p < 0.001). The abnormal frequency of Hcy and vitamin B₁₂ was statistically different in two groups. The difference of vitamin B₆ between the patients and controls was marginal (48.7 ± 16.5 vs. 42.0 ± 10.5 mg/L, p = 0.051). Moreover, folate and vitamin B₁₂ levels were negatively correlated with Hcy while vitamin B₆ was positively correlated with Hcy. Positive correlation was observed between folate and vitamin B₁₂ levels. Conclusion: Our data confirm that higher Hcy, lower folate and vitamin B₁₂ are risk factors for NTDs. Besides folate, vitamin B₁₂ should be supplied to decrease NTDs occurrence. Further study is required to investigate the levels and accurate role of vitamin B₆.     

Homocysteine and other vascular risk factors in patients with phenylketonuria on a diet

The aim of this study was to investigate the known risk factors, such as lipids, homocysteine and endothelin, for the development of coronary artery disease (CAD) in phenylketonuria (PKU) patients, depending on their diet. The PKU patients (n = 74) were divided into two groups. Group A (n = 34; mean age 6.78 +/- 1.5 y) adhered strictly to a diet and group B (n = 40; mean age 8.0 +/- 3.2 y) did not comply with the diet. The control group comprised 50 healthy non-PKU children. All groups were evaluated for blood levels of homocysteine and vitamin B6 by high-performance liquid chromatography, vitamin B12 and folate in serum by a radioassay, lipids by a routine method, and lipoprotein(a) and endothelin-1 with an immunoassay. Homocysteine levels (28.65 +/- 3.3 micromol l(-1)) were increased in group A compared with group B (6.86 +/- 1.6 micromol l(-1)) and the controls (6.9 +/- 2.0 micromol l(-1)) (p < 0.001). Vitamin B6 (10.7 +/- 10.9 nmol l(-1)), vitamin B12 (98.5 +/- 22.3 pmol l(-1)), folate (2.35 +/- 1.3 nmol l(-1)) and lipids were decreased in group A. The other vascular risk factors, which were not dependent on diet [lipoprotein(a) and endothelin-1], did not differ among the three groups. Conclusion: PKU patients on a strict diet had low vitamin B6, vitamin B12 and folate levels resulting in moderate hyperhomocysteinaemia. The evaluation of these vitamins at short intervals and their supplementation could be an early measure in the prevention of CAD.