Introduction
Methods
Patients and molecular analysis
Literature search
Results
Molecular analysis
Patient | A | B | C | D | E | F [2] | G [13] | H [14] | I [14] | Female patientsd
|
---|---|---|---|---|---|---|---|---|---|---|
Age at inclusion (years) | 10 | 13 | 14 | 24 months | 13 | 7 | 6 | 4 | 3,5 | 1–54 |
Varianta
| c.1864G > C, p.Gly622Arg | c.840C > G, p.Tyr280* | c.462C > G, p.Tyr154* | c.1682C > G, p.Pro561Arg | c.799G > T, p.Glu267* | del PCDH19
| c.605C > A, p.Ser202* | c.918C > G, p.Tyr306* | c.1352 C > T, p.Pro451Leu |
PCHD19 deletions, duplications, missense and nonsense variants |
% of mosaicism | 60% (blood) | 22% (blood) | 65% (blood) | 78% (blood) | 20% (blood) | 100% (lymphocytes), 47% (fibroblasts) | 50% (blood), 70% (buccal cells), 100% (urine sediment) | 10% (lymphocytes, saliva, hair) | 90% (lymphocytes, urine) | − |
Technique used (number of alternate alleles/total read depth at base position) | NGS gene panel (92/153 reads) | NGS gene panel (77/380 reads) | NGS gene panel (38/59 reads) | NGS gene panel (351/450 reads) | NGS gene panel (19/93 reads) | Detection by microarray, estimation of % mosaicism by FISH (100 cells) | Detection by exome sequencing, estimation of % mosaicism by Sanger | NGS gene panel (157 reads) | NGS gene panel (135 reads) | Various |
Sex | Male | Male | Male | Male | Male | Male | Male | Male | Male | Female |
Exam at birth | Meconium stained amniotic fluid, bradycardia | Normal | Normal | Umbilical cord around neck, quick recovery | Normal | ? | Normal | ? | ? | Normal |
Development prior to sz onset | Normal | Normal | Normal | Normal | Speech delay | Normal | Normal | Normal | Normal | Normal |
Sz onset age (months) | 5 | 10 | 10 | 7 | 31 | 12 | 9 | 9 | 10 | 3–70 (most <12) |
Sz type at onset | Generalized, clonic (fs) | Generalized clonic | Cluster of CP seizures | Clusters of focal sz, generalizing to GTC and tonic seizures | Clusters of focal sz, generalizing to one hemisphere | GTC (fs, prolonged, repetitive) | Focal myoclonic, tonic–clonic, FSsG | Afebrile hypotonic seizure with hypopnea (40 min) | 24 h cluster of febrile sz with fixed gaze, loss of contact, upper limb hypertonia, and jerks (30–40 s.) | Febrile, febrile SE, afebrile; GTC, generalized tonic; hemiconvulsion; focal, FSsG; CP |
Later sz types | CP, secondary generalized. Focal with affective symptoms, secondary generalized. Primairy generalized | Generalized clonic | CP, secondary tonic clonic, tonic, status | Focal, febrile, GTC, tonic, CP | CP, febrile | Hemiclonic, GTC, myoclonic jerks | Focal myoclonic, tonic–clonic, rapid secondary generalization | FS, focal tonic-vibratory | FS and afebrile seizure clusters, tonic. Often fearful screaming at start | FS or afebrile; generalized clonic, tonic, tonic-clonic or atonic; hemiclonic; focal, CP, FSsG, myoclonic; absences; SE |
Clusters of sz | + (fever related) | + | + | + | + | + | ? | + | + | + |
Focal sz with affective symptoms | + | − | + | − | + | ? | ? | ? | + | + |
Fever sensitivity | + | + | + | + | + | + | ? | + | + | + |
AEDs used and responseb
| VPA: -, LTG: -, CBZ:- | VPA: + | VPA:?, LEV: +/−, LZP (during clusters): -, TPM, CBZ, OXC, PHT, PHB, LTG, CLB, VGB:? | LEV:+/−, TPM: -, OXC:-, VPA:+, PHB:+, LSM:-, Diazepam:- | VPA:+; CBZ: +/−; OXC: +/− | VPA, CLB, CLN, TPM, STP:? | LEV: +/−, ZNS: +, multiple AEDs: - | VPA:? | PHB:?, VPA: | LEV, VPA, CLB, CLN, TPM, STP, LTG, PHB, CBZ, OXC, ZNS, NTZ, VGB, KBR, LZP: different responses |
Current AEDsb
| LEV, OXC, CLB, TPM | VPA | LEV | OXC, VPA, PHB, LEV | OXC | ? | ZNS | − | PHB, VPA | Many different AED’s, some cases no AED’s |
Sz outcome | 1 cluster of sz per year (5–10 sz/cluster) | Last sz at age 10 years | Ongoing sz | Ongoing sz | Ongoing sz during febrile illness | Persistence of febrile sz in spite of treatment | Seizure free for 20 months | Seizure free age 14–42 months (no AEDs), since then 1 cluster of sz | 4–5 clusters per year | Often seizures less frequent or seizure free at certain age (4–36 years) |
EEG at onset | 7–8 months: normal. 10–11 months: asymmetrical background activity, non-specific high voltage delta-activity occipital right > left. | Frequent generalized epileptic discharges | 2 years: normal | Multiple focal discharges, right centroparietal, secondary generalization. Mild diffuse background slowing | Focal epileptic discharges left parietotemporal with generalization to one hemisphere (ictal) | ? | Slower rhythm for age, mild diffuse disturbance. Infrequent right frontal, and rare left temporal sharp wave discharges, suggestive of epileptiform activity | Rare right frontotemporal sharp waves | Normal | Mostly normal |
EEG at follow-up | 3,5 years: normal | − | 3 years: No epileptic activity, generalized and focal slow activity | - | ? | ? | ? | Bilateral centroparietal onset of seizures | Normal, interictal spikes, generalized poly-spike waves, slow waves, slow background | |
Last EEG | 6 years: normal background activity, diffuse fast activity mainly frontal. No epileptic activity. | − | 4 years: No epileptic activity, generalized and focal slow activity | - | 32 months: interictal EEG normal | ? | ? | ? | Normal interictal | − |
IDc
| ++ (estimated: slowed PMD, special education) | + (IQ 66 at 5 years) | ++ to +++ | - (only delayed speech development, but no true ID yet, based on clinical evaluation) | + (IQ 55 at 9 years) | ++ to +++ | +/− (IQ = 76) | +/− (GDQ 78 at 46 months, 72 at 52 months) | - (GDQ 101 at 30 months and 103 at 40 months) | - to +++ |
Developmental stagnation/regression | − | − | − | − | − | ? | ? | − | − | Regression in some cases |
Language (words/sentences) | Delayed: words, sentences | Not delayed. First words at 12 months. Two-word sentences at 16 months | Sentences, stereotyped phrases | Mildly delayed speech development | Mildly delayed speech development | delay: words-sentences | ? | ? | ? | Sometimes normal, often delayed, words-sentences, in rare cases absent |
Behavioural/psychiatric disturbances | Autism, aggression, behavioural problems, ADHD | Autism, mood disorder | Autism spectrum disorder, anxiety | − | Behaviour problems resembling autism spectrum disorder, short attention span | Behavioural problems, autistic features | Irritability, aggression, rigidity, poor sleep, ADHD, anxiety, OCD, ODD | Compulsive and stereotyped behaviours | − | Prominent behavioural problems in most cases (autism, attention deficit, hyperactivity, aggression, emotional lability, impulsiveness, anxiety, jealousy, obsession, depression psychogenic nonepileptic sz) |
Neurological examination | Crouched gait | Hypotonia | Motor delay and balance problems | Balance problems (medication induced), improving | Reduced coordination | Motor delay, ataxia | ? | ? | ? | Mostly normal; hypotonia, dyspraxia, ataxia or motor delay in some |
MRI images (age) | Expanded perivascular spaces (8 years) | Normal (7 years) | Widened peripheral subarachnoid spaces | Normal (7 months) | Normal (2,5 years) | ? | Normal | ? (CT: normal) | Normal (10 months) | Usually normal (mild atrophy/cortical dysplasia is rarely reported) |
Additional comments | − | Pes plano valgus, obesity (BMI 23.3; +2.3 SD) | − | Hand food mouth disease | dysmorphic features: plagiocephaly occipital/parietal area, cupped ears, intradigital webbing of phalanges. Severe myopia |