BackgroundDiseases associated with the germline PIGA gene include multiple congenital anomalies-hypotonia-seizures syndrome 2 (MCAHS2) and neurodevelopmental disorder with epilepsy. The clinical heterogeneity of PIGA-related diseases is extensive, so its diagnosis and treatment remain challenging.MethodsWe identified five germline missense pathogenic/likely pathogenic variants in PIGA across six unrelated families (NM_002641.3, c.130C>T p.P44S, c.368C>T p.T123M, c.241C>T p.R81C, c.751T>C p.C251R, and c.985G>T p.V329L), of which three variants have not been reported previously.ResultsIn all probands, the clinical symptoms included early-onset epilepsy, hypotonia, dysmorphic features, and variable congenital anomalies. A literature review of 107 cases supports reclassification of the phenotypic spectrum into severe (15.9%), intermediate (72.0%), and milder (12.1%) categories. Notably, the phenotypes of the five cases were classified as severe (n = 2) or milder (n = 3), consistent with prior reports, but revealed population-specific traits such as universal febrile sensitivity and normal serum alkaline phosphatase levels that are in contrast to elevated levels often noted in Western cohorts. The three children with the milder phenotype were found to have pathogenic/likely pathogenic variants located in exon 2, while the two severe phenotypes showed these variants located in exons 3 and 5.ConclusionOverall, we report three novel pathogenic/likely pathogenic variants that expand clinicians’ understanding of the genetic diversity within this phenotypic spectrum. These insights are expected to be valuable for future pathogenic/likely pathogenic variant analysis and accurate classification of clinical subtypes, which would help improve the understanding of PIGA-related diseases. In addition, our research contributes to ongoing efforts to elucidate the underlying molecular mechanisms and inform precision medicine approaches for affected individuals.

Background:Microcephaly, seizures and developmental delay, known as MCSZ, is an uncommon autosomal recessive neurodevelopmental disorder linked to a bifunctional enzyme named polynucleotide-kinase-3'-phosphatase (PNKP). Prompt identification and management of the disorder are crucial, as delayed diagnosis or intervention may lead to severe complications or mortality. Case Description:We describe a patient with small anterior fontanelle and head circumference, refractory epilepsy and global developmental delay. He was a baby conceived via in vitro fertilization (IVF). Microcephaly and oligohydramnios were detected at 32 weeks. At 4 months, the patient had recurrent convulsions without fever, presenting with tonic-clonic seizures. He was treated with four anti-seizure medications (ASMs), but did not achieve satisfactory control. At the age of 5 years old, he had not learned to speak and was unable to stand unaided. The patient harbored two novel mutations, c. 1299-1G>A and c.1283_1287dup (p.S430Pfs*39), in the PNKP gene. We confirmed, through RNA-seq, that c. 1299-1G>A results in exon 15 skipping and intron 14 retention. Both variants led to a truncated protein and may affect protein stability and enzyme activity. Conclusions:This is the third report of MCSZ in a non-consanguineous Chinese mainland family. Our results offer additional evidence for clinical variability associated with disorders stemming from mutations in the PNKP gene, which complicates disease diagnosis. This underscores the significance of genetic testing to identify the underlying causes of these conditions. Furthermore, these findings expand the mutation spectrum of the PNKP gene and establish a solid foundation for both clinical and prenatal diagnoses within this family.

Purpose: Perampanel (PER) and lacosamide (LCM) are the new third-generation anti-seizure medications (ASMs) that were approved for the monotherapy of focal epilepsy in children over four years of age in China, in 2021. Very few studies have analyzed the application of PER monotherapy among pediatric patients aged four years, and no study compared the efficacy and tolerability of PER monotherapy with LCM monotherapy in pediatric patients with focal epilepsy. The present study aimed to investigate the efficacy, tolerability, and effect on behavior and emotion of PER and LCM as monotherapy in pediatric patients with newly diagnosed focal epilepsy, which is beneficial for clinicians to have more choices to treat pediatric patients with focal epilepsy. Methods: This was a prospective, single-center, observational study that involved pediatric patients (disease onset age four years) with newly diagnosed focal epilepsy treated with PER or LCM as primary monotherapy. Outcomes included retention, being responders, and seizure-free rates after 3, 6, and 12 months. Adverse events (AEs) were noticed throughout the follow-up period. Behavioral outcomes were evaluated with Achenbach Child Behavior Checklist (CBCL/4-16) at baseline and after three and six months. Results: Using randomization, 60 patients receiving PER (31 females, 29 males, median age: 7.79 [5.34, 10.16] years, median dose: 3.0 [2.0, 4.0] mg/day) and 60 patients receiving LCM (25 females, 35 males, median age: 7.72 [5.91, 10.72] years, median dose: 150.0 [100.0, 200.0] mg/day) were enrolled in the study. At the 12-month follow-up, the retention rates in the PER and LCM groups, both were 90.4%, and the responder rates were 65.4% and 71.2%, while seizure-free rates were 57.7% and 67.3%, respectively. There were no significant differences in the retention, responder and seizure-free rates between the two groups (P > 0.05). There were no significant differences in the responder rates between patients with BECTS, abnormal brain magnetic resonance imaging (MRI), or types of seizure in the two groups (P > 0.05). In the PER group, 28.8% (15/52) of patients experienced AEs, of which the most frequently reported were irritability (n = 7; 13.5%), dizziness (n = 5; 9.6%), somnolence (n = 3; 5.8%), ataxia (n = 1; 1.9%), headache (n = 1; 1.9%), and rash (n = 1; 1.9%). In the LCM group, 15.4% (8/52) of the patients had AEs, including headache (n = 4; 7.5%), dizziness (n = 4; 7.5%), nausea (n = 2; 3.8%), somnolence (n = 2; 3.8%), irritability (n = 1; 1.9%), stomach ache (n = 1; 1.9%), and vomiting (n = 1; 1.9%). The incidence of irritability was significantly higher in the PER group than in the LCM group (13.5% vs. 1.9%, P = 0.031), which occurred mainly within eight weeks after drug administration. Patients with irritability were not dangerous to surrounding people by the assessment of parental observation in the life. And the symptoms were relieved spontaneously within a few months. The outcomes of total scores, internalizing scores, and externalizing scores of the CBCL did not show statistically significant differences in the PER and LCM groups between baseline and three and six months. Characteristics of behavior and emotion did not have substantial changes in patients treated with PER and LCM monotherapy. Conclusions: The present study documented similar good effectiveness and good tolerance of PER and LCM as monotherapy in pediatric patients with newly diagnosed focal epilepsy and showed no behavioral or emotional impact, as assessed by the CBCL. Though the incidence of irritability with PER monotherapy may be higher than that with LCM monotherapy soon after medication initiation, this side effect appears to resolve spontaneously within a few months. At present, this study was the first research about PER and LCM monotherapy in pediatric patients with newly diagnosed focal epilepsy evaluating efficacy, tolerability, and behavior in China. (c) 2023 Elsevier Inc. All rights reserved.

Clinical phenotype and gene characteristics of a patient diagnosed with Imerslund-Gr?sbeck syndrome (IGS) in Department of Neurology, Children′s Hospital of Soochow University in December 2018 were analyzed retrospectively, and literature review was conducted.The 16 years and 5 months old boy was admitted to the hospital with symptoms of weakness of lower limbs for 2 weeks.He had a history of megaloblastic anemia and isolated proteinuria.Genetic metabolism of hematuria showed methylmalonic academia.Genetic analysis revealed a compound heterozygous AMN gene mutation[c.742C>T(p.Q248 *) and c. 761G>A(p.G254E)]. These two mutations were derived from his parents respectively, which had been reported before.Symptoms of the patient improved after intramuscular administration of hydroxycobalamin and oral betaine.Review of the literature indicated that the clinical manifestations of AMN gene-related IGS were mostly megaloblastic anemia and isolated proteinuria, and the older children might suffer from neurological symptoms such as movement disorders, dementia, delirium or psychosis.The clinical phenotype of this disease was variable, which might easily lead to misdiagnosis.The patient presented with a special phenotype of mild reversible peripheral neuropathy, which expanded the clinical phenotype of pathogenic genes of AMN gene.In addition, peripheral neuropathy caused by vitamin B 12 metabolic disorders is reversible, and it is suggested to measure vitamin B 12, test related genes and treatment with vitamin B 12 in peripheral neuropathy of unknown etiology.

Background GNAO1 variants have been found to be associated with epileptic encephalopathies, developmental delays (DDs), and movement disorders (MDs). Therapies for patients with GNAO1 variants vary. However, treatments for GNAO1-related diseases are still in their infancy. Previous reports suggest that few pharmacological treatments are effective for patients with GNAO1 variant-related MDs. Deep brain stimulation (DBS) treatment appears to be effective, however surgical procedures and equipment failures pose risks to the patients. Effectiveness for oxcarbazepine (OXC) in GNAO1 variant-related MDs is first reported in our study, and it expand the effective drugs for MD treatment. Case Description We report the case of a 5-year-old male patient with a MD, who suffered from hypotonia and refractory choreoathetosis. The patient was found to have a DD and an intellectual disability. A de-novo variant of the GNAO1 gene (NM_138736: exom6: c.709G>A [p. Glu237Lys]) was identified by whole exome sequencing (WES) when he was 8 months old. The patient visited our hospital at the age of 4 years and 3 months because of fever and recurrent convulsions. Electroencephalogram (EEG) results show abnormal spikes, and magnetic resonance imaging (MRI) showed the enlargement of the lateral ventricles. The administration of tiapride hydrochloride, phenobarbital, midazolam, and hormones had no effect. OXC treatment was then initiated. No MD behaviors, such as rigidity and twisting of the limbs and trunk, or chorea, were observed after 10 days OXC treatment. Eventually, incremental doses of OXC were effective, and our patient achieved good control of his MD. Conclusions We are the first to demonstrate the role of OXC in alleviating MDs associated with GNAO1 mutations. This report provides a novel possibility for the clinical treatment of this rare disease. To manage MDs associated with GNAO1 mutations, we recommend that OXC treatment be attempted before invasive surgical therapy.

Progressive myoclonic epilepsy is a group of neurodegenerative diseases with complex clinical and genetic heterogeneity, which is associated with spontaneous or action-induced myoclonus and progressive neurodegeneration. Since 2020, 4 families with progressive myoclonic epilepsy-11 [OMIM#618876] have been reported with a very limited spectrum of SEMA6B pathogenic variants. In our study, whole-exome sequencing was used in a proband from a nonconsanguineous Chinese family presenting with growth retardation and recurrent atonic seizures. A deletion mutation (c.1960_1978del, p.Leu654Argfs*25) in the last exon of SEMA6B was detected, which is a de novo variant and pathogenic. The new genetic evidence we reported here strengthened the gene-disease relationship, and the gene curation level between SEMA6B and progressive myoclonic epilepsy-11 became "strong" following the ClinGen SOP. Therefore, the results of this study broaden the mutation spectrum of SEMA6B in different ethnic groups and strengthen the gene-disease relationship between SEMA6B and progressive myoclonic epilepsy-11.

Background ATP1A2 gene mutation has been indicated to cause alternating hemiplegia of childhood (AHC); however, limited evidence supports this relationship so far. Case presentation We reported two Chinese patients with de novo ATP1A2 variants (c.970G>A and c.889G>A). Both patients presented with episodes of alternating hemiplegia, seizures and mild developmental delay. Brain magnetic resonance imaging revealed abnormal signals in both patients. Conclusions The new genetic evidence we reported here strengthened the gene–disease relationship, and the gene curation level between ATP1A2 and AHC became “Moderate” following the ClinGen Standard Operation Procedure. Consequently, the two variants can be reclassified as likely pathogenic.

细菌性脑膜炎是各种细菌侵入中枢神经系统引起的脑实质、脑膜或血管的中枢神经系统感染性疾病,而肺炎链球菌(Streptococcus Pneumoniae,SP)是目前细菌性脑膜炎最常见和最主要的致病菌之一.研究SP性脑膜炎脑损伤的发生发展机制可为寻求该疾病新的治疗手段提供初步的实验和理论依据.通过探讨髓样相关蛋白MRP8/14对小鼠脑组织中IgG,Albumin,NSE,caspase3的影响,探讨MRP8/14在小鼠肺炎链球菌性脑膜炎脑损伤中的作用.将48只1.5～2个月健康雄性BALB/C小鼠随机分为四组:磷酸缓冲盐溶液对照组(PBS组)、MRP8/14蛋白组(MRP8/14组)、肺炎链球菌组(SP组)、肺炎链球菌+MRP8/14蛋白组(SP+MRP8/14组),每组12只;经侧脑室穿刺分别注入PBS、MRP8/14蛋白、SP混悬液、SP+MRP8/14建立动物模型.注射后6,24,48 h对小鼠进行神经行为学评分和体质量的变化率测定;处死小鼠取脑,记录脑组织含水量变化;观察不同时间点小鼠脑组织中Nissl染色阳性细胞及其数量的改变;制备脑组织匀浆,采用ELISA法测定血脑屏障通透性指标IgG,Albumin水平;采用免疫组织化学方法检测脑组织中脑损伤标志物NSE、凋亡相关蛋白caspase3蛋白的表达.结果显示,侧脑室注射6,24,48 h后,SP组小鼠与PBS组相比神经行为学评分明显降低,脑组织含水量明显增加,Nissl染色阳性神经细胞数量减少,IgG和Albumin浓度明显增加,NSE阳性细胞数明显减少,caspase3表达明显升高;SP+MRP8/14组与SP组相比神经行为学评分降低,脑组织含水量增加,Nissl染色阳性神经细胞数量减少,IgG和Albumin浓度增加,NSE阳性细胞数减少,caspase3表达升高趋势更加明显.因此,在小鼠SP性脑膜炎模型中,髓样相关蛋白MRP8/14加剧了SP性脑膜炎小鼠的临床症状、脑水肿、脑组织神经元丢失及脑损伤.

Infantile Sandhoff disease is an autosomal recessive inherited disease primarily characterized by cherry red spots in the retina, muscle weakness, seizure, truncal hypotonia, hyperacusis, developmental delay and regression. The pathogenic genetic defects of the HEXB gene, which encodes the β subunit of the hexosaminidase A (ɑβ) and hexosaminidase B (ββ) enzymes, cause deficiency of both the Hex A and Hex B enzymes, resulting in the deposition of GM2 ganglion glycerides in the lysosomes of the central nervous system and somatic cells. The aim of this study was to discover disease-causing variants of the HEXB gene in two Chinese families through the use of exome sequencing. By characterizing three novel variants by molecular genetics, bioinformatics analysis, and three-dimensional structure modeling, we showed that all these novel variants influenced the protein structure. The results broaden the variant spectrum of HEXB in different ethnic groups. Furthermore, not all patients diagnosed with infantile Sandhoff disease had characteristic cranial imaging findings, which can only be used as supplementary information for diagnosis. The results of this study may contribute to clinical management, genetic counseling, and gene-targeted treatments for Sandhoff disease.

It has been reported that myeloid-related protein 8/14 (MRP8/14) participates in the progression of inflammation after release from neutrophils and monocytes. This study aimed to clarify the mechanism(s) of the MRP8/14-augmented inflammatory response in mice with pneumococcal meningitis. Streptococcus pneumoniae (SP) meningitis was established by intracerebral injection of SP suspension. Balb/c mice were randomly divided into four groups and received the following injections: phosphate-buffer saline (PBS), MRP8/14 alone, SP alone, and SP plus MRP8/14. At 6 h, 24 h and 48 h postinfection, the clinical disease status was measured by the modified neurological severity score test, body weight loss and degree of cerebral edema; mice were anaesthetized, blood samples and brain samples were collected and brain inflammation was detected by haematoxylin and eosin (HE) staining; tumour necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), C-reactive protein (CRP) and monocyte chemoattractant protein-1 (MCP-1) levels in serum and brain homogenates were assessed by an enzyme-linked immunosorbent assay (ELISA), and the mRNA levels of the above cytokines in brain homogenates were measured by polymerase chain reaction (PCR); and the expression of nuclear factor-kappa B (NF-κB) p65 in brain tissues was determined by immunohistochemical assay. In this study, we identified that MRP8/14 substantially augmented the SP-stimulated inflammatory response, aggravated clinical disease status and exacerbated SP-induced brain edema in a murine model of pneumococcal meningitis. Exogenous administration of MRP8/14 significantly enhanced mRNA and protein expression of the proinflammatory cytokines and chemokines TNF-α, CRP, IL-6 and MCP-1 in brain homogenates and serum from mice with pneumococcal meningitis, which may be related to the NF-κB signalling pathway. We further found that MRP8/14 strongly augmented SP-induced phosphorylation of NF-κB p65 in brain tissue slices from the same model. In conclusion, our results indicated that MRP8/14 augmented the inflammatory response in mice with pneumococcal meningitis and contributed to the development of disease, which was probably through NF-κB signalling pathway activation.

尼曼匹克病(Niemann-Pick disease,NPD)又称鞘磷脂沉积病,是一组由鞘磷脂沉积引起的罕见常染色体隐性遗传疾病,自1914年首次报道以来,亚洲人发病率最低,本病在我国非常罕见 [1] 。其特点是全单核巨噬细胞和神经系统含大量神经鞘磷脂的泡沫细胞。其中C型NPD(NPC)以神经系统症状为主要表现,如智力低下、运动障碍、言语不清、癫痫发作等,易导致误诊。

Wilson’s disease (WD) is an autosomal recessive disorder caused by defective function of the copper-transporting ATP7B protein. Symptoms are typically related to the brain and liver, while endocrinologic abnormalities are rare. Here, we reported a 12-year-old female patient that was initially presented with unusual skin darkening and low serum level of adrenocorticotropic hormone and diagnosed as having adrenocortical insufficiency. We further screened the mutation in ATP7B by direct DNA sequencing and found compound heterozygous mutations: a known pathogenic mutation in exon8:c.2333G>T (Arg778Leu) inherited from her mother and a variant in intron4:c.1707 + 5G>A inherited from her father. To explore the pathogenicity of the intronic variant, a minigene splicing assay was used to determine the effects of the splicing variant by analyzing reverse transcription PCR of ATP7B minigene transcript production. The result indicated that the c.1707 + 5G>A variant resulted in exon 4 skipping. We herein identified that 1707 + 5G>A intron 4 variant is a pathogenic mutation. Molecular genetic analysis and laboratory examination definitely confirmed the patient’s condition as WD. Clinical status improved considerably after penicillamine treatment. Our results extended the mutation spectrum of ATP7B gene and highlighted the importance of molecular genetic analysis for the accurate diagnosis of atypical WD. WD may have diverse presentations and should be considered in children especially presenting with adrenocortical insufficiency as initial symptom, and this study highlights the importance of screening for hormone abnormal in WD.

The costimulatory protein B7-H3 has been shown to play a contributory role in the development and progression of experimental pneumococcal meningitis by augmentation of the innate immunity-associated inflammatory response via a TLR2-dependent manner. This study aimed to clarify the component(s) of TLR2-mediated signal transduction pathways responsible for B7-H3-augmented inflammatory response and subsequent brain damage during experimental pneumococcal meningitis. Administration of B7-H3 did not augment expression of TLR2 and other TLR2 upstream components, but led to an enhanced formation of MyD88-IRAK immunocomplex in the brain of S. pneumoniae-infected mice. Furthermore, B7-H3 substantially augmented S. pneumoniae-induced activation of TLR2 downstream NF-κB p65 and MAPK p38 pathways in the brain of S. pneumoniae-infected mice. Notably, blockage of NF-κB p65 and/or MAPK p38 with their specific inhibitors strongly attenuated B7-H3-amplified inflammatory response with significantly reduced proinflammatory cytokine and chemokine production, and markedly ameliorated B7-H3-exacerbated disruption of blood-brain barrier and severity of disease status in S. pneumoniae-infected mice. These results indicate that targeting NF-κB p65 and/or MAPK p38 may represent a promising therapeutic option for amelioration of overwhelming inflammatory response-associated brain injury frequently observed during pneumococcal meningitis.

目的 系统评价左乙拉西坦添加治疗儿童难治性部分性癫痫的疗效和耐受性.方法 计算机检索1998年1月-2017年1月Cochrane图书馆、PubMed、EMbase、中国知网中国期刊全文数据库和万方及中国生物医学文献数据库,并手工检索相关杂志,RevMan 5.3统计软件进行Meta分析.结果 根据Cochrane 5.0.2版随机对照临床试验质量评价标准,纳入4项随机对照临床试验共498例受试者(左乙拉西坦组268例、安慰剂对照组230例).Meta分析结果显示,左乙拉西坦组部分性癫痫发作频率减少≥50％的病例数高于对照组[OR =2.940,95％ CI(1.99,4.34),P＜0.000 01];完全不发作病例明显高于对照组[OR=5.310,95％ CI(2.49,11.32),P＜0.000 01].左乙拉西坦组失访率与安慰剂对照组之间差异无统计学意义[OR=0.760,95％ CI(0.32,1.82),P=0.54].药物不良反应中嗜睡[OR=2.57,95％ CI(1.36,4.86)]及精神行为改变[OR =2.54,95％ CI(1.56,4.14)]与左乙拉西坦组显著相关(P＜0.05),其他不良反应与左乙拉西坦组无显著相关.结论 现有Meta分析显示,左乙拉西坦添加治疗难治性部分性癫痫的疗效与安慰剂组相比效果显著.左乙拉西坦添加治疗儿童难治性癫痫部分性发作有确切的疗效,且长期治疗效果稳定,有良好的安全性,保留率较高,可在临床进一步推广使用.