Clinical profile of patients with ATP1A3 mutations in alternating hemiplegia of childhood-a study of 155 patients.

BACKGROUND: Mutations in the gene ATP1A3 have recently been identified to be prevalent in patients with alternating hemiplegia of childhood (AHC2). Based on a large series of patients with AHC, we set out to identify the spectrum of different mutations within the ATP1A3 gene and further establish any correlation with phenotype. METHODS: Clinical data from an international cohort of 155 AHC patients (84 females, 71 males; between 3 months and 52 years) were gathered using a specifically formulated questionnaire and analysed relative to the mutational ATP1A3 gene data for each patient. RESULTS: In total, 34 different ATP1A3 mutations were detected in 85 % (132/155) patients, seven of which were novel. In general, mutations were found to cluster into five different regions. The most frequent mutations included: p.Asp801Asn (43 %; 57/132), p.Glu815Lys (16 %; 22/132), and p.Gly947Arg (11 %; 15/132). Of these, p.Glu815Lys was associated with a severe phenotype, with more severe intellectual and motor disability. p.Asp801Asn appeared to confer a milder phenotypic expression, and p.Gly947Arg appeared to correlate with the most favourable prognosis, compared to the other two frequent mutations. Overall, the comparison of the clinical profiles suggested a gradient of severity between the three major mutations with differences in intellectual (p = 0.029) and motor (p = 0.039) disabilities being statistically significant. For patients with epilepsy, age at onset of seizures was earlier for patients with either p.Glu815Lys or p.Gly947Arg mutation, compared to those with p.Asp801Asn mutation (p < 0.001). With regards to the five mutation clusters, some clusters appeared to correlate with certain clinical phenotypes. No statistically significant clinical correlations were found between patients with and without ATP1A3 mutations. CONCLUSIONS: Our results, demonstrate a highly variable clinical phenotype in patients with AHC2 that correlates with certain mutations and possibly clusters within the ATP1A3 gene. Our description of the clinical profile of patients with the most frequent mutations and the clinical picture of those with less common mutations confirms the results from previous studies, and further expands the spectrum of genotype-phenotype correlations. Our results may be useful to confirm diagnosis and may influence decisions to ensure appropriate early medical intervention in patients with AHC. They provide a stronger basis for the constitution of more homogeneous groups to be included in clinical trials

Study of the role of the cerebellum in cerebral plasticity : case of dystonia

Ce travail précise le rôle du cervelet dans la physiopathologie de la dystonie. Nous étudions comment le cervelet contrôle le développement et l’étendue de la plasticité sensorimotrice, celle-ci étant anormale dans la dystonie. Nous démontrons l’implication du cervelet dans la dystonie en constatant des performances anormales à une tâche d’adaptation sensorimotrice dépendant du cervelet. (Hubsch et al., 2011) Puis chez des sujets sains, en utilisant des techniques d’induction de plasticité cérébrale nous démontrons que le cervelet module la plasticité corticale reposant sur des afférences sensorielles. Ainsi, une inhibition du cortex cérébelleux amplifie la réponse du cortex à un protocole d’induction de plasticité sensorimotrice, une excitation du cortex cérébelleux bloque la réponse du cortex à ce protocole. (Popa et al., 2013) Avec les mêmes méthodes, nous étudions le rôle du cervelet dans la modulation de la plasticité du cortex sensori-moteur chez des sujets atteints de dystonie focale. Dans la crampe de l’écrivain, le cervelet n’exerce plus ce rôle modulateur de la plasticité sensorimotrice: il n’y a ni inhibition ni renforcement du phénomène de plasticité induit par une modulation des sorties cérébelleuses. (Hubsch et al., 2013)Dans la dystonie cervicale, il persiste une modulation de la plasticité sensorimotrice par le cervelet mais cette modulation a une direction opposée par rapport aux sujets sains contrôles. Par des expériences complémentaires, nous démontrons que le contrôle cérébelleux sur la plasticité corticale sensorimotrice est adaptatif aux afférences proprioceptives de la nuque possiblement en rapport avec la construction de l’espace égocentré.This study specifies the role of the cerebellum in the physiopathology of dystonia. We study how the cerebellum controls the development and the extent of sensorimotor plasticity, this one being abnormal in dystonia. We show the implication of the cerebellum in dystonia by noting abnormal performances with a task of sensorimotor adaptation depending on cerebellum. (Hubsch and al., 2011) Then with healthy subjects, by using techniques of cerebral plasticity’s induction we show that the cerebellum modulates cortical plasticity depending on sensory afferents. Thus, an inhibition of the cerebellar cortex amplifies the response of the cortex to a protocol of induction of sensorimotor plasticity, an excitation of the cerebellar cortex blocks the response of the cortex to this protocol. (Popa and al., 2013) With the same methods, we study the role of the cerebellum in the modulation of the plasticity of the sensorimotor cortex with dystonic subjects. In writer's cramp, the cerebellum does not exert any more this modulating role of sensorimotor plasticity: there is neither inhibition nor reinforcement of the phenomenon of plasticity induced by a modulation of the cerebellar outputs. (Hubsch and al., 2013) In the cervical dystonia, it persists a modulation of sensorimotor plasticity by the cerebellum but this modulation has a direction opposed compared to the healthy subjects. By complementary experiments, we show that cerebellar control on cortical sensorimotor plasticity is adaptive with the proprioceptive afferents of the neck possibly in keeping with the construction of egocentric space

Clinical profile of patients with ATP1A3 mutations in Alternating Hemiplegia of Childhood-a study of 155 patients.

BACKGROUND: Mutations in the gene ATP1A3 have recently been identified to be prevalent in patients with alternating hemiplegia of childhood (AHC2). Based on a large series of patients with AHC, we set out to identify the spectrum of different mutations within the ATP1A3 gene and further establish any correlation with phenotype. METHODS: Clinical data from an international cohort of 155 AHC patients (84 females, 71 males; between 3 months and 52 years) were gathered using a specifically formulated questionnaire and analysed relative to the mutational ATP1A3 gene data for each patient. RESULTS: In total, 34 different ATP1A3 mutations were detected in 85 % (132/155) patients, seven of which were novel. In general, mutations were found to cluster into five different regions. The most frequent mutations included: p.Asp801Asn (43 %; 57/132), p.Glu815Lys (16 %; 22/132), and p.Gly947Arg (11 %; 15/132). Of these, p.Glu815Lys was associated with a severe phenotype, with more severe intellectual and motor disability. p.Asp801Asn appeared to confer a milder phenotypic expression, and p.Gly947Arg appeared to correlate with the most favourable prognosis, compared to the other two frequent mutations. Overall, the comparison of the clinical profiles suggested a gradient of severity between the three major mutations with differences in intellectual (p = 0.029) and motor (p = 0.039) disabilities being statistically significant. For patients with epilepsy, age at onset of seizures was earlier for patients with either p.Glu815Lys or p.Gly947Arg mutation, compared to those with p.Asp801Asn mutation (p < 0.001). With regards to the five mutation clusters, some clusters appeared to correlate with certain clinical phenotypes. No statistically significant clinical correlations were found between patients with and without ATP1A3 mutations. CONCLUSIONS: Our results, demonstrate a highly variable clinical phenotype in patients with AHC2 that correlates with certain mutations and possibly clusters within the ATP1A3 gene. Our description of the clinical profile of patients with the most frequent mutations and the clinical picture of those with less common mutations confirms the results from previous studies, and further expands the spectrum of genotype-phenotype correlations. Our results may be useful to confirm diagnosis and may influence decisions to ensure appropriate early medical intervention in patients with AHC. They provide a stronger basis for the constitution of more homogeneous groups to be included in clinical trials

Clinical profile of patients with ATP1A3 mutations in alternating hemiplegia of childhood-a study of 155 patients.

BACKGROUND: Mutations in the gene ATP1A3 have recently been identified to be prevalent in patients with alternating hemiplegia of childhood (AHC2). Based on a large series of patients with AHC, we set out to identify the spectrum of different mutations within the ATP1A3 gene and further establish any correlation with phenotype. METHODS: Clinical data from an international cohort of 155 AHC patients (84 females, 71 males; between 3 months and 52 years) were gathered using a specifically formulated questionnaire and analysed relative to the mutational ATP1A3 gene data for each patient. RESULTS: In total, 34 different ATP1A3 mutations were detected in 85 % (132/155) patients, seven of which were novel. In general, mutations were found to cluster into five different regions. The most frequent mutations included: p.Asp801Asn (43 %; 57/132), p.Glu815Lys (16 %; 22/132), and p.Gly947Arg (11 %; 15/132). Of these, p.Glu815Lys was associated with a severe phenotype, with more severe intellectual and motor disability. p.Asp801Asn appeared to confer a milder phenotypic expression, and p.Gly947Arg appeared to correlate with the most favourable prognosis, compared to the other two frequent mutations. Overall, the comparison of the clinical profiles suggested a gradient of severity between the three major mutations with differences in intellectual (p = 0.029) and motor (p = 0.039) disabilities being statistically significant. For patients with epilepsy, age at onset of seizures was earlier for patients with either p.Glu815Lys or p.Gly947Arg mutation, compared to those with p.Asp801Asn mutation (p < 0.001). With regards to the five mutation clusters, some clusters appeared to correlate with certain clinical phenotypes. No statistically significant clinical correlations were found between patients with and without ATP1A3 mutations. CONCLUSIONS: Our results, demonstrate a highly variable clinical phenotype in patients with AHC2 that correlates with certain mutations and possibly clusters within the ATP1A3 gene. Our description of the clinical profile of patients with the most frequent mutations and the clinical picture of those with less common mutations confirms the results from previous studies, and further expands the spectrum of genotype-phenotype correlations. Our results may be useful to confirm diagnosis and may influence decisions to ensure appropriate early medical intervention in patients with AHC. They provide a stronger basis for the constitution of more homogeneous groups to be included in clinical trials

La Petite presse : journal quotidien... / [rédacteur en chef : Balathier Bragelonne]

21 juin 18691869/06/21 (A4,N1159)