Presentation
These cutaneous markers for TSC may be present at birth, but most commonly develop during childhood. Ungual fibromas are present in 20%-90% of individuals with TSC (Figure 5). [clinicaladvisor.com]
Patients tend to present with symptoms after the age of 50 and then progression can be very variable depending on the individual. [icommunicatetherapy.com]
Patients typically present clinical symptoms between the ages of… Continue Reading BridgeBio Pharma Raises $299 Million January 23, 2019 By Daniel S. [globalgenes.org]
Some patients at presentation have focal epileptiform discharges, primarily in the occipital region. [thieme-connect.com]
In individuals with epilepsy non-convulsive status epilepticus may present with cognitive or behavioural deterioration without much else in the way of clinical signs. Progressive hydrocephalus may present late with cognitive decline. [jnnp.bmj.com]
Entire Body System
- Developmental Delay
developmental delay followed by regression, deafness, blindness, vomiting, hyperirritability, hypersensitivity to stimuli, increased deep-tendon reflex, and spasticity; seizures; diffuse cerebral atrophy and demyelination; elevated CSF protein; peripheral [merckmanuals.com]
Delay, Microcephaly and Hypomyelination Dihydrolipoamide dehydrogenase deficiency Dihyropyrimidine dehydrogenase deficiency Dyskeratosis Congenita, Autosomal Recessive 5 Ehlers-Danos Syndrome, Type VIIC Ethylmalonic encephalopathy Factor XI deficiency [genpathdiagnostics.com]
delay, liver dysfunction, and abnormal subcortical white matter A #175100 Familial adenomatous polyposis 1 (FAP1) M #614937 Familial Cortical Myoclonus M #615999 Familial dysalbuminemic hyperthyroxinemia A #227645 Fanconi anemia, complementation group [biochemgenetics.ca]
Technical Information Patient History Form Constitutional Chromosome Studies SNP CHR PB, CMA SNP, array, CGH, aCGH, CNV, mental retardation, intellectual and developmental disability, IDD, ID, pervasive developmental delay, congenital anomalies, MCA, [aruplab.com]
delay and microcephaly, SLC1A4 related SLC1A4 Developmental delay, GNAQ related GNAQ Developmental delay, KMT2C related KMT2C DI-CMTB DNM2 DI-CMTC YARS DI-CMTD MPZ Dravet syndrome GABRG2 Dravet syndrome SCN2A Dravet syndrome, modifier of SCN9A Dysautonomia [centogene.com]
- Pain
[…] syndrome Complex regional pain syndrome type 1 Complex regional pain syndrome type 2 Cone rod dystrophy Congenital absence/hypoplasia of thumb Congenital adrenal hyperplasia Congenital communicating hydrocephalus Congenital contractural arachnodactyly [sanfordresearch.org]
Associated with Gastrointestinal Diseases E-2785 160 Counseling Children with Neurologic Disorders and Their Families E-2823 161 Approaches to Personalized Medicine in Pediatric Neurology E-2831 162 Pediatric Neurorehabilitation Medicine E-2839 163 Pain [books.google.com]
[…] bone marrow transplantation Gaucher disease Glucosylceramide β -glucosidase GBA (1q21)* Type I (adult or chronic form; 230800) Onset: Childhood or adolescence Urine metabolites: None Clinical features: Hepatosplenomegaly, osteolytic lesions with bone pain [merckmanuals.com]
Common momentary symptoms include, blurring vision or pain in the eye, weakness and ataxia. These symptoms can be accelerated by exhaustion or stress. [icommunicatetherapy.com]
Hypokalemic periodic paralysis type 1 CACNA1S Hypomyelination with brainstem and spinal cord involvement and leg spasticity DARS Inclusion body myopathy GNE Inclusion body myopathy MYH2 Infantile neuroaxonal dystrophy type 1 PLA2G6 Insensitivity to pain [centogene.com]
Respiratoric
- Respiratory Insufficiency
Common manifestations include coarse facial features, neurodevelopmental delays and regression, joint contractures, organomegaly, stiff hair, progressive respiratory insufficiency (caused by airway obstruction and sleep apnea), cardiac valvular disease [merckmanuals.com]
Eyes
- Visual Impairment
Impairment Sample DNA My Products My Coffalyser.Net My Profile Login Application: Region: Item no. [mlpa.com]
Conditions Conditions that may accompany or occur at the same time as CP include, visual impairment, challenges with communication (speech maybe difficult to understand), feeding disorders – leading to problems with growth and nutrition, seizures (epilepsy [ckfto.org]
[…] vision loss Progressive visual impairment Slowly progressive visual loss Vision loss, progressive Visual loss, progressive [ more ] 0000529 Restlessness 0000711 30%-79% of people have these symptoms Developmental regression Loss of developmental milestones [rarediseases.info.nih.gov]
They can present as refractive error, strabismus, cortical visual impairment, and premature retinopathy. [9] Causes [ edit ] The disease pathophysiology is mostly unknown, but some evidence implicates cortical hyperexcitability occurring at critical periods [en.wikipedia.org]
impairment, and ataxia in the second or third decade of life. [thieme-connect.com]
- Visual Impairment
Impairment Sample DNA My Products My Coffalyser.Net My Profile Login Application: Region: Item no. [mlpa.com]
Conditions Conditions that may accompany or occur at the same time as CP include, visual impairment, challenges with communication (speech maybe difficult to understand), feeding disorders – leading to problems with growth and nutrition, seizures (epilepsy [ckfto.org]
[…] vision loss Progressive visual impairment Slowly progressive visual loss Vision loss, progressive Visual loss, progressive [ more ] 0000529 Restlessness 0000711 30%-79% of people have these symptoms Developmental regression Loss of developmental milestones [rarediseases.info.nih.gov]
They can present as refractive error, strabismus, cortical visual impairment, and premature retinopathy. [9] Causes [ edit ] The disease pathophysiology is mostly unknown, but some evidence implicates cortical hyperexcitability occurring at critical periods [en.wikipedia.org]
impairment, and ataxia in the second or third decade of life. [thieme-connect.com]
Musculoskeletal
- Muscle Weakness
Common symptoms include muscle weakness and wasting, and fatigue. Upper motor neuron involvement causes symptoms of muscle weakness or paralysis and increased tone. [icommunicatetherapy.com]
weakness, hypotonia, strokelike episodes, seizures, olivopontine hypoplasia, peripheral neuropathy, hypothyroidism, hyperinsulinism, factor XI deficiency, antithrombin III deficiency, thrombocytosis, decreased IgA and IgG, leukocyte adhesion defect [merckmanuals.com]
weakness, muscle pain, myotonia). [aetna.com]
- Muscle Hypotonia
[…] dysfunction syndrome ACTA2 Muscle hypertrophy MSTN Muscle-eye-brain disease, POMK related POMK Muscular dystrophy type 1A LAMA2 Muscular dystrophy type 1C FKRP Muscular dystrophy type 1D LARGE Muscular dystrophy, Becker type DMD Muscular dystrophy, congenital [centogene.com]
Psychiatrical
- Distractibility
The employee tells the supervisor about his disability and the side effect of the medication he takes, and asks to be moved to a quieter work space to lessen the distractions. [eeoc.gov]
Neurologic
- Mental Deterioration
deterioration in childhood [ more ] 0002376 Intellectual disability Mental deficiency Mental retardation Mental retardation, nonspecific Mental-retardation [ more ] 0001249 Mental deterioration Cognitive decline Cognitive decline, progressive Intellectual [rarediseases.info.nih.gov]
Unsteadiness, muscle rigidity, and mental deterioration are often also present. Who gets it? This is a group of rare disorders. [epilepsy.com]
Signs and symptoms include progressive vision loss, progressive motor skills deterioration, mental impairment, and seizures. Infantile neuronal ceroid lipofuscinosis in which the signs and symptoms appear later in life. [icd10data.com]
deterioration, and hearing loss, MT-TV related MT-TV Ataxia-oculomotor apraxia type 1 APTX Ataxia-oculomotor apraxia type 2 SETX Ataxia-oculomotor apraxia type 3 PIK3R5 Ataxia-oculomotor apraxia type 4 PNKP Ataxia-telangiectasia ATM Attention deficit-hyperactivity [centogene.com]
deterioration Limb-girdle muscular dystrophy Palmoplantar keratoderma-sclerodactyly syndrome Limb-body wall complex Lopes Gorlin syndrome Currarino triad Spondylometaphyseal dysplasia with cone-rod dystrophy Brachydactyly with hypertension Acral peeling [checkrare.com]
- Generalized Seizure
Generalized tonic–clonic seizures predominate, although there may also be other types of seizures such as absence, tonic, and focal seizures. [thieme-connect.com]
The most common seizure types are tonic-axial, atonic, and absence seizures, but myoclonic, generalized tonic-clonic, and partial seizures can be observed (see Clinical Presentation). An EEG is an essential part of the workup for LGS. [emedicine.medscape.com]
"Lamotrigine for generalized seizures associated with the Lennox–Gastaut syndrome. Lamictal Lennox–Gastaut Study Group". The New England Journal of Medicine. 337 (25): 1807–12. doi : 10.1056/NEJM199712183372504. [en.wikipedia.org]
Not many years ago, infantile spasms were considered to be a generalized seizure disorder, and thus surgery was not possible. [childneurologyfoundation.org]
Myoclonus with or without generalized seizures and progressive cognitive decline were universally present in all the patients. Seizures are often refractory to antiepileptic medications. [neurologyindia.com]
- Generalized Tonic-Clonic Seizure
Showing of 19 | 80%-99% of people have these symptoms Clumsiness 0002312 EEG abnormality 0002353 Focal impaired awareness seizure 0002384 Generalized tonic-clonic seizures Grand mal seizures 0002069 Progressive visual loss Progressive loss of vision Progressive [rarediseases.info.nih.gov]
Progression to hemiconvulsions or generalized tonic–clonic seizures (GTCS) occurs in around half of children and hemiconvulsions may be followed by postictal Todd’s hemiparesis [ 11 ]. Duration of seizures is usually brief, lasting for 1-2 minutes. [omicsonline.org]
Table 2 :Clinical and electrophysiologic profile of 97 patients of PME, cohort from NIMHANS, Bangalore[7] Click here to view » Lafora Body Disease The characteristics of LBD include: generalized tonic-clonic seizures (GTCS), resting and action myoclonus [neurologyindia.com]
- Paresis
Sterol 27-hydroxylase CYP27A (2q33-qter)* Onset: Adolescence Urine metabolites: Elevated 7- α -hydroxylated bile alcohol Clinical features: Juvenile cataracts, tendon and skin xanthomas, xanthelasma, fractures, atherosclerosis, dementia, spinal cord paresis [merckmanuals.com]
Episodic ataxia type 2 CACNA1A Episodic ataxia type 5 CACNB4 Episodic ataxia type 6 SLC1A3 Episodic pain syndrome type 2, familial SCN10A Episodic pain syndrome type 3, familial SCN11A Erythermalgia, primary SCN9A Ethylmalonic encephalopathy ETHE1 Facial paresis [centogene.com]
[…] deficiency syndrome Ring chromosome 9 Aplasia cutis congenita intestinal lymphangiectasia Sitosterolemia Benallegue Lacete syndrome Cutis laxa, autosomal dominant PMM2-CDG (CDG-Ia) Hereditary paraganglioma-pheochromocytoma Hereditary congenital facial paresis [checkrare.com]
- Global Developmental Delay
Angelman and Prader-Willi syndromes Angelman syndrome (AS) is a neurogenic disorder characterized by developmental delay, lack of speech, seizures and walking and balance disorders. [aetna.com]
Workup
An EEG is an essential part of the workup for LGS. Neuroimaging is an important part of the search for an underlying etiology (see Workup). [emedicine.medscape.com]
It is not always necessary to do the complete metabolic/genetic workup on every child. If the history or exam suggests the possibility of a metabolic or genetic disorder then the treating physician will undertake the evaluation. [childneurologyfoundation.org]
[…] activator protein PTG and interaction with laforin.[ 21 ] Because of clinically atypical features, some patients with mild Lafora disease could escape a correct diagnosis because adult patients with mild PME traditionally have not undergone diagnostic workup [thieme-connect.com]
Treatment
Brand-new chapters in the drug and diet section cover perampanel, ezogabine, and lacosamide, while the existing chapters on major medical treatments have been comprehensively updated to reflect the latest trials and studies. [books.google.com]
Treatment of mucopolysaccharidosis type I (Hurler syndrome) is enzyme replacement with α -l-iduronidase, which effectively halts progression and reverses all non-CNS complications of the disease. [merckmanuals.com]
Food and Drug Administration has chosen Wave Life Sciences’ planned phase 2/3 study of suvodirsen, its lead experimental therapy for the treatment of Duchenne muscular dystrophy, to break new ground. [globalgenes.org]
You may also want to contact a university or tertiary medical center in your area, because these centers tend to see more complex cases and have the latest technology and treatments. [rarediseases.info.nih.gov]
In either case, the treatment that gives the child the best chance to achieve complete control of spasms is the treatment of choice. [childneurologyfoundation.org]
Prognosis
The prognosis for LGS is poor with a 5% mortality in childhood and persistent seizures into adulthood (80%–90%). [3] LGS was named for neurologists William G. [en.wikipedia.org]
Long-term prognosis of Lennox-Gastaut syndrome. Epilepsia. 1996. 37 Suppl 3:44-7. [Medline]. Ohtsuka Y, Amano R, Mizukawa M, Ohtahara S. Long-term prognosis of the Lennox-Gastaut syndrome. Jpn J Psychiatry Neurol. 1990 Jun. 44(2):257-64. [Medline]. [emedicine.medscape.com]
Long-term prognosis in childhood epilepsy: survival and seizure prognosis. Epilepsia 1987 ;28: 324 - 330 13. Berg AT, Shinnar S, Testa FM, Levy SR, Smith SN, Beckerman B. Mortality in childhood-onset epilepsy. [nejm.org]
Evolution and Prognosis Prognosis of BECTS is excellent. By the mid teenage children outgrow of the disease in 100% cases [ 45 ]. [omicsonline.org]
Peripheral Visual Fields: Prognosis: The likely outcome or course of a disease; the chance of recovery or recurrence. [childneurologyfoundation.org]
Etiology
Etiology LGS can be classified according to its suspected etiology as either idiopathic or symptomatic. [emedicine.medscape.com]
First and foremost is the underlying etiology or cause. Some etiologies will lead to death or mental retardation, whether or not the patient developed infantile spasms. [childneurologyfoundation.org]
Ataxia, X-linked Non Progressive Cerebellar Ataxia, X-linked Cerebellar Ataxia, Vitamin B12 Deficiency Ataxia, Toxic Exposure Ataxia, Unclassified Autosomal Dominant Spinocerebellar Ataxia, Thyroid Antibody Ataxia, Sporadic Adult-onset Ataxia of Unknown Etiology [crm.diseaseinfosearch.org]
Vadlamudi L, Kjeldsen MJ, Corey LA, Solaas MH, Friis ML, et al. (2006) Analyzing the etiology of benign rolandic epilepsy: a multicenter twin collaboration. Epilepsia 47: 550-555. [omicsonline.org]
Etiologic and pathogenetic aspects. Acta Paediatr Scand 1981 ; 70 : 445 –52. ↵ Khalifa MM, Struthers JL. Klinefelter syndrome is a common cause for mental retardation of unknown etiology among prepubertal males. [jnnp.bmj.com]
Epidemiology
From basic mechanisms and epidemiology, through diagnosis and therapy, to quality of life issues, the new edition of this established reference covers every aspect of childhood epilepsy and will continue to be the definitive core text for all professionals [books.google.com]
Prevalence and descriptive epidemiology of Lennox-Gastaut syndrome among Atlanta children. Epilepsia. 1997 Dec. 38(12):1283-8. [Medline]. Arzimanoglou A, French J, Blume WT, Cross JH, Ernst JP, Feucht M, et al. [emedicine.medscape.com]
Relevant External Links for CLN8 Genetic Association Database (GAD) CLN8 Human Genome Epidemiology (HuGE) Navigator CLN8 Atlas of Genetics and Cytogenetics in Oncology and Haematology: CLN8 No data available for Genatlas for CLN8 Gene Mutations in CLN7 [genecards.org]
Commission on Epidemiology and Prognosis, International League Against Epilepsy. Guidelines for epidemiologic studies on epilepsy. Epilepsia 1993 ;34: 592 - 596 24. [nejm.org]
"Prevalence and descriptive epidemiology of Lennox–Gastaut syndrome among Atlanta children". Epilepsia. 38 (12): 1283–8. doi : 10.1111/j.1528-1157.1997.tb00065.x. PMID 9578523. ^ a b c d Tyagi, Satyanand; et al. (Jul–Sep 2010). [en.wikipedia.org]
Pathophysiology
See the following articles for more information: Pathophysiology The pathophysiology of LGS is not known. No animal models exist. A variety of possible pathophysiologies have been proposed. [emedicine.medscape.com]
They can present as refractive error, strabismus, cortical visual impairment, and premature retinopathy. [9] Causes [ edit ] The disease pathophysiology is mostly unknown, but some evidence implicates cortical hyperexcitability occurring at critical periods [en.wikipedia.org]
The current review focuses on the newer advancements in the understanding of the clinical presentation & pathophysiology of BECTS, its genetics and the prognosis. [omicsonline.org]
Pathophysiology TSC1 and TSC2 function as tumor suppressor genes. TSC1 encodes the protein hamartin while TSC2 encodes the protein tuberin. Together, hamartin and tuberin form a functional complex, referred to as the TSC1/TSC2 complex. [clinicaladvisor.com]
Gaucher disease: the metabolic defect, pathophysiology, phenotypes and natural history. Pediatr Endocrinol Rev 2014; 12 (Suppl. 01) 72-81 37 Park JK, Orvisky E, Tayebi N, et al. [thieme-connect.com]
Prevention
Measures for prevention are becoming increasingly feasible. [esperanzaservices.us]
prevent transmission of disease from or to patients). [eeoc.gov]
Their function is to prevent some objectively unlikely event, often involving harm to or caused by the patient, which he or she fears might otherwise occur. [euro.who.int]
Other important prenatal (and potentially preventable) factors include maternal heroin and cocaine abuse, and HIV encephalopathy. The evidence of prenatal insult may be very subtle. [jnnp.bmj.com]
There have been advancements in understanding the genetics of BECTS, however at this point in time cannot be translated into prevention and better management. [omicsonline.org]