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Unusual 4p16.3 deletions suggest an additional chromosome region for the Wolf-Hirschhorn syndrome-associated seizures disorder.
[wolf-hirschhorn syndrome]
Seizure
disorder
is
one
of
the
most
relevant
clinical
manifestations
in
Wolf-
Hirschhorn
syndrome
(
WHS
)
and
it
acts
as
independent
prognostic
factor
for
the
severity
of
intellectual
disability
(
ID
)
.
LETM
1
,
encoding
a
mitochondrial
protein
playing
a
role
in
K
(
+
)
/
H
(
+
)
exchange
and
in
Ca
(
2
+
)
homeostasis
,
is
currently
considered
the
major
candidate
gene
.
However
,
whether
haploinsufficiency
limited
to
LETM
1
is
enough
to
cause
epilepsy
is
still
unclear
.
The
main
purpose
of
the
present
research
is
to
define
the
4
p
chromosome
regions
where
genes
for
seizures
reside
.
Comparison
of
our
three
unusual
4
p
16
.
3
deletions
with
13
literature
reports
.
Array-comparative
genomic
hybridization
(
a-
CGH
)
.
Real-time
polymerase
chain
reaction
(
RT-PCR
)
on
messanger
RNA
(
mRNA
)
of
LETM
1
and
CPLX
1
.
Direct
sequencing
of
LETM
1
.
Three
unusual
4
p
16
.
3
deletions
were
detected
by
array-
CGH
in
absence
of
a
obvious
clinical
diagnosis
of
WHS
.
Two
of
these
,
encompassing
LETM
1
,
were
found
in
subjects
who
never
had
seizures
.
The
deletions
were
interstitial
,
spanning
1
.
1
Mb
with
preservation
of
the
terminal
1
.
77
Mb
region
in
one
case
and
0
.
84
Mb
with
preservation
of
the
terminal
1
.
07
Mb
region
in
the
other
.
The
other
deletion
was
terminal
,
affecting
a
0
.
564
Mb
segment
,
with
preservation
of
LETM
1
,
and
it
was
associated
with
seizures
and
learning
difficulties
.
Upon
evaluating
our
patients
along
with
literature
reports
,
we
noted
that
six
of
eight
subjects
with
terminal
4
p
deletions
preserving
LETM
1
had
seizures
,
whereas
seven
of
seven
with
interstitial
deletions
including
LETM
1
and
preserving
the
terminal
1
Mb
region
on
4
p
did
not
.
An
additional
chromosome
region
for
seizures
is
suggested
,
falling
within
the
terminal
1
.
5
Mb
on
4
p
,
not
including
LETM
1
.
We
consider
that
haploinsufficiency
not
limited
to
LETM
1
but
including
other
genes
acts
as
a
risk
factor
for
the
WHS-associated
seizure
disorder
,
according
to
a
comorbidity
model
of
pathogenesis
.
Additional
candidate
genes
reside
in
the
terminal
1
.
5
Mb
region
on
4
p
,
most
likely
distal
to
LETM
1
.
A
PowerPoint
slide
summarizing
this
article
is
available
for
download
in
the
Supporting
Information
section
here
.
Diseases
Validation
Diseases presenting
"epilepsy"
symptom
22q11.2 deletion syndrome
adrenomyeloneuropathy
alexander disease
canavan disease
classical phenylketonuria
cohen syndrome
cowden syndrome
familial hypocalciuric hypercalcemia
gm1 gangliosidosis
hereditary cerebral hemorrhage with amyloidosis
hirschsprung disease
homocystinuria without methylmalonic aciduria
kabuki syndrome
locked-in syndrome
lymphangioleiomyomatosis
monosomy 21
neonatal adrenoleukodystrophy
pendred syndrome
phenylketonuria
proteus syndrome
pyruvate dehydrogenase deficiency
sneddon syndrome
wolf-hirschhorn syndrome
zellweger syndrome
This symptom has already been validated