Kumakura Akira, Ito Masatoshi, Hata Daisuke, Oh Norifumi, Kurahashi Hirokazu, Wang Ji-wen, Hirose Shinichi
Department of Pediatrics, Kitano Hospital, The Tazuke Kofukai Medical Institute, Ohgimachi, Kita-Ku, Osaka 530-8480, Japan.
Brain Dev. 2009 Feb;31(2):179-82. doi: 10.1016/j.braindev.2008.06.001. Epub 2008 Jul 15.
This report describes a 4-year-old male patient experienced prolonged febrile seizures after 1 year of age, multiple febrile seizures and complex partial seizures with secondary generalization. The gene encoding voltage-gated sodium channel alpha1-subunit: SCN1A analysis revealed a heterozygous de novo one-point mutation (IVS16+2 T>C) at a splice-acceptor site. This mutation was inferred to cause truncation of the alpha1-subunit molecule and, thereby, a loss of channel function. To date, truncation mutation has been found exclusively in patients with severe myoclonic epilepsy in infancy (SMEI), although only missense mutations have been found in generalized epilepsy with febrile seizures plus (GEFS+), partial epilepsy with FS+, FS+, and FS. The patient's phenotype is consistent with that of partial epilepsy with FS+, rather than SMEI, including borderline SMEI (SMEB). We present the first case report of partial epilepsy with FS+ associated with a truncation mutation of SCN1A. The possibility exists for concomitant involvement of multiple genes other than SCN1A for seizure phenotypes.
本报告描述了一名4岁男性患者,1岁后出现长时间热性惊厥、多次热性惊厥以及伴有继发性全身性发作的复杂部分性发作。对编码电压门控钠通道α1亚基的基因:SCN1A进行分析,发现在剪接受体位点存在杂合性新生单点突变(IVS16+2 T>C)。据推测,该突变导致α1亚基分子截短,进而导致通道功能丧失。迄今为止,截短突变仅在婴儿严重肌阵挛性癫痫(SMEI)患者中发现,而在伴有热性惊厥附加症的全身性癫痫(GEFS+)、伴有FS+的部分性癫痫、FS+和FS中仅发现错义突变。患者的表型与伴有FS+的部分性癫痫一致,而非SMEI,包括边缘性SMEI(SMEB)。我们首次报道了伴有FS+的部分性癫痫与SCN1A截短突变相关的病例。除SCN1A外,多个基因可能同时参与癫痫发作表型的形成。