Maas, Roeltje R, Iwanicka-Pronicka, Katarzyna, Kalkan-Ucar, Sema, Alhaddad, Bader, AlSayed, Moeenaldeen, Al-Owain, Mohammed, Al-Zaidan, Hamad I, Balasubramaniam, Shanti, Barić, Ivo, Bubshait, Dalal K, Burlina, Alberto, Christodoulou, John, Chung, Wendy K., Colombo, Roberto, Darin, Niklas, Freisinger, Peter, Garcia Silva, Maria Teresa, Grunewald, Stephanie, Haack, Tobias B., van Hasselt, Peter M, Hikmat, Omar, Hörster, Friederike, Isohanni, Pirjo, Ramzan, Khushnooda, Kovacs-Nagy, Reka, Krumina, Zita, Martin-Hernandez, Elena, Mayr, Johannes A, McClean, Patricia, Meirleir, Linda De, Naess, Karin, Ngu, Lock H, Pajdowska, Magdalena, Rahman, Shamima, Riordan, Gillian, Riley, Lisa, Roeben, Benjamin, Rutsch, Frank, Santer, Rene, Schiff, Manuel, Seders, Martine, Sequeira, Silvia, Sperl, Wolfgang, Staufner, Christian, Synofzik, Matthis, Taylor, Robert W, Trubicka, Joanna, Tsiakas, Konstantinos, Unal, Ozlem, Wassmer, Evangeline, Wedatilake, Yehani, Wolff, Toni, Prokisch, Holger, Morava, Eva, Pronicka, Ewa, Wevers, Ron A., de Brouwer, Arjan P M, Wortmann, Saskia B., Ege Üniversitesi, Reproduction and Genetics, Neurogenetics, Clinical sciences, and İç Hastalıkları
WOS: 000418389700017, PubMed ID: 29205472, Objective3-Methylglutaconic aciduria, dystonia-deafness, hepatopathy, encephalopathy, Leigh-like syndrome (MEGDHEL) syndrome is caused by biallelic variants in SERAC1. MethodsThis multicenter study addressed the course of disease for each organ system. Metabolic, neuroradiological, and genetic findings are reported. ResultsSixty-seven individuals (39 previously unreported) from 59 families were included (age range=5 days-33.4 years, median age=9 years). A total of 41 different SERAC1 variants were identified, including 20 that have not been reported before. With the exception of 2 families with a milder phenotype, all affected individuals showed a strikingly homogeneous phenotype and time course. Severe, reversible neonatal liver dysfunction and hypoglycemia were seen in >40% of all cases. Starting at a median age of 6 months, muscular hypotonia (91%) was seen, followed by progressive spasticity (82%, median onset=15 months) and dystonia (82%, 18 months). The majority of affected individuals never learned to walk (68%). Seventy-nine percent suffered hearing loss, 58% never learned to speak, and nearly all had significant intellectual disability (88%). Magnetic resonance imaging features were accordingly homogenous, with bilateral basal ganglia involvement (98%); the characteristic putaminal eye was seen in 53%. The urinary marker 3-methylglutaconic aciduria was present in virtually all patients (98%). Supportive treatment focused on spasticity and drooling, and was effective in the individuals treated; hearing aids or cochlear implants did not improve communication skills. InterpretationMEGDHEL syndrome is a progressive deafness-dystonia syndrome with frequent and reversible neonatal liver involvement and a strikingly homogenous course of disease. Ann Neurol 2017;82:1004-1015, Else Kroner-Fresenius Stiftung; German Bundesministerium fur Bildung und Forschung (BMBF)Federal Ministry of Education & Research (BMBF); Horizon2020 through the E-Rare project GENOMIT [01GM1603, 01GM1207, FWF I 2741-B26]; Vereinigung zur Forderung Padiatrischer Forschung und Fortbildung Salzburg; Wellcome Centre for Mitochondrial Research [203105/Z/16/Z]; Medical Research Council (MRC) Centre for Translational Research in Neuromuscular Disease, Mitochondrial Disease Patient Cohort (UK)Medical Research Council UK (MRC) [G0800674]; Lily Foundation; UK NHS Highly Specialised Service for Rare Mitochondrial Disorders of Adults and Children, M.S. was supported by the Else Kroner-Fresenius Stiftung" This study was supported by the German Bundesministerium fur Bildung und Forschung (BMBF) and Horizon2020 through the E-Rare project GENOMIT (01GM1603 and 01GM1207 for HP and FWF I 2741-B26 for J.A.M. J.A.M., S.B.W., W.S. were supported by the Vereinigung zur Forderung Padiatrischer Forschung und Fortbildung Salzburg. R.W.T. was supported by the Wellcome Centre for Mitochondrial Research (203105/Z/16/Z), the Medical Research Council (MRC) Centre for Translational Research in Neuromuscular Disease, Mitochondrial Disease Patient Cohort (UK) (G0800674), the Lily Foundation and the UK NHS Highly Specialised Service for Rare Mitochondrial Disorders of Adults and Children.