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WOS: 000481590200024, PubMed ID: 31427717, Rett syndrome (RTT) is a severe neurological disorder usually caused by mutations in the MECP2 gene. Since the MECP2 gene is located on the X chromosome, X chromosome inactivation (XCI) could play a role in the wide range of phenotypic variation of RTT patients; however, classical methylation-based protocols to evaluate XCI could not determine whether the preferentially inactivated X chromosome carried the mutant or the wild-type allele. Therefore, we developed an allele-specific methylation-based assay to evaluate methylation at the loci of several recurrent MECP2 mutations. We analyzed the XCI patterns in the blood of 174 RTT patients, but we did not find a clear correlation between XCI and the clinical presentation. We also compared XCI in blood and brain cortex samples of two patients and found differences between XCI patterns in these tissues. However, RTT mainly being a neurological disease complicates the establishment of a correlation between the XCI in blood and the clinical presentation of the patients. Furthermore, we analyzed MECP2 transcript levels and found differences from the expected levels according to XCI. Many factors other than XCI could affect the RTT phenotype, which in combination could influence the clinical presentation of RTT patients to a greater extent than slight variations in the XCI pattern., Spanish Ministry of Health (Instituto de Salud Carlos III/FEDER) [PI15/01159]; Crowdfunding program PRECIPITA, from the Spanish Ministry of Health (Fundacion Espanola para la Ciencia y la Tecnologia); Catalan Association for Rett Syndrome; Fondobiorett; Mi Princesa Rett, We thank all patients and their families who contributed to this study. The work was supported by grants from the Spanish Ministry of Health (Instituto de Salud Carlos III/FEDER, PI15/01159); Crowdfunding program PRECIPITA, from the Spanish Ministry of Health (Fundacion Espanola para la Ciencia y la Tecnologia); the Catalan Association for Rett Syndrome; Fondobiorett and Mi Princesa Rett.

Background. Mutations in hepatocyte nuclear factor 1B (HNF1B) have been associated with congenital anomalies of the kidney and urinary tract (CAKUT) in humans. Diabetes and other less frequent anomalies have also been described. Variable penetrance and intrafamilial variability have been demonstrated including severe prenatal phenotypes. Thus, it is important to differentiate this entity from others with similar clinical features and perform confirmatory molecular diagnosis. Methods. This study reports the results of HNF1B screening in a cohort of 60 patients from 58 unrelated families presenting with renal structural anomalies and/or non-immune glucose metabolism alterations, and other minor features suggesting HNF1B mutations. Results. This study identified a pathogenic variant in 23 patients from 21 families. The most frequent finding was bilateral cystic dysplasia or hyperechogenic kidneys (87% of patients). Sixty percent of them also fulfilled the criteria for impaired glucose metabolism, and these were significantly older than those patients with an HNF1B mutation but without diabetes or prediabetes (14.4 versus 3.3 years, P < 0.05). Furthermore, patients with HNF1B mutations had higher frequency of pancreatic structural anomalies and hypomagnesaemia than patients without mutations (P < 0.001 and P = 0.003, respectively). Hyperuricaemia and increased liver enzymes were detected in some patients as well. Conclusions. Renal anomalies found in patients with HNF1B mutations are frequently unspecific and may resemble those found in other renal pathologies (CAKUT, ciliopathies). Active searching for extrarenal minor features, especially pancreatic structural anomalies or hypomagnesaemia, could support the indication for molecular diagnosis to identify HNF1B mutations.

Rett syndrome (RTT) is an early-onset neurodevelopmental disorder that almost exclusively affects girls and is totally disabling. Three genes have been identified that cause RTT: MECP2, CDKL5 and FOXG1. However, the etiology of some of RTT patients still remains unknown. Recently, next generation sequencing (NGS) has promoted genetic diagnoses because of the quickness and affordability of the method. To evaluate the usefulness of NGS in genetic diagnosis, we present the genetic study of RTT-like patients using different techniques based on this technology. We studied 1577 patients with RTT-like clinical diagnoses and reviewed patients who were previously studied and thought to have RTT genes by Sanger sequencing. Genetically, 477 of 1577 patients with a RTT-like suspicion have been diagnosed. Positive results were found in 30% by Sanger sequencing, 23% with a custom panel, 24% with a commercial panel and 32% with whole exome sequencing. A genetic study using NGS allows the study of a larger number of genes associated with RTT-like symptoms simultaneously, providing genetic study of a wider group of patients as well as significantly reducing the response time and cost of the study.

Levetiracetam (LEV) is the latest drug approved in the European Union for use in polytherapy in children over 4 years of age with partial epileptic seizures that are resistant to other antiepileptic drugs. AIM. To report our experience of associating LEV in children with medication resistant epileptic seizures.We conducted an open, observational, respective study involving 133 children with refractory epilepsies: 106 with focal seizures and 27 with other types of seizures. LEV was associated over a period of more than 6 months and we evaluated its repercussion on the frequency of the seizures and the side effects related to the drug.With average doses of LEV of 1,192 +/- 749 mg/day the frequency of the seizures was reduced by over 50% in 58.6% of cases and seizures were quelled in 15.8% of patients. Side effects were produced in 27.8% of cases, and were usually transient or tolerable; these effects led to withdrawal of LEV in only eight cases (6.02%). In 37 children (27.8%), their relatives noted an improvement in their social behaviour and cognitive abilities.a) LEV is an effective drug that is well tolerated in children with refractory epilepsy; b) Its effectiveness in different types of seizures indicates a broad therapeutic spectrum; and c) LEV can even condition favourable secondary effects, a circumstance that has been reported only exceptionally in the case of other antiepileptic drugs.

Limb Girdle Muscular Dystrophy type 2I (LGMD2I) is an autosomal recessive muscular dystrophy caused by mutations in the Fukutin Related Protein(FKRP). This gene is located at 19q13.3 and contains four exons. Immunohistochemical analysis is not possible to date because no specific antibodies have been isolated. Thus, mutational analysis is the method to obtain an accurate molecular diagnosis of the disease. The aim of this work is: 1) to diagnose the patients with clinical features suggesting LGMD2I, 2) to observe the frequency of this pathology in these two populations and, 3) to offer genetic counselling to the affected families. We studied 60 Spanish and 10 Croatian patients presenting a LGMD2I phenotype and in whom we previously excluded a dystrophinopathy, LGMD2A, LGMD2C and LGMD2D. The molecular study was performed following two steps: 1) The analysis of the L276L mutation reccurrent in North European population) by restriction enzyme analysis. 2)The sequencing of the unique coding exon 4. We found four missens mutations in seven patients: E55Q, R143S, L276L and G373S, two of them were novel mutations: E55Q and g373S. Their pathogenia were demonstrate analysing 50 chromosomes from normal controls and 50 chromosomes from other myopathy patients. The L276L mutation was identified in four patients (3Spanish and 1 Croatian) and should be considered the more frequent FKRP mutation in the population studied. The low number of FKRP mutations identified despite the patients were very well classified could indicate the low frequency of LGMD2I in these two populations.

To determine the reliability of squatting jumps (SJ), counter-movement jumps (CMJ) and drop jumps (DJ) tests, as well as the reliability of the optimal dropping height during drop jumping.Jumping performance was assessed in 8 male and 9 female physical education students. Their age, weight and height (mean +/- SD) were 23.9 +/- 2.1 years, 72.0 +/- 12.1 kg, 174.3 +/- 10.4 cm, and 23.1 +/- 2.0 years, 54.8 +/- 4.9 kg, 160.1 +/- 5.0 cm for the males and females, respectively. The jumping performance was determined on six different testing days. On each testing day, squatting jumps (SJ) and counter-movement jumps (CMJ) were performed as well as drop jumps (DJ) from heights between 20 and 100 cm. The dropping height given the maximum attained height was registered as the optimal dropping height (ODH). After a 15 min rest period, a 30 sec hopping test (HT) was performed and the mean height attained (MHT) as well as the number of jumps executed (NHT) were recorded. The height attained was computed from the flight time, which was measured with a digital timer (+/- 0.001 sec) connected to a resistive platform.The pooled coefficients of variation in percentage were 5.4 (SJ), 6.3 (CMJ), 6.2 (DJ), 31.9 (ODH), 3.1 (NHT) and 6.7 (MHT). A parabolic relationship between dropping height and attained height was found (r = 0.39-0.43, p0.001). The ODH was 48.2 +/- 14.0 cm and 62.9 +/- 21.3 cm for females and males, respectively (p0.05). Multiple regression analysis showed than ODH can be predicted from the SJ with a standard error of 9 cm.The variability of the assessment of jumping performance is similar to that reported for other variables used in the assessment of physical fitness. In contrast, the assessment of the optimal dropping height is less reliable.

Glutaryl-CoA dehydrogenase (GCDH) deficiency causes glutaric aciduria type I (GA I), an inborn error of metabolism that is characterized clinically by dystonia and dyskinesia and pathologically by neural degeneration of the caudate and putamen. Studies of metabolite excretion allowed us to categorize 43 GA I Spanish patients into two groups: group 1 (26 patients), those presenting with high excretion of both glutarate and 3-hydroxyglutarate, and group 2 (17 patients), those who might not be detected by routine urine organic acid analysis because glutarate might be normal and 3-hydroxyglutarate only slightly higher than controls. Single-strand conformation polymorphism (SSCP) screening and sequence analysis of the 11 exons and the corresponding intron boundaries of the GCDH gene allowed us to identify 13 novel and 10 previously described mutations. The most frequent mutations in group 1 were A293T and R402W with an allele frequency of 30% and 28%, respectively. These two mutations were also found in group 2, but always in heterozygosity, in particular in combination with mutations V400M or R227P. Interestingly, mutations V400M and R227P were only found in group 2, and at least one of these mutations was found in 11 of 15 unrelated alleles, accounting together for 53% of the mutant alleles in group 2. Therefore, it seems clear that two genetically and biochemically distinct groups of patients exist. The severity of the clinical phenotype seems to be closely linked to the development of encephalopathic crises rather than to residual enzyme activity or genotype. Comparison of GCDH protein with other acyl-CoA dehydrogenases (whose x-ray crystal structure has been determined) reveals that most of the mutations identified in GCDH protein seem to affect folding and tetramerization, as has been described for a number of mutations affecting mitochondrial beta-oxidation acyl-CoA dehydrogenases.

Rett syndrome was described in 1966 and became known through the English medical literature in 1983. There are typical and atypical forms. The objective of this study was to record the cases diagnosed in Spain and discover their clinical characteristics in order to describe its phenotype and geographical distribution.

Introduccion. El levetiracetam (LEV) es el ultimo farmaco aprobado en la Union Europea para su utilizacion en politerapia en ninos mayores de 4 anos con crisis epilepticas parciales rebeldes a otros antiepilepticos. Objetivo. Referir nuestra experiencia al asociar LEV en ninos con crisis epilepticas farmacorresistentes. Pacientes y metodos. Estudio abierto, observacional, retrospectivo, de 133 ninos con epilepsias refractarias, 106 con crisis focales y 27 con otros tipos de crisis, asociando LEV durante mas de 6 meses, valorando su repercusion en la frecuencia de crisis y los efectos secundarios relacionados con el farmaco. Resultados. Con dosis medias de LEV de 1.192 ± 749 mg/dia se ha reducido mas de un 50% la frecuencia de las crisis en el 58,6% de los casos y se han suprimido las crisis en el 15,8% de los pacientes. Se han producido efectos adversos en el 27,8% de los casos, habitualmente transitorios o tolerables; estos efectos motivaron la supresion del LEV solo en ocho casos (6,02%). En 37 ninos (27,8%) los familiares apreciaron una mejoria de la conducta social y de las habilidades cognitivas. Conclusiones. a) El LEV es un farmaco eficaz y bien tolerado en ninos con epilepsias refractarias; b) Su eficacia en diversos tipos de crisis denota un espectro terapeutico amplio; y c) El LEV puede incluso condicionar efectos secundarios favorables, circunstancia referida excepcionalmente en otros antiepilepticos.