title: Chromosome 20 ring: a chromosomal disorder associated with a particular electroclinical pattern.
abstract: OBJECTIVE
  The chromosome 20 ring [r(20)] is a rare chromosomal disorder without clear phenotypical markers. We describe the electroclinical pattern in a group of patients with r(20).
  
  
  METHODS
  We observed 3 patients (a boy, patient 1; his mother, patient 2; and an unrelated man, patient 3), performing prolonged video-EEG and cytogenetic studies and fluorescent in situ hybridization (FISH) with chromosome-specific telomeric probes.
  
  
  RESULTS
  All 3 patients had a very similar abnormal electroclinical pattern characterized by long bursts or trains of rhythmic theta waves, which were sharply contoured or had a notched appearance (with no detectable clinical correlate), and generalized spike waves (SW) associated with seizures of probable frontotemporal origin (SFT). In all 3 patients, the cytogenetic analysis of T lymphocytes showed mosaicism with a normal cell line and a second cell line with a chromosome 20, although the latter was little represented in patients 2 and 3. A few cells with a single chromosome 20 were also found. The same cytogenetic findings were confirmed in the lymphoblastoid cell line of patient 1 and in the fibroblasts of patient 3. FISH with chromosome-specific telomeric probes and TTAGGG sequences demonstrated the integrity of the ring chromosomes.
  
  
  CONCLUSIONS
  The clinical picture of these patients appears to be related to the instability of the r(20)-generating cells monosomic for chromosome 20 and is thus haploinsufficient for a gene. In these patients, the electroclinical pattern of theta waves (probably unrelated to epilepsy) and the SW and SFT, even with mild mental retardation (MR) or no MR and without dysmorphic features, suggest that the r(20) syndrome may be present.
authors.affiliation: Centro Regionale Epilessia, Ospedale San Paolo, Università degli Studi, Milan, Italy.
authors.forename: M P
authors.initials: MP
authors.lastname: Canevini
authors.forename: V
authors.initials: V
authors.lastname: Sgro
authors.forename: O
authors.initials: O
authors.lastname: Zuffardi
authors.forename: R
authors.initials: R
authors.lastname: Canger
authors.forename: R
authors.initials: R
authors.lastname: Carrozzo
authors.forename: E
authors.initials: E
authors.lastname: Rossi
authors.forename: D
authors.initials: D
authors.lastname: Ledbetter
authors.forename: F
authors.initials: F
authors.lastname: Minicucci
authors.forename: A
authors.initials: A
authors.lastname: Vignoli
authors.forename: A
authors.initials: A
authors.lastname: Piazzini
authors.forename: L
authors.initials: L
authors.lastname: Guidolin
authors.forename: A
authors.initials: A
authors.lastname: Saltarelli
authors.forename: B
authors.initials: B
authors.lastname: dalla Bernardina
mesh_terms: D000293:Adolescent; D000328:Adult; D002869:Chromosome Aberrations / Q000175:diagnosis / Q000235:genetics; D025063:Chromosome Disorders; D002874:Chromosome Mapping; D002890:Chromosomes, Human, Pair 20 / Q000235:genetics*; D004569:Electroencephalography / Q000706:statistics & numerical data*; D004827:Epilepsy / Q000175:diagnosis / Q000235:genetics; D006801:Humans; D017403:In Situ Hybridization; D008607:Intellectual Disability / Q000235:genetics; D008297:Male; D012091:Repetitive Sequences, Nucleic Acid; D012303:Ring Chromosomes; D012640:Seizures / Q000175:diagnosis* / Q000235:genetics; D013577:Syndrome; D016615:Telomere