A longer polyalanine expansion mutation in the ARX gene causes early infantile epileptic encephalopathy with suppression-burst pattern (Ohtahara syndrome).
Early infantile epileptic encephalopathy with suppression-burst pattern (EIEE) is one of the most severe and earliest forms of epilepsy, often evolving into West syndrome; however, the pathogenesis of EIEE remains unclear. ARX is a crucial gene for the development of interneurons in the fetal brain, and a polyalanine expansion mutation of ARX causes mental retardation and seizures, including those of West syndrome, in males. We screened the ARX mutation and found a hemizygous, de novo, 33-bp duplication in exon 2, 298_330dupGCGGCA(GCG)9, in two of three unrelated male patients with EIEE. This mutation is thought to expand the original 16 alanine residues to 27 alanine residues (A110_A111insAAAAAAAAAAA) in the first polyalanine tract of the ARX protein. Although EIEE is mainly associated with brain malformations, ARX is the first gene found to be responsible for idiopathic EIEE. Our observation that EIEE had a longer expansion of the polyalanine tract than is seen in West syndrome is consistent with the findings of earlier onset and more-severe phenotypes in EIEE than in West syndrome.
Department of Pediatrics, Yamagata University School of Medicine, Yamagata, and Nishi-Niigata Chuo National Hospital, Niigata, Japan. mkato@med.id.yamagata-u.ac.jp
Mitsuhiro
M
Kato
Shinji
S
Saitoh
Atsushi
A
Kamei
Hideaki
H
Shiraishi
Yuki
Y
Ueda
Manami
M
Akasaka
Jun
J
Tohyama
Noriyuki
N
Akasaka
Kiyoshi
K
Hayasaka
D001483:Base Sequence; D001921:Brain / Q000033:anatomy & histology; D002658:Developmental Disabilities / Q000235:genetics; D004569:Electroencephalography; D004827:Epilepsy / Q000235:genetics; D018398:Homeodomain Proteins / Q000235:genetics*; D006801:Humans; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D008969:Molecular Sequence Data; D009154:Mutation; D010455:Peptides; D013036:Spasms, Infantile / Q000235:genetics; D013577:Syndrome; D014157:Transcription Factors / Q000235:genetics*
C469264:ARX protein, human; D018398:Homeodomain Proteins; D010455:Peptides; D014157:Transcription Factors; C019529:polyalanine