Early-onset seizure variant of Rett syndrome: definition of the clinical diagnostic criteria.
BACKGROUND
Rett syndrome is a severe neurodevelopmental disorder affecting almost exclusively females. Among Rett clinical variants, the early-onset seizure variant describes girls with early onset epilepsy and it is caused by mutations in CDKL5.


METHODS
Four previously reported girls and five new cases with CDKL5 mutation, ranging from 14 months to 13 years, were evaluated by two clinical geneticists, classified using a severity score system based on the evaluation of 22 different clinical signs and compared with 128 classic Rett and 25 Zappella variant MECP2-mutated patients, evaluated by the same clinical geneticists. Clinical features were compared with previously described CDKL5 mutated patients. Both the statistical and the descriptive approach have been used to delineate clinical diagnostic criteria.


RESULTS
All girls present epilepsy with onset varying from 10 days to 3 months. Patients may present different type of seizures both at onset and during the whole course of the disease; multiple seizure types may also occur in the same individual. After treatment with antiepileptic drugs patients may experience a short seizure-free period but epilepsy progressively relapses. Typical stereotypic hand movements severely affecting the ability to grasp are present. Psychomotor development is severely impaired. In the majority of cases head circumference is within the normal range both at birth and at the time of clinical examination.


CONCLUSIONS
For the practical clinical approach we propose to use six necessary and eight supportive diagnostic criteria. Epilepsy with onset between the first week and 5 months of life, hand stereotypies, as well as severe hypotonia, are included among the necessary criteria.
Artuso
R
R
Medical Genetics, Molecular Biology Department, University of Siena, Viale Bracci, 2, 53100 - Siena, Italy.
Mencarelli
M A
MA
Polli
R
R
Sartori
S
S
Ariani
F
F
Pollazzon
M
M
Marozza
A
A
Cilio
M R
MR
Specchio
N
N
Vigevano
F
F
Vecchi
M
M
Boniver
C
C
Dalla Bernardina
B
B
Parmeggiani
A
A
Buoni
S
S
Hayek
G
G
Mari
F
F
Renieri
A
A
Murgia
A
A
D000293:Adolescent; D017668:Age of Onset; D000927:Anticonvulsants / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004827:Epilepsy / Q000175:diagnosis / Q000188:drug therapy / Q000235:genetics; D005260:Female; D014644:Genetic Variation; D006257:Head / Q000473:pathology; D006801:Humans; D007223:Infant; D051783:Methyl-CpG-Binding Protein 2 / Q000235:genetics; D009123:Muscle Hypotonia / Q000175:diagnosis / Q000235:genetics; D009154:Mutation; D017346:Protein Serine-Threonine Kinases / Q000235:genetics; D015518:Rett Syndrome / Q000175:diagnosis* / Q000188:drug therapy / Q000235:genetics; D012640:Seizures / Q000175:diagnosis* / Q000188:drug therapy / Q000235:genetics; D016896:Treatment Outcome
D000927:Anticonvulsants; C497392:MECP2 protein, human; D051783:Methyl-CpG-Binding Protein 2; D017346:Protein Serine-Threonine Kinases; C114482:CDKL5 protein, human