title: Partial epilepsy and developmental delay in infant with ring chromosome 14.
abstract: Ring chromosome 14 (r14) is clinically characterized by early-onset epilepsy, mental retardation, delayed speech, microcephaly, extremely mild facial dysmorphisms and ophthalmologic abnormalities. We report a case presenting with partial seizures and delayed development in infancy in which r14 was diagnosed based on chromosomal analysis. The patient was a girl with a normal family and delivery history. Afebrile generalized convulsions developed at age 9 months, and phenobarbital was started, but was changed to zonisamide due to impaired liver function. Chromosome analysis led to a diagnosis of 46, XX, r(14) (p11.2q32.3). At age 5 years, while under treatment with zonisamide and clobazam, epilepsy was characterized by multiple daily episodes of complex partial seizures. Although there are no consistent brain MRI or electroencephalogram findings, experienced pediatric neurologists can make a diagnosis based on facial dysmorphisms. When refractory epilepsy is encountered in infancy with developmental delay of unknown cause, chromosome analysis should be performed.
authors.affiliation: Department of Pediatrics, Dokkyo Medical University School of Medicine, Tochigi, Japan. geo@dokkyomed.ac.jp
authors.forename: G
authors.initials: G
authors.lastname: Imataka
authors.forename: M
authors.initials: M
authors.lastname: Noguchi
authors.forename: K
authors.initials: K
authors.lastname: Tsukada
authors.forename: T
authors.initials: T
authors.lastname: Takahashi
authors.forename: H
authors.initials: H
authors.lastname: Yamanouchi
authors.forename: O
authors.initials: O
authors.lastname: Arisaka
mesh_terms: D000927:Anticonvulsants / Q000627:therapeutic use; D001569:Benzodiazepines / Q000627:therapeutic use; D002675:Child, Preschool; D025063:Chromosome Disorders / Q000175:diagnosis* / Q000235:genetics; D002883:Chromosomes, Human, Pair 14 / Q000235:genetics; D000078306:Clobazam; D002658:Developmental Disabilities / Q000175:diagnosis* / Q000235:genetics; D004828:Epilepsies, Partial / Q000175:diagnosis* / Q000188:drug therapy / Q000235:genetics; D005260:Female; D006801:Humans; D007223:Infant; D007555:Isoxazoles / Q000627:therapeutic use; D010634:Phenobarbital / Q000627:therapeutic use; D012303:Ring Chromosomes; D013577:Syndrome; D000078305:Zonisamide
chemical_list: D000927:Anticonvulsants; D007555:Isoxazoles; D001569:Benzodiazepines; D000078306:Clobazam; D000078305:Zonisamide; D010634:Phenobarbital