Dystonia in children and adolescents: a systematic review and a new diagnostic algorithm.
Early aetiological diagnosis is of paramount importance for childhood dystonia because some of the possible underlying conditions are treatable. Numerous genetic and non-genetic causes have been reported, and diagnostic workup is often challenging, time consuming and costly. Recently, a paradigm shift has occurred in molecular genetic diagnostics, with next-generation sequencing techniques now allowing us to analyse hundreds of genes simultaneously. To ensure that patients benefit from these new techniques, adaptation of current diagnostic strategies is needed. On the basis of a systematic literature review of dystonia with onset in childhood or adolescence, we propose a novel diagnostic strategy with the aim of helping clinicians determine which patients may benefit by applying these new genetic techniques and which patients first require other investigations. We also provide an up-to-date list of candidate genes for a dystonia gene panel, based on a detailed literature search up to 20 October 2014. While new genetic techniques are certainly not a panacea, possible advantages of our proposed strategy include earlier diagnosis and avoidance of unnecessary investigations. It will therefore shorten the time of uncertainty for patients and their families awaiting a definite diagnosis.
University of Groningen, University Medical Center Groningen, Department of Neurology, Groningen, The Netherlands.
Martje E
http://orcid.org/0000-0003-2648-6937
ME
van Egmond
University of Groningen, University Medical Center Groningen, Department of Neurology, Groningen, The Netherlands.
Anouk
A
Kuiper
University of Groningen, University Medical Center Groningen, Department of Neurology, Groningen, The Netherlands.
Hendriekje
H
Eggink
University of Groningen, University Medical Center Groningen, Department of Genetics, Groningen, The Netherlands.
Richard J
RJ
Sinke
University of Groningen, University Medical Center Groningen, Department of Neurology, Groningen, The Netherlands.
Oebele F
OF
Brouwer
University of Groningen, University Medical Center Groningen, Department of Genetics, Groningen, The Netherlands.
Corien C
CC
Verschuuren-Bemelmans
University of Groningen, University Medical Center Groningen, Department of Pediatrics, Groningen, The Netherlands.
Deborah A
DA
Sival
University of Groningen, University Medical Center Groningen, Department of Neurology, Groningen, The Netherlands.
Marina A J
MA
Tijssen
University of Groningen, University Medical Center Groningen, Department of Genetics, Groningen, The Netherlands University of Groningen, University Medical Center Groningen, Department of Pediatrics, Groningen, The Netherlands.
Tom J
TJ
de Koning
D000293:Adolescent; D000465:Algorithms; D002648:Child; D003661:Decision Support Techniques; D003937:Diagnosis, Differential; D004421:Dystonia / Q000145:classification / Q000175:diagnosis* / Q000209:etiology / Q000235:genetics; D005820:Genetic Testing; D006801:Humans
DYSTONIA; GENETICS