Autosomal dominant mental retardation type 5 caused by SYNGAP1 gene mutations: a report of 8 cases and literature review
WANG Xiao-Le1, TIAN Ya-Nan2, CHEN Chen1, PENG Jing1,3
.Department of Pediatrics, Xiangya Hospital of Central South University, Changsha 410008, China .Clinical Research Center for Children's Neurodevelopmental Disabilities of Hunan Province, Changsha 410008, China
Abstract Objective To summarize the clinical phenotype and genetic characteristics of children with autosomal dominant mental retardation type 5 caused by SYNGAP1 gene mutations. Methods A retrospective analysis was performed on the medical data of 8 children with autosomal dominant mental retardation type 5 caused by SYNGAP1 gene mutations who were diagnosed and treated in the Department of Pediatrics, Xiangya Hospital of Central South University. Results The mean age of onset was 9 months for the 8 children. All children had moderate-to-severe developmental delay (especially delayed language development), among whom 7 children also had seizures. Among these 8 children, 7 had novel heterozygous mutations (3 with frameshift mutations, 2 with nonsense mutations, and 2 with missense mutations) and 1 had 6p21.3 microdeletion. According to the literature review, there were 48 Chinese children with mental retardation caused by SYNGAP1 gene mutations (including the children in this study), among whom 40 had seizures, and the mean age of onset of seizures was 31.4 months. Frameshift mutations (15/48, 31%) and nonsense mutations (19/48, 40%) were relatively common in these children. In terms of treatment, among the 33 children with a history of epileptic medication, 28 (28/33, 85%) showed response to valproic acid antiepileptic treatment and 16 (16/33, 48%) achieved complete seizure control after valproic acid monotherapy or combined therapy. Conclusions Children with autosomal dominant mental retardation type 5 caused by SYNGAP1 gene mutations tend to have an early age of onset, and most of them are accompanied by seizures. These children mainly have frameshift and nonsense mutations. Valproic acid is effective for the treatment of seizures in most children.
WANG Xiao-Le,TIAN Ya-Nan,CHEN Chen et al. Autosomal dominant mental retardation type 5 caused by SYNGAP1 gene mutations: a report of 8 cases and literature review[J]. CJCP, 2023, 25(5): 489-496.
WANG Xiao-Le,TIAN Ya-Nan,CHEN Chen et al. Autosomal dominant mental retardation type 5 caused by SYNGAP1 gene mutations: a report of 8 cases and literature review[J]. CJCP, 2023, 25(5): 489-496.
Dressler A, Trimmel-Schwahofer P, Reithofer E, et al. Efficacy and tolerability of the ketogenic diet in Dravet syndrome—comparison with various standard antiepileptic drug regimen[J]. Epilepsy Res, 2015, 109: 81-89. PMID: 25524846. DOI: 10.1016/j.eplepsyres.2014.10.014.
Pei Y, Li W, Du L, et al. Novel mutation of SYNGAP1 associated with autosomal dominant mental retardation 5 in a Chinese patient[J]. Fetal Pediatr Pathol, 2018, 37(6): 400-403. PMID: 30572772. DOI: 10.1080/15513815.2018.1497113.
Mignot C, von Stülpnagel C, Nava C, et al. Genetic and neurodevelopmental spectrum of SYNGAP1-associated intellectual disability and epilepsy[J]. J Med Genet, 2016, 53(8): 511-522. PMID: 26989088. DOI: 10.1136/jmedgenet-2015-103451.
Berryer MH, Hamdan FF, Klitten LL, et al. Mutations in SYNGAP1 cause intellectual disability, autism, and a specific form of epilepsy by inducing haploinsufficiency[J]. Hum Mutat, 2013, 34(2): 385-394. PMID: 23161826. DOI: 10.1002/humu.22248.
18 Jr Holder JL, Hamdan FF, Michaud JL. SYNGAP1-Related Intellectual Disability[M]//AdamMP, MirzaaGM, PagonRA, alet. GeneReviews?[Internet]. Seattle (WA): University of Washington, Seattle, 1993-2023.
Roche Martínez A, Alonso Colmenero MI, Gomes Pereira A, et al. Reflex seizures in Rett syndrome[J]. Epileptic Disord, 2011, 13(4): 389-393. PMID: 22258043. DOI: 10.1684/epd.2011.0475.
von Stülpnagel C, Hartlieb T, Borggr?fe I, et al. Chewing induced reflex seizures ("eating epilepsy") and eye closure sensitivity as a common feature in pediatric patients with SYNGAP1 mutations: review of literature and report of 8 cases[J]. Seizure, 2019, 65: 131-137. PMID: 30685520. DOI: 10.1016/j.seizure.2018.12.020.
Lo Barco T, De Gaetano L, Santangelo E, et al. SYNGAP1-related developmental and epileptic encephalopathy: the impact on daily life[J]. Epilepsy Behav, 2022, 127: 108500. PMID: 34954508. DOI: 10.1016/j.yebeh.2021.108500.
Parker MJ, Fryer AE, Shears DJ, et al. De novo, heterozygous, loss-of-function mutations in SYNGAP1 cause a syndromic form of intellectual disability[J]. Am J Med Genet A, 2015, 167A(10): 2231-2237. PMID: 26079862. PMCID: PMC4744742. DOI: 10.1002/ajmg.a.37189.
Writzl K, Knegt AC. 6p21.3 microdeletion involving the SYNGAP1 gene in a patient with intellectual disability, seizures, and severe speech impairment[J]. Am J Med Genet A, 2013, 161A(7): 1682-1685. PMID: 23687080. DOI: 10.1002/ajmg.a.35930.
Zollino M, Gurrieri F, Orteschi D, et al. Integrated analysis of clinical signs and literature data for the diagnosis and therapy of a previously undescribed 6p21.3 deletion syndrome[J]. Eur J Hum Genet, 2011, 19(2): 239-242. PMID: 21119708. PMCID: PMC3025798. DOI: 10.1038/ejhg.2010.172.
von Stülpnagel C, Funke C, Haberl C, et al. SYNGAP1 mutation in focal and generalized epilepsy: a literature overview and a case report with special aspects of the EEG[J]. Neuropediatrics, 2015, 46(4): 287-291. PMID: 26110312. DOI: 10.1055/s-0035-1554098.
Kuchenbuch M, D'Onofrio G, Chemaly N, et al. Add-on cannabidiol significantly decreases seizures in 3 patients with SYNGAP1 developmental and epileptic encephalopathy[J]. Epilepsia Open, 2020, 5(3): 496-500. PMID: 32913957. PMCID: PMC7469777. DOI: 10.1002/epi4.12411.