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Photosensitivity is an early marker of neuronal ceroid lipofuscinosis type 2 disease
Author(s) -
Specchio Nicola,
Bellusci Marcello,
Pietrafusa Nicola,
Trivisano Marina,
Palma Luca,
Vigevano Federico
Publication year - 2017
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1111/epi.13820
Subject(s) - medicine , electroencephalography , pediatrics , magnetic resonance imaging , epilepsy , age of onset , myoclonic jerk , deep brain stimulation , neuronal ceroid lipofuscinosis , batten disease , retrospective cohort study , disease , parkinson's disease , radiology , psychiatry
Summary Objective This study aimed to identify early clinical, magnetic resonance imaging ( MRI ), and electroencephalographic ( EEG ) characteristics of neuronal ceroid lipofuscinosis type 2 (CLN2) disease to enable early diagnosis, thus providing the key to early treatment, and optimized care and outcomes. Methods Retrospective clinical chart review of a series of patients diagnosed with CLN 2 disease from 2005 to 2015 at a single center in Italy. Clinical, MRI , and EEG findings were reviewed. Results A total of 14 patients were included. For the whole group, median (range) age at disease onset was 3.0 (2.0–3.8) years. Epilepsy was the most commonly reported presenting symptom (in 50% [seven of 14] of patients), occurring at the age of 3.2 (2.6–3.8) years. First seizure was myoclonic in 36% (five of 14) of patients, followed by generalized tonic–clonic in 29% (4 of 14), atonic in 22% (three of 14), and focal with motor signs in 14% (two of 14). All patients walked independently at the age of 12.0 (11.0–18.0) months, but delayed speech or regression of acquired verbal skills was present in 100% of patients at 3 years. EEG s revealed a photoparoxysmal response (PPR) on intermittent photic stimulation in 93% (13 of 14) of patients. PPR was present from the first EEG , which was performed at 3.6 (3.1–4.0) years, in 43% (six of 14) of patients; it was documented at low (1–3 Hz) stimulation frequencies in 69% (nine of 13) and took the form of a flash‐per‐flash response in 69% (nine of 13). First brain MRI at the age of 3.8 (3.0–5.1) years revealed cerebellar atrophy in 100% (14 of 14) of patients and alteration of the periventricular white matter signal in the posterior hemispheric region in 79% (11 of 14). Significance Early photosensitivity (typically PPR at low stimulation frequencies of 1–3 Hz) is a hallmark of CLN 2 disease. This diagnosis should be considered in a child presenting with any type of seizure, and particularly if it is accompanied by delayed speech and/or ataxia or MRI abnormalities (posterior white matter signal alteration or cerebellar atrophy).