临床儿科杂志 ›› 2021, Vol. 39 ›› Issue (8): 592-.doi: 10.3969/j.issn.1000-3606.2021.08.008

• 神经系统疾病专栏 • 上一篇    下一篇

WWOX 基因变异致早发性婴儿癫痫性脑病1 例报告并文献复习

田杨, 石真, 侯池, 王秀英, 李小晶, 朱海霞, 吴文晓, 陈文雄   

  1. 广州市妇女儿童医疗中心神经内科(广东广州 510000)
  • 发布日期:2021-08-17
  • 通讯作者: 陈文雄 电子信箱:gzchcwx@126 .com

Early infantile-onset epileptic encephalopathy caused by WWOX commpound heterozygous mutation: a case report and literature review

TIAN Yang, SHI Zhen, HOU Chi, WANG Xiuying, LI Xiaojing, ZHU Haixia, WU Wenxiao, CHEN Wenxiong   

  1. Guangzhou Women and Children’s Medical Center, Guangzhou 510000 , Guangdong, China
  • Published:2021-08-17

摘要: 目的 报道早发性婴儿癫痫性脑病致病性变异。方法 收集1例早发性婴儿癫痫性脑病患儿及其家系成员 的基因检测结果,并复习相关文献。结果 先证者为男性,3月龄,反复抽搐发作1个月,表现为局灶性发作和痉挛发作; 先证者父亲、母亲表型无异常。先证者存在WWOX基因c.183C>G(p.Tyr61*)无义变异和c.178-16T>G(内含子)复合杂 合变异,前者源自母亲,后者源自父亲。上述2个变异均未见报道,根据美国遗传学和基因组学学会指南判断前者为“可能 致病”,后者为“意义未明”。给予患儿左乙拉西坦联合硝基安定口服治疗后,癫痫仍反复发作,精神及运动发育显著落后, 肌张力低下。检索到临床资料齐全的WWOX基因文献报道 22篇共64例患者,涉及30多个位点,其中复合杂合变异和纯 合变异最常见,后者多来自中东地区的近亲婚配家庭,癫痫以早期婴儿癫痫性脑病最常见。结论 WWOX基因复合杂合 变异是该婴儿癫痫性脑病的致病性变异;WWOX基因变异所致的癫痫为药物难治性。

关键词: WWOX基因; 癫痫; 脑病

Abstract: Objective To identify etiology of a child with early infantile-onset epileptic encephalopathy. Methods Clinical data of a child with early infantile-onset epileptic encephalopathy were collected. DNA was extracted from peripheral blood of the child and his parents. Whole exome sequencing and copy number variation were performed, and the result was confirmed by Sanger sequencing. The relevant literature of WWOX gene was reviewed. Result The patient was a three-monthold boy who was taken to hospital for repeated seizures in a month, manifested as multiple focal seizures and infantile spasms, and the phenotype of his parent is normal. Compound heterozygous mutaions of c.183C>G (p.Tyr61*) inherited from his mother and c.178-16T>G inherited from his father in WWOX gene were detected in the proband, which were classified as “likely pathogenic” and “uncertain”, respectively, according to the American Society for Genetics and Genomics Guidelines. After oral administration of levetiracetam combined with nitrazepam, the child still suffered from recurrent epilepsy, with serious mental and motor developmental retardation, and hypotonia. There were 22 articles in languages other than Chinese provided case data of more than 30 mutation loci in 64 patients, compound heterozygous and homozygous mutations were the two commonest, and the latter mostly coming from consanguineous families in the Middle East, who were mainly manifested as early infantile-onset epileptic encephalopathy. Conclusion The study identified a novel compound heterozygous mutation of WWOX gene in a child with early infantile-onset epileptic encephalopathy, providing basis for family genetic counseling; seizures caused by WWOX gene mutation are refractory to medicine administration.

Key words: WWOX gene; epilepsy; encephalopathy