Focal cortical dysplasia (FCD) represents the most common cause of drug-resistant epilepsy in adult and pediatric surgical series. However, genetic factors contributing to severe phenotypes of FCD remain unknown. We present a patient with an exceptionally rapid development of drug-resistant epilepsy evolving in super-refractory status epilepticus. We performed multiple clinical (serial EEG, MRI), biochemical (metabolic and immunological screening), genetic (WES from blood- and brain-derived DNA), and histopathological investigations. The patient presented 1 month after an uncomplicated varicella infection. MRI was negative, as well as other biochemical and immunological examinations. Whole-exome sequencing of blood-derived DNA detected a heterozygous paternally inherited variant NM_006267.4(RANBP2):c.5233A>G p.(Ile1745Val) (Chr2[GRCh37]:g.109382228A>G), a gene associated with a susceptibility to infection-induced acute necrotizing encephalopathy. No combination of anti-seizure medication led to a sustained seizure freedom and the patient warranted induction of propofol anesthesia with high-dose intravenous midazolam and continuous respiratory support that however failed to abort seizure activity. Brain biopsy revealed FCD type IIa; this finding led to the indication of an emergency right-sided hemispherotomy that rendered the patient temporarily seizure-free. Postsurgically, he remains on antiseizure medication and experiences rare nondisabling seizures. This report highlights a uniquely severe clinical course of FCD putatively modified by the RANBP2 variant. PLAIN LANGUAGE SUMMARY: We report a case summary of a patient who came to our attention for epilepsy that could not be controlled with medication. His clinical course progressed rapidly to life-threatening status epilepticus with other unusual neurological findings. Therefore, we decided to surgically remove a piece of brain tissue in order to clarify the diagnosis that showed features of a structural brain abnormality associated with severe epilepsy, the focal cortical dysplasia. Later, a genetic variant in a gene associated with another condition, was found, and we hypothesize that this genetic variant could have contributed to this severe clinical course of our patient.

• MeSH
• dítě MeSH
• DNA MeSH
• epilepsie * komplikace   MeSH
• fokální kortikální dysplazie * MeSH
• komplex proteinů jaderného póru * MeSH
• lidé MeSH
• midazolam MeSH
• molekulární chaperony * MeSH
• nemoci mozku * MeSH
• předškolní dítě MeSH
• progrese nemoci MeSH
• refrakterní epilepsie * genetika   chirurgie   MeSH
• status epilepticus * genetika   chirurgie   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Chromosomal band 17q12 is a gene-rich region flanked by segmental duplications, making the region prone to deletions and duplications via the non-allelic homologous recombination mechanism. While deletions cause a well-described disorder with a specific phenotype called renal cysts and diabetes mellitus, the phenotype caused by reciprocal duplications is less specific, primarily because of variable expressivity, and incomplete penetrance. We present an unusual family with four children carrying the 17q12 microduplication inherited from their clinically healthy mother, who was a carrier of both the duplication and, interestingly, also of an atypical deletion of the 17q12 region. The duplication was inherited from her diabetic father and the deletion from her diabetic mother who also suffered from a renal disorder. Clinical manifestations in the family were variable, but all children showed some degree of a neurodevelopmental disorder, such as epilepsy, intellectual disability, delayed speech development, or attention deficit disorder. The simultaneous occurrence of a deletion and duplication in the same chromosomal region in one family is very rare, and to our knowledge, individuals carrying both a deletion and a duplication of this region have never been described.

• MeSH
• chromozomální delece MeSH
• duplikace chromozomů genetika   MeSH
• fenotyp MeSH
• lidé MeSH
• mentální retardace * genetika   MeSH
• mnohočetné abnormality * genetika   MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika MeSH

Autoimunitní encefalitidy představují heterogenní skupinu nemocí, jejímž podkladem je postižení mozku imunitně zprostředkovanými mechanismy. Encefalitida s pozitivitou protilátek proti glutamátovým N-metyl-D-aspartát receptorům (tzv. anti-NMDAR encefalitida) je charakterizována difuzním postižením kortikálních i subkortikálních struktur. Představuje nejčastěji udávanou autoimunitní encefalitidu dospělých, která se může manifestovat i u dětí a mladistvých. Prezentované sdělení formou kazuistiky se věnuje závažnému průběhu anti-NMDAR encefalitidy u sedmnáctiletého chlapce s typickou iniciální psychiatrickou symptomatologií.

Autoimmune encephalitis represent a heterogenous group of diseases which is based on an immune response against neuronal autoantigens with production of antibodies. Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is characterised by diffused involvement of cortical and subcorticale structures and represents the most frequent type of autoimmune encephalitis in adults which can manifest also in children and adolescents. We present a case report of a seventeen-year-old boy with severe anti-NMDAR encephalitis and typical initial psychiatric symptomatology.

• MeSH
• encefalitida s protilátkami proti NMDA receptorům * diagnóza   terapie   MeSH
• hormony kůry nadledvin terapeutické užití   MeSH
• intravenózní imunoglobuliny terapeutické užití   MeSH
• lidé MeSH
• mladiství MeSH
• neurozobrazování metody   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH