Subacute Neuropsychiatric Syndrome in Girls With SHANK3 Mutations Responds to Immunomodulation.

Autor:	Bey AL; Departments of Psychiatry and Behavioral Sciences., Gorman MP; Department of Neurology, Boston Children's Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts., Gallentine W; Departments of Psychiatry and Behavioral Sciences.; Neurology, and., Kohlenberg TM; Department of Psychiatry, Medical School, University of Massachusetts, Worcester, Massachusetts; and., Frankovich J; Division of Rheumatology, Department of Pediatrics and., Jiang YH; Pediatrics and Neurobiology, and.; Genomics and Genetics Graduate Program and.; Duke Institute for Brain Sciences, Duke University, Durham, North Carolina., Van Haren K; Department of Neurology and Neurological Sciences, School of Medicine, Stanford University, Palo Alto, California kpv@stanford.edu.
Jazyk:	angličtina
Zdroj:	Pediatrics [Pediatrics] 2020 Feb; Vol. 145 (2).
DOI:	10.1542/peds.2019-1490
Abstrakt:	Phenotypic and biological characterization of rare monogenic disorders represents 1 of the most important avenues toward understanding the mechanisms of human disease. Among patients with SH3 and multiple ankyrin repeat domains 3 ( SHANK3 ) mutations, a subset will manifest neurologic regression, psychosis, and mood disorders. However, which patients will be affected, when, and why are important unresolved questions. Authors of recent studies suggest neuronal SHANK3 expression is modulated by both inflammatory and hormonal stimuli. In this case series, we describe 4 independent clinical observations of an immunotherapy responsive phenotype of peripubertal-onset neuropsychiatric regression in 4 girls with pathogenic SHANK3 mutations. Each child exhibited a history of stable, mild-to-moderate lifelong developmental disability until 12 to 14 years of age, at which time each manifested a similar, subacute-onset neurobehavioral syndrome. Symptoms included mutism, hallucinations, insomnia, inconsolable crying, obsessive-compulsive behaviors, loss of self-care, and urinary retention and/or incontinence. Symptoms were relatively refractory to antipsychotic medication but improved after immunomodulatory treatment. All 4 patients exhibited chronic relapsing courses during a period of treatment and follow-up ranging from 3 to 6 years. Two of the 4 girls recovered their premorbid level of functioning. We briefly review the scientific literature to offer a conceptual and molecular framework for understanding these clinical observations. Future clinical and translational investigations in this realm may offer insights into mechanisms and therapies bridging immune function and human behavior. Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose. (Copyright © 2020 by the American Academy of Pediatrics.)
Databáze:	MEDLINE
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