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Neuroimaging Type 1 lissencephaly and multiple afebrile seizures in a 2‑month‑old baby Mithilesh Shibchurn
Department of Neurology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University Loma Linda University, China
Address for correspondence: Dr. Mithilesh Shibchurn, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University Loma Linda University, China. E‑mail:
[email protected]
Case Report A 2‑month‑old baby boy was brought to the Neurology Department following an abnormally high number of generalized seizures he experienced, both when awake and in his sleep (over 10 times per 24 h for 10 days). Each seizure lasted for 1–2 min. Upon admission, he was administered 0.25 mg/kg of intravenous (IV) diazepam. Electroencephalography test showed that this patient had an abnormal wave brain pattern (epilepsy). Five days later, we started 1.30 mg/kg/day Topamax because IV diazepam was unable to effectively control the seizures. He was a term baby from nonconsanguineous parents (father 34 and mother 32 years old) and was healthy at birth (Apgar scores of 8 and 9). None of the parents has neurological disorders. This is a good case of lissencephaly type 1 (classic type) as revealed by the patient’s brain magnetic resonance imaging (MRI) [Figure 1a‑c]. Besides, the diagnosis of lissencephaly was detected on antenatal ultrasound at 34 weeks of gestation.
known as fluorescence in situ hybridization for chromosomal testing.[1] Pinard et al. found that lissencephaly is genetically X‑linked (recurrence in siblings within the same family) or chromosome 17‑linked.[1,2] In a study by Saillour et al., conducted on a group of 63 patients, median life expectancy was found to be 6 years.[3] Prognosis of such patients is based on the severity of the brain malformation.[1] Previous researches showed that babies suffering from lissencephaly, in addition to seizures, also display mild to moderate retardation, failure to thrive, muscle spasticity, developmental delay, and slight to profound cognitive impairment.[1,2] Other symptoms may include unusual facial appearance, hands or toes malformation
Discussion Lissencephaly is a rare severe congenital cortical disorder in which abnormal organization of cortical layers occurs during embryogenesis.[1] There are two types of lissencephaly: Type 1 and type 2. Type 2 presents with the clinical features described as epileptic seizures, mental retardation, and developmental delay. This case report, however, is about type 1. To our knowledge, few cases of lissencephaly have been reported in China. Diagnosis is based on radiological images of the brain (MRI, computed tomography) or a more specialized genetic test
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DOI: 10.4103/1817-1745.159198
c Figure 1: T2-weighted magnetic resonance imaging (MRIs) of patient. Sagittal MRI (a) and axial MRI (b) showing a smooth maldeveloped, greatly thickened brain and broad distribution of gray matter throughout. Extremely diminished volume of white matter can be noticed with enlargement of lateral ventricles in c, (arrows - right 14.39 mm and left 15 mm)
2015 / Apr-Jun / Volume 10 / Journal of Pediatric Neurosciences / 123
[Downloaded free from http://www.pediatricneurosciences.com on Wednesday, November 29, 2017, IP: 118.100.75.82] Shibchurn: Type-1 lissencephaly with multiple afebrile seizures
and difficulty in swallowing.[1,2] No cure exists for lissencephaly, but supportive care like anti seizures and gastrostomy tube insertion for feeding difficulties may be provided if such complications are encountered. MRI should be performed in parents or siblings who present with epilepsy or mental retardation because it provides detailed cortical anatomy, superb gray‑white matter distinction, and thereby clearly reveals detailed structural changes of the brain.[2]
Acknowledgments I thank Dr. Lai Can for granting me access to radiological data from The Children Hospital, Zhejiang University School of Medicine. I also thank Dr. Xiaojing Yu for advising on the selection and interpretion of the radiological images from Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University Loma Linda University. I am thankful to the parents for giving me the permission to write an article about their son to be published in Journal of Pediatric Neurosciences. I, Mithilesh Shibchurn, had full access to
124 / Journal of Pediatric Neurosciences / Volume 10 / Apr-Jun / 2015
all the data in the study and take responsibility for the integrity of the data and accuracy of the data analysis.
References 1. Mokánszki A, Körhegyi I, Szabó N, Bereg E, Gergev G, Balogh E, et al. Lissencephaly and band heterotopia: LIS1, TUBA1A, and DCX mutations in Hungary. J Child Neurol 2012;27:1534‑40. 2. Pinard JM, Motte J, Chiron C, Brian R, Andermann E, Dulac O. Subcortical laminar heterotopia and lissencephaly in two families: A single X linked dominant gene. J Neurol Neurosurg Psychiatry 1994;57:914‑20. 3. Saillour Y, Carion N, Quelin C, Leger PL, Boddaert N, Elie C, et al. LIS1-related isolated lissencephaly spectrum of mutations and relationships with malformation severity. JAMA Neurol 2009;66:1007-15.
Cite this article as: Shibchurn M. Type 1 lissencephaly and multiple afebrile seizures in a 2-month-old baby. J Pediatr Neurosci 2015;10:123-4.
Source of Support: Nil. Conflict of Interest: None declared.
