中国循证儿科杂志 ›› 2017, Vol. 12 ›› Issue (5): 368-372.

• 论著 • 上一篇    下一篇

SLC6A1基因突变致儿童失神发作1例并文献复习

张赟健,周水珍   

  1. 复旦大学附属儿科医院神经科 上海,201102
  • 收稿日期:2017-10-25 修回日期:2017-10-25 出版日期:2017-10-25 发布日期:2017-10-25
  • 通讯作者: 周水珍

SLC6A1 gene mutation in a child with absence seizures and literature review

ZHANG Yun-jian, ZHOU Shui-zhen   

  1. Department of Neurology, Children's Hospital of Fudan University, Shanghai 201102,China
  • Received:2017-10-25 Revised:2017-10-25 Online:2017-10-25 Published:2017-10-25
  • Contact: ZHOU Shui-zhen

摘要: 摘要目的:探讨SLC6A1基因突变儿童失神发作的临床特征和基因变异。方法:对2007年12月至2017年7月于复旦大学附属儿科医院神经科诊治随访的1例SLC6A1基因突变失神发作患儿的临床资料进行分析。以“SLC6A1”、“癫”及“SLC6A1”、“epilepsy”为关键词,对万方数据库、中国期刊全文数据库和Pubmed建库至2017年6月收录的论文进行检索。总结SLC6A1基因突变患儿的临床表现及基因突变特点。结果:患儿男,13岁,3岁发热时出现首次癫发作,表现为清醒时发呆、凝视伴眼睑扑动,肢体无明显抽搐,无跌倒,无尿便失禁,持续数秒缓解。后反复发作,持续数秒至数十秒,数周发作1次至1天内丛集性发作。患儿智力、运动发育迟缓,否认发育倒退,目前接受特殊教育,12岁行瑞文智力测试IQ 44。体格检查无特殊。脑电图检查背景活动正常,醒睡各期左侧颞区尖慢波发放以及广泛性3~3.5 Hz棘慢波阵发,并监测到清醒期多次典型失神发作。基因突变分析发现患儿SLC6A1基因存在杂合剪切突变c.370+1G>T,父母未检测到该变异。该位点为罕见变异,位于经典的剪切位,经MutationTaster预测为有害变异。共检索到5篇英文文献,包括本例患儿共12例(男3 例)SLC6A1基因突变者,11例患儿有失神发作,其中典型失神和眼睑肌阵挛伴失神发作各5例,1例为不典型失神;共报道10种SLC6A1基因变异,其中5个为错义突变,2个为截短突变,1个为移码突变,1个为剪切突变,1个为染色体微缺失。结论:SLC6A1基因变异为失神发作伴精神运动发育迟缓或发育倒退的病因之一。

Abstract: AbstractObjective:To explore the clinical features and genetic characteristics of patients with SLC6A1 gene mutations. Methods:The clinical data of a patient with SLC6A1 gene mutation from Children's hospital of Fudan university were collected. The related literatures were searched from Wanfang Data Service Platform, China National Knowledge Infrastructure, National Center for Biotechnology Information and Pubmed (up to June 2017) by using search terms "SLC6A1" and "epilepsy". The clinical features, electroencephalogram and treatment of the patients with SLC6A1 gene mutations were studied. Results:A boy with absence seizures and psychomotor retardation was followed up whose first attack happened at the age of 3 years. The seizures manifested as absence with eyelid flutter, with no limb convulsions and the duration varied from seconds to dozens of seconds. The seizure frequency ranged from once in several weeks to daily cluster seizures. Electroencephalogram was abnormal because of bursts of generalized 3 to 3.5 Hz spikeandwave activity. Whole exomesequencing study (trios) identified a de novo splicing mutation of c.370+1G>T in SLC6A1. It was not previously reported in public database and predicted deleterious by Mutation Taster. And this was the first case of SLC6A1 gene mutation in China. A total of twelve patients including the present case with SLC6A1 gene mutation were studied. Among them, 11 cases had absence seizures, including 5 typical absence and 5 absences with eyelid myoclonias, the other one case was atypical absence. Ten mutations were identified, including 5 missense mutations, 2 truncated mutations, 1 frameshift mutation, 1 splicing mutation and one with chromosome microdeletion.Conclusion:SLC6A1 gene mutation is one of the causes of absence seizures with mental retardation or developmental regression.