Journal of Pediatric Epilepsy 2015; 04(03): 109-117
DOI: 10.1055/s-0035-1556734
Review Article
Georg Thieme Verlag KG Stuttgart · New York

Progressive Myoclonus Epilepsy with Adolescent Onset: Clinical Features and Diagnosis

Aimee F. Luat
1   Department of Pediatrics and Neurology, Wayne State University School of Medicine, Detroit Medical Center, Detroit, Michigan, United States
› Author Affiliations
Further Information

Publication History

25 September 2014

22 December 2014

Publication Date:
21 August 2015 (online)

Abstract

Many of the progressive epilepsy syndromes with adolescent onset are classified as progressive myoclonus epilepsies. It is a heterogenous group of epilepsy syndromes associated with seizure, myoclonus, and progressive neurologic decline. This review focuses on the different adolescent-onset progressive myoclonus epilepsies including Unverricht–Lundborg disease, Lafora disease, juvenile-onset neuronal ceroid lipofuscinosis, sialidosis (cherry-red spot myoclonus), dentatorubral–pallidoluysian atrophy, and myoclonic epilepsy and ragged-red fibers. Their clinical presentations, neurophysiologic and neuroimaging findings, genetics, pathology, and diagnosis are discussed.

 
  • References

  • 1 Marseille Consensus Group. Classification of progressive myoclonus epilepsies and related disorders. Ann Neurol 1990; 28 (1) 113-116
  • 2 Shahwan A, Farrell M, Delanty N. Progressive myoclonic epilepsies: a review of genetic and therapeutic aspects. Lancet Neurol 2005; 4 (4) 239-248
  • 3 Berg AT, Berkovic SF, Brodie MJ , et al. Revised terminology and concepts for organization of seizures and epilepsies: report of the ILAE Commission on Classification and Terminology, 2005-2009. Epilepsia 2010; 51 (4) 676-685
  • 4 de Siqueira LF. Progressive myoclonic epilepsies: review of clinical, molecular and therapeutic aspects. J Neurol 2010; 257 (10) 1612-1619
  • 5 Genton P, Malafosse A, Moulard B , et al. Progressive myoclonus epilepsies. In: Roger J, Bureau M, Dravet C, Genton P, Tassinari CA, Wolf P, , eds. Epileptic Syndromes in Infancy, Childhood and Adolescence. France: John Libbey Eurotext; 2005: 443
  • 6 Delgado-Escueta AV, Ganesh S, Yamakawa K. Advances in the genetics of progressive myoclonus epilepsy. Am J Med Genet 2001; 106 (2) 129-138
  • 7 Koskiniemi ML. Baltic myoclonus. Adv Neurol 1986; 43: 57-64
  • 8 Genton P, Michelucci R, Tassinari CA, Roger J. The Ramsay Hunt syndrome revisited: Mediterranean myoclonus versus mitochondrial encephalomyopathy with ragged-red fibers and Baltic myoclonus. Acta Neurol Scand 1990; 81 (1) 8-15
  • 9 Lehesjoki AE, Koskiniemi M, Sistonen P , et al. Localization of a gene for progressive myoclonus epilepsy to chromosome 21q22. Proc Natl Acad Sci U S A 1991; 88 (9) 3696-3699
  • 10 Kälviäinen R, Khyuppenen J, Koskenkorva P, Eriksson K, Vanninen R, Mervaala E. Clinical picture of EPM1-Unverricht-Lundborg disease. Epilepsia 2008; 49 (4) 549-556
  • 11 Pennacchio LA, Lehesjoki AE, Stone NE , et al. Mutations in the gene encoding cystatin B in progressive myoclonus epilepsy (EPM1). Science 1996; 271 (5256) 1731-1734
  • 12 Lalioti MD, Scott HS, Buresi C , et al. Dodecamer repeat expansion in cystatin B gene in progressive myoclonus epilepsy. Nature 1997; 386 (6627) 847-851
  • 13 Lafrenière RG, Rochefort DL, Chrétien N , et al. Unstable insertion in the 5′ flanking region of the cystatin B gene is the most common mutation in progressive myoclonus epilepsy type 1, EPM1. Nat Genet 1997; 15 (3) 298-302
  • 14 Michelucci RSJ, Genton P, Tassinari CA. Seizures, myoclonus and cerebellar dysfunction in progressive myoclonus epilepsies. In: Guerrini RAJ, Anderman F, Hallett M, , eds. Epilepsy and Movement Disorders. UK: Cambridge University Press; 2001: 228-229
  • 15 Karhu J, Hari R, Paetau R, Kajola M, Mervaala E. Cortical reactivity in progressive myoclonus epilepsy. Electroencephalogr Clin Neurophysiol 1994; 90 (2) 93-102
  • 16 Canafoglia L, Ciano C, Panzica F , et al. Sensorimotor cortex excitability in Unverricht-Lundborg disease and Lafora body disease. Neurology 2004; 63 (12) 2309-2315
  • 17 Mascalchi M, Michelucci R, Cosottini M , et al. Brainstem involvement in Unverricht-Lundborg disease (EPM1): an MRI and (1)H MRS study. Neurology 2002; 58 (11) 1686-1689
  • 18 Lehesjoki AE, Kälviäinen R. 2004 June 24 [Updated 2014 Nov 26]. Unverricht-Lundborg disease. In: GeneReviews at GeneTests Medical Genetics Information Resource (database online). Copyright, University of Washington, Seattle. 1997-2013. Available at http://www.ncbi.nlm.nih.gov/books/NBK1142 . Last accessed on July 24, 2014
  • 19 Nanduri AS, Kaushal N, Clusmann H, Binder DK. The maestro don Gonzalo Rodríguez-Lafora. Epilepsia 2008; 49 (6) 943-947
  • 20 Chan EM, Bulman DE, Paterson AD , et al. Genetic mapping of a new Lafora progressive myoclonus epilepsy locus (EPM2B) on 6p22. J Med Genet 2003; 40 (9) 671-675
  • 21 Serratosa JM, Delgado-Escueta AV, Posada I , et al. The gene for progressive myoclonus epilepsy of the Lafora type maps to chromosome 6q. Hum Mol Genet 1995; 4 (9) 1657-1663
  • 22 Minassian BA, Lee JR, Herbrick JA , et al. Mutations in a gene encoding a novel protein tyrosine phosphatase cause progressive myoclonus epilepsy. Nat Genet 1998; 20 (2) 171-174
  • 23 Gentry MS, Worby CA, Dixon JE. Insights into Lafora disease: malin is an E3 ubiquitin ligase that ubiquitinates and promotes the degradation of laforin. Proc Natl Acad Sci U S A 2005; 102 (24) 8501-8506
  • 24 Ganesh S, Puri R, Singh S, Mittal S, Dubey D. Recent advances in the molecular basis of Lafora's progressive myoclonus epilepsy. J Hum Genet 2006; 51 (1) 1-8
  • 25 Mittal S, Dubey D, Yamakawa K, Ganesh S. Lafora disease proteins malin and laforin are recruited to aggresomes in response to proteasomal impairment. Hum Mol Genet 2007; 16 (7) 753-762
  • 26 Singh S, Ganesh S. Lafora progressive myoclonus epilepsy: a meta-analysis of reported mutations in the first decade following the discovery of the EPM2A and NHLRC1 genes. Hum Mutat 2009; 30 (5) 715-723
  • 27 Tinuper P, Aguglia U, Pellissier JF, Gastaut H. Visual ictal phenomena in a case of Lafora disease proven by skin biopsy. Epilepsia 1983; 24 (2) 214-218
  • 28 Roger J, Pellissier JF, Bureau M, Dravet C, Revol M, Tinuper P. Early diagnosis of Lafora disease. Significance of paroxysmal visual manifestations and contribution of skin biopsy [in French]. Rev Neurol (Paris) 1983; 139 (2) 115-124
  • 29 Andrade DM, del Campo JM, Moro E, Minassian BA, Wennberg RA. Nonepileptic visual hallucinations in Lafora disease. Neurology 2005; 64 (7) 1311-1312
  • 30 Acharya JN, Satishchandra P, Asha T, Shankar SK. Lafora's disease in south India: a clinical, electrophysiologic, and pathologic study. Epilepsia 1993; 34 (3) 476-487
  • 31 Ponsford S, Pye IF, Elliot EJ. Posterior paroxysmal discharge: an aid to early diagnosis in Lafora disease. J R Soc Med 1993; 86 (10) 597-599
  • 32 Kumada S, Kubota M, Hayashi M, Uchiyama A, Kurata K, Kagamihara Y. Fixation-sensitive myoclonus in Lafora disease. Neurology 2006; 66 (10) 1574-1576
  • 33 Kobayashi K, Iyoda K, Ohtsuka Y, Ohtahara S, Yamada M. Longitudinal clinicoelectrophysiologic study of a case of Lafora disease proven by skin biopsy. Epilepsia 1990; 31 (2) 194-201
  • 34 Canafoglia L, Ciano C, Visani E , et al. Short and long interval cortical inhibition in patients with Unverricht-Lundborg and Lafora body disease. Epilepsy Res 2010; 89 (2-3) 232-237
  • 35 Monaghan TS, Delanty N. Lafora disease: epidemiology, pathophysiology and management. CNS Drugs 2010; 24 (7) 549-561
  • 36 Villanueva V, Alvarez-Linera J, Gómez-Garre P, Gutiérrez J, Serratosa JM. MRI volumetry and proton MR spectroscopy of the brain in Lafora disease. Epilepsia 2006; 47 (4) 788-792
  • 37 Jennesson M, Milh M, Villeneuve N , et al. Posterior glucose hypometabolism in Lafora disease: early and late FDG-PET assessment. Epilepsia 2010; 51 (4) 708-711
  • 38 Jansen AC, Andermann E. 2007 December 28 [Updated 2015 Jan 22]. Progressive Myoclonus Epilepsy, Lafora Type. In GeneReviews at GeneTests Medical Genetics Information Resource (database online). Copyright, University of Washington, Seattle. 1997-2013. Available at http://www.ncbi.nlm.nih.gov/books/NBK1389 . Last accessed on August 24, 2014
  • 39 Bennett MJ, Rakheja D. The neuronal ceroid-lipofuscinoses. Dev Disabil Res Rev 2013; 17 (3) 254-259
  • 40 Mole SE, Williams RE. 2001 October 10 [Updated 2013 Aug 1]. Neuronal Ceroid-Lipofuscinoses. In GeneReviews at GeneTests Medical Genetics Information Resource (database online). Copyright, University of Washington Seattle. 1997-2013. Available at http://www.ncbi.nlm.nih.gov/books/NBK1428 . Last accessed on September 20, 2014
  • 41 The International Batten Disease Consortium. Isolation of a novel gene underlying Batten disease, CLN3. Cell 1995; 82 (6) 949-957
  • 42 Cotman SL, Staropoli JF. The juvenile Batten disease protein, CLN3, and its role in regulating anterograde and retrograde post-Golgi trafficking. Clin Lipidol 2012; 7 (1) 79-91
  • 43 Lehesjoki AE, Gardiner M. Progressive myoclonus epilepsy: Unverricht-Lundborg disease and neuronal ceroid lipofuscinoses. In: Noebels JL, Avoli M, Rogawski MA, Olsen RW, Delgado-Escueta AV, , eds. Jasper's Basic Mechanisms of the Epilepsies. 4th ed. Bethesda, MD: National Center for Biotechnology Information (US); 2012. . Available at: http://www.ncbi.nlm.nih.gov/books/NBK98154/
  • 44 Margraf LR, Boriack RL, Routheut AA , et al. Tissue expression and subcellular localization of CLN3, the Batten disease protein. Mol Genet Metab 1999; 66 (4) 283-289
  • 45 Golabek AA, Kida E, Walus M, Kaczmarski W, Michalewski M, Wisniewski KE. CLN3 protein regulates lysosomal pH and alters intracellular processing of Alzheimer's amyloid-beta protein precursor and cathepsin D in human cells. Mol Genet Metab 2000; 70 (3) 203-213
  • 46 Holopainen JM, Saarikoski J, Kinnunen PK, Järvelä I. Elevated lysosomal pH in neuronal ceroid lipofuscinoses (NCLs). Eur J Biochem 2001; 268 (22) 5851-5856
  • 47 Ramirez-Montealegre D, Pearce DA. Defective lysosomal arginine transport in juvenile Batten disease. Hum Mol Genet 2005; 14 (23) 3759-3773
  • 48 Puranam KL, Guo WX, Qian WH, Nikbakht K, Boustany RM. CLN3 defines a novel antiapoptotic pathway operative in neurodegeneration and mediated by ceramide. Mol Genet Metab 1999; 66 (4) 294-308
  • 49 Andrade DM, Paton T, Turnbull J, Marshall CR, Scherer SW, Minassian BA. Mutation of the CLN6 gene in teenage-onset progressive myoclonus epilepsy. Pediatr Neurol 2012; 47 (3) 205-208
  • 50 Williams R. NCL incidence and prevalence data. In: Mole S, Williams RE, Goebel H, , eds. The Neuronal Ceroid Lipofuscinoses: Batten disease. 2nd ed. Oxford: Oxford University Press; 2011: 117
  • 51 Nielsen AK, Østergaard JR. Do females with juvenile ceroid lipofuscinosis (Batten disease) have a more severe disease course? The Danish experience. Eur J Paediatr Neurol 2013; 17 (3) 265-268
  • 52 Cialone J, Adams H, Augustine EF , et al. Females experience a more severe disease course in Batten disease. J Inherit Metab Dis 2012; 35 (3) 549-555
  • 53 Vanhanen SL, Sainio K, Lappi M, Santavuori P. EEG and evoked potentials in infantile neuronal ceroid-lipofuscinosis. Dev Med Child Neurol 1997; 39 (7) 456-463
  • 54 Binelli S, Canafoglia L, Panzica F, Pozzi A, Franceschetti S. Electroencephalographic features in a series of patients with neuronal ceroid lipofuscinoses. Neurol Sci 2000; 21 (3, Suppl): S83-S87
  • 55 Jadav RH, Sinha S, Yasha TC , et al. Clinical, electrophysiological, imaging, and ultrastructural description in 68 patients with neuronal ceroid lipofuscinoses and its subtypes. Pediatr Neurol 2014; 50 (1) 85-95
  • 56 Jadav RH, Sinha S, Yasha TC , et al. Magnetic resonance imaging in neuronal ceroid lipofuscinosis and its subtypes. Neuroradiol J 2012; 25 (6) 755-761
  • 57 Autti T, Hämäläinen J, Aberg L, Lauronen L, Tyynelä J, Van Leemput K. Thalami and corona radiata in juvenile NCL (CLN3): a voxel-based morphometric study. Eur J Neurol 2007; 14 (4) 447-450
  • 58 De Volder AG, Cirelli S, de Barsy T , et al. Neuronal ceroid-lipofuscinosis: preferential metabolic alterations in thalamus and posterior association cortex demonstrated by PET. J Neurol Neurosurg Psychiatry 1990; 53 (12) 1063-1067
  • 59 Federico A, Battistini S, Ciacci G , et al. Cherry-red spot myoclonus syndrome (type I sialidosis). Dev Neurosci 1991; 13 (4-5) 320-326
  • 60 Guazzi GC, Ghetti B, Barbieri F, Cecio A. Mycolonus epilepsy with cherry-red spot in adult: a peculiar form of mucopolysaccharidosis. (A clinical genetic, chemical and ultrastructural study). Acta Neurol (Napoli) 1973; 28 (5) 542-549
  • 61 Rapin I, Goldfischer S, Katzman R, Engel Jr. J, O'Brien JS. The cherry-red spot—myoclonus syndrome. Ann Neurol 1978; 3 (3) 234-242
  • 62 Pshezhetsky AV, Richard C, Michaud L , et al. Cloning, expression and chromosomal mapping of human lysosomal sialidase and characterization of mutations in sialidosis. Nat Genet 1997; 15 (3) 316-320
  • 63 Zupanc ML, Legros B. Progressive myoclonic epilepsy. Cerebellum 2004; 3 (3) 156-171
  • 64 Lowden JA, O'Brien JS. Sialidosis: a review of human neuraminidase deficiency. Am J Hum Genet 1979; 31 (1) 1-18
  • 65 Tobimatsu S, Fukui R, Shibasaki H, Kato M, Kuroiwa Y. Electrophysiological studies of myoclonus in sialidosis type 2. Electroencephalogr Clin Neurophysiol 1985; 60 (1) 16-22
  • 66 Rapin I. Myoclonus in neuronal storage and Lafora diseases. Adv Neurol 1986; 43: 65-85
  • 67 Canafoglia L, Franceschetti S, Uziel G , et al. Characterization of severe action myoclonus in sialidoses. Epilepsy Res 2011; 94 (1-2) 86-93
  • 68 Sekijima Y, Nakamura K, Kishida D , et al. Clinical and serial MRI findings of a sialidosis type I patient with a novel missense mutation in the NEU1 gene. Intern Med 2013; 52 (1) 119-124
  • 69 Tsuji S. Dentatorubral-pallidoluysian atrophy. Handb Clin Neurol 2012; 103: 587-594
  • 70 Tsuji S, Onodera O, Goto J, Nishizawa M ; Study Group on Ataxic Diseases. Sporadic ataxias in Japan—a population-based epidemiological study. Cerebellum 2008; 7 (2) 189-197
  • 71 Koide R, Ikeuchi T, Onodera O , et al. Unstable expansion of CAG repeat in hereditary dentatorubral-pallidoluysian atrophy (DRPLA). Nat Genet 1994; 6 (1) 9-13
  • 72 Yamada M, Wood JD, Shimohata T , et al. Widespread occurrence of intranuclear atrophin-1 accumulation in the central nervous system neurons of patients with dentatorubral-pallidoluysian atrophy. Ann Neurol 2001; 49 (1) 14-23
  • 73 Naito H, Oyanagi S. Familial myoclonus epilepsy and choreoathetosis: hereditary dentatorubral-pallidoluysian atrophy. Neurology 1982; 32 (8) 798-807
  • 74 Kasai K, Onuma T, Kato M , et al. Differences in evoked potential characteristics between DRPLA patients and patients with progressive myoclonic epilepsy: preliminary findings indicating usefulness for differential diagnosis. Epilepsy Res 1999; 37 (1) 3-11
  • 75 Koide R, Onodera O, Ikeuchi T , et al. Atrophy of the cerebellum and brainstem in dentatorubral pallidoluysian atrophy. Influence of CAG repeat size on MRI findings. Neurology 1997; 49 (6) 1605-1612
  • 76 Fukuhara N, Tokiguchi S, Shirakawa K, Tsubaki T. Myoclonus epilepsy associated with ragged-red fibres (mitochondrial abnormalities ): disease entity or a syndrome? Light-and electron-microscopic studies of two cases and review of literature. J Neurol Sci 1980; 47 (1) 117-133
  • 77 Shoffner JM, Lott MT, Lezza AM, Seibel P, Ballinger SW, Wallace DC. Myoclonic epilepsy and ragged-red fiber disease (MERRF) is associated with a mitochondrial DNA tRNA(Lys) mutation. Cell 1990; 61 (6) 931-937
  • 78 Bindoff LA, Engelsen BA. Mitochondrial diseases and epilepsy. Epilepsia 2012; 53 (Suppl. 04) 92-97
  • 79 DiMauro S, Hirano M. 2003 June 3 [Updated 2015 January 29]. Myoclonic Epilepsy Associated with Ragged Red Fibers. In: GeneReviews at GeneTests Medical Genetics Information Resource (database online). Copyright, University of Washington Seattle. 1997-2013. Available at http://www.ncbi.nlm.nih.gov/books/NBK1520/ . Last accessed on September 23, 2014
  • 80 Naumann M, Kiefer R, Toyka KV, Sommer C, Seibel P, Reichmann H. Mitochondrial dysfunction with myoclonus epilepsy and ragged-red fibers point mutation in nerve, muscle, and adipose tissue of a patient with multiple symmetric lipomatosis. Muscle Nerve 1997; 20 (7) 833-839
  • 81 So N, Berkovic S, Andermann F, Kuzniecky R, Gendron D, Quesney LF. Myoclonus epilepsy and ragged-red fibres (MERRF). 2. Electrophysiological studies and comparison with other progressive myoclonus epilepsies. Brain 1989; 112 (Pt 5) 1261-1276
  • 82 Barkovich AJ, Good WV, Koch TK, Berg BO. Mitochondrial disorders: analysis of their clinical and imaging characteristics. AJNR Am J Neuroradiol 1993; 14 (5) 1119-1137
  • 83 Chuang CS, Lo MC, Lee KW, Liu CS. Magnetic resonance spectroscopy study in basal ganglia of patients with myoclonic epilepsy with ragged-red fibers. Neurol India 2007; 55 (4) 385-387