Wednesday, May 13, 2026

Acute disseminated encephalomyelitis 2

Jamie Lynn Sigler is sharing why her son Beau is her “hero” after receiving a life-altering diagnosis nearly two years ago.

The 44-year-old mother of two shared how she is navigating life after her eldest son was diagnosed with ADEM in the upcoming Tuesday, May 12, episode of Amanda Hirsch’s Not Skinny But Not Fat podcast.

Acute disseminated encephalomyelitis (ADEM) is a rare inflammatory condition that affects the brain and spinal cord. Sigler described the condition as encephalitis.

“He got a random virus at camp and instead of his body,” the Sopranos star said of her 14-year-old in a preview clip shared exclusively with PEOPLE, adding that “lakes and camp” don’t seem to be the best mix.

“Instead of making antibodies to fight the virus, his body made dumb antibodies and attacked itself,” she explained.

Sigler shares Beau with her husband, Cutter Dykstra. The couple welcomed Beau in August 2013 and married in 2016. They are also mom and dad to his brother, Jack Adam Dykstra, who was born in January 2018.

The Mob Town actress recalled how it took approximately a week for doctors to find out what was wrong with Beau after he exhibited symptoms such as a high fever and loss of appetite. Before doctors revealed the diagnosis, Sigler said her “mother's intuition” knew all along that something wasn’t right.

“I remember when we were leaving the ER the day before we finally got admitted, they're sending us home again and my feet literally didn't want to move,” she said. “I was like, I know in my soul that there is something seriously wrong that they are missing.”

“But what finally got us admitted was when he lost the ability to urinate, and that's when they were able to really understand what was going on,” Sigler continued. “And that was the most painful and traumatic time of my life, but also a moment where I felt more love than I've ever felt and support... I kind of learned who I am and what I've become in that moment.”

The actress added that the situation helped her to become a better advocate for her son’s needs.

“Even when with the doctors, right? Like you're at their mercy,” she said. “They're saving your child's life, but also my opinion mattered. Like, I had a say in his care. I had a say in what they were doing. And he is a miracle.”

Looking back on the experience, Sigler told Hirsch, “There were times that we all thought we were going to lose him.”

She also called Beau “a fighter,” noting that the last couple of years haven't "been easy for him.”

“His recovery has been really hard,” she said, adding that it feels like he’s become a different kid since the incident.

“And that's been hard for me as a mom,” Sigler said. “It has, and I'm trying to give myself as much grace as I can through that because it's like you have this version of your kid for so long, for 10 years. Like I know who Beau is. I know him.”

During Beau’s recovery, “he was in a severe state of psychosis for a while,” before behaving as if he were “Buddy the Elf,” Sigler said.

The mother of two also said that while her eldest began seeing everything as “beautiful” and “great,” it was “a lot” and he was “bullied so much at school for it and it was really devastating.”

“But he's also my hero,” she said, adding that she placed him with a therapist who “helped us as a family remind Beau of who he is.”

Angel Saunders

https://people.com/jamie-lynn-sigler-details-life-since-son-beau-was-diagnosed-with-adem-11972014

Jamie-Lynn Sigler has learned to live with pain since being diagnosed with multiple sclerosis when she was 20 — but nothing prepared her for the kind of anguish she faced last summer when her 11-year-old son Beau was hospitalized with a rare, life-threatening autoimmune condition.

"Those were the hardest days I've ever had in my entire life," Sigler, 43, tells PEOPLE. "It was probably the most helpless I've ever been."

Their crisis began last July after her "healthy, active" son suffered a week of high fevers and headaches that culminated in his being unable to urinate. "He was screaming in pain," The Sopranos actress says.

Beau was admitted to Dell Children's Medical Center in their hometown of Austin, Texas, and diagnosed with a rare autoimmune condition known as acute disseminated encephalomyelitis, or ADEM, which causes inflammation of the central nervous system and can develop after a viral or bacterial infection.

Over the next two weeks in the hospital, "he got worse every day," Sigler says. "He lost his ability to walk, and then to talk. Then he couldn't eat or move his mouth." He lost 25 lbs. "There was nothing recognizable about my son."

Doctors put him on a 24-hour IV of epinephrine to keep him alive because the inflammation in his spine and brain prevented him from regulating his own blood pressure and heart rate. "My husband and I would look at each other like, "Is this really happening?'" Sigler says of her husband of nine years, Cutter Dykstra. "Truly, we thought he was going to die."

For more than a month, Sigler stayed at the hospital by Beau's side while Dykstra cared for their younger son, Jack, 7, and she drew upon her years of experience managing the challenges of MS.

"It was wild to watch my son have neurological issues that mirrored mine in very many ways," she says. "My experience understanding the body and inflammation and the brain helped. From 6 a.m. till 8 p.m., I was on it. I was a coach. I would speak to him and tell him he could do it." But, she says, "the nights were when I could fall apart and just be a mom and be completely heartbroken and terrified."

Sigler relied on family and friends for support, including her MeSsy podcast co-host Christina Applegate. "She was there for me in a really scary moment. We sat in prayer together."

Asking for help doesn't come easily to Sigler. "My friends joke that on my tombstone it's going to say in quotes, 'I'm fine.' But for the first time in my life I was actually able to accept help because it wasn't for me — or it didn't seem like it was for me in that moment — it was for Beau," she says. "To realize how loved and supported you are, it's something I'm going to take with me for the rest of my life."

And then, 33 days after he was admitted, Beau was able to walk out of the hospital. "The care that we received, the attention that every family receives, was unparalleled," Sigler says of Dell Children's.


At first, "we were just in a constant state of gratitude." But, she says, "there's still a road of recovery." Beau is back in school, back on his baseball team and is working with a personal trainer to regain his strength. "There's some residual things physically we deal with, and because of what he sees me deal with, he knows I understand. I know it's hard to not be able to do something that you used to be able to do."

The psychological toll of the trauma can be an even greater challenge. Although Beau doesn't remember anything from his hospitalization, "mentally he went through something profound and he's trying to figure out how to integrate that back into life and still be the 11-year-old little boy he was," Sigler says. "When you have a near-death experience, there's an intense amount of gratitude you have for life, and he constantly wants to express it, which is beautiful. He wants to go up and tell everyone he loves them and how amazing they are. But for another 11-year-old, that's not how you do things."

She's had to adjust as well. "My son is different than the 10-year-old Beau that entered the hospital in July," says Sigler. "We joke, calling him Beau 2.0. The person that's really benefited from what happened this summer is my little one, Jack, because they don't fight anymore!"

Beau is also learning guitar and has developed a love for songwriting: "It's been how he channels his emotions."

Stress can exacerbate a disease like multiple sclerosis, but Sigler says helping Beau recover has actually given her strength. "Sometimes when you take the focus off yourself and make yourself a service, your body shows up for you," says Sigler, a spokesperson for Novartis who developed a guide with the drug company to help others manage life with the degenerative neurological disease. "There's been no big fallout. I am okay. I'm not struggling physically like I think a lot of people anticipated."

And, she says, she's been inspired by watching her son. "I saw the way a body can heal, and that was something I needed to see. And I saw Beau's commitment to his healing. That's added another layer of discipline I've had for myself and my health."

Sigler, who's in the process of writing a memoir, says that as traumatic as the experience was, it "slowed our family down in such a beautiful way. We are so present with each other. There's just not a lot more we need than being at home, just the four of us."

Eileen Finan

https://people.com/jamie-lynn-sigler-fell-apart-terrified-fearing-son-was-going-to-die-exclusive-11691337

Jamie-Lynn Sigler's son Beau has finally left the hospital.

The Sopranos actress, 43, shared a heartwarming video on Instagram over the weekend of her 10-year-old son Beau “busting out” of the hospital to cheers from medical staff after being diagnosed with the rare inflammatory autoimmune disorder, acute disseminated encephalomyelitis (ADEM).

“After 33 days, we are busting out of here! My brave boy, you are a walking miracle,” Sigler wrote alongside the clip shared on Aug. 16. “The rest of this story will be Beau’s to tell, if he chooses to one day.”

“Thank you to the INCREDIBLE staff at Dells Children’s Hospital. The way you take care of your patients and the way you guide their families through the process, I just don’t have enough words,” she continued. “I’m in awe of your patience, dedication, and expertise … But, no offense ... I hope we never see you again✌️.”

“Thank you all for the love and prayers. They worked. 🙏🏻🩷,” Sigler concluded.

The preview photo of the post showed Beau standing with his back to the camera in what appeared to be a waiting room pointing to himself as a caption above him read, “Heros this way,” with an arrow pointing to the left.



In the video shared, a smiling Beau walked down the hospital corridor to loud cheers from medical staff and patients, who lined each side of the corridor as they watched him leave. At one point, the 10-year-old skipped down the hallway as he high-fived some of those cheering him on.

Following Beau's hospital exit, Sigler also reshared a post on her Instagram Stories about having a “Lifequake,” defining it as, “A significant, sudden and unexpected shift in the trajectory of your life that initially feels devastating but has the beneficial outcome of catalyzing personal growth, transformation and rebirth."

Her latest hopeful post regarding Beau comes after revealing his “nightmare” diagnosis on Instagram on Aug. 6.

“4 weeks ago, what seemed like a normal virus for our son, turned into a nightmare,” she wrote alongside a photo of her and Beau smiling at the time. “Beau has what we believe to be, ADEM.”

ADEM is an acute, rapidly progressive autoimmune disease that affects the brain and spinal cord, which is typically caused by inflammation due to a prior infection or immunization, per the National Institute of Health.

“To say this has been hard, is an understatement, and I’ve never felt more broken,” Sigler continued, adding, however, that she has also never felt more love” from her supportive friends and family, including her husband Cutter Dykstra and son Jack, 6.

Sigler shared on her MeSsy podcast with Christina Applegate that ahead of Beau being admitted to the hospital, his symptoms included having a 105-degree fever, "screaming" that his head hurt, and being unable to eat and urinate.

“It was and has been like the darkest, hardest, most f---ed up thing I’ve ever been through,” Sigler said on the podcast on Aug. 6, adding that she thought her son was "dying."

Escher Walcott

https://people.com/jamie-lynn-sigler-son-beau-leaves-hospital-after-33-days-autoimmune-disorder-diagnosis-8697978








Tuesday, May 12, 2026

Diffusional kurtosis imaging in neonatal encephalopathy

Moss HG, Yazdani M, Jensen JH, Katikaneni L, Wiest DB, Wagner CL, Jenkins DD. Neonatal encephalopathy: a diffusional kurtosis imaging analysis of white matter to assess injury severity and recovery. Pediatr Res. 2025 Oct 30. doi: 10.1038/s41390-025-04434-x. Epub ahead of print. PMID: 41168400.

Abstract

Background: Diffusional kurtosis imaging (DKI) may be more sensitive to white matter (WM) injury than diffusion tensor imaging (DTI) in infants with neonatal encephalopathy (NE) presumed from hypoxic ischemic encephalopathy (HIE). We hypothesized that DKI would differentiate encephalopathy severity, predict outcomes, and indicate treatment response.

Methods: DKI was acquired using 3 T MRI in neonates with HIE on day 4-10 following hypothermia (n = 21, HIE-C), or day 5-6 (n = 16, NVD-A) and 2-6 weeks (n = 18, NVD-R) in infants who received N-acetylcysteine and vitamin D (NVD) with hypothermia. We utilized tensor-derived diffusion metrics in generalized linear models to estimate Peabody Gross Motor, Cognitive Adaptive, Clinical Linguistic, and Auditory Milestones test scores.

Results: Mean kurtosis differentiated stage 3 and 2 encephalopathy in all cohorts. The recovery scan predicted outcomes better than the acute scan. Kurtosis metrics and Vitamin D dose were significant determinants of gross motor and cognitive scores in NVD-R group.

Conclusion: Kurtosis reflects the degree of acute CNS injury and was sensitive to treatment effects in term infants with a clinical diagnosis of HIE. Our data are consistent with prior work in adult stroke, which indicates that diffusivity and kurtosis at different stages of recovery capture distinct aspects of WM injury.

Impact: Diffusional kurtosis imaging (DKI) is an advanced diffusion MRI modality rarely applied in pediatric imaging that quantifies the complexity of water movement in white matter (WM), and which offers increased sensitivity to the severity of injury and recovery after neonatal encephalopathy due to presumed hypoxic-ischemic brain injury. We demonstrate that kurtosis in early-myelinating WM tracts differentiates the severity of neonatal encephalopathy (NE) better than diffusivity, which may have therapeutic implications. DKI provides complementary information about WM injury and recovery after NE beyond current methods, which are lacking in subjective clinical MRI assessments. DKI indicates the effect of therapeutics on WM injury in NE.

Monday, May 11, 2026

Functional neurological disorder

Courtesy of a colleague

A young woman will have both her legs surgically amputated after they bent at a 45-degree angle upwards.

Megan Dixon, 21, has been left with unbearable, constant pain for the past eight years when her legs were fixed completely straight.



Megan, who also suffers from functional neurological disorder (FND), has bewildered doctors who have not been able to find a cause of her condition.

But she says it has taken them so long to take action that her only choice left is to have them both amputated as she struggles with basic, daily tasks.

Megan, from Cambridgeshire, is fundraising for an electric wheelchair to bring back her independence post-amputation – having not walked since she was 14.

She said: “It was the hardest when I met with the amputee clinic and they said amputation was my best and only option.

“I was hoping deep down they would say there was another way.

“But this is my reality now, and I haven’t fully come to terms with it yet.”

Megan first became ill when she was 13-years-old, suffering from whooping cough and glandular fever.

A year later, she found her legs began to stop working, and she hasn’t walked since.

Megan, who was initially diagnosed with myalgic encephalomyelitis (ME), had physiotherapy, but her legs had locked straight.

She said, “From there I got worse and worse.

“I started to go into a comatose-like state. When I was 16, I stopped being able to sit up by myself, and I started to lose the ability to speak.

“My paediatrician was concerned I’d had a stroke, so I was rushed to hospital.

“I was supposed to be in for tests over four days – I came out a year and a half later.”

At Bristol Hospital, Megan lost her speech, mobility, strength, and her sight.

She was diagnosed with FND, a condition where the brain struggles to send and receive signals correctly.

She became paralysed from the neck down, needing an NG tube in her nose for feeding.

Megan said: “I could feel my bones in my legs grating together, but I kept being told the pain was in my head and it wasn’t real.

“I was silently screaming for 24-hours a day.

“When I went into a coma-like state, I had no idea what was going on. No one could wake me up.

“I could feel my bones in my legs grating together, but I kept being told the pain was in my head, and it wasn’t real,” Megan said.

“My legs were completely locked straight, and even under anaesthetic, they couldn’t bend my knees.

“My left leg had started to bend the wrong way by ten degrees.”

Meg was discharged from the children’s hospital when she turned 18 and said she was left in the community for a year, ‘with no help whatsoever’.

Doctors remained baffled as to why Megan’s legs had locked and began to bend.

She said, “I had essentially been left to rot and die in bed.

“My family complained about my care, and I was sent to a private nursing home specializing in neurological disorders.

“I was completely paralysed from the neck down, and I had to work on getting all of my functions back.

“But equally, my legs got worse and worse.

“I’d seen six different surgeons and was turned away by five.

“When I finally found a surgeon to help me, it had been so long that the damage in my knees was irreversible.

“My left knee is bent at a 45-degree angle, and my right is close behind. My only option left is amputation.”

As well as battling seizures and chronic pain, Megan said even day-to-day tasks have been extraordinarily difficult due to her legs.

She explained: “I can’t walk on my own, so I have to bum shuffle everywhere or use my wheelchair.

“Getting from the floor to the bed is absolute agony for me because of the weight and pressure through my knees.

“I have to be carried to the bed or the toilet, and simple tasks take me so much longer.”

Megan is due to have her legs amputated in August and is fundraising for an electric wheelchair and other medical equipment to give her independence back.

She added: “Despite not being able to walk since I was 14, I’ve only really been in a wheelchair since I was 19 because I spent so long bedbound or in a coma.



“I want to be able to go out with my partner, visiting the zoo, and have him by my side holding hands – as opposed to being on a day out with my carer.

“This is my last resort and my only option.”

Megan’s message of hope: “If something doesn’t feel right in your body, please listen to it and trust yourself. For six years I was dismissed, and as a result the only surgery now available to me is, regrettably, amputation.

“If you are facing amputation, I want to be honest with you—there are no words that can truly make it easier. It is a devastating and life-changing experience, and something I would never wish on anyone.

“All you can do is take it one day at a time. There will be days when it feels overwhelming, and that’s okay. Allow yourself to feel everything that comes with this journey. Struggling doesn’t mean you are weak—it means you are human.

Megan Dixon in a wheelchair with her legs bent at a 45-degree angle, with Oliver Carrick standing behind her.

“But even in the darkest moments, try to hold on to the smallest positives. Sometimes hope comes in the smallest forms: a kind word, a moment of strength, or simply getting through another day.

“Keep fighting for the life that comes after. None of us should have to face something like this, but if it leads to a future where life is a little more bearable, a little less painful, and holds more independence. Then all of this will be worth it.”

You can find Megan’s GoFundMe here.
 
Faye Mayern,

https://nypost.com/2026/05/11/lifestyle/21-year-old-to-have-legs-amputated-after-legs-locked-straight-bent-backwards/





Sunday, May 10, 2026

Neurofibromatosis 1 homozygosity

Alghamdi M, Monies D, Alsohime F, Temsah H, Almodaihsh F, Aldawasri M, Alsultan A, Alkuraya FS. Implications of mosaicism in variant interpretation: A case of a de novo homozygous NF1 variant. Eur J Med Genet. 2021 Jul;64(7):104236. doi: 10.1016/j.ejmg.2021.104236. Epub 2021 May 20. PMID: 33965620.

Abstract

Neurofibromatosis type 1 is a common multisystem autosomal dominant syndrome caused by pathogenic heterozygous variants in the neurofibromin gene (NF1). It is associated with a substantially increased cancer risk. Mosaicism for NF1 has been clinically well-established for "second hit" variants in skin lesions and tumor tissues. Here, we report on a 3-month-old boy with multiple café au lait macules (CAMs) and juvenile myelomonocytic leukemia (JMML) who was found to carry a previously established pathogenic NF1 variant (c.586+5G>A), as revealed by whole-exome sequencing. Surprisingly, however, this variant was detected in the homozygous state in the patient and was absent in the parents and siblings. Deep sequencing of this variant using blood, buccal swabs and skin samples was performed. As expected for an NF1 gene mutation promoting JMML, the variant was detected in 90.6% of the blood DNA reads, in sharp contrast to the mere 5% and 0.74% of reads in the saliva- and skin fibroblast-derived DNA, respectively. Our analysis, therefore, confirmed postzygotic origin of the variant followed by a mitotic event resulting in its homozygosity, although we could not differentiate between the possibilities of a gene conversion and mitotic crossover. Apparently de novo homozygous variants should trigger a careful investigation into mosaicism to achieve accurate interpretation.

Schinzel-Giedion syndrome

Inspired by a patient

Liu WL, He ZX, Li F, Ai R, Ma HW. Schinzel-Giedion syndrome: a novel case, review and revised diagnostic criteria. J Genet. 2018 Mar;97(1):35-46. PMID: 29666323.

Abstract

Schinzel-Giedion syndrome (SGS) is a rare autosomal dominant inheritance disorder. Heterozygous de novo mutations in the SETBP1 gene have been identified as the genetic cause of SGS. Here, we report a novel case with the syndrome with a novel insertion mutation in SETBP1. We also present a review of SGS cases, and first revise diagnostic criteria of SGS based on clinicalfindings and/or SETBP1 mutation worldwide. A revised diagnostic criteria and typing of SGS can be determined. Type I (complex and classic type) SGS patients present a development delay and typical facial features (prominent forehead, midface retraction, and short and upturned nose) associated with hydronephrosis or two of the characteristic skeletal anomalies (a sclerotic skull base, wideoccipital synchondrosis, increased cortical density or thickness, and broad ribs). Type II (middle type) patients show development delay and the distinctive facial phenotype (midface retraction, short and upturned nose), lacking both hydronephrosis and typical skeletal abnormalities, with existence of SETBP1mutation. Type III (simple type) patients with SETBP1 alteration show their major symptom is development delay, in which expressive language delay is the most striking feature. Central nervous system involvement with development delay in which expressive language delay is much more obviously affected is the most prominent feature of SGS. There is another indication that severity of phenotype of SGS may be inversely correlated with degree of SETBP1 alteration, besides gain-of-function or dominant-negative effects in SETBP1 alteration causing SGS.

Duis J, van Bon BWM. Schinzel-Giedion Syndrome. 2024 Mar 7. In: Adam MP, Bick S, Mirzaa GM, Pagon RA, Wallace SE, Amemiya A, editors. GeneReviews® [Internet]. Seattle (WA): University of Washington, Seattle; 1993–2026. PMID: 38452171.

Excerpt

Clinical characteristics: Classic Schinzel-Giedion syndrome (SGS), an ultra-rare multisystem disorder caused by gain-of-function pathogenic variants in a SETBP1 mutational hot spot, is characterized by global neurodevelopmental impairment leading to moderate-to-profound intellectual disability, epilepsy (often refractory to treatment), hypotonia, spasticity, dysautonomia, hearing loss, and cerebral visual impairment. Other findings can include poor weight gain often associated with gastroesophageal reflux disease, chronic vomiting, constipation, gastroparesis, and/or feeding intolerance. Structural malformations can involve the heart, skeleton, kidney and urinary tract, genitalia, and brain. Anomalies of the liver, spleen, and/or pancreas are less common. Other features may include neuroepithelial neoplasia, severely disrupted sleep, choanal stenosis, inguinal hernia, sensitive skin, and increased risk of infection.

To date, more than 50 individuals have been reported with molecularly confirmed classic SGS.

Atypical SGS, reported in five individuals to date, is caused by pathogenic SETBP1 variants in proximity to – but not within – the mutational hot spot. The broad spectrum of clinical features of variable severity partially overlaps with classic SGS; however, this spectrum does not include risk for neuroepithelial neoplasia to date.

Diagnosis/testing: The diagnosis of classic SGS can be established in a proband based on published clinical diagnostic criteria, or the molecular diagnosis can be established in a proband with suggestive findings and a heterozygous SETBP1 pathogenic gain-of-function variant within the mutational hot spot (i.e., a 12-base-pair region in exon 4 encoding a canonical degron). The diagnosis of atypical SGS syndrome is established in a proband with suggestive findings and a heterozygous SETBP1 pathogenic variant adjacent to – but not within – the mutational hot spot.

Management: Treatment of manifestations: There is no cure for classic or atypical SGS. Supportive treatment to improve quality of life, maximize function, and reduce complications can include multidisciplinary care by specialists in pediatrics, neurology, physiatry, occupational and physical therapy, speech-language pathology, psychiatry, ophthalmology, ENT, surgery, pulmonology, oncology, urology, nephrology, audiology, gastroenterology, orthopedics, cardiology, and medical genetics.

Surveillance: At each visit, evaluate for feeding issues (including nutritional status and safety of oral intake), gastrointestinal issues, respiratory issues, neurologic manifestations (including seizures, changes in tone, movement disorders, mood, irritability, and alertness), kidney and urinary tract manifestations, and musculoskeletal manifestations. In individuals with classic SGS, age-related surveillance for occurrence of neoplasia includes liver ultrasound and serum alpha-fetoprotein levels, renal ultrasound examination, pelvic MRI for sacrococcygeal teratoma, and monitoring for clinical signs of leukemia.

Agents/circumstances to avoid: Nephrotoxic drugs such as nonsteroidal anti-inflammatory drugs and vancomycin should be used with caution due to high frequency of chronic renal impairment from recurrent pyelonephritis and structural renal anomalies.

Genetic counseling: Classic and atypical SGS are autosomal dominant disorders typically caused by a de novo SETBP1 pathogenic variant. Rarely, individuals diagnosed with SGS have the disorder as the result of a pathogenic variant inherited from a parent. Sib recurrence of clinically defined classic SGS, presumed to be due to parental germline mosaicism, has been reported in two families. Transmission of a SETBP1 pathogenic missense variant from an unaffected parent to a child with atypical SGS has been reported in one family (of note, the possibility of mosaicism in the unaffected parent was not excluded). Once the SETBP1 pathogenic variant has been identified in an affected family member, prenatal and preimplantation genetic testing are possible.

Morison LD, Summerfield N, Bradley D, van Bon BW, Morgan AT. Schinzel-Giedion syndrome: communication, feeding and motor skills in 16 individuals. Neurogenetics. 2025 Aug 27;26(1):64. doi: 10.1007/s10048-025-00846-3. PMID: 40859069; PMCID: PMC12380911.

Abstract

Schinzel-Giedion Syndrome (SGS) is a rare neurodevelopmental disorder caused by pathogenic SETBP1 gain-of-function variants. SGS medical features have been well described. Associated skills critical to quality of life have such as communication, feeding, and motor skills are yet to be characterised. Here we used standardised caregiver report tools to characterise these skills as well as the medical features, in 16 children with SGS (median = 5 years, 7 months, range 6 months to 12.5 years). Vineland-3 scores reflected severe impairment in communication, daily living, socialisation and motor skills. Average receptive and expressive language skills were equivalent to a 0-to-1-month-old. Average motor skills were slightly stronger with age equivalents of 2-months-old for gross motor skills and 4-months for fine motor skills. 13/16 (81%) children could attend to someone's voice, and 15/16 (94%) could make happy vocalisations. One individual (6%) could follow basic instructions. Despite a relatively homogenous phenotype, some children presented with relative strengths when compared to the rest of the cohort. Our expanded phenotype of SGS allows better targeted therapies and supports, highlighting the importance of early feeding intervention and augmentative and alternative communication (e.g., assistive technology for communication). Given the severity of the SGS profile, our data highlight the need for sensitive measurement tools for detecting subtle skill changes in SGS in response to precision medicine interventions.

Friday, May 8, 2026

2q13 duplication

Inspired by a colleague's patient

Messina C, Zuccarello M. Parietal Lobe Epilepsy Associated With 2q13 Duplication: Expanding the Neurogenetic Spectrum. Cureus. 2025 Aug 19;17(8):e90456. doi: 10.7759/cureus.90456. PMID: 40979016; PMCID: PMC12444579.

Abstract

Copy number variations (CNVs) involving the 2q13 region have been associated with a wide range of phenotypes, including developmental delay, dysmorphic features, hypotonia, and congenital heart defects. However, parietal lobe epilepsy has not yet been reported in association with 2q13 duplication. We describe the case of a 20-year-old woman with a duplication of the 2q13 region identified during childhood, who later presented with recurrent, brief episodes of right upper limb paresthesia spreading to other limbs, followed by transient pain. Her past medical history included dyspraxia, polycystic ovary syndrome, atrial fibrillation, and intellectual disability. Electroencephalography (EEG) revealed interictal epileptiform discharges, consisting of paroxysmal sharp theta waves in the left parietal and temporal regions, spreading to adjacent and contralateral areas, particularly during hyperventilation. Based on clinical and EEG features, a diagnosis of parietal lobe epilepsy was established. Treatment with levetiracetam resulted in significant clinical improvement, characterized by complete resolution of the previously described episodes of recurrent, brief right upper limb paresthesia spreading to other limbs, followed by transient pain, as well as a reduction of epileptiform abnormalities on EEG. The duplicated region includes several genes involved in neuronal development, synaptic regulation, and myelination, such as MERTK, TMEM87B, and FBLN7. Their altered expression may contribute to cortical excitability and epileptogenesis. This case adds to the phenotypic variability reported in individuals with 2q13 duplication and underscores the importance of further studies to explore possible gene-specific contributions to neurological findings. This is the first report linking 2q13 duplication with parietal epilepsy, underlining the importance of considering CNVs in unexplained focal epilepsy presentations.

Digilio MC, Dentici ML, Loddo S, Laino L, Calcagni G, Genovese S, Capolino R, Bottillo I, Calvieri G, Dallapiccola B, Marino B, Novelli A, Versacci P. Congenital heart defects in the recurrent 2q13 deletion syndrome. Eur J Med Genet. 2022 Jan;65(1):104381. doi: 10.1016/j.ejmg.2021.104381. Epub 2021 Nov 8. PMID: 34763108.

Abstract

The recurrent 2q13 deletion syndrome is a rare genetic disorder associated with developmental delay, cardiac and urogenital malformations, and minor facial anomalies. Congenital heart defects (CHDs) are the most frequent malformations associated with del2q13. Experimental studies in zebrafish suggest that two genes mapping within the 2q13 critical region (FBLN7 and TMEM87B) could confer susceptibility to congenital heart defects in affected individuals. We reviewed the cardiac characteristics in four patients with 2q13 deletion admitted to our hospitals, and in published patients. Two of our patients had congenital heart defects, consisting in partial anomalous pulmonary venous connection, ostium secundum atrial septal defect ostium secundum, and small muscular ventricular septal defect in one of them, and aortic valve insufficiency with partial fusion of two commissures (incomplete bicuspid aortic valve) and mitral valve insufficiency due to trivial mitral valve prolapse in the other. The anatomic types of CHD in del2q13 syndrome are highly variable and distributed widely, including laterality defects, complex atrioventricular septal defect, septal anomalies, and cardiomyopathies. Cardiac evaluation should be part of the clinical workup at diagnosis of 2q13 deletion.

Riley KN, Catalano LM, Bernat JA, Adams SD, Martin DM, Lalani SR, Patel A, Burnside RD, Innis JW, Rudd MK. Recurrent deletions and duplications of chromosome 2q11.2 and 2q13 are associated with variable outcomes. Am J Med Genet A. 2015 Nov;167A(11):2664-73. doi: 10.1002/ajmg.a.37269. Epub 2015 Jul 31. PMID: 26227573.

Abstract

Copy number variation (CNV) in the long arm of chromosome 2 has been implicated in developmental delay (DD), intellectual disability (ID), autism spectrum disorder (ASD), congenital anomalies, and psychiatric disorders. Here we describe 14 new subjects with recurrent deletions and duplications of chromosome 2q11.2, 2q13, and 2q11.2-2q13. Though diverse phenotypes are associated with these CNVs, some common features have emerged. Subjects with 2q11.2 deletions often exhibit DD, speech delay, and attention deficit hyperactivity disorder (ADHD), whereas those with 2q11.2 duplications have DD, gastroesophageal reflux, and short stature. Congenital heart defects (CHDs), hypotonia, dysmorphic features, and abnormal head size are common in those with 2q13 deletions. In the 2q13 duplication cohort, we report dysmorphic features, DD, and abnormal head size. Two individuals with large duplications spanning 2q11.2-2q13 have dysmorphic features, hypotonia, and DD. This compilation of clinical features associated with 2q CNVs provides information that will be useful for healthcare providers and for families of affected children. However, the reduced penetrance and variable expressivity associated with these recurrent CNVs makes genetic counseling and prediction of outcomes challenging. © 2015 Wiley Periodicals, Inc.

Costain G, Lionel AC, Fu F, Stavropoulos DJ, Gazzellone MJ, Marshall CR, Scherer SW, Bassett AS. Adult neuropsychiatric expression and familial segregation of 2q13 duplications. Am J Med Genet B Neuropsychiatr Genet. 2014 Jun;165B(4):337-44. doi: 10.1002/ajmg.b.32236. Epub 2014 May 8. PMID: 24807792; PMCID: PMC4464821.

Abstract

New genomic disorders associated with large, rare, recurrent copy number variations (CNVs) are being discovered at a rapid pace. Detailed phenotyping and family studies are rare, however, as are data on adult phenotypic expression. Duplications at 2q13 were recently identified as risk factors for developmental delay/autism and reported in the prenatal setting, yet few individuals (all children) have been extensively phenotyped. During a genome-wide CNV study of schizophrenia, we identified two unrelated probands with 2q13 duplications. In this study, detailed phenotyping and genotyping using high-resolution microarrays was performed for 12 individuals across their two families. 2q13 duplications were present in six adults, and co-segregated with clinically significant later-onset neuropsychiatric disorders. Convergent lines of evidence implicated GABAminergic dysfunction. Analysis of the genic content revealed promising candidates for neuropsychiatric disease, including BCL2L11, ANAPC1, and MERTK. Intrafamilial genetic heterogeneity and "second hits" in one family may have been the consequence of assortative mating. Clinical genetic testing for the 2q13 duplication and the associated genetic counseling was well received. In summary, large rare 2q13 duplications appear to be associated with variable adult neuropsychiatric and other expression. The findings represent progress toward clinical translation of research results in schizophrenia. There are implications for other emerging genomic disorders where there is interest in lifelong expression.

Thursday, May 7, 2026

Early diagnostic changes in autism spectrum disorder

Yeom JS, Kim YS, Park JS, Park ES, Seo JH, Lim JY, Woo HO. Early Diagnostic Changes in Autism Spectrum Disorder: A Retrospective Study. Ann Child Neurol. 2026;34(2):136-143.

Abstract

Purpose
Autism spectrum disorder (ASD) exhibits heterogeneous developmental trajectories; however, longitudinal studies using the Korean Childhood Autism Rating Scale (K-CARS) are scarce. This study examined diagnostic changes and related developmental characteristics through repeated K-CARS assessments.

Methods
We retrospectively reviewed the medical records of children who underwent repeated K-CARS assessments between May 2021 and December 2024 at Gyeongsang National University Hospital. Based on diagnostic status at the initial (T1) and follow-up (T2) evaluations, participants were classified as having persistent ASD (ASD at T1 and T2), emerging ASD (non-ASD at T1 but ASD at T2), or desisting ASD (ASD at T1 but non-ASD at T2). Developmental profiles were evaluated using the social quotient (SQ), visual-motor integration (VMI), and language quotients.

Results
Forty-three children (32 boys; median age, 2.9 years at T1 and 4.3 years at T2) were included. Twenty-two met ASD criteria at T1, and 15 (68%) retained the diagnosis at T2. Across the cohort, 15 (35%) had persistent ASD, 21 (49%) had emerging ASD, and seven (16%) had desisting ASD. The desisting group showed higher baseline VMI and better outcomes at follow-up. The emerging group initially had higher SQ and VMI than the persistent group, but these differences disappeared over time. Higher baseline VMI was associated with desisting status and higher baseline SQ with emerging ASD (odds ratios, 3.14 and 2.59 per standard deviation increase, respectively; P=0.06 and P=0.07).

Conclusion
Early ASD diagnoses were generally stable yet variable, supporting repeated assessment. Baseline VMI and SQ may relate to later diagnostic changes.