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Perisylvian polymicrogyria

MedGen UID:
481305
Concept ID:
C3279675
Disease or Syndrome; Finding
Synonyms: Polymicrogyria, frontoparietal; Polymicrogyria, perisylvian
 
HPO: HP:0012650

Definition

Polymicrogyria (an excessive number of small gyri or convolutions) that is maximal in perisylvian regions (the regions that surround the Sylvian fissures), which may be symmetric or asymmetric and may extend beyond perisylvian regions. The Sylvian fissures often extend posteriorly and superiorly. [from HPO]

Term Hierarchy

Conditions with this feature

Warburg micro syndrome 1
MedGen UID:
333142
Concept ID:
C1838625
Disease or Syndrome
RAB18 deficiency is the molecular deficit underlying both Warburg micro syndrome (characterized by eye, nervous system, and endocrine abnormalities) and Martsolf syndrome (characterized by similar – but milder – findings). To date Warburg micro syndrome comprises >96% of reported individuals with genetically defined RAB18 deficiency. The hallmark ophthalmologic findings are bilateral congenital cataracts, usually accompanied by microphthalmia, microcornea (diameter <10), and small atonic pupils. Poor vision despite early cataract surgery likely results from progressive optic atrophy and cortical visual impairment. Individuals with Warburg micro syndrome have severe to profound intellectual disability (ID); those with Martsolf syndrome have mild to moderate ID. Some individuals with RAB18 deficiency also have epilepsy. In Warburg micro syndrome, a progressive ascending spastic paraplegia typically begins with spastic diplegia and contractures during the first year, followed by upper-limb involvement leading to spastic quadriplegia after about age five years, often eventually causing breathing difficulties. In Martsolf syndrome infantile hypotonia is followed primarily by slowly progressive lower-limb spasticity. Hypogonadism – when present – manifests in both syndromes, in males as micropenis and/or cryptorchidism and in females as hypoplastic labia minora, clitoral hypoplasia, and small introitus.
Bilateral frontoparietal polymicrogyria
MedGen UID:
376107
Concept ID:
C1847352
Disease or Syndrome
Complex cortical dysplasia with other brain malformations-14A (CDCBM14A) is an autosomal recessive neurologic disorder characterized by global developmental delay with impaired intellectual development, motor delay, poor speech development, and early-onset seizures, often focal or atypical absence. Additional features may include strabismus, nystagmus, exo- or esotropia, axial hypotonia, and spasticity. Brain imaging shows bilateral frontoparietal polymicrogyria, a frontal-predominant cobblestone malformation of the cortex, scalloping of the cortical/white matter junction, enlarged ventricles, and hypoplasia of the pons, brainstem, and cerebellum. The disorder can be classified as a malformation of cortical development (summary by Parrini et al., 2009; Luo et al., 2011; Zulfiqar et al., 2021). For a discussion of genetic heterogeneity of CDCBM, see CDCBM1 (614039).
Spondyloepimetaphyseal dysplasia, Genevieve type
MedGen UID:
355314
Concept ID:
C1864872
Disease or Syndrome
Spondyloepiphyseal dysplasia of the Genevieve type (SEMDG) is characterized by infantile-onset severe developmental delay and skeletal dysplasia, including short stature, premature carpal ossification, platyspondyly, longitudinal metaphyseal striations, and small epiphyses (summary by van Karnebeek et al., 2016).
Warburg micro syndrome 4
MedGen UID:
816595
Concept ID:
C3810265
Disease or Syndrome
RAB18 deficiency is the molecular deficit underlying both Warburg micro syndrome (characterized by eye, nervous system, and endocrine abnormalities) and Martsolf syndrome (characterized by similar – but milder – findings). To date Warburg micro syndrome comprises >96% of reported individuals with genetically defined RAB18 deficiency. The hallmark ophthalmologic findings are bilateral congenital cataracts, usually accompanied by microphthalmia, microcornea (diameter <10), and small atonic pupils. Poor vision despite early cataract surgery likely results from progressive optic atrophy and cortical visual impairment. Individuals with Warburg micro syndrome have severe to profound intellectual disability (ID); those with Martsolf syndrome have mild to moderate ID. Some individuals with RAB18 deficiency also have epilepsy. In Warburg micro syndrome, a progressive ascending spastic paraplegia typically begins with spastic diplegia and contractures during the first year, followed by upper-limb involvement leading to spastic quadriplegia after about age five years, often eventually causing breathing difficulties. In Martsolf syndrome infantile hypotonia is followed primarily by slowly progressive lower-limb spasticity. Hypogonadism – when present – manifests in both syndromes, in males as micropenis and/or cryptorchidism and in females as hypoplastic labia minora, clitoral hypoplasia, and small introitus.
Proximal myopathy with extrapyramidal signs
MedGen UID:
816615
Concept ID:
C3810285
Disease or Syndrome
Myopathy with extrapyramidal signs is an autosomal recessive disorder characterized by early childhood onset of proximal muscle weakness and learning disabilities. While the muscle weakness is static, most patients develop progressive extrapyramidal signs that may become disabling (summary by Logan et al., 2014). Brain MRI in 1 patient showed congenital malformations, including polymicrogyria and cerebellar dysplasia (Wilton et al., 2020).
Polymicrogyria, bilateral perisylvian, autosomal recessive
MedGen UID:
816735
Concept ID:
C3810405
Disease or Syndrome
Complex cortical dysplasia with other brain malformations-14B (CDCBM14B) is an autosomal recessive disorder characterized by strikingly restricted polymicrogyria limited to the cortex surrounding the Sylvian fissure. Affected individuals have variable intellectual and language difficulty and seizures, but no motor disability (Bae et al., 2014). For a discussion of genetic heterogeneity of CDCBM, see CDCBM1 (614039).
Macrocephaly-intellectual disability-neurodevelopmental disorder-small thorax syndrome
MedGen UID:
899689
Concept ID:
C4225259
Disease or Syndrome
Smith-Kingsmore syndrome (SKS) is a rare autosomal dominant syndromic intellectual disability syndrome characterized by macrocephaly, seizures, umbilical hernia, and facial dysmorphic features including frontal bossing, midface hypoplasia, small chin, hypertelorism with downslanting palpebral fissures, depressed nasal bridge, smooth philtrum, and thin upper lip (Smith et al., 2013; Baynam et al., 2015).
Polymicrogyria, perisylvian, with cerebellar hypoplasia and arthrogryposis
MedGen UID:
899982
Concept ID:
C4225295
Disease or Syndrome
PI4KA-related disorder is a clinically variable disorder characterized primarily by neurologic dysfunction (limb spasticity, developmental delay, intellectual disability, seizures, ataxia, nystagmus), gastrointestinal manifestations (multiple intestinal atresia, inflammatory bowel disease), and combined immunodeficiency (leukopenia, variable immunoglobulin defects). Age of onset is typically antenatal or in early childhood; individuals can present with any combination of these features. Rare individuals present with later-onset hereditary spastic paraplegia. Brain MRI findings can include hypomyelinating leukodystrophy, cerebellar hypoplasia/atrophy, thin or dysplastic corpus callosum, and/or perisylvian polymicrogyria.
Spinal muscular atrophy, lower extremity-predominant, 2b, prenatal onset, autosomal dominant
MedGen UID:
1648362
Concept ID:
C4749003
Disease or Syndrome
SMALED2B is a severe neuromuscular disorder with onset in utero. Affected individuals show decreased fetal movements and are usually born with congenital contractures consistent with arthrogryposis multiplex congenita (AMC). After birth, they have severe hypotonia and muscle atrophy as well as respiratory insufficiency due to muscle weakness. Some patients may have dysmorphic facial features and/or abnormalities on brain imaging. Many patients die in early childhood (summary by Storbeck et al., 2017) For discussion of genetic heterogeneity of lower extremity-predominant spinal muscular atrophy, see SMALED1 (158600).
Neurodevelopmental disorder with or without variable brain abnormalities; NEDBA
MedGen UID:
1675664
Concept ID:
C5193102
Disease or Syndrome
Neurodevelopmental disorder with or without variable brain abnormalities (NEDBA) is characterized by global developmental delay apparent from infancy or early childhood, resulting in mildly delayed walking, variably impaired intellectual development, and poor or absent speech. Additional features may include hypotonia, spasticity, or ataxia. About half of patients have abnormal findings on brain imaging, including cerebral or cerebellar atrophy, loss of white matter volume, thin corpus callosum, and perisylvian polymicrogyria. Seizures are not a prominent finding, and although some patients may have nonspecific dysmorphic facial features, there is no common or consistent gestalt (summary by Platzer et al., 2019).
Neurodevelopmental disorder with cardiomyopathy, spasticity, and brain abnormalities
MedGen UID:
1750805
Concept ID:
C5436848
Disease or Syndrome
Neurodevelopmental disorder with cardiomyopathy, spasticity, and brain abnormalities (NEDCASB) is an autosomal recessive multisystemic disorder characterized by global neurodevelopmental delay, severely impaired intellectual development, poor overall growth, and spasticity of the lower limbs resulting in gait difficulties. Most affected individuals also develop progressive hypertrophic cardiomyopathy in childhood or have cardiac developmental anomalies. Additional more variable features include dysmorphic facies and axonal sensory peripheral neuropathy. Brain imaging tends to show thin corpus callosum and polymicrogyria (summary by Garcia-Cazorla et al., 2020).
Developmental and epileptic encephalopathy 98
MedGen UID:
1794227
Concept ID:
C5562017
Disease or Syndrome
Developmental and epileptic encephalopathy-98 (DEE98) is characterized by onset of seizures in the first decade (range infancy to late childhood) associated with variable global developmental delay. Other features may include hypotonia, spasticity, and quadriparesis. Brain imaging may be normal or show nonspecific and variable abnormalities, including polymicrogyria. The severity is variable; some patients may die of refractory status epilepticus (summary by Vetro et al., 2021). For a general phenotypic description and a discussion of genetic heterogeneity of DEE, see 308350.
Developmental and epileptic encephalopathy 99
MedGen UID:
1794228
Concept ID:
C5562018
Disease or Syndrome
Developmental and epileptic encephalopathy-99 (DEE99) is characterized by onset of seizures in early childhood associated with global developmental delay and severely impaired intellectual development. Other features may include hypotonia, quadriparesis, nystagmus, and apnea. Brain imaging may be normal or show nonspecific and variable abnormalities, including cerebral atrophy and polymicrogyria. The severity is variable; some patients die of refractory status epilepticus (summary by Vetro et al., 2021). For a general phenotypic description and a discussion of genetic heterogeneity of DEE, see 308350.

Professional guidelines

PubMed

Piao X, Chang BS, Bodell A, Woods K, Benzeev B, Topcu M, Guerrini R, Goldberg-Stern H, Sztriha L, Dobyns WB, Barkovich AJ, Walsh CA
Ann Neurol 2005 Nov;58(5):680-7. doi: 10.1002/ana.20616. PMID: 16240336
Guerrini R, Carrozzo R
Seizure 2002 Apr;11 Suppl A:532-43; quiz 544-7. PMID: 12185771
Guerrini R, Carrozzo R
Seizure 2001 Oct;10(7):532-43; quiz 544-7. doi: 10.1053/seiz.2001.0650. PMID: 11749114

Recent clinical studies

Etiology

Epilepsy Phenome/Genome Project, Epi4K Consortium
Epilepsia 2021 Apr;62(4):973-983. Epub 2021 Apr 5 doi: 10.1111/epi.16854. PMID: 33818783Free PMC Article
Braden RO, Boyce JO, Stutterd CA, Pope K, Goel H, Leventer RJ, Scheffer IE, Morgan AT
Neurology 2021 Apr 6;96(14):e1898-e1912. Epub 2021 Feb 15 doi: 10.1212/WNL.0000000000011698. PMID: 33589534
Lenge M, Barba C, Montanaro D, Aghakhanyan G, Frijia F, Guerrini R
Cereb Cortex 2018 Mar 1;28(3):1076-1086. doi: 10.1093/cercor/bhx036. PMID: 28334078
Pagnamenta AT, Howard MF, Wisniewski E, Popitsch N, Knight SJ, Keays DA, Quaghebeur G, Cox H, Cox P, Balla T, Taylor JC, Kini U
Hum Mol Genet 2015 Jul 1;24(13):3732-41. Epub 2015 Apr 8 doi: 10.1093/hmg/ddv117. PMID: 25855803Free PMC Article
Verrotti A, Spalice A, Ursitti F, Papetti L, Mariani R, Castronovo A, Mastrangelo M, Iannetti P
Eur J Paediatr Neurol 2010 Jan;14(1):1-12. Epub 2009 Mar 4 doi: 10.1016/j.ejpn.2009.01.005. PMID: 19264520

Diagnosis

Epilepsy Phenome/Genome Project, Epi4K Consortium
Epilepsia 2021 Apr;62(4):973-983. Epub 2021 Apr 5 doi: 10.1111/epi.16854. PMID: 33818783Free PMC Article
Arya R, Spaeth C, Zhang W
Epileptic Disord 2021 Apr 1;23(2):392-396. doi: 10.1684/epd.2021.1258. PMID: 33772511
Braden RO, Leventer RJ, Jansen A, Scheffer IE, Morgan AT
Dev Med Child Neurol 2019 Oct;61(10):1145-1152. Epub 2019 Jan 25 doi: 10.1111/dmcn.14153. PMID: 30680716
Pagnamenta AT, Howard MF, Wisniewski E, Popitsch N, Knight SJ, Keays DA, Quaghebeur G, Cox H, Cox P, Balla T, Taylor JC, Kini U
Hum Mol Genet 2015 Jul 1;24(13):3732-41. Epub 2015 Apr 8 doi: 10.1093/hmg/ddv117. PMID: 25855803Free PMC Article
Bahi-Buisson N, Guerrini R
Handb Clin Neurol 2013;111:653-65. doi: 10.1016/B978-0-444-52891-9.00068-3. PMID: 23622213

Therapy

Vercellino F, Siri L, Brisca G, Scala M, Riva A, Severino M, Striano P
Ital J Pediatr 2021 Jun 12;47(1):137. doi: 10.1186/s13052-021-01051-2. PMID: 34118959Free PMC Article
De Coene A, Van Coster R, Verhelst H
Eur J Paediatr Neurol 2010 May;14(3):270-3. Epub 2009 Jun 25 doi: 10.1016/j.ejpn.2009.05.005. PMID: 19559633
Boscariol M, Garcia VL, Guimarães CA, Montenegro MA, Hage SR, Cendes F, Guerreiro MM
Brain Dev 2010 Apr;32(4):299-304. Epub 2009 May 1 doi: 10.1016/j.braindev.2009.04.002. PMID: 19410403
Piccinelli P, Borgatti R, Perucca E, Tofani A, Donati G, Balottin U
Epilepsia 2000 Nov;41(11):1485-8. doi: 10.1111/j.1528-1157.2000.tb00126.x. PMID: 11077464
Barkovich AJ, Hevner R, Guerrini R
AJNR Am J Neuroradiol 1999 Nov-Dec;20(10):1814-21. PMID: 10588102Free PMC Article

Prognosis

Bonardi CM, Bayat A, Madsen CG, Hammer TB, Reale C, Gardella E, Marjanovic D, Beniczky S, Møller RS, Rubboli G
Epileptic Disord 2022 Jun 1;24(3):577-582. doi: 10.1684/epd.2022.1423. PMID: 35770758
Lacombe D, Van-Gils J, Lebrun M, Trimouille A, Michaud V, Cabet S, Chateil JF, Pedespan JM, Bar C, Lesca G
Brain Dev 2022 Sep;44(8):567-570. Epub 2022 May 24 doi: 10.1016/j.braindev.2022.05.001. PMID: 35623960
Pagnamenta AT, Howard MF, Wisniewski E, Popitsch N, Knight SJ, Keays DA, Quaghebeur G, Cox H, Cox P, Balla T, Taylor JC, Kini U
Hum Mol Genet 2015 Jul 1;24(13):3732-41. Epub 2015 Apr 8 doi: 10.1093/hmg/ddv117. PMID: 25855803Free PMC Article
Clark M, Chong WK, Cox T, Neville BG
Dev Med Child Neurol 2010 Jan;52(1):33-9. Epub 2009 Jun 22 doi: 10.1111/j.1469-8749.2009.03348.x. PMID: 19549204
Saletti V, Bulgheroni S, D'Incerti L, Franceschetti S, Molteni B, Airaghi G, Pantaleoni C, D'Arrigo S, Riva D
J Child Neurol 2007 Sep;22(9):1090-8. doi: 10.1177/0883073807306247. PMID: 17890406

Clinical prediction guides

Arya R, Spaeth C, Zhang W
Epileptic Disord 2021 Apr 1;23(2):392-396. doi: 10.1684/epd.2021.1258. PMID: 33772511
Andelman-Gur MM, Leventer RJ, Hujirat M, Ganos C, Yosovich K, Carmi N, Lev D, Nissenkorn A, Dobyns WB, Bhatia K, Lerman-Sagie T, Blumkin L
Am J Med Genet A 2020 Oct;182(10):2207-2213. Epub 2020 Aug 17 doi: 10.1002/ajmg.a.61795. PMID: 33001581
Lenge M, Barba C, Montanaro D, Aghakhanyan G, Frijia F, Guerrini R
Cereb Cortex 2018 Mar 1;28(3):1076-1086. doi: 10.1093/cercor/bhx036. PMID: 28334078
Pagnamenta AT, Howard MF, Wisniewski E, Popitsch N, Knight SJ, Keays DA, Quaghebeur G, Cox H, Cox P, Balla T, Taylor JC, Kini U
Hum Mol Genet 2015 Jul 1;24(13):3732-41. Epub 2015 Apr 8 doi: 10.1093/hmg/ddv117. PMID: 25855803Free PMC Article
De Ciantis A, Barkovich AJ, Cosottini M, Barba C, Montanaro D, Costagli M, Tosetti M, Biagi L, Dobyns WB, Guerrini R
AJNR Am J Neuroradiol 2015 Feb;36(2):309-16. Epub 2014 Sep 25 doi: 10.3174/ajnr.A4116. PMID: 25258368Free PMC Article

Recent systematic reviews

Braden RO, Leventer RJ, Jansen A, Scheffer IE, Morgan AT
Dev Med Child Neurol 2019 Oct;61(10):1145-1152. Epub 2019 Jan 25 doi: 10.1111/dmcn.14153. PMID: 30680716

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