无脑回畸形儿1例报告并文献复习

Lissencephaly: a case report and literature review

目的 探讨无脑回畸形的临床特征及其致病基因LIS1 基因的检测特点.方法 回顾性分析1 例无脑回畸形患儿的临床、实验室检查及基因检测结果,同时复习相关文献.结果 女性,5 月龄,确诊癫痫20 d,3 d 内再次抽搐发作30余次入院,抽搐发作表现为双眼凝视、上翻,口唇、面色发绀,口吐白沫,四肢强直,意识丧失,约2 - 3 min 自行缓解.外周血白细胞计数13.67×10^9/L,血红蛋白108 g/L,红细胞计数3.90×1012/L,淋巴细胞10.26×10^9/L ;心肌酶谱、肝肾功能均正常;血氨23 μmol/L,乳酸2.11 mmol/L ;长程视频脑电图显示高度失律,频繁部分性发作,有时继发全身阵挛发作.头部MRI提示无脑回畸形.口服左乙拉西坦片,约27 mg/（kg·d）,托吡酯片约6.5 mg/（kg·d）,目前暂无发作.患儿LIS1 基因检测发现c.232delG杂合突变,导致蛋白移码突变（p.E78NfsX25）;患儿父母均未见突变.结论 无脑回畸形患儿可合并癫痫,可能由LIS1 基因突变所致,该基因c.232delG位点突变在国内外未见报道.

Objective To explore the clinical features of lissencephaly and the detection ofLISI gene.MethodsThe characteristic of clinical features, laboratory examination and gene detection in one case of lissencephaly was retrospectively analyzed. Meanwhile, the related literatures were reviewed.ResultsA 5-month-old female child diagnosed with epilepsy 20 days ago was hospitalized for convulsive seizure more than 30 times in 3 days. The manifestations were eyes staring, and turning upward, cyanosis of lips and face, froth at the mouth, extremities rigidity and loss of consciousness, and the symptoms can spontaneously remitted in 2-3 minutes. Laboratory examination showed that peripheral blood white cell count was 13.67×109/L, hemoglobin 108 g/L, red blood cell count 3.90×1012/L, lymphocyte 10.26×109/L; maocardial enzyme and hepatic and renal function were normal; blood ammonia was 23 μmol/L and lactic acid 2.11 mmol/L. Long-range video EEG showed highly arrhythmia, and frequent partial epilepsy, and sometimes secondary generalized epilepsy. Head MRI showed lissencephaly. The child was treated with oral administration of Keppra 27 mg/(kg·day), Topiramate 6.5 mg/(kg·day), currently no seizure. The detection ofLIS1 gene found that heterozygous mutation of c.232delG, which lead to protein shift mutation (p.E78NfsX25). No mutation was found in her parents.ConclusionsChild with lissencephaly may combine with epilepsy which may cause by mutation inLIS1 gene. And there was no information about point mutation of c.232delG inLIS1 gene being reported at home and abroad so far.