Dados do Trabalho
TREATMENT MANAGEMENT OF MTOROPATHIES: A CASE REPORT
Apresentação do caso
A 16-year-old girl, born to healthy and non-consanguineous parents at 34 weeks, from a twin pregnancy, presented with recurrent focal motor seziures since she was three years old. Her family history of epilepsy was negative. In the complementary investigation, brain MRI was normal and the electroencephalogram (EEG) showed hypermotor seizures with right frontal or temporal onset. Exome sequencing identified a pathogenic NPRL3 heterozygous variant (NM_001077350.3: c.1032-1G>A). Epilepsy had been pharmacoresistant for many years, despite the use of different antiseizure medication (ASM) in mono or polytherapy. With the use of Vigabatrin the patient became seizure free and she has been followed with annual electroretinogram.
The mammalian target of rapamycin (mTOR) pathways are associated with cell growth and survival, protein synthesis and synaptic plasticity. Variants in genes that correlate with these pathways, such as mTOR, DEPDC5, NPRL3, NPRL2, can lead to intractable epilepsy and developmental delay due to hyperactivation of mTOR signaling. These genes are frequently associated with focal epilepies and eventually with focal cortical dysplasias. Vigabatrin is an ASM with a possible property to supress the mTOR pathway. Its use to treat focal epilepsies is controvertial due to the high risk of gabaergic retinopathy.
The therapeutic management of mTORopathies must involve therapies that decrease or inhibit the activation of the mTOR pathway, such as the use of vigabatrin, and in cases that present malformations of cortical development, surgical treatment is well established. Despite the risk of side effects with the chronic use of vigabatrin, it should be better evaluated in the mTORopathies associated with pharmacoresistant seizures.
Referências (se houver)
mTORopathies, NPRL3 , Vigabatrin, seziures
Fonte de Fomento (se houver)
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Não há conflito de interesses.
Larisse Souza Morais Sommavilla, Ana Carolina Piauilino Santos Falcão, Isabelle Salgado Castellano , Maria Luiza Benevides , Helena Tadiello de Moraes, Luciana Cardoso Bonadia, Iscia Lopes Cendes, Ana Carolina Coan