Skip to main content

Advertisement

Log in

Progressive myoclonic epilepsies: review of clinical, molecular and therapeutic aspects

  • Review
  • Published:
Journal of Neurology Aims and scope Submit manuscript

Abstract

The progressive myoclonic epilepsies (PME) are a rare group of inherited neurodegenerative diseases with debilitating evolution, resistance to treatment and poor prognosis. However, advances in molecular genetics have enabled better understanding of the pathogenesis of these diseases, bringing hope for improved treatment options in the future. This manuscript is an overview of the clinical and molecular findings in patients with PME. Furthermore, it describes therapeutic approaches that are currently recommended in the literature.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Shahwan A, Farrell M, Delanty N (2005) Progressive myoclonic epilepsies: a review of genetic and therapeutic aspects. Lancet Neurol 4:239–248

    Article  CAS  PubMed  Google Scholar 

  2. Jorge CL, Valerio RMF (2003) Epilepsias mioclônicas progressivas. In: Manreza ML, Grossmann RM, Valério RM, Guilhoto LM (eds) Epilepsia na infância e adolescência. Lemos Editorial, São Paulo, pp 171–188

    Google Scholar 

  3. Berkovic SF, Cochius J, Andermann E, Andermann F (1993) Progressive myoclonus epilepsies: clinical and genetic aspects. Epilepsia 3:S10–S30

    Google Scholar 

  4. Unverricht H (1891) Die myoclonie. Franz Deuticke, Leipzig

    Google Scholar 

  5. Lundborg H (1903) Die progressive myoclonus-epilepsie (Unverricht’s Myoclonie). Almqvist and Wiksell, Uppsala

    Google Scholar 

  6. Norio R, Koskiniemi M (1979) Progressive myoclonus epilepsy: genetic and nosological aspects with special reference to 107 Finish patients. Clin Genet 15:382–398

    Article  CAS  PubMed  Google Scholar 

  7. Ramachandran N, Girard JM, Turnbull J, Minassian BA (2009) The autosomal recessively inherited progressive myoclonus epilepsies and their genes. Epilepsia 50(supl5):29–36

    Article  CAS  PubMed  Google Scholar 

  8. Pennacchio LA, Lehesjoki AE, Stone NE, Willour VL, Virtaneva K, Miao J et al (1996) Mutations in the gene encoding cystatin B in progressive myoclonus epilepsy (EPM1). Science 271:1731–1734

    Article  CAS  PubMed  Google Scholar 

  9. Lehesjoki AE (2002) Clinical features and genetics of Unverricht-Lundborg disease. Adv Neurol 89:193–197

    PubMed  Google Scholar 

  10. Kyllerman M, Sommerfelt TK, Hedstrom A, Wennergren G, Holmgren D (1991) Clinical and neurophysiological development of Unverricht-Lundborg disease in four Swedish siblings. Epilepsia 32:900–909

    Article  CAS  PubMed  Google Scholar 

  11. Mascalchi M, Michelucci R, Cosottini M et al (2002) Brainstem involvement in Unverricht-Lundborg disease (EPM1): an MRI and 1H MRS study. Neurology 58:1686–1689

    CAS  PubMed  Google Scholar 

  12. Lehesjoki AE, Koskiniemi M, Sistonen P et al (1991) Localization of a gene for progressive myoclonus epilepsy to chromosome 21q22. Proc Natl Acad Sci USA 88:3696–3699

    Article  CAS  PubMed  Google Scholar 

  13. Turk V, Bode W (1991) The cystatins: protein inhibitors of cysteine proteinases. FEBS Lett 285:213–219

    Article  CAS  PubMed  Google Scholar 

  14. Joensuu T, Lehesjoki AE, Kopra O (2008) Molecular background of EPM1 Unverricht-Lundborg disease. Epilepsia 49(4):557–563

    Article  CAS  PubMed  Google Scholar 

  15. Pennacchio LA, Bouley DM, Higgins KM, Scott MP, Noebels JL, Myers RM (1998) Progressive ataxia, myoclonic epilepsy and cerebellar apoptosis in cystatin B-deficient mice. Nat Genet 20:251–258

    Article  CAS  PubMed  Google Scholar 

  16. Shannon P, Pennacchio LA, Houseweart MK, Minassian BA, Myers RM (2002) Neuropathological changes in a mouse model of progressive myoclonus epilepsy: cystatin B deficiency and Unverricht-Lundborg disease. J Neuropathol Exp Neurol 61:1085–1091

    PubMed  Google Scholar 

  17. Lafreniere RG, Rochefort DL, Chretien N et al (1997) 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 15:298–302

    Article  CAS  PubMed  Google Scholar 

  18. Lalioti MD, Mirotsou M, Buresi C et al (1997) Identification of mutations in cystatin B, the gene responsible for the Unverricht-Lundborg type of progressive myoclonus epilepsy (EPM1). Am J Hum Genet 60:342–351

    CAS  PubMed  Google Scholar 

  19. Berkovic SF, Mazarib A, Walid S, Neufeld MY et al (2005) A new clinical and molecular form of Unverricht-Lundborg disease localized by homozygosity mapping. Brain 128:652–658

    Article  PubMed  Google Scholar 

  20. Minassian BA (2001) Lafora’s disease: towards a clinical, pathologic, and molecular synthesis. Pediatr Neurol 25:21–29

    Article  CAS  PubMed  Google Scholar 

  21. Acharya JN, Satishchandra P, Shankar SK (1995) Familial progressive myoclonus epilepsy: clinical and electrophysiologic observations. Epilepsia 36:429–434

    Article  CAS  PubMed  Google Scholar 

  22. Kobayashi K, Iyoda K, Ohtsuka Y, Ohtahara S, Yamada M (1990) Longitudinal clinicoelectrophysiologic study of a case of Lafora disease proven by skin biopsy. Epilepsia 31:194–201

    CAS  PubMed  Google Scholar 

  23. Minassian BA, Lee JR, Herbrick JA et al (1998) Mutations in a gene encoding a novel protein tyrosine phosphatase cause progressive myoclonus epilepsy. Nat Genet 20:171–174

    Article  CAS  PubMed  Google Scholar 

  24. Ganesh S, Agarwala KL, Ueda K et al (2000) Laforin, defective in progressive myoclonus epilepsy of Lafora type, is a dual specificity phosphatase associated with polyribosomes. Hum Mol Genet 9:2251–2261

    CAS  PubMed  Google Scholar 

  25. Chan EM, Bulman DE, Paterson AD et al (2003) Genetic mapping of a new Lafora progressive myoclonus epilepsy locus (EPM2B) on 6p22. J Med Genet 40:671–675

    Article  CAS  PubMed  Google Scholar 

  26. Minassian BA (2002) Progressive myoclonus epilepsy with polyglucosan bodies: Lafora disease. Adv Neurol 89:199–210

    PubMed  Google Scholar 

  27. Luft R, Ikkos D, Palmieri G, Ernster L, Afzelius B (1962) A case of severe hypermetabolism of nonthyroid origin with a defect in the maintenance of mitochondrial respiratory control: a correlated clinical, biochemical, and morphological study. J Clin Invest 41:1776–1804

    Article  CAS  PubMed  Google Scholar 

  28. Engel WK, Cunningham GG (1963) Rapid examination of muscle tissue. An improved trichrome method for fresh-frosen biopsy sections. Neurology 13:919–923

    CAS  PubMed  Google Scholar 

  29. Tsairis P, Engel W, Kark P (1973) Familial myoclonic epilepsy syndrome associated with skeletal muscle citochondrial abnormalities. Neurology 23:408

    Google Scholar 

  30. Fukuhara NS, Tokiguchi K et al (1980) Myoclonus epilepsy associated with ragged-red fibers (mitochondrial abnormalities)—disease entity or a syndrome? Light- and electron- microscopic studies of two cases and review of the literature. J Neurol Sci 7:117

    Article  Google Scholar 

  31. Shoffner JM, Lott MT et al (1990) Myoclonic epilepsy and ragged-red fiber disease (MERRF) is associated with a mitochondrial DNA tRNA(Lys) mutation. Cell 61:931

    Article  CAS  PubMed  Google Scholar 

  32. Kogelnik AM, Lott MT, Brown MD, Navathe SB, Wallace DC (1998) MITOMAP: a human mitochondrial genome database—1998 update. Nucleic Acids Res 26:112–115

    Google Scholar 

  33. DiMauro S, Hirano M, Kaufmann P et al (2002) Clinical features and genetics of myoclonic epilepsy with ragged-red fibers. Adv Neurol 89:217–229

    PubMed  Google Scholar 

  34. So N, Berkovic SF, Andermann F, Kuzniecky R, Gendron D, Quesney LF (1989) Myoclonus epilepsy and ragged-red fibers (MERRF). Electrophysiological studies and comparison with the other progressive myoclonus epilepsies. Brain 112:1261–1276

    Article  PubMed  Google Scholar 

  35. Berkovic SF, Carpenter S, Evans A et al (1989) Myoclonus epilepsy and ragged-red fibers (MERRF). 1. A clinical, pathological, biochemical, magnetic resonance spectroscopic and positron emission tomographic study. Brain 112:1231–1260

    Article  PubMed  Google Scholar 

  36. Barkovich AJ, Good WV, Koch TK, Berg BO (1993) Mitochondrial disorders: analysis of their clinical and imaging characteristics. Am J Neuroradiol 14:1119–1137

    CAS  PubMed  Google Scholar 

  37. Riggs JE, Shochet SS, Fakaday AV et al (1984) Mitochondrial encephalomyopathy with decreased succinate-cytochrome c reductase activity. Neurology 34:48

    CAS  PubMed  Google Scholar 

  38. Boulet L, Karpati G, Shoubridge EA (1992) Distribution and threshold expression of the tRNALys mutation in skeletal muscle of patients with myoclonic epilepsy and ragged-red fibers (MERRF). Am J Hum Genet 51:1187–1200

    CAS  PubMed  Google Scholar 

  39. Moraes CT, Ciacci F, Bonilla E et al (1993) Two novel pathogenic mitochondrial DNA mutations affecting organelle number and protein synthesis. J Clin Invest 92:2906

    Article  CAS  PubMed  Google Scholar 

  40. Williams RE, Aberg L, Autti T et al (2006) Diagnosis of the neuronal ceroid lipofuscinoses: an update. Biochim Biophys Acta 1762:865–872

    CAS  PubMed  Google Scholar 

  41. Autti T, Raininko R, Vanhanen SL, Santavuori P (1996) MRI of neuronal ceroid lipofuscinosis. Part I: cranial MRI of 30 patients with juvenile neuronal ceroid lipofuscinosis. Neuroradiology 38:476–482

    Article  CAS  PubMed  Google Scholar 

  42. Autti T, Raininko R, Santavuori P, Vanhanen SL, Poutanen VP, Haltia M (1997) MRI evaluation of neuronal ceroid lipofuscinosis: part II: postmortem MRI and histopathological study of the brain in 16 patients with neuronal ceroid lipofuscinosis of juvenile or late infantile type. Neuroradiology 39:371–377

    Article  CAS  PubMed  Google Scholar 

  43. Mole SE, Williams RE, Goebel HH (2005) Correlations between genotype, ultrastructural morphology and clinical phenotype in the neuronal ceroid lipofuscinoses. Neurogenetics 6:107–126

    Article  PubMed  Google Scholar 

  44. Steinfeld R, Heim P, von Gregory H, Meyer K, Ullrich K et al (2002) Late infantile neuronal ceroid lipofuscinosis: quantitative description of the clinical course in patients with CLN2 mutations. Am J Med Genet 112:347–354

    Article  PubMed  Google Scholar 

  45. Holmberg V, Lauronen L, Autti T, Santavuori P, Savukoski M, Uvebrant P et al (2000) Phenotype—genotype correlation in eight patients with Finnish variant late infantile NCL (CLN5). Neurology 55:579–581

    CAS  PubMed  Google Scholar 

  46. Santavuori P, Rapola J, Sainio K, Raitta C (1982) A variant of Jansky-Bielschowsky disease. Neuropediatrics 13:135–141

    Article  CAS  PubMed  Google Scholar 

  47. Sharp JD, Wheeler RB, Parker KA, Gardiner RM, Williams RE, Mole SE (2003) Spectrum of CLN6 mutations in variant late infantile neuronal ceroid lipofuscinosis. Human Mutat 22:35–42

    Article  CAS  Google Scholar 

  48. Ranta S, Zhang Y, Ross B, Lonka L, Takkunen E et al (1999) The neuronal ceroid lipofuscinoses in human EPMR and mnd mutant mice are associated with mutations in CLN8. Nat Genet 23:233–236

    Article  CAS  PubMed  Google Scholar 

  49. Striano P, Specchio N, Biancheri R, Cannelli N, Simonati A et al (2007) Clinical and electrophysiological features of epilepsy in Italian patients with CLN8 mutations. Epilepsy Behav 10:187–191

    Article  PubMed  Google Scholar 

  50. Hofmann SL, Das AK, Yi W, Lu JY, Wisniewski KE (1999) Genotype–phenotype correlations in neuronal ceroid lipofuscinosis due to palmitoylprotein thioesterase deficiency. Mol Genet Metab 66:234–239

    Article  CAS  PubMed  Google Scholar 

  51. Rapin I, Goldfisher S, Katzman R, Engel J, O’Brien JS (1978) The cherry-red spot myoclonus syndrome. Ann Neurol 3:234–242

    Article  CAS  PubMed  Google Scholar 

  52. Palmeri S, Villanova M, Malandrini A et al (2000) Type I sialidosis: a clinical, biochemical and neuroradiological study. Eur Neurol 43:88–94

    Article  CAS  PubMed  Google Scholar 

  53. Engel J, Rapin I, Giblin D (1977) Electrophysiological studies in two patients with cherry-red spot myoclonus syndrome. Epilepsia 18:73–87

    Article  PubMed  Google Scholar 

  54. Seyrantepe V, Poupetova H, Froissart R, Zabot MT, Maire I, Pshezhetsky AV (2003) Molecular pathology of NEU1 gene in sialidosis. Hum Mutat 22:343–352

    Article  CAS  PubMed  Google Scholar 

  55. Tsuji S (2002) Dentatorubral-pallidoluysian atrophy: clinical aspects and molecular genetics. Adv Neurol 89:231–239

    PubMed  Google Scholar 

  56. Koide R, Ikeuchi T, Onodera O et al (1994) Unstable expansion of CAG repeat in hereditary dentatorubral-pallidoluysian atrophy (DRPLA). Nat Genet 6:9–13

    Article  CAS  PubMed  Google Scholar 

  57. Nagafuchi S, Yanagisawa H, Sato K et al (1994) Expansion of an unstable CAG trinucleotide on chromosome 12p in dentatorubral and pallidoluysian atrophy. Nat Genet 6:14–18

    Article  CAS  PubMed  Google Scholar 

  58. Iivanainen M, Himberg JJ (1982) Valproate and clonazepam in the treatment of severe progressive myoclonus epilepsy. Arch Neurol 39:236–238

    CAS  PubMed  Google Scholar 

  59. Tein I, DiMauro S, Xie Z-W, De Vivo DC (1993) Valproic acid impairs carnitine uptake in cultured human skin fibroblasts: an in vitro model for pathogenesis of valproic acid-associated carnitine deficiency. Pediatr Res 34:281–287

    Article  CAS  PubMed  Google Scholar 

  60. Remy C, Genton P (1991) Effect of high dose of oral piracetam on myoclonus in progressive myoclonus epilepsy (Mediterranean myoclonus). Epilepsia 32:6

    Google Scholar 

  61. Magaudda A, Gelisse P, Genton P (2004) Antimyoclonic effect of levetiracetam in 13 patients with Unverricht-Lundborg disease: clinical observations. Epilepsia 45:678–681

    Article  CAS  PubMed  Google Scholar 

  62. Eldridge R, Iivanainen M, Stern R, Koerber T, Wilder BJ (1983) “Baltic”myoclonus epilepsy: hereditary disorder of childhood made worse by phenytoin. Lancet 2(8354):838–842

    Article  CAS  PubMed  Google Scholar 

  63. Smith B, Shatz R, Elisevich K, Bespalova IN, Burmeister M (2000) Effects of vagus nerve stimulation on progressive myoclonus epilepsy of Unverricht-Lundborg type. Epilepsia 41:1046–1048

    Article  CAS  PubMed  Google Scholar 

  64. Kyllerman M, Ben-Menachem E (1998) Zonisamide for progressive myoclonus epilepsy: long-term observations in seven patients. Epilepsy Res 29:109–114

    Article  CAS  PubMed  Google Scholar 

  65. Vossler DG, Conry JA, Murphy JV, ZNS-502/505 PME Study Group (2008) Zonisamide for the treatment of myoclonic seizures in progressive myoclonic epilepsy: an open-label study. Epileptic Disord 10(1):31–34

    PubMed  Google Scholar 

  66. DiMauro S, Hirano M, Schon EA (2000) Mitochondrial encephalomyopathies: therapeutic approaches. Neurol Sci 21(suppl 5):S901–S908

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Luis Felipe Mendonça de Siqueira.

Rights and permissions

Reprints and permissions

About this article

Cite this article

de Siqueira, L.F.M. Progressive myoclonic epilepsies: review of clinical, molecular and therapeutic aspects. J Neurol 257, 1612–1619 (2010). https://doi.org/10.1007/s00415-010-5641-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00415-010-5641-1

Keywords

Navigation