Familial adult myoclonus epilepsy : a clinical, neurophysiological and genetic study of a familial form of myoclonic epilepsy

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dc.contributor.advisorBrink, P. A.en_ZA
dc.contributor.authorCarr, Jonathanen_ZA
dc.contributor.otherUniversity of Stellenbosch. Faculty of Health Sciences. Dept. of Medicine. Internal Medicine.
dc.date.accessioned2009-11-26T04:32:02Zen_ZA
dc.date.accessioned2010-06-01T08:14:55Z
dc.date.available2009-11-26T04:32:02Zen_ZA
dc.date.available2010-06-01T08:14:55Z
dc.date.issued2009-12
dc.descriptionThesis (DMed (Medicine. Internal Medicine))--University of Stellenbosch, 2009.en_ZA
dc.description.abstractENGLISH ABSTRACT: Progressive Myoclonic Epilepsies (PME) are characterized by progressive neurological impairment with myoclonus, seizures and dementia. In contradistinction, Familial Adult Myoclonic Epilepsy (FAME) is characterized by a benign course with rare seizures and cortical tremor. Both conditions have neurophysiological features suggestive of a cortical origin for their myoclonus. This dissertation reports on a novel form of PME. Many of those who were affected had no or minimal progression of their illness, low seizure frequency and were cognitively intact, suggestive of non-progressive disorders linked to the FAME loci. The majority of patients had features of cortical myoclonus, with generalized spike and wave discharges on electroencephalography, enlarged evoked potentials, enhanced C reflexes, and evidence of cortical excitability with magnetic stimulation. However, there was evidence of cerebellar dysfunction both pathologically and on imaging. With regard to similar conditions, dentatorubral pallidoluysian atrophy and Unverricht-Lundborg syndrome were excluded by linkage analysis. Similarly, linkage was not present for either the FAME 1 or FAME 2 loci. This syndrome is both clinically and genetically novel, and has a nosology which is difficult to characterize, in which the condition appears to lie on the spectrum between FAME and PME. The dissociation between the pathological and radiological findings which suggest subcortical dysfunction, and the neurophysiological findings of cortical myoclonus is striking. Review of the literature associated with the neurophysiology of related conditions associated with PME and FAME suggests that: 1. The assumption that generalized forms of myoclonic disorders represent multifocal forms of focal cortical discharges is an oversimplification. 2. The dissociation between initial and later components of the evoked potential is less robust than is generally supposed, and that subcortical inputs may affect later components of the evoked potential. 3. In a high proportion of cases the latency from cortical spike discharge to myoclonic jerk obtained with jerk locked averaging is incompatible with a cortical origin for the spike discharge. 4. The proposal that myoclonus is a form of long latency reflex and that myoclonus represents a reflex arising from subclinical sensory input, is unproven.en_ZA
dc.description.abstractAFRIKAANSE OPSOMMING: Progressiewe Miokloniese Epilepsie (PME) word gekenmerk deur progressiewe neurologiese agteruitgang met mioklonus, konvulsies en demensie. Daarenteen word Familiële Volwasse Miokloniese Epilepsie (FAME) gekenmerk deur 'n benigne verloop met ongereelde konvulsies en kortikale tremor. Beide entiteite het neurofisiologiese kenmerke suggestief van 'n kortikale oorsprong vir die mioklonus. Hierdie manuskrip beskryf 'n nuwe vorm van PME. Baie van die aangetaste persone toon geen of min agteruitgang van die siekte oor tyd nie, met 'n lae frekwensie van konvulsies en is kognitief intak, wat suggestief is van 'n nie-progressiewe siekte gekoppel aan die FAME loci. Die oorgrote meerderheid van pasiente het kenmerke van kortikale mioklonus gehad, met algemene spits en boog ontladings op elektroensefalografie, hoë amplitude ontlokte potensiale, versterkte C-reflekse, en tekens van kortikale eksiteerbaarheid met magnetiese stimulasie. Met neurobeelding en patologie was daar egter bewyse van serebellêre disfunksie. Soortgelyke toestande, naamlik dentatorubro-pallidoluysiese atrofie en Unverricht-Lundborg sindroom is uitgeskakel deur middel van koppelingsanalise. Koppeling met die FAME1 of FAME2 loci kon ook nie aangetoon word nie. Die sindroom is beide klinies sowel as geneties nuut en het 'n nosologie wat moeilik gekaraktiseer kan word. Dit wil voorkom of die siekte op 'n spektrum lê tussen FAME en PME. Die dissosiasie tussen die patologiese en radiologiese bevindinge, wat suggestief is van subkortikale disfunksie, en die neurofisiologiese bevindinge van kortikale mioklonus is opmerklik. ’n Oorsig van die literatuur in verband met die neurofisiologie van toestande geassosieer met PME en FAME suggesteer die volgende: 1. Die aanname dat algemene vorme van miokloniese toestande multifokale vorme van fokale kortikale ontladings verteenwoordig, is ’n oorvereenvoudiging. 2. Die dissosiasie tussen inisiële en latere komponente van die ontlokte potensiaal is minder robuust as wat algemeen aanvaar word, en subkortikale invoer mag latere komponente van die ontlokte potensiaal beïnvloed. 3. In ’n groot proporsie van gevalle is die latensie van kortikale spits ontlading tot miokloniese ruk, verkry deur “jerk locked averaging”, nie verenigbaar met met ’n kortikale oorsprong vir die spits ontlading nie. 4. Geen bewyse bestaan vir die teorie dat mioklonus ’n vorm van ’n lang latensie refleks is en dat mioklonus ’n refleks is wat ontstaan uit subkliniese sensoriese invoer nie.en_ZA
dc.identifier.urihttp://hdl.handle.net/10019.1/1201
dc.language.isoenen_ZA
dc.publisherStellenbosch : University of Stellenbosch
dc.rights.holderUniversity of Stellenbosch
dc.subjectProgressive myoclonic epilepsyen_ZA
dc.subjectDissertations -- Internal medicine
dc.subjectTheses -- Internal medicine
dc.subject.lcshMyoclonusen_ZA
dc.subject.lcshEpilepsyen_ZA
dc.subject.lcshGenetic disordersen_ZA
dc.titleFamilial adult myoclonus epilepsy : a clinical, neurophysiological and genetic study of a familial form of myoclonic epilepsyen_ZA
dc.typeThesisen_ZA
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