Hyperekplexia : Adaptative Skills and Neurodevelopmental Trajectory

Official title

Study of Adaptative Skills and Neurodevelopmental Trajectory for Patients With Hyperekplexia (Startle Disease)

Overview

Hereditary hyperekplexia is a rare neuronal disorder, caused by genetic defects leading to dysfunction of glycinergic neurotransmission. The clinical presentation is characterized by stiffness and exaggerated startle responses to unexpected stimuli, that appear shortly after birth. The generalised stiffness can lead to apnea and sudden infant death syndrome. Several genes are known to be associated with hereditary hyperekplexia. The most frequent are Glycine Receptor Alpha 1 (GLRA1), Glycine Receptor Beta (GLRB) and Solute Carrier Family 6 Member 5 (SLC6A5). They encode for the postsynaptic glycine receptor (GLRA1, GLRB) and the presynaptic glycine transport (SLC6A5). Genetic mutations in these genes lead to dysfunction in the glycinergic inhibitory neurotransmission. The neurodevelopment was initially described as normal, or as delayed due to the motor difficulties. Global development delay and intellectual disability are reported as well, in the most recent studies. Nevertheless, the degree of severity of the learning difficulties and the adaptive faculties of the patients is not specified. Similarly, the efficacy of clonazepam in hyperekplexia is well known, but the evolution of dosage over time and the frequency of complete withdrawal have never been studied. The primary endpoint of this study is to describe adaptive skills using a standardized questionnaire, Vineland Adaptive Behavior Scale (VABS2). Secondary endpoints are: * Neurodevelopmental course study * Description of the evolution of the clinical manifestations over the years * Evaluation of the efficacity of the treatment CLONAZEPAM, initially and over time, and evolution of the dosage * Comparison of clinical and therapeutical characteristics according to the genotype

Interventions

• Other collection of medical data
  The data collected concerns: * Sex * Age * Socio-professional category of patients or parents / level of education of the parents * Family history * Neonatal patient data (pregnancy, childbirth) * Clinical data (age of onset of symptoms, evolution of these symptoms over the years, psychomotor development, schooling, learning difficulties, rehabilitation) * Therapeutic data (treatments tried, their dosage and effectiveness, changes in dosage over the years) * Paraclinical examinations (Magnetic
• Other Vineland Adaptive Behaviour Scales (VABS2) questionnaire
  This is a standardized semi structured interview that measures adaptative skills in 4 areas, in the fields of communication, socialization, daily living, and motricity (for children under 7 years). It can be used for children and adults. Rating: 2 = yes, usually, 1 = sometimes or partly, 0 = no, never, N = not applicable (when a child is not yet of sufficient age, for example), NS = don't know. The results by domain and by sub-domain are given in raw scores which are then transformed into equiv

Primary outcome measures

• VABS2 total score and specific scores (socialization, communication, daily living and motricity) [Time frame: maximum 2 months after the inclusion]

Eligibility criteria

Inclusion criteria

• Clinical diagnostic criteria for hyperekplexia (see Thomas et al. BRAIN, 2013):

• The presence of hypertonia (either hypertonia on examination, axial or segmental, or access of stiffness)
• Exaggerated reflex startles, to auditory, tactile or visual stimuli
• The presence of reflex bursts on percussion of the midline
• Children >2 years and adults
• No opposition of one of the two parents (or legal representative) or of the adult patient

Exclusion criteria

• The presence of a cause secondary to the hyperekplexia (traumatic, autoimmune, etc.)
• The presence of another cause for a delay in psychomotor development (other neurological pathology, serious head trauma, etc.)
• Pregnant or breastfeeding women
• Person deprived of liberty by judicial or administrative decision

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Observational model

Cohort

Study locations

France · 1 center

• Hopital Femme Mère Enfant — Bron

Identifiers

NCT: NCT05652101 · 69HCL22_0568 · 2022-A02107-36

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗