Prolyl endopeptidase-like (PREPL) deficiency (MIM# 616224) is a rare autosomal recessive inherited congenital myasthenic syndrome characterized by neonatal hypotonia, feeding problems, mild dysmorphism, and neuromuscular symptoms, followed by hyperphagia and obesity in later childhood. Some patients also exhibit growth deficits, sexual hormone deficiency, and cognitive impairments. This syndrome is caused by biallelic mutations in PREPL. To date, only one nucleotide deletion and seven small microdeletions in PREPL have been reported. Here we report a female patient with a novel homozygous frameshift mutation in PREPL (NM_006036.4, c.342delA:p.Val115Leufs*39). Her clinical features are similar to those of previously reported cases. The mutation is the first homozygous point mutation reported in humans.
Background: Neurofibromatosis 1 and 2 (NF1 and NF2) are autosomal dominant genetic disorders caused by mutations in tumour suppressor genes. Methods: We conducted a systematic review of the incidence and prevalence of NF1 and NF2 in OVID Medline, OVID Embase, Web of Science, and Cinahl. We included studies until February 19, 2021, that identified cases based on established criteria. Studies were appraised for quality using the Joanna Briggs Institute Prevalence Critical Appraisal tool. Pooled incidence and prevalence rates were estimated through meta-analysis. Results: Of 1,936 studies, 1,866 were irrelevant after title and abstract screening. Sixteen of 69 studies with full text assessment were included for full review: 13 regarding NF1 and 6 regarding NF2. Incidence rates for NF1 and NF2 ranged from 1/11,494 to 1/1,871 and 1/62,185 to 1/33,000 respectively. Prevalence rates for NF1 and NF2 ranged from 1/6,238 to 1/1,001 and 1/600,000 to 1/56,161 respectively. Meta-analysis will be presented at the conference. Conclusions: An accurate estimate of the incidence and prevalence of NF1 and NF2 will offer more insight into health resource allocation. Increased funding and resources for the development of early diagnostic and treatment tools for NF1 and NF2 may improve the quality of life of patients.
PurposeEarly detection and tracking of bulbar dysfunction in amyotrophic lateral sclerosis (ALS) are critical for directing management of the disease. Existing physiological assessments of bulbar dysfunction are often inaccessible and cost-prohibitive for clinical application. Existing clinical assessments are limited. The overall goal of our research is to develop a brief and reliable, clinician-administered assessment tool, the ALS Bulbar Dysfunction Index (ALS-BDI) to evaluate bulbar dysfunction. The aim of this study was to establish content and face validity of the ALS-BDI through item generation and reduction, including item scoring.MethodsThe design of the ALS-BDI followed guidelines outlined by the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). The design stage of the ALS-BDI involved two steps: (Step 1) the generation of candidate items from a literature review of commonly used clinical tools, and selection of items following a review of item reliability and item relevance and expert consensus; (Step 2) the assessment of their content and face validity via online survey feedback from experts (n = 35). The initial design was followed by a semi-structured cognitive interview with Speech-Language Pathologists (n = 5) to finalize a testable draft of the instrument.ResultsTwo drafts of the ALS-BDI were developed. The first draft contained 48 items, after a review of existing clinical tools for their relevance to bulbar dysfunction in ALS. Of the 48 items, 35 items were retained after surveying experts and clinician users for their relevance, feasibility, interpretability, and appropriateness. The second draft of the ALS-BDI contained 37 items, due to one item splitting, based on users cognitive interviews.ConclusionsThe ALS-BDI described in this study aims to provide a brief and reliable, clinician-administered assessment tool to evaluate bulbar dysfunction in patients with ALS. Future research will evaluate the psychometric properties of this tool including its reliability, validity, and responsiveness to change over time.
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