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From the Division of Child Neurology and Psychiatry (Drs. Sicca and Guerrini), University of Pisa, Italy; IRCCS Stella Maris Foundation (Drs. Sicca, Moro, and Guerrini, D. Mei), Scientific Institute for Child and Adolescence Neurology and Psychiatry, Pisa, Italy; National Institute of Neurology and Psychiatry (Dr. Kelemen), Epilepsy Center, Budapest, Hungary; Centre Saint Paul (Dr. Genton), Marseille, France; and Department of Human Genetics, Neurology and Pediatrics (Drs. Das and Dobyns), The University of Chicago, IL.
Address correspondence and reprint requests to Dr. Renzo Guerrini, Division of Child Neurology and Psychiatry, IRCCS Fondazione Stella Maris, University of Pisa, Via dei Giacinti 2, 56018–Calambrone, Pisa, Italy; e-mail: renzo.guerrini{at}inpe.unipi.it
Background: Subcortical band heterotopia (SBH) is a neuronal migration disorder. DCX mutations are responsible for almost all familial cases, 80% of sporadic female cases, and 25% of sporadic male cases of SBH, and are associated with more severe gyral and migration abnormality over the anterior brain regions. Somatic mosaicism has previously been hypothesized in a patient with posteriorly predominant SBH and a mutation of the LIS1 gene, which is usually mutated in patients with severe lissencephaly. The authors identified mosaic mutations of LIS1 in two patients (Patients 1 and 2) with predominantly posterior SBH.
Methods: After ruling out DCX mutations, the authors performed sequencing of the LIS1 gene in lymphocyte DNA. Because sequence peaks in both patients were suggestive of mosaic mutations, they followed up with denaturing high-pressure liquid chromatography analysis on blood and hair root DNA and compared the areas of heteroduplex and homoduplex peaks. A third patient showing the same mutation as Patient 2 but with no evidence of mosaicism was used for comparing the phenotype of mosaic vs full mutation.
Results: The two patients with posterior SBH harbored a missense (Arg241Pro) and a nonsense (R8X) mosaic mutation of LIS1. The rate of mosaicism in Patient 1 was 18% in the blood and 21% in the hair roots, whereas in Patient 2 it was 24% and 31% in the same tissues. The patient with a full R8X mutation of LIS1 had severe lissencephaly.
Conclusions: Subcortical band heterotopia can occur with mosaic mutations of the LIS1 gene. Mutation analysis of LIS1, using highly sensitive techniques such as denaturing high-pressure liquid chromatography, should be considered for patients with posteriorly predominant subcortical band heterotopia and pachygyria.
Received April 1, 2003. Accepted in final form July 25, 2003.
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