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      Tourette-like syndrome secondary to Kleefstra syndrome 1 with a de novo microdeletion in the EHMT1 gene

      case-report

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          Abstract

          Background

          Gills de la Tourette syndrome (TS) is a childhood-onset neurodevelopmental disorder manifested by motor and vocal tics. Kleefstra syndrome 1 (KS1), a rare genetic disorder, is caused by haploinsufficiency of the EHMT1 gene and is characterized by intellectual disability (ID), childhood hypotonia, and distinctive facial features. Tourette-like syndrome in KS1 has rarely been reported.

          Case presentation

          Here we describe a 7-year-old girl presenting involuntary motor and vocal tics, intellectual disability, childhood hypotonia, and dysmorphic craniofacial appearances, as well as comorbidities including attention deficit-hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), and self-injurious behavior (SIB). The patient’s CNV-seq testing revealed a de novo 320-kb deletion in the 9q34.3 region encompassing the EHMT1 gene.

          Conclusions

          This is the first case reporting Tourette-like syndrome secondary to KS1 with a de novo microdeletion in the EHMT1 gene. Our case suggests TS with ID and facial anomalies indicate a genetic cause and broadens the phenotypic and genotypic spectrum of both TS and KS1.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s12883-023-03417-x.

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          Most cited references10

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          Histone Methylation by the Kleefstra Syndrome Protein EHMT1 Mediates Homeostatic Synaptic Scaling

          Homeostatic plasticity, a form of synaptic plasticity, maintains the fine balance between overall excitation and inhibition in developing and mature neuronal networks. Although the synaptic mechanisms of homeostatic plasticity are well characterized, the associated transcriptional program remains poorly understood. We show that the Kleefstra-syndrome-associated protein EHMT1 plays a critical and cell-autonomous role in synaptic scaling by responding to attenuated neuronal firing or sensory drive. Chronic activity deprivation increased the amount of neuronal dimethylated H3 at lysine 9 (H3K9me2), the catalytic product of EHMT1 and an epigenetic marker for gene repression. Genetic knockdown and pharmacological blockade of EHMT1 or EHMT2 prevented the increase of H3K9me2 and synaptic scaling up. Furthermore, BDNF repression was preceded by EHMT1/2-mediated H3K9me2 deposition at the Bdnf promoter during synaptic scaling up, both in vitro and in vivo. Our findings suggest that H3K9me2-mediated changes in chromatin structure govern a repressive program that controls synaptic scaling.
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            Tourette's syndrome

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              Tourette syndrome: clinical features, pathophysiology, and treatment

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                Author and article information

                Contributors
                wyw11380@rjh.com.cn
                Journal
                BMC Neurol
                BMC Neurol
                BMC Neurology
                BioMed Central (London )
                1471-2377
                10 October 2023
                10 October 2023
                2023
                : 23
                : 365
                Affiliations
                [1 ]GRID grid.412277.5, ISNI 0000 0004 1760 6738, Department of Neurology, Institute of Neurology, , Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, ; Shanghai, China
                [2 ]GRID grid.16821.3c, ISNI 0000 0004 0368 8293, Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, , Shanghai Jiao Tong University School of Medicine, ; Shanghai, China
                Article
                3417
                10.1186/s12883-023-03417-x
                10563308
                37817104
                b6a1e2f4-4a3e-4963-9911-dcacabfcf14b
                © BioMed Central Ltd., part of Springer Nature 2023

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 14 May 2023
                : 1 October 2023
                Funding
                Funded by: National Natural Science Foundation of China
                Award ID: 82101335
                Award ID: 82171239
                Funded by: Shanghai Sailing Program
                Award ID: 1YF1426800
                Categories
                Case Report
                Custom metadata
                © BioMed Central Ltd., part of Springer Nature 2023

                Neurology
                tourette syndrome,kleefstra syndrome 1,ehmt1 gene,intellectual disability,tic disorders
                Neurology
                tourette syndrome, kleefstra syndrome 1, ehmt1 gene, intellectual disability, tic disorders

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