NEWS - YEAR 2020

APRIL 2020

10 April 2020 

The group of the AHC Clinic at the Duke University Medical Center, directed by Professor Mohamad Mikati,  has recently published four sequential articles about Alternating Hemiplegia of Childhood.
These are their comments and recommendations about each of these articles.

  • In the article by Ghusayni et al. (Ghusayni R, Richardson JP, Uchitel J, Abdelnour E, McLean M, Prange L, Abrahamsen T, Song A, Petrella JR, Mikati MA. Magnetic resonance imaging volumetric analysis in patients with Alternating hemiplegia of childhood: A pilot study. Eur J Paediatr Neurol. 2020 Feb 13:S1090-3798(20)30032-5.) they used the technique of Quantitative MRI to determine the volume of different brain regions of AHC patients as compared to normal controls. First they determined that the use of this technique whether automated using the special program called FreeSurfer or done by manual segmentation of different brain regions was highly reproducible with high correlation between automated and manual segmentation and between two consecutive manual segmentations. Then they found that there was a negative correlation between cerebellar volume and age of 14 patients studied suggesting that cerebellar volume may decrease with age in AHC patients. Given that this is a cross sectional study (each patient’s MRI was evaluated once) there is a need to perform prospective studies in which serial MRIs are done on the same patient to definitively determine volume changes with time.
    This study showed that the techniques used can be used perform such studies in AHC patients. Depending on the results of such studies the above technique could potentially be useful as an outcome measure, biomarker, to follow progress of AHC patients during long-term therapeutic trials. link
  • In the article of Tran et al. (Tran L, Richards J, McDonald M, McConkie-Rosell A, Stong N, Jasien J, Shashi V, Mikati MA. Epileptic encephalopathy with features of rapid-onset dystonia Parkinsonism and alternating hemiplegia of childhood: a novel combination phenotype associated with ATP1A3 mutation. Epileptic Disord. 2020 Feb 1;22(1):103-109.) a four-year, nine-month-old boy is reported who presented with the following manifestations.
    1) Frequent and recurrent episodes of focal and generalized tonic seizures and of convulsive status epilepticus since the age of four months of age with concurrent developmental delay that started with the onset of the seizures.
    2) Recurrent attacks of unilateral and bilateral hemiplegia between the ages of 7 months and 2.5 years.
    3) Regression at the age of 21 months, after a febrile illness with status epilepticus, with development of continuous severe dystonia and bradykinesia with superimposed intermittent painful dystonic spasms.
    The etiology was determined to be a novel and de novo p.V589F ATP1A3 mutation.
    This article showed that this ATP1A3 mutation caused a combination phenotype that features of each of epileptic encephalopathy, alternating hemiplegia of childhood, and rapid-onset dystonia Parkinsonism. Thus, physicians and caretakers taking care of patients with epileptic encephalopathy should be on the lookout for symptoms of AHC and regression with dystonia as combination phenotypes can occur. link
  • In the article of Uchitel et al. (Uchitel J, Abdelnour E, Boggs A, Prange L, Pratt M, Bonner M, Jasien J, Dawson G, Abrahamsen T, Mikati MA. Social impairments in alternating hemiplegia of childhood. Dev Med Child Neurol. 2020 Feb 7.) they studied 34 AHC patients of social responsiveness an autism. They found that 27 of the 34 AHC patients had impaired social responsiveness as indicated by a high Social Responsiveness Scale, Second Edition (SRS-2) scores as compared to the scores of normally developing individuals. In these AHC patients, all categories of social responsiveness were impaired. These included social cognition, social communication, social awareness, social motivation, restricted interests, and repetitive behavior. The presence of epilepsy increased the chance of impaired social responsiveness. Of these 27 patients at the time of the completion of the study, 9 had been referred for formal evaluations of autism and all those nine had been diagnosed to have autism spectrum disorder.
    This study highlighted the importance of screening AHC patients, as early as possible, for autism spectrum disorder symptoms and of referring them for formal evaluation for autism as this will allow them be appropriately managed and will allow them to have more resources for their management. link
  • In the editorial written by Fernandes and Mikati (Fernandes C, Mikati MA. The expanding spectrum of ATP1A3 related disease. Eur J Paediatr Neurol. 2019 May;23(3):345-346.) the authors review expanding spectrum of ATP1A3 related disorders and provide a table that shows the distinct and overlapping symptoms of these diseases. These include in Alternating Hemiplegia of Childhood (AHC), Rapid Onset Dystonia-Parkinsonism (RDP), Relapsing encephalopathy with cerebellar ataxia (RECA), Childhood schizophrenia, autism, epileptic encephalopathy, Cerebellar ataxia, areflexia, pes cavus, optic atrophy and sensorineural hearing loss (CAPOS), and childhood rapid onset ataxia (CROA). The symptoms associated with these syndromes are presented in a succinct table for quick reference and comparison. There are, in addition, many reported patients with intermediate and combination phenotypes.
    The editorial then argues that based on the above observations, the presence of multiple symptoms associated with ATP1A3 mutations even if the patients do not fit a specific syndrome should raise the suspicion of ATP1A3 related disease. In the absence of any other clear etiology, this should lead to gene sequencing of such patient to rule out an ATP1A3 mutation. link
   Article about Social Impairments in Alternating Hemiplegia of Childhood    

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NEWS - YEAR 2019


30 November 2019 

Data collection for the OBSERV-AHC Study (a Study of the IAHCRC Consortium) started last September 1st, in Spain, France, UK and USA, supported by their national patient associations. In Italy, they are still waiting for the approval of their Ethics Committee, but they too are ready to start as soon as they obtain it.
Data will be collected and entered in the IAHCRC-CLOUD Platform by the data-entry clinicians during the neurological visits to the patients organized in collaboration with their supporting patient associations.
The caregivers of the enrolled patients are offered the possibility to record their AHC episodes directly in the IAHCRC-CLOUD Platform, through its Mobile App, so that also their data can be included in the Study.

   Read Prof. Mikati's Article on the Neurology Website    ObservAhcDataCollectionItalyMar2019  

Prof. Mohamad Mikati presenting the OBSERV-AHC Study
at the International Symposium on AHC
organized by the Spanish Patient Association AESHA
and the Reference Center for AHC at the San Juan de Deu Hospital
in Barcelona, 9 February 2019


  Prsentation of the OBSERV-AHC Study
at the Family Meeting of the Italian Patient Association
in Milan, March 2019

  ObservAhcDataCollectionSpainSep2019   ObservAhcDataCollectionFranceSep2019  
  Family Meeting for the start of the data collection
for the OBSERV-AHC Study, organized by
the Spanish Patient Association in Barcelona, September 2019
  Family Meeting for the start of the data collection
for the OBSERV-AHC Study, organized by
the French Patient Association in Lyon, October 2019
  ObservAhcMeetingReykjavikOct2019    IahcrcCloudEventCalendarMobileBrowser02  
  Working meeting organized on the occasion of the
8th Symposium on ATP1A3 in Disease (Reykjavik, Iceland, 3 October 2019),
about the start of the data collection for the OBSERV-AHC Study.
Standing, Prof. Mohamad Mikati, Scientific Coordinator of the Study;
seated, the data-entry clinicians of the Centers participating in the Study,
in France, Spain, Italy, UK and the United States.
  The Mobile App through which a caretaker
can record the patient's events in the IAHCRC-CLOUD Platform



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NEWS - YEARS 2014 to 2018


17 September 2018 
a service for the international research on AHC and the ATP1A3 diseases

Tuesday October 30 2018, 3.30pm
I.E.ME.S.T. Institute
via Michele Miraglia, 20 – Palermo, Italy

Palermo, 17 September 2018
The President of the Euro-Mediterranean Institute of Science and Technology (I.E.ME.S.T.) Bartolomeo Sammartino communicates that on Tuesday October 30 2018, at 3.30pm, the press conference will take place at the headquarters of the Institute (via Michele Miraglia, 20 – IT Palermo), for the presentation of the Project “IAHCRC-CLOUD Platform”, aimed at establishing an international platform for the data collection and sharing serving the collaborative studies of the IAHCRC Consortium.
The technical and ethical aspects will be presented, as well as the innovative features of the IAHCRC-CLOUD Platform, making it a Second Generation Rare Disease Registry, implementing the principles and methods of patient engagement and platform cooperativism.
The current studies of the IAHCRC Consortium using the Platform will also be presented; among them, the longitudinal Study OBSERV-AHC, coordinated by the Division of Pediatric Neurology - AHC and Related Disorders Program of the Duke University in Durham, NC USA. In addition, some anticipations will be given on future developments already foreseen for the Platform, to make it an open, scalable and adaptable tool for any other rare disease.
Please confirm your participation via email to This email address is being protected from spambots. You need JavaScript enabled to view it. by Friday October 26 2018.

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IAHCRC - International Consortium for the Research on Alternating Hemiplegia of Childhood and other ATP1A3 related diseases