Background: Malformations of cortical development (MCDs) are a major source of handicap. Much progress in understanding the genetic causes has been made recently. The number of affected children in whom a molecularly confirmed diagnosis can be made is unclear. Objective: To evaluate the etiology of MCDs in children and the effect of a combined radiological, clinical, and syndrome classification. Design: A case series of 113 children with a radiological diagnosis of MCD from January 1, 1992, to January 1, 2006. Setting: The Erasmus Medical Center-Sophia Children's Hospital, a secondary and tertiary referral center. Patients: Patients with MCD underwent a complete radiological, clinical, and neurological assessment and testing for known genes involved in the pathogenesis of MCD as appropriate for their phenotype. Results: We established an etiological diagnosis in 45 of 113 cases (40%). For 21 patients (19%), this included molecular and/or genetic confirmation (Miller-Dieker syndrome; LIS1, DCX, FLNA, EIF2AK3, or KIAA1279 mutations; or an inborn error of metabolism). In 17 (15%), a syndrome with an unknown genetic defect was diagnosed. In 7 patients (6%), we found evidence of a gestational insult. Of the remaining 68 patients, 34 probably have a yet-unknown genetic disorder based on the presence of multiple congenital anomalies (15 patients), a family history with multiple affected persons (12 patients), or consanguineous parents (7 patients). Conclusions: In our cohort, combining diagnostic molecular testing with clinical, radiological, and genetic classification; syndrome identification; and family study provided a diagnosis in 40% of the cases of MCD. This contributes to the possibility of prenatal diagnosis and improved patient treatment and disease management.

doi.org/10.1001/archneur.65.3.358, hdl.handle.net/1765/32408
Archives of Neurology
Erasmus MC: University Medical Center Rotterdam

de Wit, M.C.Y, Leguin, M, de Coo, I.F.M, Brusse, E, Halley, D, van de Graaf, R, … Mancini, G.M.S. (2008). Cortical brain malformations: Effect of clinical, neuroradiological, and modern genetic classification. Archives of Neurology, 65(3), 358–366. doi:10.1001/archneur.65.3.358