Descripción general
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El trastorno del espectro autista (TEA) es un trastorno del neurodesarrollo que se caracteriza por déficits persistentes en la comunicación social y la interacción social y patrones de comportamiento, intereses y actividades restringidos y repetitivos. Estos síntomas aparecen desde la primera infancia y limitan o perjudican el funcionamiento diario. El TEA puede ser una condición aislada e idiopática o asociada a enfermedades genéticas como el síndrome de Rett, neurofibromatosis, esclerosis tuberosa y síndrome de X frágil, entre otras. Esto aumenta la heredabilidad de los TEA a más del 90%. El trastorno por déficit de atención con hiperactividad (TDAH) es uno de los trastornos neuropsiquiátricos más comunes de la niñez y la adolescencia, y a menudo persiste hasta la edad adulta. El TDAH se caracteriza por síntomas de falta de atención, impulsividad, inquietud, disfunción ejecutiva y desregulación emocional que conducen a una marcada disminución del funcionamiento. A menudo, el TDAH comparte comorbilidad con otras afecciones psiquiátricas como el trastorno obsesivo compulsivo. El TDAH es altamente heredable y multifactorial; múltiples genes y factores no hereditarios contribuyen al trastorno. El riesgo de TDAH en padres y hermanos de niños con TDAH aumenta de 2 a 8 veces con una heredabilidad de aproximadamente el 76%.
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El panel de precisión del trastorno por déficit de atención e hiperactividad de Igenomix puede servir como una herramienta de diagnóstico precisa y dirigida que, en última instancia, conduce a un mejor manejo y pronóstico de la enfermedad. Proporciona un análisis completo de los genes involucrados en esta enfermedad utilizando secuenciación de próxima generación (NGS) para comprender completamente el espectro de genes relevantes involucrados.
Indicaciones
- El Trastorno de Autismo e Hiperactividad por Déficit de Atención está indicado en pacientes con sospecha clínica o diagnóstico de con o sin las siguientes manifestaciones:
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Déficits persistentes en la comunicación social y la interacción social en múltiples entornos.
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Patrones de comportamiento, intereses o actividades restringidos y repetitivos
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Deterioro de capacidades funcionales
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Síntomas no explicados por discapacidad intelectual
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Síntomas presentes en el período de desarrollo temprano.
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Dificultad para realizar las tareas diarias, falta de concentración.
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Hiperactividad y distracción.
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Retrasos y desviaciones del idioma
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Patrones de olvido
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Hablar en exceso
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Utilidad clínica
La utilidad clínica de este panel es:
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El diagnóstico genético y molecular para un diagnóstico clínico preciso de un paciente sintomático. Mejorar los criterios diagnósticos, los estudios de historia natural y las nuevas opciones terapéuticas.
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Inicio temprano del tratamiento con un equipo multidisciplinario en forma de terapias conductuales, educativas y psicológicas, que han demostrado ser las más efectivas para los TEA.
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En el caso del TDAH, la reestructuración ambiental y la terapia conductual, así como los desarrollos en la capacitación conductual para padres (BPT) y la gestión conductual del aula (BCM). La atención médica con estimulantes también se considera un tratamiento de primera línea.
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Evaluación de riesgos y asesoramiento genético de familiares asintomáticos según modalidad hereditaria.
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Mejora de la delimitación de la correlación genotipo-fenotipo.
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Genes y enfermedades
GENE |
OMIM DISEASES |
INHERITANCE* |
% GENE COVERAGE (20X) |
HGMD** |
ABCC8 |
Permanent Neonatal |
AD,AR |
99.98 |
710 of 712 |
ACADM |
Medium Chain |
AR |
99.98 |
181 of 181 |
ACTA1 |
Congenital Myopathy |
AD,AR |
100 |
224 of 224 |
ADCY6 |
Lethal Congenital |
AR |
100 |
2 of 2 |
ADGRG6 |
Lethal Congenital |
AR |
99.91 |
NA of NA |
AGRN |
Congential Myasthenic |
AR |
99.71 |
18 of 18 |
AIMP1 |
Hypomyelinating |
AR |
100 |
10 of 10 |
AK9 |
Postsynaptic |
– |
98.37 |
4 of 4 |
ALG14 |
Congenital |
AR |
99.99 |
7 of 7 |
ALG2 |
Congenital Disorder |
AR |
99.61 |
7 of 7 |
ALG3 |
Congenital Disorder |
AR |
99.2 |
25 of 25 |
ASCC1 |
Spinal Muscular |
AR |
99.97 |
6 of 6 |
ATAD1 |
Hereditary |
AR |
99.97 |
3 of 3 |
AUTS2 |
Autosomal Dominant |
AD |
99.63 |
9 of 17 |
BICD2 |
Autosomal Dominant |
AD |
99.94 |
39 of 39 |
BIN1 |
Autosomal Recessive |
AR |
100 |
20 of 20 |
C12ORF65 |
Combined Oxidative |
AR |
na |
na |
CACNA1E |
Epileptic |
AD |
99.94 |
25 of 25 |
CASK |
Nonspherocytic Hemolytic |
X,XR,XD,G |
99.98 |
NA of NA |
CCDC47 |
Trichohepatoneu- |
AR |
99.94 |
5 of 5 |
CDK5 |
Lissencephaly With |
AR |
100 |
5 of 5 |
CEP55 |
Multinucleated Neurons, |
AR |
99.22 |
3 of 3 |
CFL2 |
Nemaline Myopathy |
AR |
99.98 |
9 of 9 |
CHAT |
Congenital Myasthenic |
AR |
100 |
49 of 49 |
CHMP1A |
Pontocerebellar |
AR |
100 |
4 of 4 |
CHRNA1 |
Multiple Pterygium |
AD,AR |
100 |
35 of 35 |
CHRNB1 |
Congential Myasthenic |
AD,AR |
95 |
9 of 9 |
CHRND |
Multiple Pterygium |
AD,AR |
100 |
31 of 31 |
CHRNE |
Familial Infantile |
AD,AR |
99.87 |
138 of 138 |
CHRNG |
Multiple Pterygium |
AR |
100 |
36 of 36 |
CHST14 |
Musculocontractural |
AR |
97.7 |
21 of 22 |
CHUK |
Cocoon |
AR |
100 |
5 of 5 |
CNTNAP1 |
Lethal Congenital |
AR |
99.97 |
25 of 25 |
COL13A1 |
Congenital Myasthenic |
AR |
99.97 |
16 of 16 |
COL6A2 |
Bethlem Myopathy |
AD,AR |
100 |
223 of 225 |
COLQ |
Endplate Acetylcholinesterase |
AR |
100 |
70 of 71 |
DHCR24 |
Desmosterolosis |
AR |
100 |
10 of 10 |
DOK7 |
Fetal Akinesia Deformation |
AR |
99.88 |
72 of 72 |
DPAGT1 |
Congenital Disorder Of |
AR |
100 |
41 of 41 |
DSE |
Musculocontractural |
AR |
99.94 |
3 of 3 |
ECEL1 |
Distal Arthrogryposis |
AR |
99.52 |
39 of 39 |
EGR2 |
Demyelinating Charcot- |
AD,AR |
100 |
23 of 23 |
ERBB3 |
Lethal Congenital |
AD,AR |
99.91 |
6 of 6 |
ERCC1 |
Cerebrooculofacioskeletal |
AR |
93.12 |
6 of 6 |
ERCC2 |
Cerebrooculofacioskeletal |
AR |
100 |
102 of 102 |
ERCC5 |
Cerebrooculofacioskeletal |
AR |
99.94 |
58 of 58 |
ERCC6 |
Cerebrooculofacioskeletal |
AD,AR |
99.98 |
127 of 128 |
ERGIC1 |
Neurogenic |
AR |
100 |
2 of 2 |
EXOSC3 |
Pontocerebellar |
AR |
100 |
19 of 20 |
FAM20C |
Lethal Osteosclerotic |
AR |
97.8 |
29 of 29 |
FBN2 |
Congenital Contractural |
AD |
100 |
115 of 115 |
FHL1 |
Reducing Body Myopathy, |
X,XR,XD,G |
99.98 |
NA of NA |
FIG4 |
Amyotrophic Lateral |
AD,AR |
99.92 |
72 of 72 |
FKBP10 |
Bruck Syndrome, |
AR |
100 |
51 of 51 |
FKTN |
Muscular Dystrophy- |
AR |
98 |
54 of 56 |
FLAD1 |
Lipid Storage Myopathy |
AR |
97.13 |
13 of 14 |
FLVCR2 |
Proliferative Vasculopathy |
AR |
99.97 |
16 of 16 |
GBA |
Gaucher Disease- |
AD,AR |
100 |
469 of 471 |
GBE1 |
Glycogen Storage |
AR |
99.95 |
71 of 74 |
GCK |
Permanent Neonatal |
AD,AR |
100 |
905 of 909 |
GFM2 |
Combined Oxidative |
AR |
99.35 |
5 of 7 |
GFPT1 |
Congenital Myasthenic |
AR |
100 |
57 of 57 |
GLDN |
Lethal Congenital |
AR |
98.46 |
13 of 13 |
GLE1 |
Congenital Arthrogryposis |
AR |
100 |
17 of 17 |
GLI3 |
Greig Cephalopolysyndactyly |
AD,AR |
100 |
231 of 231 |
GMPPB |
Muscular Dystrophy- |
AR |
99.95 |
53 of 53 |
HSPG2 |
Dyssegmental Dysplasia, |
AR |
99.41 |
68 of 69 |
HYMAI |
Paternal Uniparental |
AD |
na |
na |
IBA57 |
Multiple Mitochondrial |
AR |
93.35 |
25 of 27 |
INS |
Permanent Neonatal |
AD,AR |
100 |
78 of 84 |
ITGA6 |
Epidermolysis Bullosa |
AR |
100 |
10 of 10 |
ITGB4 |
Epidermolysis Bullosa |
AD,AR |
99.12 |
115 of 115 |
KAT6B |
Genitopatellar Syndrome, |
AD |
99.97 |
80 of 80 |
KBTBD13 |
Childhood-Onset |
AD |
99.66 |
15 of 15 |
KCNJ11 |
Permanent Neonatal |
AD,AR |
100 |
190 of 191 |
KIAA1109 |
Alkuraya-Kucinskas |
AR |
99.95 |
21 of 21 |
KIF14 |
Meckel Syndrome, |
AR |
99.84 |
18 of 18 |
KIF1A |
Autosomal Dominant |
AD,AR |
100 |
76 of 76 |
KIF5C |
Cortical Dysplasia, |
AD |
99.96 |
7 of 7 |
KLHL40 |
Severe Congenital |
AR |
99.98 |
26 of 26 |
KLHL41 |
Childhood-Onset |
AR |
99.92 |
8 of 8 |
LAMB2 |
Pierson Syndrome , |
AR |
100 |
129 of 129 |
LGI4 |
Arthrogryposis Multiplex |
AR |
99.86 |
9 of 9 |
LMNA |
Charcot-Marie-Tooth Disease |
AD,AR |
100 |
619 of 620 |
LMOD3 |
Severe Congenital |
AR |
98.68 |
23 of 26 |
LRP4 |
Cenani-Lenz Syndactyly |
AD,AR |
100 |
32 of 32 |
MAGEL2 |
Prader-Willi |
AD |
99.99 |
43 of 48 |
MED13L |
Mental Retardation And |
AD |
100 |
90 of 92 |
MPZ |
Axonal Type Charcot-Marie- |
AD,AR |
99.98 |
245 of 245 |
MTM1 |
Myotubular Myopathy, |
X,XR,G |
99.98 |
NA of NA |
MUSK |
Fetal Akinesia |
AR |
95.58 |
23 of 25 |
MYBPC1 |
Distal Arthrogryposis |
AD,AR |
100 |
13 of 13 |
MYH2 |
Proximal Myopathy |
AD,AR |
99.98 |
31 of 31 |
MYH3 |
Distal Arthrogryposis, |
AD,AR |
100 |
46 of 47 |
MYH8 |
Carney Complex Variant, |
AD |
100 |
6 of 6 |
MYO9A |
Congenital Myasthenic |
AR |
99.62 |
7 of 7 |
MYOD1 |
Congenital Myopathy With |
AR |
99.97 |
6 of 6 |
MYPN |
Nemaline Myopathy, |
AD,AR |
99.94 |
49 of 49 |
NALCN |
Congenital Contractures |
AD,AR |
99.97 |
69 of 69 |
NEB |
Nemaline Myopathy, |
AR |
86.77 |
304 of 339 |
NEK9 |
Arthrogryposis, Perthes |
AR |
99.98 |
4 of 4 |
NUP88 |
Fetal Akinesia |
AR |
95.82 |
3 of 3 |
PDX1 |
Pancreatic Permanent |
AD,AR |
98.02 |
32 of 36 |
PHGDH |
Neu-Laxova Syndrome, |
AR |
100 |
26 of 26 |
PI4KA |
Polymicrogyria, Perisylvian, |
AR |
99.76 |
4 of 4 |
PIEZO2 |
Distal Arthrogryposis, |
AD,AR |
96.93 |
37 of 37 |
PIGS |
Glycosylphosphatidylinositol |
AR |
100 |
6 of 6 |
PIP5K1C |
Lethal Congenital |
AR |
99.83 |
3 of 3 |
PLAGL1 |
Paternal Uniparental |
– |
95.56 |
2 of 2 |
PLEC |
Epidermolysis Bullosa |
AD,AR |
99.98 |
113 of 113 |
PLOD2 |
Bruck Syndrome |
AR |
99.97 |
29 of 29 |
PLXND1 |
Moebius |
– |
98.44 |
6 of 6 |
PMM2 |
Congenital Disorder |
AR |
100 |
127 of 129 |
PPP3CA |
Arthrogryposis, Cleft Palate, |
AD |
99.98 |
16 of 16 |
PREPL |
Congenital Myasthenic |
AR |
99.92 |
7 of 12 |
PSAT1 |
Neu-Laxova Syndrome, |
AR |
99.95 |
9 of 9 |
PSMB8 |
Proteasome-Associated |
AR |
100 |
11 of 11 |
RAPSN |
Fetal Akinesia Deformation |
AR |
99.98 |
59 of 61 |
RARS2 |
Pontocerebellar |
AR |
99.98 |
39 of 40 |
REV3L |
Moebius |
|
99.08 |
7 of 7 |
RFT1 |
Congenital Disorder |
AR |
99.98 |
18 of 18 |
RIPK4 |
Popliteal Pterygium |
AR |
99.98 |
16 of 16 |
RYR1 |
Central Core Disease |
AD,AR |
97.63 |
733 of 746 |
SCN4A |
Congenital Myasthenic |
AD,AR |
99.77 |
136 of 142 |
SCO2 |
Autosomal Recessive |
AD,AR |
100 |
38 of 38 |
SELENON |
Congoenital Myopathy |
AD,AR |
89 |
NA of NA |
SHPK |
Isolated Sedoheptulokinase |
– |
99.96 |
2 of 2 |
SLC18A3 |
Congenital Myasthenic |
AR |
99.97 |
5 of 5 |
SLC25A1 |
Congenital Myasthenic |
AR |
90 |
23 of 25 |
SLC35A3 |
Arthrogryposis, Mental |
AR |
99.94 |
5 of 5 |
SLC5A7 |
Congenital Myasthenic |
AD,AR |
99.92 |
21 of 21 |
SLC6A9 |
Glycine Encephalopathy |
AR |
99.99 |
5 of 5 |
SLC9A6 |
Christianson |
X,XD,G |
98.87 |
NA of NA |
SMN1 |
Spinal Muscular |
AR |
5.2 |
17 of 91 |
SMN2 |
Spinal Muscular |
AR |
7.6 |
0 of 3 |
SNAP25 |
Congenital Myasthenic |
AD |
100 |
6 of 6 |
SOX10 |
Peripheral Demyelinating |
AD |
99.74 |
139 of 147 |
STAC3 |
Native American |
AR |
99.98 |
5 of 5 |
STAT3 |
Multisystem Autoimmune |
AD |
100 |
171 of 171 |
STIM1 |
Immune Dysfunction |
AD,AR |
100 |
28 of 28 |
SYNE1 |
Arthrogryposis Multiplex |
AD,AR |
99.99 |
193 of 193 |
SYT2 |
Congenital Myasthenic |
AD |
99.98 |
4 of 4 |
TBCD |
Progressive Encephalopathy, |
AR |
94.89 |
28 of 28 |
TGFB3 |
Loeys-Dietz Syndrome, |
AD |
100 |
34 of 35 |
TK2 |
External Ophthalmoplegia |
AR |
97.08 |
64 of 65 |
TNNI2 |
Distal Arthrogryposis |
AD |
100 |
11 of 11 |
TNNT1 |
Nemaline |
AR |
89.94 |
7 of 8 |
TNNT3 |
Distal Arthrogryposis |
AD |
99.98 |
5 of 5 |
TPM2 |
Distal Arthrogryposis, |
AD,AR |
100 |
41 of 41 |
TPM3 |
Congenital Myopathy |
AD,AR |
100 |
27 of 27 |
TRIP4 |
Congenital Muscular |
AR |
99.92 |
3 of 3 |
TRPV4 |
Brachyrachia, Familial |
AD |
100 |
88 of 88 |
TSEN2 |
Pontocerebellar |
AR |
95.47 |
4 of 5 |
TSEN54 |
Fatal Infantile |
AR |
96.94 |
20 of 22 |
UBA1 |
Infantile-Onset X- |
X,XR,G |
99.58 |
NA of NA |
VAMP1 |
Spastic Ataxia, |
AD,AR |
99.51 |
8 of 8 |
VIPAS39 |
Arthrogryposis, |
AR |
100 |
15 of 15 |
VPS33B |
Arthrogryposis, |
AR |
100 |
62 of 62 |
VRK1 |
Pontocerebellar |
AR |
99.64 |
15 of 15 |
YY1 |
Gabriele-de Vries |
AD |
99.89 |
13 of 13 |
ZBTB42 |
Lethal Congenital |
AR |
99.81 |
1 of 1 |
ZC4H2 |
Wieacker-Wolff |
X,XR,XD,G |
99.69 |
NA of NA |
ZFP57 |
Transient Neonatal |
AD |
100 |
15 of 15 |
ZMPSTE24 |
Mandibuloacral |
AR |
100 |
35 of 36 |
ZNF335 |
Primary Autosomal |
AR |
99.83 |
20 of 20 |
ZNHIT3 |
Peho |
AR |
73.96 |
1 of 1 |
* Herencia: AD: Autosómico Dominante; AR: autosómico recesivo; X: ligado a X; XLR: recesivo vinculado a X; Mi: mitocondrial; Mu: multifactorial; G: herencia gonosomal; D: herencia digénica
** HGMD: número de mutaciones clínicamente relevantes según HGMD
Referencias
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Bamshad, M., Van Heest, A. E., & Pleasure, D. (2009). Arthrogryposis: A review and update. Journal of Bone and Joint Surgery, 91(Supplement_4), 40-46. doi:10.2106/jbjs.i.00281
Ravenscroft, G., Clayton, J. S., Faiz, F., Sivadorai, P., Milnes, D., Cincotta, R., Moon, P., Kamien, B., Edwards, M., Delatycki, M., Lamont, P. J., Chan, S. H., Colley, A., Ma, A., Collins, F., Hennington, L., Zhao, T., McGillivray, G., Ghedia, S., Chao, K., … Davis, M. R. (2020). Neurogenetic fetal akinesia and arthrogryposis: genetics, expanding genotype-phenotypes and functional genomics. Journal of medical genetics, jmedgenet-2020-106901. Advance online publication. https://doi.org/10.1136/jmedgenet-2020-106901
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Rodríguez Cruz, P. M., Palace, J., & Beeson, D. (2018). The Neuromuscular Junction and Wide Heterogeneity of Congenital Myasthenic Syndromes. International journal of molecular sciences, 19(6), 1677. https://doi.org/10.3390/ijms19061677
Finsterer J. (2019). Congenital myasthenic syndromes. Orphanet journal of rare diseases, 14(1), 57. https://doi.org/10.1186/s13023-019-1025-5
Engel A. G. (2018). Genetic basis and phenotypic features of congenital myasthenic syndromes. Handbook of clinical neurology, 148, 565–589. https://doi.org/10.1016/B978-0-444-64076-5.00037-5
Engel A. G. (2018). Congenital Myasthenic Syndromes in 2018. Current neurology and neuroscience reports, 18(8), 46. https://doi.org/10.1007/s11910-018-0852-4
Abicht, A., Müller, J., S, & Lochmüller, H. (2003). Congenital Myasthenic Syndromes. In M. P. Adam (Eds.) et. al., GeneReviews®. University of Washington, Seattle.
Hall, J. G. (2014). Arthrogryposis (multiple congenital contractures): Diagnostic approach to etiology, classification, genetics, and general principles. European Journal of Medical Genetics, 57(8), 464-472. doi:10.1016/j.ejmg.2014.03.008