Review Article

Phenotypic Diversity in GNAO1 Patients: A Comprehensive Overview of Variants and Phenotypes

Table 1

Phenotypes of previously unreported GNAO1 patients.

Patient 1Patient 2Patient 3Patient 4Patient 5Patient 6Patient 7Patient 8

Variantc.833_835del (p.K278del)c.833_835del (p.K278del) (p.S229R)(p.G203R) (p.S47R) (p.R209C) (p.E208Q) (p.G184S)
Current age8 years8 yearsDeceased (8 months)2 yearsDeceased (4 years)13 years9 years2 years
SexFFFFMMMM
Age of onset2 d2 d8 d10 d<2 monthsFirst weeks1 d1 d
Symptoms of onsetSeizureSeizureSeizureSeizureSeizureAxial hypotonia and stiffness of limbsHypotonia and swallowing difficultiesHypotonia, feeding difficulties
EpilepsyYesYesYesYesYesYesNoNo
DEEYesYesYesYesYesNoNoNo
MDDystonia (8 years)Dystonia (8 years)NoChoreoathetosis dystonia (intermittent paroxysmal)NoSpasticity and dystonia. Recurrent status dystonicus despite medication.DystoniaNo
Axial hypotoniaYesYesYesYesYesYesYesYes
Treatment
 EpilepsyTP, DPK, CNZ, LEVPB (seizure free)LEV, CBZ, PB, and CLBLEV, PB, CBZ, VA, PN, VGB, MDZ, LTG, and TPMVPA
DRESeizure freeDRESeizure freeDRESeizure free
 MDNoNoNoDZP, LVD, CH, GBP, CND, and BCFGBP, LEV, BCF, and CLBGBP and CNZ
Since deep brain stimulation, no more hospital admissions for status dystonicus
 MRI2 weeks: no abnormalities2 weeks: no abnormalitiesNo abnormalitiesNo abnormalities2 months: no abnormalities7 and 11 years: at 11 years compared to 7 years mild widening of the ventricular width and subarachnoid space5 months, 17 months, and 8 years: stable, aspecific T2 hyperintensities near occipital horn right and bilateral frontally.

Suspected DEE as determined from age of onset, EEG data, and presence of developmental delay. Criteria used from [26]. MD = movement disorder; N/A = not available; TP = topiramate; DPK = depakine; CNZ = clonazepam; LEV = levetiracetam; DRE = drug resistant epilepsy; CBZ = carbamazepine; PB = phenobarbital; CLB = clobazam; DZP = diazepam; LVD = levodopa; CH = chloral hydrate; GBP = gabapentin; CND = clonidine; BCF = baclofen; TPM = topiramate; LTG = lamotrigine; Bold: mild or fully successful treatment.