{Reference Type}: Journal Article
{Title}: Molecular and neurological features of MELAS syndrome in paediatric patients: A case series and review of the literature.
{Author}: Seed LM;Dean A;Krishnakumar D;Phyu P;Horvath R;Harijan PD;
{Journal}: Mol Genet Genomic Med
{Volume}: 10
{Issue}: 7
{Year}: 07 2022
{Factor}: 2.473
{DOI}: 10.1002/mgg3.1955
{Abstract}: Mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes (MELAS) syndrome is one of the most well-known mitochondrial diseases, with most cases attributed to m.3243A>G. MELAS syndrome patients typically present in the first two decades of life with a broad, multi-systemic phenotype that predominantly features neurological manifestations--stroke-like episodes. However, marked phenotypic variability has been observed among paediatric patients, creating a clinical challenge and delaying diagnoses.<BR>A literature review of paediatric MELAS syndrome patients and a retrospective analysis in a UK tertiary paediatric neurology centre were performed.<BR>Three children were included in this case series. All patients presented with seizures and had MRI changes not confined to a single vascular territory. Blood heteroplasmy varied considerably, and one patient required a muscle biopsy. Based on a literature review of 114 patients, the mean age of presentation is 8.1 years and seizures are the most prevalent manifestation of stroke-like episodes. Heteroplasmy is higher in a tissue other than blood in most cases.<BR>The threshold for investigating MELAS syndrome in children with suspicious neurological symptoms should be low. If blood m.3243A>G analysis is negative, yet clinical suspicion remains high, invasive testing or further interrogation of the mitochondrial genome should be considered.