TY  - JOUR
A1  - Wente, Sarah
A1  - Schröder, Simone
A1  - Buckard, Johannes
A1  - Büttel, Hans-Martin
A1  - von Deimling, Florian
A1  - Diener, Wilfried
A1  - Häussler, Martin
A1  - Hübschle, Susanne
A1  - Kinder, Silvia
A1  - Kurlemann, Gerhard
A1  - Kretzschmar, Christoph
A1  - Lingen, Michael
A1  - Maroske, Wiebke
A1  - Mundt, Dirk
A1  - Sánchez-Albisua, Iciar
A1  - Seeger, Jürgen
A1  - Toelle, Sandra P.
A1  - Boltshauser, Eugen
A1  - Brockmann, Knut
T1  - Nosological delineation of congenital ocular motor apraxia type Cogan: an observational study
JF  - Orphanet Journal of Rare Diseases
N2  - Background
The nosological assignment of congenital ocular motor apraxia type Cogan (COMA) is still controversial. While regarded as a distinct entity by some authorities including the Online Mendelian Inheritance in Man catalog of genetic disorders, others consider COMA merely a clinical symptom.

Methods
We performed a retrospective multicenter data collection study with re-evaluation of clinical and neuroimaging data of 21 previously unreported patients (8 female, 13 male, ages ranging from 2 to 24 years) diagnosed as having COMA.

Results
Ocular motor apraxia (OMA) was recognized during the first year of life and confined to horizontal pursuit in all patients. OMA attenuated over the years in most cases, regressed completely in two siblings, and persisted unimproved in one individual. Accompanying clinical features included early onset ataxia in most patients and cognitive impairment with learning disability (n = 6) or intellectual disability (n = 4). Re-evaluation of MRI data sets revealed a hitherto unrecognized molar tooth sign diagnostic for Joubert syndrome in 11 patients, neuroimaging features of Poretti-Boltshauser syndrome in one case and cerebral malformation suspicious of a tubulinopathy in another subject. In the remainder, MRI showed vermian hypo-/dysplasia in 4 and no abnormalities in another 4 patients. There was a strong trend to more severe cognitive impairment in patients with Joubert syndrome compared to those with inconclusive MRI, but otherwise no significant difference in clinical phenotypes between these two groups.

Conclusions
Systematical renewed analysis of neuroimaging data resulted in a diagnostic reappraisal in the majority of patients with early-onset OMA in the cohort reported here. This finding poses a further challenge to the notion of COMA constituting a separate entity and underlines the need for an expert assessment of neuroimaging in children with COMA, especially if they show cognitive impairment.
KW  - congenital ocular motor apraxia
KW  - molar tooth sign
KW  - Joubert syndrome
Y1  - 2016
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-166534
VL  - 11
IS  - 104
ER  -