Background: This study aimed to evaluate the clinical symptoms of Angelman syndrome (AS) in adults and to identify the neurological pathways affected in this disease. AS is a neurogenetic disorder resulting due to the deletion or inactivation of the ubiquitin-protein-ligase E3A gene on maternal chromosome 15. Summary: A retrospective analysis of data from six adults patients with clinical, electroencephalographic and genetic confirmation of AS was performed. Movement disorders of the hands and mouth, laughing spells, severe expressive speech disorders, a happy nature, hyposomnia and anxiety are the major neurological characteristics of AS in adulthood. Cerebellar ataxia, muscle hypotonia and tremor, though constant in childhood, tend to be attenuated in adulthood. Epilepsy, one of the most frequent symptoms in childhood and in adulthood, is characterised by specific electroencephalographic patterns. Key Messages: These clinical characteristics are important to improve the clinical awareness and genetic diagnosis of AS. Clinicians must be better informed concerning the adult phenotype as it is not well described in the literature. We stress the importance of AS as one of the main causes of intractable epilepsy. The authors suggest frontal and cerebellar dysfunction. Further functional cerebral imaging studies are necessary.

1.
Kishino T, Lalande M, Wagstaff J: UBE3A/E6-AP mutations cause Angelman syndrome. Nat Genet 1997;15:70-73.
2.
Albrecht U, Sutcliffe JS, Cattanach BM, et al: Imprinted expression of the murine Angelman syndrome gene, Ube3a, in hippocampal and Purkinje neurons. Nat Genet 1997;17:75-78.
3.
Thibert RL, Larson AM, Hsieh DT, Raby AR, Thiele EA: Neurologic manifestations of Angelman syndrome. Pediatr Neurol 2013;48:271-279.
4.
Dagli A, Buiting K, Williams CA: Molecular and clinical aspects of Angelman syndrome. Mol Syndromol 2011;2:100-112.
5.
Brun Gasca C, Obiols JE, Bonillo A, Artigas J, Lorente I, Gabau E, Guitart M, Turk J: Adaptive behaviour in Angelman syndrome: its profile and relationship to age. J Intellect Disabil Res 2010;54:1024-1029.
6.
Tan WH, Bacino CA, Skinner SA, et al: Angelman syndrome: mutations influence features in early childhood. Am J Med Genet A 2011;155A:81-90.
7.
Online Medenlian Inheritance in Man. Baltimore, MD, McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University. http://omim.org/ (accessed July 1, 2012).
8.
Tzagkaraki E, Sofocleous C, Fryssira-Kanioura H, Dinopoulos A, Goulielmos G, Mavrou A, Kitsiou-Tzeli S, Kanavakis E: Screening of UBE3A gene in patients referred for Angelman syndrome. Eur J Paediatr Neurol 2013;17:366-373.
9.
Williams CA, Beaudet AL, Clayton-Smith J, et al: Angelman syndrome 2005: updated consensus for diagnostic criteria. Am J Med Genet A 2006;140:413-418.
10.
Beckung E, Steffenburg S, Kyllerman M: Motor impairments, neurological signs, and developmental level in individuals with Angelman syndrome. Dev Med Child Neurol 2004;46:239-243.
11.
Williams CA: The behavioral phenotype of the Angelman syndrome. Am J Med Genet C Semin Med Genet 2010;154C:432-437.
12.
Varela MC, Kok F, Otto PA, Koiffmann CP: Phenotypic variability in Angelman syndrome: comparison among different deletion classes and between deletion and UPD subjects. Eur J Hum Genet 2004;12:987-992.
13.
Galvan-Manso M, Campistol J, Conill J, Sanmarti FX: Analysis of the characteristics of epilepsy in 37 patients with the molecular diagnosis of Angelman syndrome. Epileptic Disord 2005;7:19-25.
14.
Thibert RL, Conant KD, Braun EK, et al: Epilepsy in Angelman syndrome: a questionnaire-based assessment of the natural history and current treatment options. Epilepsia 2009;50:2369-2376.
15.
Valente KD, Koiffmann CP, Fridman C, et al: Epilepsy in patients with Angelman syndrome caused by deletion of the chromosome 15q11-13. Arch Neurol 2006;63:122-128.
16.
Buoni S, Grosso S, Pucci L, Fois A: Diagnosis of Angelman syndrome: clinical and EEG criteria. Brain Dev 1999;21:296-302.
17.
Uemura N, Matsumoto A, Nakamura M, et al: Evolution of seizures and electroencephalographical findings in 23 cases of deletion type Angelman syndrome. Brain Dev 2005;27:383-388.
18.
Espay AJ, Andrade DM, Wennberg RA, Lang AE: Atypical absences and recurrent absence status in an adult with Angelman syndrome due to the UBE3A mutation. Epileptic Disord 2005;7:227-230.
19.
Vendrame M, Loddenkemper T, Zarowski M, Gregas M, Shuhaiber H, Sarco DP, Morales A, Nespeca M, Sharpe C, Haas K, Barnes G, Glaze D, Kothare SV: Analysis of EEG patterns and genotypes in patients with Angelman syndrome. Epilepsy Behav 2012;23:261-265.
20.
Valente KD, Andrade JQ, Grossmann RM, et al: Angelman syndrome: difficulties in EEG pattern recognition and possible misinterpretations. Epilepsia 2003;44:1051-1063.
21.
Yum MS, Lee EH, Kim JH, Ko TS, Yoo HW: Implications of slow waves and shifting epileptiform discharges in Angelman syndrome. Brain Dev 2013;35:245-251.
22.
Laan LA, Vein AA: A Rett patient with a typical Angelman EEG. Epilepsia 2002;43:1590-1592.
23.
Harting I, Seitz A, Rating D, Sartor K, Zschocke J, Janssen B, Ebinger F, Wolf NI: Abnormal myelination in Angelman syndrome. Eur J Paediatr Neurol 2009;13:271-276.
24.
Peters SU, Kaufmann WE, Bacino CA, et al: Alterations in white matter pathways in Angelman syndrome. Dev Med Child Neurol 2010;53:361-367.
25.
Castro-Gago M, Gómez-Lado C, Eirís-Puňal J, et al: Abnormal myelination in Angelman syndrome. Eur J Paediatr Neurol 2010;14:292.
26.
Wilson BJ, Sundaram SK, Huq AH, et al: Abnormal language pathway in children with Angelman syndrome. Pediatr Neurol 2011;44:350-356.
27.
Tiwari VN, Jeong JW, Wilson BJ, Behen ME, Chugani HT, Sundaram SK: Relationship between aberrant brain connectivity and clinical features in Angelman syndrome: a new method using tract based spatial statistics of DTI color-coded orientation maps. Neuroimage 2012;59:349-355.
28.
Smith JC: Angelman syndrome: evolution of the phenotype in adolescents and adults. Dev Med Child Neurol 2001;43:476-480.
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