Which are the causes of Hyperekplexia?

Hyperekplexia, also known as startle disease, is a rare genetic neurological disorder characterized by an exaggerated startle response to unexpected stimuli. This condition is caused by mutations in specific genes that affect the normal functioning of inhibitory neurotransmitters in the brain, particularly glycine receptors.

Glycine receptors: Glycine is an inhibitory neurotransmitter that plays a crucial role in regulating the excitability of neurons in the central nervous system. It binds to glycine receptors, which are ion channels responsible for inhibiting the transmission of signals between neurons. In individuals with hyperekplexia, mutations in genes encoding glycine receptors result in dysfunctional or reduced receptor activity, leading to an abnormal startle response.

Genetic mutations: Hyperekplexia is primarily caused by mutations in several genes, including GLRA1, GLRB, GPHN, and ARHGEF9. The GLRA1 and GLRB genes provide instructions for making the alpha-1 and beta subunits of glycine receptors, respectively. Mutations in these genes can disrupt the structure or function of glycine receptors, impairing their ability to regulate neuronal excitability effectively. GPHN gene mutations affect the production of gephyrin, a protein that helps anchor glycine receptors at specific locations in the neurons. ARHGEF9 gene mutations are associated with a rare form of hyperekplexia known as the "Hyperekplexia-Epilepsy Syndrome," which involves additional symptoms such as epilepsy and intellectual disability.

Inheritance: Hyperekplexia can be inherited in an autosomal dominant or autosomal recessive manner, depending on the specific gene involved. Autosomal dominant hyperekplexia occurs when a person inherits one copy of the mutated gene from an affected parent. Autosomal recessive hyperekplexia requires both copies of the gene to be mutated, with each parent being a carrier of the mutated gene.

Other causes: While genetic mutations are the primary cause of hyperekplexia, there have been rare cases where the condition is acquired rather than inherited. Acquired hyperekplexia can be caused by factors such as brainstem lesions, brain trauma, or certain medications that affect the glycine receptors or neurotransmitter signaling.

Symptoms: The hallmark symptom of hyperekplexia is an exaggerated startle response, which can be triggered by sudden noises, touch, or unexpected movements. Infants with hyperekplexia may experience episodes of stiffness or rigidity, often leading to falls or injury. Other symptoms may include muscle stiffness, hypertonia, and in some cases, additional neurological abnormalities like seizures or developmental delays.

Treatment: While there is no cure for hyperekplexia, management of symptoms is possible. Medications such as benzodiazepines or clonazepam can help reduce the frequency and severity of startle episodes. Physical therapy may also be beneficial in improving muscle tone and coordination. Genetic counseling is essential for affected individuals and their families to understand the inheritance pattern and potential risks in future pregnancies.