Sirolimus Treatment in Sturge-Weber Syndrome

Alison J. Sebold, Alyssa M. Day, Joshua Ewen, Jack Adamek, Anna Byars, Bernard Cohen, Eric H. Kossoff, Tomoyuki Mizuno, Matthew Ryan, Jacqueline Sievers, Lindsay Smegal, Stacy Jennifer M Suskauer, Cameron Thomas, Alexander Vinks, Theodore A Zabel, Adrienne M. Hammill, Anne Marie Spalding Comi

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Sturge-Weber syndrome is a rare neurovascular disorder associated with capillary malformation, seizures, cognitive impairments, and stroke-like episodes (SLEs), arising from a somatic activating mutation in GNAQ. Studies suggest this mutation may cause hyperactivation of the mammalian target of rapamycin pathway. Sirolimus is an mammalian target of rapamycin inhibitor studied in other vascular anomalies and a potentially promising therapy in Sturge-Weber syndrome. Methods: Ten patients with Sturge-Weber syndrome brain involvement and cognitive impairments were enrolled. Oral sirolimus was taken for six months (maximum dose: 2 mg/day, target trough level: 4-6 ng/mL). Neuropsychological testing, electroencephalography, and port-wine score were performed at baseline and after six months on sirolimus. Neuroquality of life, adverse events, and Sturge-Weber Syndrome Neurological Score (neuroscore) were recorded at each visit. Results: Sirolimus was generally well tolerated; one subject withdrew early. Adverse events considered related to sirolimus were mostly (15/16) grade 1. A significant increase in processing speed was seen in the overall group (P = 0.031); five of nine patients with available data demonstrated statistically rare improvement in processing speed. Improvements were seen in the neuroquality of life subscales measuring anger (P = 0.011), cognitive function (P = 0.015), and depression (P = 0.046). Three subjects experiencing SLEs before and during the study reported shortened recovery times while on sirolimus. Conclusions: Sirolimus was well tolerated in individuals with Sturge-Weber syndrome and may be beneficial for cognitive impairments, especially in patients with impaired processing speed or a history of SLE. A future, randomized, placebo-controlled trial of sirolimus in patients with Sturge-Weber syndrome is needed to further understand these potentially beneficial effects.

Original languageEnglish (US)
Pages (from-to)29-40
Number of pages12
JournalPediatric Neurology
Volume115
DOIs
StatePublished - Feb 2021

Keywords

  • Cognitive function
  • Drug trial
  • mTOR pathway
  • qEEG
  • Seizure
  • Sirolimus
  • Stroke
  • Sturge-Weber syndrome

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Neurology
  • Developmental Neuroscience
  • Clinical Neurology

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