1
|
Islam F, Lee W. A Case of Generalized Chorea Presenting as an Early Feature of Fragile-X Associated Tremor/Ataxia Syndrome. Mov Disord Clin Pract 2020; 7:464-466. [PMID: 32373667 DOI: 10.1002/mdc3.12944] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 02/27/2020] [Accepted: 03/03/2020] [Indexed: 11/09/2022] Open
Affiliation(s)
- Fariha Islam
- Neurology Department, Eastern Health Box Hill Victoria Australia
| | - Will Lee
- Neurology Department, Eastern Health Box Hill Victoria Australia
| |
Collapse
|
2
|
Suardi GAM, Haddad LA. FMRP ribonucleoprotein complexes and RNA homeostasis. ADVANCES IN GENETICS 2020; 105:95-136. [PMID: 32560791 DOI: 10.1016/bs.adgen.2020.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The Fragile Mental Retardation 1 gene (FMR1), at Xq27.3, encodes the fragile mental retardation protein (FMRP), and displays in its 5'-untranslated region a series of polymorphic CGG triplet repeats that may undergo dynamic mutation. Fragile X syndrome (FXS) is the leading cause of inherited intellectual disability among men, and is most frequently due to FMR1 full mutation and consequent transcription repression. FMR1 premutations may associate with at least two other clinical conditions, named fragile X-associated primary ovarian insufficiency (FXPOI) and tremor and ataxia syndrome (FXTAS). While FXPOI and FXTAS appear to be mediated by FMR1 mRNA accumulation, relative reduction of FMRP, and triplet repeat translation, FXS is due to the lack of the RNA-binding protein FMRP. Besides its function as mRNA translation repressor in neuronal and stem/progenitor cells, RNA editing roles have been assigned to FMRP. In this review, we provide a brief description of FMR1 transcribed microsatellite and associated clinical disorders, and discuss FMRP molecular roles in ribonucleoprotein complex assembly and trafficking, as well as aspects of RNA homeostasis affected in FXS cells.
Collapse
Affiliation(s)
- Gabriela Aparecida Marcondes Suardi
- Human Genome and Stem Cell Research Center, Department of Genetics and Evolutionary Biology, Instituto de Biociências, Universidade de São Paulo, São Paulo, Brazil
| | - Luciana Amaral Haddad
- Human Genome and Stem Cell Research Center, Department of Genetics and Evolutionary Biology, Instituto de Biociências, Universidade de São Paulo, São Paulo, Brazil.
| |
Collapse
|
3
|
Seritan AL, Kim K, Benjamin I, Seritan I, Hagerman RJ. Risk Factors for Cognitive Impairment in Fragile X-Associated Tremor/Ataxia Syndrome. J Geriatr Psychiatry Neurol 2016; 29:328-337. [PMID: 27647792 PMCID: PMC5357600 DOI: 10.1177/0891988716666379] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Fragile X-associated tremor/ataxia syndrome (FXTAS) is a late-onset neurodegenerative disease with motor, psychiatric, and cognitive manifestations that occurs in carriers of the fragile X mental retardation 1 ( FMR1) gene premutations. This was a retrospective chart review of 196 individuals (127 men and 69 women) with FXTAS. Forty-six (23%) participants were cognitively impaired, of whom 19 (10%) had dementia. Risk factors for dementia were examined (CGG repeat size; alcohol, benzodiazepine, and opioid use; diabetes; hyperlipidemia; hypertension; hypothyroidism; obesity; sleep apnea; surgeries with general anesthesia; depression; family history of dementia). Thirteen individuals with FXTAS and dementia were then compared to 13 cognitively intact individuals matched on age, gender, and FXTAS stage. CGG repeat size was significantly higher (mean = 98.5, standard deviation [SD] = 22.2) in the dementia group, compared to the cognitively intact group (mean = 81.6, SD = 11.5; P = .0256). These results show that CGG repeat size is a risk factor for FXTAS dementia.
Collapse
Affiliation(s)
- Andreea L. Seritan
- Department of Psychiatry, University of California, San Francisco, San Francisco, California
| | - Kyoungmi Kim
- Department of Public Health Sciences, Division of Biostatistics, University of California, Davis, Davis California,Medical Investigation of Neurodevelopmental Disorders (M.I.N.D.) Institute, Sacramento, California
| | | | - Ioana Seritan
- University of California, Berkeley, Berkeley, California
| | - Randi J. Hagerman
- Medical Investigation of Neurodevelopmental Disorders (M.I.N.D.) Institute, Sacramento, California,Department of Pediatrics, University of California, Davis Medical Center, Sacramento, California
| |
Collapse
|
4
|
Abstract
Many physicians are unaware of the many phenotypes associated with the fragile X premutation, an expansion in the 5' untranslated region of the fragile X mental retardation 1 (FMR1) gene that consists of 55-200 CGG repeats. The most severe of these phenotypes is fragile X-associated tremor/ataxia syndrome (FXTAS), which occurs in the majority of ageing male premutation carriers but in fewer than 20% of ageing women with the premutation. The prevalence of the premutation is 1 in 150-300 females, and 1 in 400-850 males, so physicians are likely to see people affected by FXTAS. Fragile X DNA testing is broadly available in the Western world. The clinical phenotype of FXTAS at presentation can vary and includes intention tremor, cerebellar ataxia, neuropathic pain, memory and/or executive function deficits, parkinsonian features, and psychological disorders, such as depression, anxiety and/or apathy. FXTAS causes brain atrophy and white matter disease, usually in the middle cerebellar peduncles, the periventricular area, and the splenium and/or genu of the corpus callosum. Here, we review the complexities involved in the clinical management of FXTAS and consider how targeted treatment for these clinical features of FXTAS will result from advances in our understanding of the molecular mechanisms that underlie this neurodegenerative disorder. Such targeted approaches should also be more broadly applicable to earlier forms of clinical involvement among premutation carriers.
Collapse
|
5
|
Abstract
Premutation carriers of the fragile X mental retardation gene (especially men) older than 50 may develop a neurodegenerative disease, the fragile X-associated tremor/ataxia syndrome (FXTAS). Carriers may present with varied cognitive impairments. Attention, working memory, declarative and procedural learning, information processing speed, and recall are among the cognitive domains affected. Executive dysfunction is a prominent deficit, which has been demonstrated mostly in men with FXTAS. In more advanced stages of FXTAS, both men and women may develop a mixed cortical-subcortical dementia, manifested by psychomotor slowing and deficits in attention, retrieval, recall, visuospatial skills, occasional apraxia, as well as overt personality changes. Studies have shown dementia rates as high as 37-42% in older men with FXTAS, although more research is needed to understand the prevalence and risk factors of dementia in women with FXTAS. Neuropsychiatric symptoms are common and reflect the dysfunction of underlying frontal-subcortical neural circuits, along with components of the cerebellar cognitive affective syndrome. These include labile or depressed mood, anxiety, disinhibition, impulsivity, and (rarely) psychotic symptoms. In this paper we review the information available to date regarding the prevalence and clinical picture of FXTAS dementia. Differential diagnosis may be difficult, given overlapping motor and non-motor signs with several other neurodegenerative diseases. Anecdotal response to cholinesterase inhibitors and memantine has been reported, while symptomatic treatments can address the neuropsychiatric manifestations of FXTAS dementia.
Collapse
Affiliation(s)
- Andreea Seritan
- Department of Psychiatry and Behavioral Sciences, University of California Davis Medical Center, Sacramento, California
| | - Jennifer Cogswell
- Medical Investigation of Neurodevelopmental Disorders (M.I.N.D.) Institute, University of California Davis Medical Center, Sacramento, California
| | - Jim Grigsby
- Departments of Psychology and Medicine, University of Colorado Denver, Denver, Colorado
| |
Collapse
|
6
|
Leehey MA. Fragile X-associated tremor/ataxia syndrome: clinical phenotype, diagnosis, and treatment. J Investig Med 2011; 57:830-6. [PMID: 19574929 DOI: 10.2310/jim.0b013e3181af59c4] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Fragile X-associated tremor/ataxia syndrome (FXTAS) is a neurodegenerative disorder caused by a CGG repeat expansion in the premutation range (55-200) in the fragile X mental retardation 1 gene. Onset is typically in the early seventh decade, and men are principally affected. The major signs are cerebellar gait ataxia, intention tremor, frontal executive dysfunction, and global brain atrophy. Other frequent findings are parkinsonism (mild), peripheral neuropathy, psychiatric symptoms (depression, anxiety, and agitation), and autonomic dysfunction. The clinical presentation is heterogeneous, with individuals presenting with varied dominating signs, such as tremor, dementia, or neuropathy. Magnetic resonance imaging shows atrophy and patchy white matter lesions in the cerebral hemispheres and middle cerebellar peduncles. The latter has been designated the middle cerebellar peduncle sign, which occurs in about 60% of affected men, and is relatively specific for FXTAS. Affected females generally have less severe disease, less cognitive decline, and some symptoms different from that of men, for example, muscle pain. Management of FXTAS is complex and includes assessment of the patient's neurological and medical deficits, treatment of symptoms, and provision of relevant referrals, especially genetic counseling. Treatment is empirical, based on anecdotal experience and on knowledge of what works for symptoms of other disorders that also exist in FXTAS. Presently, the disorder is underrecognized because the first published report was only in 2001 and because the presentation is variable and mainly consists of a combination of signs common in the elderly. However, accurate diagnosis is critical for the patient and for the family because they need education regarding their genetic and health risks.
Collapse
Affiliation(s)
- Maureen A Leehey
- Department of Neurology, University of Colorado Denver, Aurora, CO 80045, USA.
| |
Collapse
|
7
|
Kasuga K, Ikeuchi T, Arakawa K, Yajima R, Tokutake T, Nishizawa M. A patient with fragile x-associated tremor/ataxia syndrome presenting with executive cognitive deficits and cerebral white matter lesions. Case Rep Neurol 2011; 3:118-23. [PMID: 21720528 PMCID: PMC3124446 DOI: 10.1159/000328838] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Fragile X-associated tremor/ataxia syndrome (FXTAS) is a late-onset neurodegenerative disorder that primarily affects males who are carriers of a premutation of a CGG expansion in the FMR1 gene. In Asian populations, FXTAS has rarely been reported. Here, we report the case of a Japanese FXTAS patient who showed predominant executive cognitive deficits as the main feature of his disease. In contrast, the patient exhibited only very mild symptoms of intention tremor and ataxia, which did not interfere with daily activities. A gene analysis revealed that the patient carried a premutation of a CGG expansion (111 CGG repeats) in the FMR1 gene. The mRNA expression level of FMR1 in the patient was 1.5-fold higher than in controls. On brain MRI scans, fluid-attenuated inversion recovery images showed high-intensity lesions in the middle cerebellar peduncles and the cerebral white matter, with a frontal predominance. The present case extends previous notions regarding the cognitive impairment in FXTAS patients. Recognizing FXTAS patients with predominant cognitive impairment from various ethnic backgrounds would contribute to our understanding of the phenotypic variation of this disease.
Collapse
Affiliation(s)
- Kensaku Kasuga
- Department of Neurology, Brain Research Institute, Niigata University, Niigata, Japan
| | | | | | | | | | | |
Collapse
|
8
|
Capelli LP, Gonçalves MRR, Leite CC, Barbosa ER, Nitrini R, Vianna-Morgante AM. The fragile x-associated tremor and ataxia syndrome (FXTAS). ARQUIVOS DE NEURO-PSIQUIATRIA 2010; 68:791-8. [DOI: 10.1590/s0004-282x2010000500023] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Accepted: 04/06/2010] [Indexed: 01/11/2023]
Abstract
FXTAS (Fragile X-associated tremor and ataxia syndrome) is a late- onset neurodegenerative disorder affecting mainly men, over 50 years of age, who are carriers of the FMR1 gene premutation. The full mutation of this gene causes the fragile X syndrome (FXS), the most common cause of inherited mental retardation. Individuals affected by FXTAS generally present intention tremor and gait ataxia that might be associated to specific radiological and/or neuropathological signs. Other features commonly observed are parkinsonism, cognitive decline, peripheral neuropathy and autonomic dysfunction. Nearly a decade after its clinical characterization, FXTAS is poorly recognized in Brazil. Here we present a review of the current knowledge on the clinical, genetic and diagnostic aspects of the disease.
Collapse
|
9
|
Nitrini R, Gonçalves MRR, Capelli LP, Barbosa ER, Porto CS, Amaro E, Otto PA, Vianna-Morgante AM. Dementia in Fragile X-associated Tremor/Ataxia Syndrome. Dement Neuropsychol 2010; 4:79-83. [PMID: 29213666 PMCID: PMC5619536 DOI: 10.1590/s1980-57642010dn40100014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Fragile X-associated tremor/ataxia syndrome (FXTAS) is a cause of movement
disorders and cognitive decline which has probably been underdiagnosed,
especially if its prevalence proves similar to those of progressive supranuclear
palsy and amyotrophic lateral sclerosis. We report a case of a 74-year-old man
who presented with action tremor, gait ataxia and forgetfulness. There was a
family history of tremor and dementia, and one of the patient’s grandsons was
mentally deficient. Neuropsychological evaluation disclosed a frontal network
syndrome. MRI showed hyperintensity of both middle cerebellar peduncles, a major
diagnostic hallmark of FXTAS. Genetic testing revealed premutation of the
FMR1 gene with an expanded (CGG)90 repeat. The
diagnosis of FXTAS is important for genetic counseling because the daughters of
the affected individuals are at high risk of having offspring with fragile X
syndrome. Tremors and cognitive decline should raise the diagnostic hypothesis
of FXTAS, which MRI may subsequently reinforce, while the detection of the
FMR1 premutation can confirm the condition.
Collapse
Affiliation(s)
- Ricardo Nitrini
- MD, Departments of Neurology, School of Medicine, University of São Paulo, São Paulo SP, Brazil
| | | | - Leonardo P Capelli
- MSc, Department of Genetics and Evolutionary Biology, Institute of Biosciences, University of São Paulo, São Paulo SP, Brazil
| | - Egberto Reis Barbosa
- MD, Departments of Neurology, School of Medicine, University of São Paulo, São Paulo SP, Brazil
| | - Cláudia Sellitto Porto
- PhD, Departments of Neurology, School of Medicine, University of São Paulo, São Paulo SP, Brazil
| | - Edson Amaro
- MD, Departments of Neurology and Radiology, School of Medicine, University of São Paulo, São Paulo SP, Brazil
| | - Paulo Alberto Otto
- MD, Department of Genetics and Evolutionary Biology, Institute of Biosciences, University of São Paulo, São Paulo SP, Brazil
| | - Angela M Vianna-Morgante
- PhD, Department of Genetics and Evolutionary Biology, Institute of Biosciences, University of São Paulo, São Paulo SP, Brazil
| |
Collapse
|
10
|
Bourgeois J, Coffey S, Rivera SM, Hessl D, Gane LW, Tassone F, Greco C, Finucane B, Nelson L, Berry-Kravis E, Grigsby J, Hagerman PJ, Hagerman RJ. A review of fragile X premutation disorders: expanding the psychiatric perspective. J Clin Psychiatry 2009; 70:852-62. [PMID: 19422761 PMCID: PMC2705685 DOI: 10.4088/jcp.08m04476] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2008] [Accepted: 11/11/2008] [Indexed: 01/28/2023]
Abstract
CONTEXT Fragile X premutation conditions are associated with a significant degree of psychopathology and thus are of interest to the psychiatrist. Remarkable advances at the molecular level have enhanced our understanding of fragile X premutation disorders. OBJECTIVE The authors review the genetic, molecular, neuroimaging, and clinical (systemic, neurologic, and psychiatric) manifestations of the premutation carrier state (55-200 CGG repeats) of the fragile X mental retardation 1 (FMR1) gene. DATA SOURCES The search for the psychiatric clinical manifestations of fragile X-associated conditions was accomplished by PubMed for clinical papers published between 1970 and 2008 with the following search terms: Fragile X syndrome, depression, psychosis, anxiety, and dementia. STUDY SELECTION Articles addressing psychiatric symptoms in premutation carriers based on review of the abstracts were reviewed. As the majority of the literature on this topic is based on case reports and small case series, these were included in the database. RESULTS Reported clinical manifestations of psychiatric illness in premutation carriers include an apparently significant rate of cognitive, mood, anxiety, and other psychiatric disorders. Fragile X premutation-associated conditions are part of the clinical differential diagnosis of several psychiatric syndromes, particularly in pedigrees with known fragile X syndrome cases. CONCLUSIONS Fragile X-associated psychiatric manifestations serve as a useful model for a molecular genesis of neuropsychiatric illness. Because of the multigenerational expression of fragile X-associated neuropsychiatric illness, there is a prominent role for genetic testing and genetic counseling of patients and their relatives. Genetic testing is confirmatory of the FMR1 premutation and is an essential component of the clinical evaluation. Psychopharmacologic and psychotherapeutic treatment of fragile X-associated psychiatric illnesses may improve patient function and assist in adaptation to the burden of a genetic neuropsychiatric illness.
Collapse
Affiliation(s)
- James Bourgeois
- Department of Psychiatry and Behavioral Sciences, University of California, Davis Medical Center, Sacramento, CA
| | - Sarah Coffey
- M.I.N.D. Institute, University of California, Davis Medical Center, Sacramento, CA., Department of Pediatrics, University of California, Davis Medical Center, Sacramento, CA
| | - Susan M. Rivera
- M.I.N.D. Institute, University of California, Davis Medical Center, Sacramento, CA., Department of Psychology, University of California, Davis
| | - David Hessl
- M.I.N.D. Institute, University of California, Davis Medical Center, Sacramento, CA., Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA
| | - Louise W. Gane
- M.I.N.D. Institute, University of California, Davis Medical Center, Sacramento, CA
| | - Flora Tassone
- M.I.N.D. Institute, University of California, Davis Medical Center, Sacramento, CA., Department of Biochemistry and Molecular Medicine, University of California, Davis, School of Medicine, Sacramento, CA
| | - Claudia Greco
- Department of Pathology, University of California, Davis Medical Center, School of Medicine, Sacramento, CA
| | - Brenda Finucane
- Genetic Services, Elwyn, Inc., 111 Elwyn Road, Elwyn, Pennsylvania
| | - Lawrence Nelson
- Integrative Reproductive Medicine Unit, Intramural Research Program on Reproductive and Adult Endocrinology, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Elizabeth Berry-Kravis
- Departments of Pediatrics, Neurological Sciences, and Biochemistry, RUSH University Medical Center, Chicago, IL
| | - Jim Grigsby
- Department of Medicine, University of Colorado at Denver and Health Sciences Center, Denver, CO
| | - Paul J. Hagerman
- Department of Biochemistry and Molecular Medicine, University of California, Davis, School of Medicine, Sacramento, CA
| | - Randi J. Hagerman
- M.I.N.D. Institute, University of California, Davis Medical Center, Sacramento, CA., Department of Pediatrics, University of California, Davis Medical Center, Sacramento, CA
| |
Collapse
|