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Leucoencefalopatie ereditarie e leucodistrofie dell’adulto. Neurologia 2022. [DOI: 10.1016/s1634-7072(22)47096-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
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2
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Wang Y, Wang SY, Li K, Zhu YL, Xia K, Sun DD, Ai WL, Fu XM, Ye QR, Li J, Chen HZ. Adult-onset Krabbe disease presenting with progressive myoclonic epilepsy and asymmetric occipital lesions: A case report. Front Neurol 2022; 13:1010150. [PMID: 36341094 PMCID: PMC9633861 DOI: 10.3389/fneur.2022.1010150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 09/30/2022] [Indexed: 11/20/2022] Open
Abstract
Krabbe disease (KD), also known as globoid cell leukodystrophy, is a rare autosomal recessive condition caused by mutations in the galactocerebrosidase (GALC) gene. KD is more common in infants and young children than in adults. We reported the case of an adult-onset KD presenting with progressive myoclonic epilepsy (PME) and cortical lesions mimicking mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome. The whole-exome sequencing (WES) identified a pathogenic homozygous missense mutation of the GALC gene. Parents of the patient were heterozygous for the mutation. The clinical, electrophysiological, and radiological data of the patient were retrospectively analyzed. The patient was a 24-year-old woman presenting with generalized seizures, progressive cognitive decline, psychiatric symptoms, gait ataxia, and action-induced myoclonus. The brain magnetic resonance imaging (MRI) revealed a right occipital cortical ribbon sign without any other damage. This single case expands the clinical phenotypes of adult-onset KD.
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Affiliation(s)
- Yu Wang
- Department of Neurology, The Affiliated Hospital of Institute of Neurology, Anhui University of Chinese Medicine, Hefei, China
| | - Su-yue Wang
- Department of Internal Medicine, Feidong County Hospital of Traditional Chinese Medicine, Hefei, China
| | - Kai Li
- Department of Neurology, The Affiliated Hospital of Institute of Neurology, Anhui University of Chinese Medicine, Hefei, China
- *Correspondence: Kai Li
| | - Yu-long Zhu
- Department of Neurology, The Affiliated Hospital of Institute of Neurology, Anhui University of Chinese Medicine, Hefei, China
| | - Kun Xia
- Department of Neurology, The Affiliated Hospital of Institute of Neurology, Anhui University of Chinese Medicine, Hefei, China
| | - Dan-dan Sun
- Department of Neurology, The Affiliated Hospital of Institute of Neurology, Anhui University of Chinese Medicine, Hefei, China
| | - Wen-long Ai
- Department of Neurology, The Affiliated Hospital of Institute of Neurology, Anhui University of Chinese Medicine, Hefei, China
| | - Xiao-ming Fu
- Department of Neurology, The Affiliated Hospital of Institute of Neurology, Anhui University of Chinese Medicine, Hefei, China
| | - Qun-rong Ye
- Department of Neurology, The Affiliated Hospital of Institute of Neurology, Anhui University of Chinese Medicine, Hefei, China
| | - Jun Li
- Department of Neurology, The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, China
| | - Huai-zhen Chen
- Department of Neurology, The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, China
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3
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Wu G, Li Z, Li J, Li X, Wang M, Zhang J, Liu G, Zhang P. A neglected neurodegenerative disease: Adult-onset globoid cell leukodystrophy. Front Neurosci 2022; 16:998275. [PMID: 36161165 PMCID: PMC9490374 DOI: 10.3389/fnins.2022.998275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 08/18/2022] [Indexed: 11/13/2022] Open
Abstract
Globoid cell leukodystrophy (GLD), or Krabbe disease (KD) is a rare neurodegenerative disease, and adult-onset GLD is more even neglected by clinicians. This review provides detailed discussions of the serum enzymes, genes, clinical manifestations, neuroimaging features, and therapies of GLD, with particular emphasis on the characteristics of adult-onset GLD, in an attempt to provide clinicians with in-depth insights into this disease.
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Affiliation(s)
- Guode Wu
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou, China
| | - Zhenhua Li
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou, China
| | - Jing Li
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou, China
| | - Xin Li
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou, China
| | - Manxia Wang
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou, China
- *Correspondence: Manxia Wang,
| | - Jing Zhang
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou, China
| | - Guangyao Liu
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou, China
| | - Pengfei Zhang
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou, China
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He Z, Pang X, Bai J, Wang H, Feng F, Du R, Huang X. A novel GALC gene mutation associated with adult-onset Krabbe disease: a case report. Neurocase 2022; 28:314-319. [PMID: 35654103 DOI: 10.1080/13554794.2022.2083518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
To analyze the clinical, imaging, and genetic characteristics of a patient diagnosed with adult-onset Krabbe disease (KD). Clinical and imaging features of the patient were retrospectively reviewed. The patient, a 40-year-old female, presented adult-onset spastic paraplegia. Brain magnetic resonance imaging (MRI) showed white matter hyperintensities along bilateral optic radiations. Colorimetry of galactocerebrosidase enzyme activity showed low enzyme levels. A heterozygous missense mutation: c.1658G>A (p.G553E) and c.1901T>C (p.L634S) was identified in the GALC gene by whole exome sequencing, and was verified by Sanger sequencing. KD should be considered when patients presented adult-onset spastic paraplegia with classical MRI imaging features. Mutation c.1658G>A (p.G553E) was novel in GALC gene and broaden the mutation spectrum.
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Affiliation(s)
- Zhengqing He
- Chinese PLA Medical School, Beijing, China.,Department of Neurology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Xinyuan Pang
- Department of Neurology, The First Medical Center, Chinese PLA General Hospital, Beijing, China.,College of Medicine, Nankai University, Tianjin, China
| | - Jiongming Bai
- Department of Neurology, The First Medical Center, Chinese PLA General Hospital, Beijing, China.,College of Medicine, Nankai University, Tianjin, China
| | - Haoran Wang
- Department of Neurology, The First Medical Center, Chinese PLA General Hospital, Beijing, China.,College of Medicine, Nankai University, Tianjin, China
| | - Feng Feng
- Department of Neurology, PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Rongrong Du
- Department of Neurology, The First Medical Center, Chinese PLA General Hospital, Beijing, China.,College of Medicine, Nankai University, Tianjin, China
| | - Xusheng Huang
- Chinese PLA Medical School, Beijing, China.,Department of Neurology, The First Medical Center, Chinese PLA General Hospital, Beijing, China.,College of Medicine, Nankai University, Tianjin, China
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Chen J, Zhao Z, Shen H, Bing Q, Li N, Guo X, Hu J. Genetic origin of patients having spastic paraplegia with or without other neurologic manifestations. BMC Neurol 2022; 22:180. [PMID: 35578252 PMCID: PMC9109329 DOI: 10.1186/s12883-022-02708-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 05/09/2022] [Indexed: 11/10/2022] Open
Abstract
Background Hereditary spastic paraplegia (HSP) is a group of neurodegenerative diseases characterized by lower-limb spastic paraplegia with highly genetic and clinical heterogeneity. However, the clinical sign of spastic paraplegia can also be seen in a variety of hereditary neurologic diseases with bilateral corticospinal tract impairment. The purpose of this study is to identify the disease spectrum of spastic paraplegia, and to broaden the coverage of genetic testing and recognize clinical, laboratorial, electrophysiological and radiological characteristics to increase the positive rate of diagnosis. Methods Twenty-seven cases were screened out to have definite or suspected pathogenic variants from clinically suspected HSP pedigrees through HSP-associated sequencing and/or expanded genetic testing. One case was performed for enzyme detection of leukodystrophy without next-generation sequencing. In addition, detailed clinical, laboratorial, electrophysiological and radiological characteristics of the 28 patients were presented. Results A total of five types of hereditary neurological disorders were identified in 28 patients, including HSP (15/28), leukodystrophy (5/28), hereditary ataxia (2/28), methylmalonic acidemia/methylenetetrahydrofolate reductase deficiency (5/28), and Charcot-Marie-tooth atrophy (1/28). Patients in the HSP group had chronic courses, most of whom were lower limbs spasticity, mainly with axonal neuropathy, and thinning corpus callosum, white matter lesions and cerebellar atrophy in brain MRI. In the non-HSP groups, upper and lower limbs both involvement was more common. Patients with homocysteine remethylation disorders or Krabbe’s disease or autosomal recessive spastic ataxia of Charlevoix-Saguenay had diagnostic results in laboratory or imaging examination. A total of 12 new variants were obtained. Conclusions HSP had widespread clinical and genetic heterogeneity, and leukodystrophy, hereditary ataxia, Charcot-Marie-Tooth atrophy and homocysteine remethylation disorders accounted for a significant proportion of the proposed HSP. These diseases had different characteristics in clinical, laboratorial, electrophysiological, and radiological aspects, which could help differential diagnosis. Genetic analysis could ultimately provide a clear diagnosis, and broadening the scope of genetic testing could improve the positive rate of diagnosis. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-022-02708-z.
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Affiliation(s)
- Jiannan Chen
- Department of Neuromuscular Disease, The Third Affiliated Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, Hebei, 050000, PR China
| | - Zhe Zhao
- Department of Neuromuscular Disease, The Third Affiliated Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, Hebei, 050000, PR China
| | - Hongrui Shen
- Department of Neuromuscular Disease, The Third Affiliated Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, Hebei, 050000, PR China
| | - Qi Bing
- Department of Neuromuscular Disease, The Third Affiliated Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, Hebei, 050000, PR China
| | - Nan Li
- Department of Neuromuscular Disease, The Third Affiliated Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, Hebei, 050000, PR China
| | - Xuan Guo
- Department of Neuromuscular Disease, The Third Affiliated Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, Hebei, 050000, PR China
| | - Jing Hu
- Department of Neuromuscular Disease, The Third Affiliated Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, Hebei, 050000, PR China.
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Fernández-Eulate G, Carreau C, Benoist JF, Lamari F, Rucheton B, Shor N, Nadjar Y. Diagnostic approach in adult-onset neurometabolic diseases. J Neurol Neurosurg Psychiatry 2022; 93:413-421. [PMID: 35140137 PMCID: PMC8921565 DOI: 10.1136/jnnp-2021-328045] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 01/02/2022] [Indexed: 12/31/2022]
Abstract
Neurometabolic diseases are a group of individually rare but numerous and heterogeneous genetic diseases best known to paediatricians. The more recently reported adult forms may present with phenotypes strikingly different from paediatric ones and may mimic other more common neurological disorders in adults. Furthermore, unlike most neurogenetic diseases, many neurometabolic diseases are treatable, with both conservative and more recent innovative therapeutics. However, the phenotypical complexity of this group of diseases and the growing number of specialised biochemical tools account for a significant diagnostic delay and underdiagnosis. We reviewed all series and case reports of patients with a confirmed neurometabolic disease and a neurological onset after the age of 10 years, with a focus on the 36 treatable ones, and classified these diseases according to their most relevant clinical manifestations. The biochemical diagnostic approach of neurometabolic diseases lays on the use of numerous tests studying a set of metabolites, an enzymatic activity or the function of a given pathway; and therapeutic options aim to restore the enzyme activity or metabolic function, limit the accumulation of toxic substrates or substitute the deficient products. A quick diagnosis of a treatable neurometabolic disease can have a major impact on patients, leading to the stabilisation of the disease and cease of repeated diagnostic investigations, and allowing for familial screening. For the aforementioned, in addition to an exhaustive and clinically meaningful review of these diseases, we propose a simplified diagnostic approach for the neurologist with the aim to help determine when to suspect a neurometabolic disease and how to proceed in a rational manner. We also discuss the place of next-generation sequencing technologies in the diagnostic process, for which deep phenotyping of patients (both clinical and biochemical) is necessary for improving their diagnostic yield.
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Affiliation(s)
- Gorka Fernández-Eulate
- Neuro-Metabolism Unit, Reference Center for Lysosomal Diseases, Neurology Department, Pitié-Salpêtrière University Hospital, APHP, Paris, France.,Reference Center for Neuromuscular Diseases, Neuro-myology Department, Pitié-Salpêtrière University Hospital, APHP, Paris, France
| | - Christophe Carreau
- Neurology Department, Saint-Louis University Hospital, APHP, Paris, France
| | - Jean-François Benoist
- Metabolic Biochemistry Laboratory, Necker Enfants Malades University Hospital, APHP, Paris-Saclay University, Paris, France
| | - Foudil Lamari
- Department of Biochemistry of Neurometabolic Diseases, Pitié-Salpêrière University Hospital, APHP, Paris, Fance
| | - Benoit Rucheton
- Department of Biochemistry of Neurometabolic Diseases, Pitié-Salpêrière University Hospital, APHP, Paris, Fance
| | - Natalia Shor
- Neuroradiology Department, Pitié-Salpêtrière University Hospital, APHP, Sorbonne University, Paris, France
| | - Yann Nadjar
- Neuro-Metabolism Unit, Reference Center for Lysosomal Diseases, Neurology Department, Pitié-Salpêtrière University Hospital, APHP, Paris, France
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Forst DA, Restrepo JA, Gonzalez RG, Jones PS, Marshall MS. Case 7-2022: A 65-Year-Old Woman with Depression, Recurrent Falls, and Inability to Care for Herself. N Engl J Med 2022; 386:977-986. [PMID: 35263523 DOI: 10.1056/nejmcpc2115853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Deborah A Forst
- From the Departments of Neurology (D.A.F.), Psychiatry (J.A.R.), Radiology (R.G.G.), Neurosurgery (P.S.J.), and Pathology (M.S.M.), Massachusetts General Hospital, and the Departments of Neurology (D.A.F.), Psychiatry (J.A.R.), Radiology (R.G.G.), Neurosurgery (P.S.J.), and Pathology (M.S.M.), Harvard Medical School - both in Boston
| | - Judith A Restrepo
- From the Departments of Neurology (D.A.F.), Psychiatry (J.A.R.), Radiology (R.G.G.), Neurosurgery (P.S.J.), and Pathology (M.S.M.), Massachusetts General Hospital, and the Departments of Neurology (D.A.F.), Psychiatry (J.A.R.), Radiology (R.G.G.), Neurosurgery (P.S.J.), and Pathology (M.S.M.), Harvard Medical School - both in Boston
| | - R Gilberto Gonzalez
- From the Departments of Neurology (D.A.F.), Psychiatry (J.A.R.), Radiology (R.G.G.), Neurosurgery (P.S.J.), and Pathology (M.S.M.), Massachusetts General Hospital, and the Departments of Neurology (D.A.F.), Psychiatry (J.A.R.), Radiology (R.G.G.), Neurosurgery (P.S.J.), and Pathology (M.S.M.), Harvard Medical School - both in Boston
| | - Pamela S Jones
- From the Departments of Neurology (D.A.F.), Psychiatry (J.A.R.), Radiology (R.G.G.), Neurosurgery (P.S.J.), and Pathology (M.S.M.), Massachusetts General Hospital, and the Departments of Neurology (D.A.F.), Psychiatry (J.A.R.), Radiology (R.G.G.), Neurosurgery (P.S.J.), and Pathology (M.S.M.), Harvard Medical School - both in Boston
| | - Michael S Marshall
- From the Departments of Neurology (D.A.F.), Psychiatry (J.A.R.), Radiology (R.G.G.), Neurosurgery (P.S.J.), and Pathology (M.S.M.), Massachusetts General Hospital, and the Departments of Neurology (D.A.F.), Psychiatry (J.A.R.), Radiology (R.G.G.), Neurosurgery (P.S.J.), and Pathology (M.S.M.), Harvard Medical School - both in Boston
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de Paiva ARB, Fonseca Neto RE, Afonso C, Freua F, Nóbrega PR, Kok F. Incidental MRI findings leading to an unusual diagnosis: adult-onset Krabbe disease. Eur J Neurol 2022; 29:1859-1862. [PMID: 35212100 DOI: 10.1111/ene.15298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/27/2022] [Accepted: 02/14/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Krabbe disease (KD), or globoid cell leukodystrophy (OMIM #245200), is an autosomal recessive lysosomal storage disease caused by mutations in GALC leading to galactocerebrosidase deficiency. Age of onset can vary from early infantile (3 to 6 months of age) to adulthood, which has been rarely reported. Little is known about the natural history and early manifestations of adult-onset Krabbe disease (AOKD). METHODS Here we report a patient with an incidental diagnosis of AOKD and discuss management options in this scenario. RESULTS A 32 year-old woman came to medical attention because of headache and had brain MRI findings compatible with AOKD, two pathogenic variants in GALC and reduced activity of galactocerebrosidase. The jury is still out about the best management of such cases, and clinicians should be aware of this diagnosis, as AOKD is a potentially treatable condition. CONCLUSIONS Adult-onset Krabbe disease is a rare and potentially treatable condition. More studies on natural history of AOKD are urgently needed to guide the best management of this disease.
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Affiliation(s)
| | | | - Clara Afonso
- Ophthalmology Service, Hospital de Olhos - HCOE, Feira de Santana, Brazil.,Associate Professor, Hospital Santa Luzia, Salvador, Brazil
| | - Fernando Freua
- Neurogenetics Unit, Department of Neurology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Paulo Ribeiro Nóbrega
- Neurogenetics Unit, Department of Neurology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil.,Division of Neurology, Department of Clinical Medicine, Universidade Federal do Ceará
| | - Fernando Kok
- Neurogenetics Unit, Department of Neurology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil.,Mendelics Genomic Analysis, Sao Paulo, Brazil
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Fearon C, Rawal S, Olszewska D, Alcaide‐Leon P, Kern DS, Sharma S, Jaiswal SK, Murthy JM, Ha AD, Schwartz RS, Fung VS, Spears C, Tholanikunnel T, Almeida L, Hatano T, Oji Y, Hattori N, Shubham S, Kumar H, Bhidayasiri R, Laohathai C, Lang AE. Neuroimaging Pearls from the MDS Congress Video Challenge. Part 2: Acquired Disorders. Mov Disord Clin Pract 2022; 9:311-325. [PMID: 35402651 PMCID: PMC8974867 DOI: 10.1002/mdc3.13415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/28/2021] [Accepted: 12/30/2021] [Indexed: 02/05/2023] Open
Abstract
The MDS Video Challenge continues to be the one of most widely attended sessions at the International Congress. Although the primary focus of this event is the presentation of complex and challenging cases through videos, a number of cases over the years have also presented an unusual or important neuroimaging finding related to the case. We reviewed the previous Video Challenge cases and present here a selection of those cases which incorporated such imaging findings. We have compiled these "imaging pearls" into two anthologies. The first focuses on pearls where the underlying diagnosis was a genetic condition. This second anthology focuses on imaging pearls in cases where the underlying condition was acquired. For each case we present brief clinical details along with neuroimaging findings, the characteristic imaging findings of that disorder and, finally, the differential diagnosis for the imaging findings seen.
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Affiliation(s)
- Conor Fearon
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital–UHN, Division of NeurologyUniversity of TorontoTorontoOntarioCanada
| | - Sapna Rawal
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western HospitalUniversity Health NetworkTorontoOntarioCanada
| | - Diana Olszewska
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital–UHN, Division of NeurologyUniversity of TorontoTorontoOntarioCanada
| | - Paula Alcaide‐Leon
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western HospitalUniversity Health NetworkTorontoOntarioCanada
| | - Drew S. Kern
- Department of Neurology and NeurosurgeryUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Soumya Sharma
- Department of Clinical Neurological Sciences, London Health Sciences CentreWestern UniversityLondonOntarioCanada
| | | | | | - Ainhi D. Ha
- Movement Disorders UnitWestmead HospitalWestmeadNew South WalesAustralia
| | - Raymond S. Schwartz
- Southern NeurologyKoharahNew South WalesAustralia,Sydney Medical SchoolThe University of SydneyCamperdownNew South WalesAustralia
| | - Victor S.C. Fung
- Movement Disorders UnitWestmead HospitalWestmeadNew South WalesAustralia,Sydney Medical SchoolThe University of SydneyCamperdownNew South WalesAustralia
| | - Chauncey Spears
- Department of NeurologyUniversity of MichiganAnn ArborMichiganUSA
| | - Tracy Tholanikunnel
- Department of Neurology, Normal Fixel Institute for Neurological DiseasesUniversity of FloridaGainesvilleFloridaUSA
| | - Leonardo Almeida
- Department of Neurology, Normal Fixel Institute for Neurological DiseasesUniversity of FloridaGainesvilleFloridaUSA
| | - Taku Hatano
- Department of Neurology, Faculty of Medicine, Juntendo UniversityTokyoJapan
| | - Yutaka Oji
- Department of Neurology, Faculty of Medicine, Juntendo UniversityTokyoJapan
| | - Nobutaka Hattori
- Department of Neurology, Faculty of Medicine, Juntendo UniversityTokyoJapan
| | | | | | - Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of MedicineChulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross SocietyBangkokThailand,The Academy of Science, The Royal Society of ThailandBangkokThailand
| | | | - Anthony E. Lang
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital–UHN, Division of NeurologyUniversity of TorontoTorontoOntarioCanada
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Zhou H, Wu Z, Wang Y, Wu Q, Hu M, Ma S, Zhou M, Sun Y, Yu B, Ye J, Jiang W, Fu Z, Gong Y. Rare Diseases in Glycosphingolipid Metabolism. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1372:189-213. [DOI: 10.1007/978-981-19-0394-6_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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11
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Hsu CL, Iwanowski P, Hsu CH, Kozubski W. Genetic diseases mimicking multiple sclerosis. Postgrad Med 2021; 133:728-749. [PMID: 34152933 DOI: 10.1080/00325481.2021.1945898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Multiple sclerosis (MS) is an inflammatory neurodegenerative disorder manifesting as gradual or progressive loss of neurological functions. Most patients present with relapsing-remitting disease courses. Extensive research over recent decades has expounded our insights into the presentations and diagnostic features of MS. Groups of genetic diseases, CADASIL and leukodystrophies, for example, have been frequently misdiagnosed with MS due to some overlapping clinical and radiological features. The delayed identification of these diseases in late adulthood can lead to severe neurological complications. Herein we discuss genetic diseases that have the potential to mimic multiple sclerosis, with highlights on clinical identification and practicing pearls that may aid physicians in recognizing MS-mimics with genetic background in clinical settings.
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Affiliation(s)
- Chueh Lin Hsu
- Department of Neurology, Poznan University of Medical Sciences, Poznan, Poland
| | - Piotr Iwanowski
- Department of Neurology, Poznan University of Medical Sciences, Poznan, Poland
| | - Chueh Hsuan Hsu
- Department of Neurology, China Medical University, Taichung, Taiwan
| | - Wojciech Kozubski
- Department of Neurology, Poznan University of Medical Sciences, Poznan, Poland
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12
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Durães J, Salsano E, Macário MDC. Adult-Onset Krabbe Disease: The Importance of a Systematic Approach to Brain MRI Findings. Neurol Clin Pract 2021; 11:e15-e17. [PMID: 33968482 DOI: 10.1212/cpj.0000000000000780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/24/2019] [Indexed: 11/15/2022]
Affiliation(s)
- João Durães
- Department of Neurology (JD, MCM), Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; and Unit of Rare Neurodegenerative and Neurometabolic Diseases (ES), Fondazione IRCCS Istituto Neurologico "C. Besta", Milano, Italy
| | - Ettore Salsano
- Department of Neurology (JD, MCM), Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; and Unit of Rare Neurodegenerative and Neurometabolic Diseases (ES), Fondazione IRCCS Istituto Neurologico "C. Besta", Milano, Italy
| | - Maria do Carmo Macário
- Department of Neurology (JD, MCM), Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; and Unit of Rare Neurodegenerative and Neurometabolic Diseases (ES), Fondazione IRCCS Istituto Neurologico "C. Besta", Milano, Italy
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13
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Pekgül F, Eroğlu-Ertuğrul NG, Bekircan-Kurt CE, Erdem-Ozdamar S, Çetinkaya A, Tan E, Konuşkan B, Karaağaoğlu E, Topçu M, Akarsu NA, Oguz KK, Anlar B, Özkara HA. Comprehensive clinical, biochemical, radiological and genetic analysis of 28 Turkish cases with suspected metachromatic leukodystrophy and their relatives. Mol Genet Metab Rep 2020; 25:100688. [PMID: 33335837 PMCID: PMC7734308 DOI: 10.1016/j.ymgmr.2020.100688] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/13/2020] [Accepted: 11/23/2020] [Indexed: 01/01/2023] Open
Abstract
Metachromatic leukodystrophy (MLD) is a glycosphingolipid storage disease caused by deficiency of the lysosomal enzyme arylsulfatase A (ASA) or its activator protein saposin B. MLD can affect all age groups in severity varying from a severe fatal form to milder adult onset forms. Diagnosis is usually made by measuring leukocyte ASA activity. However, this test can give false negative or false positive laboratory results due to pseudodeficiency of ASA and saposin B deficiency, respectively. Therefore, we aimed to evaluate patients with suspected MLD in a Turkish population by comprehensive clinical, biochemical, radiological, and genetic analyses for molecular and phenotypic characterization. We analyzed 28 suspected MLD patients and 41 relatives from 24 families. ASA activity was found to be decreased in 21 of 28 patients. Sixteen patients were diagnosed as MLD (11 late infantile, 2 juvenile and 3 adult types), 2 MSD, 2 pseudodeficiency (PD) and the remaining 8 patients were diagnosed as having other leukodystrophies. Enzyme analysis showed that the age of onset of MLD did not correlate with residual ASA activity. Sequence analysis showed 11 mutations in ARSA, of which 4 were novel (p.Trp195GlyfsTer5, p.Gly298Asp, p.Arg301Leu, and p.Gly311Asp), and 2 mutations in SUMF1 causing multiple sulfatase deficiency, and confirmed the diagnosis of MLD in 2 presymptomatic relatives. All individuals with confirmed mutations had low ASA activity and urinary sulfatide excretion. Intra- and inter-familial variability was high for the same ARSA missense genotypes, indicating the contribution of other factors to disease expression. Imaging findings were evaluated through a modified brain MRI scoring system which indicated patients with protein-truncating mutations had more severe MRI findings and late-infantile disease onset. MRI findings were not specific for the diagnosis. Anti-sulfatide IgM was similar to control subjects, and IgG, elevated in multiple sulfatase deficiency. In conclusion, the knowledge on the biochemical, clinical and genetic basis of MLD was expanded, a modified diagnostic laboratory algorithm for MLD based on integrated evaluation of ASA activity, urinary sulfatide excretion and genetic tests was devised.
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Affiliation(s)
- Faruk Pekgül
- Department of Medical Biochemistry, Faculty of Medicine, Hacettepe University, 06230 Ankara, Turkey
| | | | - Can Ebru Bekircan-Kurt
- Department of Neurology, Neuromuscular Diseases Research Laboratory, Faculty of Medicine, Hacettepe University, 06230 Ankara, Turkey
| | - Sevim Erdem-Ozdamar
- Department of Neurology, Neuromuscular Diseases Research Laboratory, Faculty of Medicine, Hacettepe University, 06230 Ankara, Turkey
| | - Arda Çetinkaya
- Department of Medical Genetics, Faculty of Medicine, Hacettepe University, 06230 Ankara, Turkey
| | - Ersin Tan
- Department of Neurology, Neuromuscular Diseases Research Laboratory, Faculty of Medicine, Hacettepe University, 06230 Ankara, Turkey
| | - Bahadır Konuşkan
- Department of Pediatric Neurology, Faculty of Medicine, Hacettepe University, 06230 Ankara, Turkey
| | - Ergun Karaağaoğlu
- Department of Biostatistics, Faculty of Medicine, Hacettepe University, 06230 Ankara, Turkey
| | - Meral Topçu
- Department of Pediatric Neurology, Faculty of Medicine, Hacettepe University, 06230 Ankara, Turkey
| | - Nurten Ayşe Akarsu
- Department of Medical Genetics, Faculty of Medicine, Hacettepe University, 06230 Ankara, Turkey
| | - Kader K Oguz
- Department of Radiology, Faculty of Medicine, Hacettepe University, 06230 Ankara, Turkey
| | - Banu Anlar
- Department of Pediatric Neurology, Faculty of Medicine, Hacettepe University, 06230 Ankara, Turkey
| | - Hatice Asuman Özkara
- Department of Medical Biochemistry, Faculty of Medicine, Hacettepe University, 06230 Ankara, Turkey
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Zhang C, Liu Z, Dong H. Two Cases of Female Chinese Adult-Onset Krabbe Disease with One Novel Mutation and a Review of Literature. J Mol Neurosci 2020; 71:1185-1192. [PMID: 33190188 DOI: 10.1007/s12031-020-01742-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 10/23/2020] [Indexed: 10/23/2022]
Abstract
This study presented two Chinese adult female patients who were diagnosed with adult-onset Krabbe disease (KD) and reviewed this disease in Chinese patients. Two young female adults in their 20s were enrolled in this study. Clinical data, including symptoms, magnetic resonance imaging (MRI) scanning, and laboratory studies were collected. Sequence alignment and structural modeling were carried out to analyze the pathogenesis of the disease. Both patients were adult-onset and both had a mild clinical course, presented with spastic weakness. The MRI study showed demyelination confined to the corticospinal tracts and parieto-occipital white matter. The β-galactocerebrosidase (GALC) activity was obviously decreased in both patients. Gene test of GALC showed that both patients were compound heterozygotes; proband I was a carrier of p.L634S (c.1901 T > C) and p.I250T (c.749 T > C), while proband II was a carrier of p.L634S (c.1901 T > C) and a new variant of c.283_284del. Molecular analysis revealed the variants may influence the function of GALC. We provided two Chinese adult-onset KD, and the clinical and genetic characteristics of proband II was especially rare due to asymmetric symptoms, spinal cord involvement, and the identification of a new point mutation c.283_284del in the GALC gene. Variant c.749 T > C can present mild syndromes except for severe cases. c.283_284del is a new variant that may occur in adult-onset type.
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Affiliation(s)
- Chengyi Zhang
- Neurology Department, Xuanwu Hospital, No 45, Changchun Road, Beijing, 100053, People's Republic of China
| | - Zheng Liu
- Neurology Department, Xuanwu Hospital, No 45, Changchun Road, Beijing, 100053, People's Republic of China
| | - Huiqing Dong
- Neurology Department, Xuanwu Hospital, No 45, Changchun Road, Beijing, 100053, People's Republic of China.
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15
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Zhong J, Jiang F, Yang H, Li J, Cheng J, Zeng Q, Xu Q. Novel GALC Mutations Cause Adult-Onset Krabbe Disease With Myelopathy in Two Chinese Families: Case Reports and Literature Review. Front Neurol 2020; 11:830. [PMID: 32973651 PMCID: PMC7473299 DOI: 10.3389/fneur.2020.00830] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 07/03/2020] [Indexed: 11/22/2022] Open
Abstract
Krabbe disease (KD), also referred to as globoid cell leukodystrophy, is a rare autosomal recessive lysosomal storage disorder caused by β-galactocerebrosidase (GALC) deficiency. Most patients affected by this disease are infants, and <10% of cases suffer from adult-onset KD. In this study, two Chinese males presented with long-term progressive weakness in their limbs. Magnetic resonance imaging of the brain and spinal cord of these patients revealed lesions with abnormally high signal intensity on T2-weighted (T2W) and T2W fluid-attenuated inversion recovery images. Whole-exome sequencing was performed for both patients, and four GALC mutations were identified. Case 1 carried a novel deletion mutation (p.T633Tfs*2) and a known missense mutation (p.T529M), while case 2 carried a novel missense mutation (p.W355C) and a known missense mutation (p.P154H). Previous literature has rarely reported myelopathy in patients with KD; in this study, we report two cases of adult-onset KD who both experienced myelopathy. We also conducted a literature review of KD and its association with myelopathy. Our findings provide a better understanding of the phenotypic and genotypic profiles associated with adult-onset KD. We recommend that physicians consider KD as a possible diagnosis in cases showing progressive motor dysfunction or gait disorder in association with typical myelopathy.
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Affiliation(s)
- Junfei Zhong
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Fei Jiang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Huan Yang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Jing Li
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Jian Cheng
- Department of Neurology, The Third Affiliated Hospital of Hunan University of Chinese Medicine, Zhuzhou, China
| | - Qiuming Zeng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Qian Xu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China.,Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China
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16
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Krieg SI, Krägeloh-Mann I, Groeschel S, Beck-Wödl S, Husain RA, Schöls L, Kehrer C. Natural history of Krabbe disease - a nationwide study in Germany using clinical and MRI data. Orphanet J Rare Dis 2020; 15:243. [PMID: 32912261 PMCID: PMC7488349 DOI: 10.1186/s13023-020-01489-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 08/05/2020] [Indexed: 12/04/2022] Open
Abstract
Background Krabbe disease or globoid cell leukodystrophy is a severe neurodegenerative disorder caused by a defect in the GALC gene leading to a deficiency of the enzyme ß-galactocerebrosidase. The aim of this work was to describe the natural disease course covering the whole spectrum of the disease. Methods Natural history data were collected with a standardized questionnaire, supplemented by medical record data. We defined different forms of the disease according to Abdelhalim et al. (2014). Developmental and disease trajectories were described based on the acquisition and loss of milestones as well as the time of first clearly identifiable symptoms and needs such as spasticity, seizures and tube feeding. MRI was assessed using the scoring system by Loes et al. (1999) and in addition a pattern recognition approach, based on Abdelhalim et al. (2014). Results Thirty-eight patients were identified, from 27 of these patients 40 MRIs were available; 30 (79%) had an infantile onset, showing first symptoms in their first year of life, almost all (27 out of 30) starting in the first six months. A later onset after the first year of life was observed in 8 patients (21%, range 18 months to 60 years). Irritability, abnormalities in movement pattern as well as general developmental regression were the first symptoms in the infantile group; disease course was severe with rapid progression, e.g. loss of visual fixation, need for tube feeding and then an early death. Gait disorders were the first symptoms in all patients of the later onset groups; progression was variable. The different forms of the disease were characterized by different MRI patterns (infantile: diffuse white matter involvement and cerebellar structures specifically affected, later onset: parieto-occipital white matter and splenium affected, adult: motor tracts specifically affected). Conclusion This is the first description of the natural history of Krabbe disease in a larger European cohort using developmental, clinical and MRI data. We would like to highlight the very different clinical and MRI characteristics of the later onset forms. These data are important for counselling affected patients and families and may serve as a basis for future treatment trials.
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Affiliation(s)
- Sarah Isabel Krieg
- Department of Child Neurology, Children's Hospital, University of Tübingen, Hoppe-Seyler-Str. 1, 72072, Tübingen, Germany
| | - Ingeborg Krägeloh-Mann
- Department of Child Neurology, Children's Hospital, University of Tübingen, Hoppe-Seyler-Str. 1, 72072, Tübingen, Germany.
| | - Samuel Groeschel
- Department of Child Neurology, Children's Hospital, University of Tübingen, Hoppe-Seyler-Str. 1, 72072, Tübingen, Germany.,Section for Experimental MR of the CNS, Department of Child Neurology and Neuroradiology, University of Tübingen, Tübingen, Germany
| | - Stefanie Beck-Wödl
- Department of Medical Genetics, University Hospital Tübingen, Tübingen, Germany
| | - Ralf A Husain
- Department of Neuropediatrics, Jena University Hospital, Jena, Germany
| | - Ludger Schöls
- Clinical Neurogenetics Section, Department of Neurology, University of Tübingen, Tübingen, Germany
| | - Christiane Kehrer
- Department of Child Neurology, Children's Hospital, University of Tübingen, Hoppe-Seyler-Str. 1, 72072, Tübingen, Germany
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17
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Xia Z, Wenwen Y, Xianfeng Y, Panpan H, Xiaoqun Z, Zhongwu S. Adult-onset Krabbe disease due to a homozygous GALC mutation without abnormal signals on an MRI in a consanguineous family: A case report. Mol Genet Genomic Med 2020; 8:e1407. [PMID: 32677356 PMCID: PMC7507702 DOI: 10.1002/mgg3.1407] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/08/2020] [Accepted: 07/01/2020] [Indexed: 01/19/2023] Open
Abstract
Background The most frequent and common form of Krabbe disease (KD) is early‐onset KD in infants, and late‐onset KD has been reported to be a rare disease. In the present study, we reported an adult‐onset KD patient in a consanguineous Chinese family. Methods Clinical and radiological data were collected for a family pedigree. The patient was diagnosed with late‐onset KD through next‐generation sequencing. The result was confirmed by Sanger sequencing. GALC enzyme activity was also examined by the colorimetry method. Both the grey matter volume (GMV) and white matter volume values were examined and compared with the average values from ten age‐matched normal controls. Moreover, we reviewed all the available KD studies on PubMed to understand the correlation between the phenotype and genotype of the identified mutation. Results The main manifestations of the proband were sudden onset seizures and cognitive decline. Mutation analysis of the GALC revealed a homozygous c.1901T>C mutation in exon 16, which resulted in an amino acid change in p.L634S. Sanger sequencing results showed that the homozygous mutation was inherited from the patient's parents, both of whom were revealed to be heterozygous carriers. Moreover, a decrease in GALC enzyme activity was also detected. However, no abnormal signals were found in the brain MRI. Further structural MRI analysis revealed a significantly decreased GMV in the proband compared to the normal controls. Moreover, it is of interest that all patients with the c.1901T>C mutation had late‐onset KD and were selected from Asian countries, especially Japan and China. Conclusions This patient with a homozygous GALC mutation expands the clinical presentation and characteristics of adult‐onset KD, as indicated by grey matter atrophy without abnormal white matter signals.
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Affiliation(s)
- Zhou Xia
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yin Wenwen
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yu Xianfeng
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Hu Panpan
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zhu Xiaoqun
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Sun Zhongwu
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei, China
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