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Saft C, Burgunder JM, Dose M, Jung HH, Katzenschlager R, Priller J, Nguyen HP, Reetz K, Reilmann R, Seppi K, Landwehrmeyer GB. Differential diagnosis of chorea (guidelines of the German Neurological Society). Neurol Res Pract 2023; 5:63. [PMID: 37993913 PMCID: PMC10666412 DOI: 10.1186/s42466-023-00292-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 11/24/2023] Open
Abstract
INTRODUCTION Choreiform movement disorders are characterized by involuntary, rapid, irregular, and unpredictable movements of the limbs, face, neck, and trunk. These movements often initially go unnoticed by the affected individuals and may blend together with seemingly intended, random motions. Choreiform movements can occur both at rest and during voluntary movements. They typically increase in intensity with stress and physical activity and essentially cease during deep sleep stages. In particularly in advanced stages of Huntington disease (HD), choreiform hyperkinesia occurs alongside with dystonic postures of the limbs or trunk before they typically decrease in intensity. The differential diagnosis of HD can be complex. Here, the authors aim to provide guidance for the diagnostic process. This guidance was prepared for the German Neurological Society (DGN) for German-speaking countries. RECOMMENDATIONS Hereditary (inherited) and non-hereditary (non-inherited) forms of chorea can be distinguished. Therefore, the family history is crucial. However, even in conditions with autosomal-dominant transmission such as HD, unremarkable family histories do not necessarily rule out a hereditary form (e.g., in cases of early deceased or unknown parents, uncertainties in familial relationships, as well as in offspring of parents with CAG repeats in the expandable range (27-35 CAG repeats) which may display expansions into the pathogenic range). CONCLUSIONS The differential diagnosis of chorea can be challenging. This guidance prepared for the German Neurological Society (DGN) reflects the state of the art as of 2023.
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Affiliation(s)
- Carsten Saft
- Department of Neurology, St. Josef-Hospital, Huntington-Zentrum NRW, Ruhr-Universität Bochum, Bochum, Germany.
| | - Jean-Marc Burgunder
- Department of Neurology, Schweizerisches Huntington-Zentrum, Bern University, Bern, Switzerland
| | - Matthias Dose
- Kbo-Isar-Amper-Klinikum Taufkirchen/München-Ost, Munich, Germany
| | - Hans Heinrich Jung
- Department of Neurology, University Hospital Zürich, Zurich, Switzerland
| | - Regina Katzenschlager
- Department of Neurology, Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Disorders, Klinik Donaustadt, Vienna, Austria
| | - Josef Priller
- Department of Psychiatry and Psychotherapy, Klinikum Rechts der Isar, School of Medicine and Health, Technical University of Munich, Munich, Germany
- Neuropsychiatry, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Huu Phuc Nguyen
- Department of Human Genetics, Huntington-Zentrum NRW, Ruhr-Universität Bochum, Bochum, Germany
| | - Kathrin Reetz
- Department of Neurology, Euregional Huntington Centre Aachen, RWTH Aachen University Hospital, Aachen, Germany
| | - Ralf Reilmann
- George-Huntington-Institute, Muenster, Germany
- Department of Radiology, Universitaetsklinikum Muenster (UKM), Westfaelische Wilhelms-University, Muenster, Germany
- Department of Neurodegenerative Diseases and Hertie-Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
| | - Klaus Seppi
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Froehner GS, Franklin GL, Meira AT, Teive HAG. Jaw-Opening Dystonia Associated With Spinocerebellar Ataxia Type 48. Neurology 2023; 101:764-765. [PMID: 37491324 PMCID: PMC10624491 DOI: 10.1212/wnl.0000000000207506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/20/2023] [Indexed: 07/27/2023] Open
Affiliation(s)
- Gabriel S Froehner
- From the Neurology Unit (G.S.F., H.A.G.T.), Federal University of Paraná, Curitiba; Internal Medicine Department (G.L.F.), Pontifical Catholic University of Paraná, Curitiba; and Internal Medicine Department (A.T.M.), Federal University of Paraíba, João Pessoa, Brazil
| | - Gustavo L Franklin
- From the Neurology Unit (G.S.F., H.A.G.T.), Federal University of Paraná, Curitiba; Internal Medicine Department (G.L.F.), Pontifical Catholic University of Paraná, Curitiba; and Internal Medicine Department (A.T.M.), Federal University of Paraíba, João Pessoa, Brazil.
| | - Alex T Meira
- From the Neurology Unit (G.S.F., H.A.G.T.), Federal University of Paraná, Curitiba; Internal Medicine Department (G.L.F.), Pontifical Catholic University of Paraná, Curitiba; and Internal Medicine Department (A.T.M.), Federal University of Paraíba, João Pessoa, Brazil
| | - Hélio A G Teive
- From the Neurology Unit (G.S.F., H.A.G.T.), Federal University of Paraná, Curitiba; Internal Medicine Department (G.L.F.), Pontifical Catholic University of Paraná, Curitiba; and Internal Medicine Department (A.T.M.), Federal University of Paraíba, João Pessoa, Brazil
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Saft C, Achenbach J, Nguyen HP, Seppi K. Comment on "A series of cases with Huntington-like phenotype and intermediate repeats in HTT" by Acuña and colleagues". J Neurol Sci 2022; 442:120409. [PMID: 36126372 DOI: 10.1016/j.jns.2022.120409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 08/31/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Carsten Saft
- Department of Neurology, Huntington-Centre NRW, St. Josef Hospital, Ruhr-University of Bochum, Gudrunstraße 56, 44791 Bochum, Germany.
| | - Jannis Achenbach
- Department of Neurology, Huntington-Centre NRW, St. Josef Hospital, Ruhr-University of Bochum, Gudrunstraße 56, 44791 Bochum, Germany
| | - Huu Phuc Nguyen
- Department of Human Genetics, Ruhr-University of Bochum, Bochum, Germany
| | - Klaus Seppi
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Reis MC, Patrun J, Ackl N, Winter P, Scheifele M, Danek A, Nolte D. A Severe Dementia Syndrome Caused by Intron Retention and Cryptic Splice Site Activation in STUB1 and Exacerbated by TBP Repeat Expansions. Front Mol Neurosci 2022; 15:878236. [PMID: 35493319 PMCID: PMC9048483 DOI: 10.3389/fnmol.2022.878236] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 03/08/2022] [Indexed: 11/23/2022] Open
Abstract
Heterozygous pathogenic variants in the STIP1 homologous and U-box containing protein 1 (STUB1) gene have been identified as causes of autosomal dominant inherited spinocerebellar ataxia type 48 (SCA48). SCA48 is characterized by an ataxic movement disorder that is often, but not always, accompanied by a cognitive affective syndrome. We report a severe early onset dementia syndrome that mimics frontotemporal dementia and is caused by the intronic splice donor variant c.524+1G>A in STUB1. Impaired splicing was demonstrated by RNA analysis and in minigene assays of mutated and wild-type constructs of STUB1. The most striking consequence of this splicing impairment was retention of intron 3 in STUB1, which led to an in-frame insertion of 63 amino acids (aa) (p.Arg175_Glu176ins63) into the highly conserved coiled-coil domain of its encoded protein, C-terminus of HSP70-interacting protein (CHIP). To a lesser extent, activation of two cryptic splice sites in intron 3 was observed. The almost exclusively used one, c.524+86, was not predicted by in silico programs. Variant c.524+86 caused a frameshift (p.Arg175fs*93) that resulted in a truncated protein and presumably impairs the C-terminal U-box of CHIP, which normally functions as an E3 ubiquitin ligase. The cryptic splice site c.524+99 was rarely used and led to an in-frame insertion of 33 aa (p.Arg175_Glu176ins33) that resulted in disruption of the coiled-coil domain, as has been previously postulated for complete intron 3 retention. We additionally detected repeat expansions in the range of reduced penetrance in the TATA box-binding protein (TBP) gene by excluding other genes associated with dementia syndromes. The repeat expansion was heterozygous in one patient but compound heterozygous in the more severely affected patient. Therefore, we concluded that the observed severe dementia syndrome has a digenic background, making STUB1 and TBP important candidate genes responsible for early onset dementia syndromes.
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Affiliation(s)
- Marlen Colleen Reis
- Institut für Humangenetik, Justus-Liebig-Universität Giessen, Giessen, Germany
| | - Julia Patrun
- Institut für Humangenetik, Justus-Liebig-Universität Giessen, Giessen, Germany
| | - Nibal Ackl
- Psychiatrische Dienste Thurgau, Münsterlingen, Switzerland
- Neurologische Klinik und Poliklinik, Klinikum der Universität München, Munich, Germany
| | - Pia Winter
- Institut für Humangenetik, Justus-Liebig-Universität Giessen, Giessen, Germany
| | | | - Adrian Danek
- Neurologische Klinik und Poliklinik, Klinikum der Universität München, Munich, Germany
| | - Dagmar Nolte
- Institut für Humangenetik, Justus-Liebig-Universität Giessen, Giessen, Germany
- *Correspondence: Dagmar Nolte,
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