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Innes EA, Qiu J, Morales‐Briceño H, Farrar MA, Mohammad SS. Oculomotor Apraxia as an Early Presenting Sign of Juvenile-Onset Huntington's Disease. Mov Disord Clin Pract 2023; 10:S12-S14. [PMID: 37636223 PMCID: PMC10448626 DOI: 10.1002/mdc3.13775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 04/02/2023] [Accepted: 04/17/2023] [Indexed: 08/29/2023] Open
Affiliation(s)
- Emily Amy Innes
- Neurology DepartmentSydney Children’ Hospital at RandwickSydneyNew South WalesAustralia
- Sydney Medical SchoolThe University of Notre DameSydneyNew South WalesAustralia
| | - Jessica Qiu
- Sydney Medical School, Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
- Movement Disorders Unit, Neurology DepartmentWestmead HospitalSydneyNew South WalesAustralia
| | - Hugo Morales‐Briceño
- Movement Disorders Unit, Neurology DepartmentWestmead HospitalSydneyNew South WalesAustralia
- Discipline of Paediatrics, School of Women's and Children's HealthUNSW Medicine, The University of New South WalesSydneyNew South WalesAustralia
| | - Michelle A. Farrar
- Neurology DepartmentSydney Children’ Hospital at RandwickSydneyNew South WalesAustralia
- Discipline of Paediatrics, School of Women's and Children's HealthUNSW Medicine, The University of New South WalesSydneyNew South WalesAustralia
| | - Shekeeb S. Mohammad
- Sydney Medical School, Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
- TY Nelson Department of Neurology and NeurosurgeryThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
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Kizhakkedath P, AlDhaheri W, Baydoun I, Tabouni M, John A, Almansoori TM, Al-Turki S, Al-Jasmi F, Alblooshi H. Case report: Birk-Landau-Perez syndrome linked to the SLC30A9 gene-identification of additional cases and expansion of the phenotypic spectrum. Front Genet 2023; 14:1219514. [PMID: 37576556 PMCID: PMC10414535 DOI: 10.3389/fgene.2023.1219514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/06/2023] [Indexed: 08/15/2023] Open
Abstract
Birk-Landau-Perez syndrome (BILAPES) is an autosomal recessive cerebro-renal syndrome associated with genetic defects in the SLC30A9 gene, initially reported in 2017 in six individuals belonging to a large Bedouin kindred. The SLC30A9 gene encodes a putative mitochondrial zinc transporter with ubiquitous expression, the highest found in the brain, kidney, and skeletal muscle. Since the first report, only one additional affected patient has been described, but there were some inconsistencies, such as hearing loss, failure to thrive, and neuroimaging findings between the clinical presentation of the disease in the Bedouin family and the second patient. Here, we present two more patients from a consanguineous Middle Eastern family with features of chronic kidney disease, neurodevelopmental regression, ataxia, hearing loss, and eye abnormalities, which were largely consistent with BILAPES. Whole-exome sequencing detected a homozygous in-frame deletion c.1049_1051delCAG (p.Ala350del) in the SLC30A9 gene, which was the same variant detected in the patients from the primary literature report and the variant segregated with disease in the family. However, in the patients described here, brain MRI showed cerebellar atrophy, which was not a cardinal feature of the syndrome from the primary report. Our findings provide further evidence for SLC30A9-associated BILAPES and contribute to defining the clinical spectrum.
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Affiliation(s)
- Praseetha Kizhakkedath
- Department of Genetics and Genomics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Watfa AlDhaheri
- Department of Pediatrics, Tawam Hospital, Al Ain, United Arab Emirates
| | - Ibrahim Baydoun
- Department of Genetics and Genomics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Mohammed Tabouni
- Department of Genetics and Genomics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Anne John
- Department of Genetics and Genomics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Taleb M. Almansoori
- Department of Radiology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Saeed Al-Turki
- Department of Genetics and Genomics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Fatma Al-Jasmi
- Department of Genetics and Genomics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
- Department of Pediatrics, Tawam Hospital, Al Ain, United Arab Emirates
| | - Hiba Alblooshi
- Department of Genetics and Genomics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
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Venkatachari M, Chakraborty S, Correa ARE, Mishra P, Kocchar KP, Kabra M, Chakrabarty B, Kalaivani M, Sapra S, Mishra P, Gulati S, Gupta N. The spectrum of neurological manifestations and genotype-phenotype correlation in Indian children with Gaucher disease. Am J Med Genet A 2023; 191:1038-1043. [PMID: 36637080 DOI: 10.1002/ajmg.a.63115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 12/01/2022] [Accepted: 12/19/2022] [Indexed: 01/14/2023]
Abstract
Gaucher disease (GD), one of the most frequent autosomal recessive lysosomal storage disorders, occurs due to bi-allelic pathogenic variants in the GBA1. Worldwide, the c.1448T>C (L483P) homozygous pathogenic variant is reported to be associated with neurological GD phenotype. Clinical distinction between GD1 and GD3 may be challenging due to subtle neurological features. Objective methods to evaluate neurological signs and saccades may help in early diagnosis. This study was conducted to assess the neurological phenotype, and its severity using a modified severity scoring tool (mSST), and the genotype-phenotype correlation. A total of 45 children aged 2 years 6 months to 15 years with a confirmed enzymatic and molecular diagnosis of GD with or without therapy were recruited. mSST tool was used to assess the severity of the neurological phenotype. A digital eye movement tracker (View Point Tracker) was used to assess eye movements. Clinical and genetic findings were analyzed. Out of 45 patients, 39 (86.7%) had at least one neurological phenotype detected using the mSST tool, with impairment of cognitive function (68.8%, 31/45) being the commonest feature. Thirty-two of 45 (71%) were assessed for saccadic eye movements using the eye tracker. Of these, 62.5% (20/32) had absent saccades. Four children (8.9%, 4/32) without clinical oculomotor apraxia had absent saccades on the viewpoint eye tracker. Overall, 77.7% (35/45), had homozygosity for c.1448T>C in GBA1 of which 91.4% (32/35) had neurological manifestations. Other alleles associated with neurological phenotype included c.1603C>T(p.R535C), c.1184C>T (p.S395F), c.115+1G>A (g.4234G>A), c.260G>A (p.R87Q) and c.1352A>G (p.Y451C). To conclude, in India, the c.1448T>C pathogenic variant in GBA1 is the commonest and is associated with neurological phenotype of GD. Therefore, every patient of GD should be assessed using the mSST scoring tool for an early pick up of neurological features. The routine use of a viewpoint eye tracker in children with GD would be useful for early recognition of saccadic abnormalities.
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Affiliation(s)
- Mahesh Venkatachari
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Soumalya Chakraborty
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | | | - Puneeta Mishra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Kanwal Preet Kocchar
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Madhulika Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | | | - Mani Kalaivani
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Savita Sapra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Pallavi Mishra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Sheffali Gulati
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Neerja Gupta
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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Wang H, Nie W, Wang C, Wang Z, Zheng Y. Novel CPLANE1 c.8948dupT (p.P2984Tfs*7) variant in a child patient with Joubert syndrome. Open Life Sci 2023; 18:20220542. [PMID: 36789003 PMCID: PMC9896164 DOI: 10.1515/biol-2022-0542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/20/2022] [Accepted: 11/23/2022] [Indexed: 02/04/2023] Open
Abstract
Joubert syndrome (JBTS) is a class of heterogeneous ciliopathy genetically associated with CPLANE1 mutations. The characteristics of clinical phenotypes and CPLANE1 variants were analyzed in a 2-month-old patient. A 2-month-old patient with JBTS was diagnosed after clinical evaluation including family history, physical examination, cerebral MRI, ultrasonography imaging, VEGG, ocular fundus examination, and comprehensive blood and urine testing. Whole exome sequencing (WES) was performed to detect CPLANE1 variants, and Sanger sequencing was used to confirm the variants. This JBTS patient presented with oculomotor apraxia, dysregulation of breathing pattern, and ataxia. MRI revealed poor continuity of cerebelli, batwing appearance, and molar tooth sign. This patient was noted with abnormal hematology, dysregulation of hepatic function, thyroid function, immunity, and renal function, and encephalopathy. CPLANE1 (c.8948dupT (p.P2984Tfs*7) and c.247G > T (p.G83X)) variants were noticed in the patient as a pathogenic variant and caused autosomal recessive inheritance. The JBTS patient with mutations in CPLANE1 (c.8948dupT (p.P2984Tfs*7) and c.247G > T (p.G83X)) developed JBTS phenotypes. The novel CPLANE1 c.8948dupT (p.P2984Tfs*7) variant will assist clinicians and geneticists in reaching a precise diagnosis for JBTS.
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Affiliation(s)
- Huiping Wang
- Department of Neurology, Kunming Children’s Hospital, Kunming Children’s Hospital Affiliated with Kunming Medical University, No. 288, Qianxing Road, Xishan District, Kunming 650228, China
| | - Wensha Nie
- Department of Neurology, Kunming Children’s Hospital, Kunming Children’s Hospital Affiliated with Kunming Medical University, No. 288, Qianxing Road, Xishan District, Kunming 650228, China
| | - Chunxia Wang
- Department of Neurology, Kunming Children’s Hospital, Kunming Children’s Hospital Affiliated with Kunming Medical University, No. 288, Qianxing Road, Xishan District, Kunming 650228, China
| | - Zuohua Wang
- Department of Neurology, Kunming Children’s Hospital, Kunming Children’s Hospital Affiliated with Kunming Medical University, No. 288, Qianxing Road, Xishan District, Kunming 650228, China
| | - Yuxia Zheng
- Department of Neurology, Kunming Children’s Hospital, Kunming Children’s Hospital Affiliated with Kunming Medical University, No. 288, Qianxing Road, Xishan District, Kunming 650228, China
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Aboulhosn P, Ryu A, Shafieesabet A, Lekshminarayanan A, Husain S, O'Connor K, D'Souza S, O'Neill S, Altschuler EL. Partial Balint's syndrome and left homonymous hemianopsia presenting after resection of a right occipito-parietal glioblastoma. Neurocase 2022; 28:483-487. [PMID: 36794351 DOI: 10.1080/13554794.2023.2176778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
A 66-year-old left-handed male was admitted to our acute inpatient rehabilitation (AIR) unit following a resection of the right occipito-parietal glioblastoma. He presented with symptoms of horizontal oculomotor apraxia, contralateral optic ataxia and left homonymous hemianopsia. We diagnosed this patient with partial Bálint's syndrome (BS)- oculomotor apraxia, optic ataxia but not simultanagnosia. BS is typically caused by bilateral posterior parietal lesions, but we here describe a unique case due toresection of a right intracranial tumor. A short AIR stay allowed our patient to learn how to compensate for visuomotor and visuospatial deficits, and improved his quality of life significantly.
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Affiliation(s)
- Petra Aboulhosn
- Department of Physical Medicine and Rehabilitation, Metropolitan Hospital, New York, NY, USA
| | - Andrew Ryu
- New York Medical College, Valhalla, NY, USA
| | - Azadeh Shafieesabet
- Department of Rehabilitation Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Anusha Lekshminarayanan
- Department of Physical Medicine and Rehabilitation, Metropolitan Hospital, New York, NY, USA
| | - Sohni Husain
- Department of Physical Medicine and Rehabilitation, Metropolitan Hospital, New York, NY, USA
| | - Kathryn O'Connor
- Department of Physical Medicine and Rehabilitation, Metropolitan Hospital, New York, NY, USA
| | - Saarah D'Souza
- Department of Physical Medicine and Rehabilitation, Metropolitan Hospital, New York, NY, USA
| | - Shannon O'Neill
- Department of Physical Medicine and Rehabilitation, Metropolitan Hospital, New York, NY, USA
| | - Eric L Altschuler
- Department of Physical Medicine and Rehabilitation, Metropolitan Hospital, New York, NY, USA.,Department of Rehabilitation Medicine, New York Medical College, Valhalla, NY, USA
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6
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Schiff ER, Aychoua N, Nutan S, Davagnanam I, Moore AT, Robson AG, Patel CK, Webster AR, Arno G. Variability of retinopathy consequent upon novel mutations in LAMA1. Ophthalmic Genet 2022; 43:671-678. [PMID: 35616092 DOI: 10.1080/13816810.2022.2076283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Bi-allelic mutations in LAMA1 (laminin 1) (OMIM # 150320) cause Poretti-Boltshauser Syndrome (PTBHS), a rare non-progressive cerebellar dysplasia disorder with ophthalmic manifestations including oculomotor apraxia, high myopia, and retinal dystrophy. Only 38 variants, nearly all loss of function have been reported. Here, we describe novel LAMA1 variants and detailed retinal manifestations in two unrelated families. METHODS Whole-genome sequencing was conducted on three siblings of a consanguineous family with myopia and retinal dystrophy and on a child from an unrelated non-consanguineous couple. Clinical evaluation included full ophthalmic examination, detailed colour, autofluorescence retinal imaging, retinal optical coherence tomography (OCT), fluorescein angiography under anesthesia, and pattern and full-field electroretinography. RESULTS Genetic analysis revealed a novel homozygous LAMA1 frameshift variant, c.1492del p.(Arg498Glyfs *25), in the affected siblings in family 1 and a novel frameshift c.3065del p.(Gly1022Valfs *2) and a deletion spanning exons 17-23 in an unrelated individual in family 2. Two of the three siblings and the unrelated child had oculomotor apraxia in childhood; none of the siblings had symptoms of other neurological dysfunction as adults. All four had myopia. The affected siblings had a qualitatively similar retinopathy of wide-ranging severity. The unrelated patient had a severe abnormality of retinal vascular development, which resulted in vitreous haemorrhage and neovascular glaucoma in the left eye and a rhegmatogenous retinal detachment in the right eye. CONCLUSIONS This report describes the detailed retinal structural and functional consequences of LAMA1 deficiency in four patients from two families, and these exhibit significant variability with evidence of both retinal dystrophy and abnormal and incomplete retinal vascularisation.
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Affiliation(s)
- Elena R Schiff
- Moorfields Eye Hospital, London, UK.,UCL Institute of Ophthalmology, London, UK
| | | | - Savita Nutan
- North Thames Genomic Laboratory Hub, Great Ormond Street NHS Foundation Trust, London, UK
| | - Indran Davagnanam
- Moorfields Eye Hospital, London, UK.,National Hospital for Neurology and Neurosurgery, London, UK.,UCL Institute of Neurology, London, UK
| | - Anthony T Moore
- UCL Institute of Ophthalmology, London, UK.,University of California, San Francisco, San Francisco, California, USA
| | - A G Robson
- Moorfields Eye Hospital, London, UK.,UCL Institute of Ophthalmology, London, UK
| | - C K Patel
- Great Ormond Street Hospital, London, UK.,Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Andrew R Webster
- Moorfields Eye Hospital, London, UK.,UCL Institute of Ophthalmology, London, UK
| | - Gavin Arno
- Moorfields Eye Hospital, London, UK.,UCL Institute of Ophthalmology, London, UK.,North Thames Genomic Laboratory Hub, Great Ormond Street NHS Foundation Trust, London, UK
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7
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Madhaw G, Kumar N, M Radhakrishnan D, Shree R. Infantile Ascending Hereditary Spastic Paralysis with Extrapyramidal and Extraocular Manifestations Associated with a Novel ALS2 Mutation. Mov Disord Clin Pract 2022; 9:118-121. [PMID: 35005076 DOI: 10.1002/mdc3.13372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 09/24/2021] [Accepted: 10/30/2021] [Indexed: 11/05/2022] Open
Affiliation(s)
- Govind Madhaw
- Department of Neurology All India Institute of Medical Sciences Rishikesh India
| | - Niraj Kumar
- Department of Neurology All India Institute of Medical Sciences Rishikesh India
| | - Divya M Radhakrishnan
- Department of Neurology All India Institute of Medical Sciences Rishikesh India.,Department of Neurology All India Institute of Medical Sciences New Delhi India
| | - Ritu Shree
- Department of Neurology All India Institute of Medical Sciences Rishikesh India.,Department of Neurology Post Graduate Institute of Medical Education and Research Chandigarh India
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Renaud M, Tranchant C, Koenig M, Anheim M. Reply to: "Autosomal-Recessive Cerebellar Ataxias With Elevated Alpha-Fetoprotein: Uncommon Diseases, Common Biomarker". Mov Disord 2021; 36:789-790. [PMID: 33749920 DOI: 10.1002/mds.28524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 01/18/2021] [Indexed: 11/10/2022] Open
Affiliation(s)
- Mathilde Renaud
- Service de Génétique Clinique, CHRU de Nancy, Nancy, France.,INSERM-U1256 NGERE, Université de Lorraine, Nancy, France
| | - Christine Tranchant
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), INSERM-U964/CNRS-UMR7104/Université de Strasbourg, Illkirch, France.,Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
| | - Michel Koenig
- Laboratoire de Génétique de Maladies Rares EA7402, Institut Universitaire de Recherche Clinique, Université de Montpellier, CHU Montpellier, Montpellier, France
| | - Mathieu Anheim
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), INSERM-U964/CNRS-UMR7104/Université de Strasbourg, Illkirch, France.,Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
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9
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Freitas E, Costa O, Rocha S. A New Phenotype of Ataxia With Oculomotor Apraxia Type 4. Cureus 2021; 13:e13601. [PMID: 33654647 PMCID: PMC7914377 DOI: 10.7759/cureus.13601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Ataxia with oculomotor apraxia is a rare neurodegenerative subgroup of diseases with manifestations that include cerebellar ataxia, oculomotor apraxia, extrapyramidal features, and sensorimotor neuropathy. In 2015, ataxia with oculomotor apraxia type 4 was described in 11 Portuguese individuals. The mean age of onset was 4.3 years, with severe extrapyramidal manifestations, neuropathy, rapid progression, and ataxia, being wheelchair-bound during adolescence. The disease is caused by homozygous or compound heterozygous mutations in the PNKP gene. In this case report, we describe two sisters, who were 52- and 58-years-old, with cerebellar dysarthria, oculomotor apraxia, dystonia, and gait ataxia. Two new mutations in the PNKP gene were detected in both sisters, confirming the diagnosis of ataxia with oculomotor apraxia. They were remarkable because they were able to walk unaided during adulthood and had epilepsy. With these clinical cases, we attempt to raise awareness of the possibility of different phenotypes of this rare disease, expanding the spectrum of manifestations of ataxia with oculomotor apraxia type 4.
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Affiliation(s)
- Eduardo Freitas
- Neurology, Hospital de Braga, Braga, PRT.,Neurology, Hospital de Viana do Castelo, Viana do Castelo, PRT
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10
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Renaud M, Tranchant C, Koenig M, Anheim M. Autosomal Recessive Cerebellar Ataxias With Elevated Alpha-Fetoprotein: Uncommon Diseases, Common Biomarker. Mov Disord 2020; 35:2139-2149. [PMID: 33044027 DOI: 10.1002/mds.28307] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/23/2020] [Accepted: 08/17/2020] [Indexed: 12/12/2022] Open
Abstract
alpha-Fetoprotein (AFP) is a biomarker of several autosomal recessive cerebellar ataxias (ARCAs), especially ataxia telangiectasia (AT) and ataxia with oculomotor apraxia (AOA) type 2 (AOA2). More recently, slightly elevated AFP has been reported in AOA1 and AOA4. Interestingly, AOA1, AOA2, AOA4, and AT are overlapping ARCAs characterized by oculomotor apraxia, with oculocephalic dissociation, choreo-dystonia, and/or axonal sensorimotor neuropathy, in addition to cerebellar ataxia with cerebellar atrophy. The genetic backgrounds in these disorders play central roles in nuclear maintenance through DNA repair [ATM (AT), APTX (AOA1), or PNKP (AOA4)] or RNA termination [SETX (AOA2)]. Partially discriminating thresholds of AFP have been proposed as a way to distinguish between ARCAs with elevated AFP. In these entities, elevated AFP may be an epiphenomenon as a result of liver transcriptional dysregulation. AFP is a simple and reliable biomarker for the diagnosis of ARCA in performance and interpretation of next-generation sequencing. Here, we evaluated clinical, laboratory, imaging, and molecular data of the group of ARCAs that share elevated AFP serum levels that have been described in the past two decades. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Mathilde Renaud
- Service de Génétique Clinique, CHRU de Nancy, Nancy, France.,INSERM-U1256 NGERE, Université de Lorraine, Nancy, France
| | - Christine Tranchant
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), INSERM-U964/CNRS-UMR7104/Université de Strasbourg, Illkirch, France.,Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
| | - Michel Koenig
- Laboratoire de Génétique de Maladies Rares EA7402, Institut Universitaire de Recherche Clinique, Université de Montpellier, CHU Montpellier, Montpellier, France
| | - Mathieu Anheim
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), INSERM-U964/CNRS-UMR7104/Université de Strasbourg, Illkirch, France.,Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
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11
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Liu Q, Wang H, Zhao J, Liu Z, Sun D, Yuan A, Luo G, Wei W, Hou M. Four novel compound heterozygous mutations in C5orf42 gene in patients with pure and mild Joubert syndrome. Int J Dev Neurosci 2020; 80:455-463. [PMID: 32233090 DOI: 10.1002/jdn.10029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/09/2020] [Accepted: 03/17/2020] [Indexed: 01/03/2023] Open
Abstract
Joubert syndrome (JS) is a rare clinically and genetically heterogeneous disease. Using whole or targeted exome sequencing, we identified four novel compound heterozygous mutations in chromosome 5 open reading frame 42 gene (C5orf42), including c.2876C>T (missense mutation) and c.3921+1G>A (splicing mutation), c.2292 -2delA (splicing mutation) and c.4067C>T (missense mutation), c.6997_6998insT (frameshift mutation) and c.8710C>T (nonsense mutation), c.3981G>C (nonsense mutation) and c.230 _233del (frameshift mutation), in four Chinese JS families. They were all inherited from their heterozygosis parents in the autosomal recessive inheritance mode. Pure JS clinical manifestations and mild neuroimaging findings were found in these patients. These verified the previous findings that C5orf42 mutations generally resulted in a purely neurological Joubert phenotype, and neuroimaging findings were mild in JS with C5orf42 mutations. Our report analyzed these C5orf42 mutations-associated phenotypes and neuroimaging findings in JS and updated the genetic variation spectrum of JS caused by C5orf42.These will help clinicians and geneticists reach a more accurate diagnosis for JS.
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Affiliation(s)
- Qiuyan Liu
- Department of Neurology and Rehabilitation, Qingdao Women and Children's Hospital, Qingdao University, Qingdao, P.R. China
| | - Haiqiao Wang
- Department of Traditional Chinese Medicine, School of Medicine, Ren Ji Hospital, Shanghai Jiaotong University, Shanghai, P.R. China
| | - Jianhui Zhao
- Department of Neurology and Rehabilitation, Qingdao Women and Children's Hospital, Qingdao University, Qingdao, P.R. China
| | - Zhicui Liu
- Department of Neurology and Rehabilitation, Qingdao Women and Children's Hospital, Qingdao University, Qingdao, P.R. China
| | - Dianrong Sun
- Department of Neurology and Rehabilitation, Qingdao Women and Children's Hospital, Qingdao University, Qingdao, P.R. China
| | - Aiyun Yuan
- Department of Neurology and Rehabilitation, Qingdao Women and Children's Hospital, Qingdao University, Qingdao, P.R. China
| | - Guangjin Luo
- Department of Neurology and Rehabilitation, Qingdao Women and Children's Hospital, Qingdao University, Qingdao, P.R. China
| | - Wei Wei
- Kangso Medical Inspection Co., Ltd, Beijing, P.R. China
| | - Mei Hou
- Department of Neurology and Rehabilitation, Qingdao Women and Children's Hospital, Qingdao University, Qingdao, P.R. China
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Gatti M, Magri S, Nanetti L, Sarto E, Di Bella D, Salsano E, Pantaleoni C, Mariotti C, Taroni F. From congenital microcephaly to adult onset cerebellar ataxia: Distinct and overlapping phenotypes in patients with PNKP gene mutations. Am J Med Genet A 2019; 179:2277-2283. [PMID: 31436889 DOI: 10.1002/ajmg.a.61339] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 08/07/2019] [Accepted: 08/09/2019] [Indexed: 12/23/2022]
Abstract
Pathogenic variants in polynucleotide kinase 3'-phosphatase (PNKP) gene have been associated with two distinct clinical presentations: autosomal recessive microcephaly, seizures, and developmental delay (MCSZ; MIM 613402) and ataxia with oculomotor apraxia type 4 (AOA4; MIM 616267). More than 40 patients have been reported so far, and their clinical presentations revealed a continuum phenotypic spectrum ranging from congenital microcephaly and early-onset intractable seizures, to adult onset slowly progressive sensory-motor neuropathy and cerebellar ataxia. We describe three unrelated Italian patients with different phenotypes and novel or recurrent pathogenic variants in PNKP gene. Patient 1, homozygous for the recurrent frameshift variant (p.Thr424Glyfs*49), had an early-onset MCSZ phenotype. Late in the disease progression, cerebellar ataxia and peripheral neuropathy were recognized. Patient 2, homozygous for a frameshift variant (p.Ala429Thrfs*42), presented a phenotype partially consistent with MCSZ including microcephaly and developmental delay, but without seizures. Patient 3 is one of the oldest patients described to date and presented polyneuropathy, and cerebellar signs. Biochemical tests showed abnormalities of cholesterol, albumin, or alpha-fetoprotein plasma levels. The clinical presentation of our patients encompassed early-to-adult-onset manifestations. For these cases, the long clinical follow-up allowed an in-depth phenotypic characterization and a better delineation of the natural history of patients carrying PNKP pathogenic variants.
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Affiliation(s)
- Marta Gatti
- Unit of Medical Genetics and Neurogenetics, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Stefania Magri
- Unit of Medical Genetics and Neurogenetics, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Lorenzo Nanetti
- Unit of Medical Genetics and Neurogenetics, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Elisa Sarto
- Unit of Medical Genetics and Neurogenetics, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Daniela Di Bella
- Unit of Medical Genetics and Neurogenetics, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Ettore Salsano
- Unit of Neurodegenerative and Neurometabolic Rare Diseases, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Chiara Pantaleoni
- Developmental Neurology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Caterina Mariotti
- Unit of Medical Genetics and Neurogenetics, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Franco Taroni
- Unit of Medical Genetics and Neurogenetics, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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Tariq H, Imran R, Naz S. A Novel Homozygous Variant of SETX Causes Ataxia with Oculomotor Apraxia Type 2. J Clin Neurol 2018; 14:498-504. [PMID: 30198223 PMCID: PMC6172491 DOI: 10.3988/jcn.2018.14.4.498] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 04/23/2018] [Accepted: 04/23/2018] [Indexed: 01/21/2023] Open
Abstract
Background and Purpose Autosomal recessive cerebellar ataxias constitute a highly heterogeneous group of neurodegenerative disorders. This study was carried out to determine the clinical and genetic causes of ataxia in two families from Pakistan. Methods Detailed clinical investigations were carried out on probands in two consanguineous families. Magnetic resonance imaging was performed. Exome sequencing data were examined for likely pathogenic variants. Candidate variants were checked for cosegregation with the phenotype using Sanger sequencing. Public databases including ExAC, GnomAD, dbSNP, and the 1,000 Genome Project as well as ethnically matched controls were checked to determine the frequencies of the alleles. Conservation of missense variants was ensured by aligning orthologous protein sequences from diverse vertebrate species. Results Reverse phenotyping identified spinocerebellar ataxia, autosomal recessive 1 [OMIM 606002, also referred to as ataxia oculomotor apraxia type 2 (AOA2)] and ataxia telangiectasia (OMIM 208900) in the two families. A novel homozygous missense mutation c.202 C>T (p.Arg68Cys) was identified within senataxin, SETX in the DNA of both patients in one of the families with AOA2. The patients in the second family were homozygous for a known variant in ataxia-telangiectasia mutated (ATM) gene: c.7327 C>T (p.Arg2443Ter). Both variants were absent from 100 ethnically matched control chromosomes and were either absent or present at very low frequencies in the public databases. Conclusions This report extends the allelic heterogeneity of SETX mutations causing AOA2 and also presents an asymptomatic patient with a pathogenic ATM variant.
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Affiliation(s)
- Huma Tariq
- School of Biological Sciences, University of the Punjab, Lahore, Pakistan
| | - Rashid Imran
- Punjab Institute of Neurosciences, Lahore General Hospital, Lahore, Pakistan
| | - Sadaf Naz
- School of Biological Sciences, University of the Punjab, Lahore, Pakistan.
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Abstract
The phenotypic and genetic spectrum of ataxia with oculomotor apraxia (AOA) disorders is rapidly evolving and new technologies such as genetic mapping using whole exome sequencing reveal subtle distinctions among the various subtypes. We report a novel PNKP mutation in two siblings with progressive ataxia, abnormal saccades, sensorimotor neuropathy and dystonia consistent with the AOA type 4 phenotype. Laboratory evaluation revealed hypoalbuminemia, hypercholesterolemia with elevated LDL, elevated IgE levels and normal α fetoprotein levels. Eye movement examination demonstrated a marked saccade initiation defect with profound hypometric horizontal saccades. Vertical saccades were also affected but less so. Also present were conspicuous thrusting head movements when attempting to change gaze, but rather than an apraxia these were an adaptive strategy to take advantage of an intact vestibulo-ocular reflex to carry the eyes to a new target of interest. This is demonstrated in accompanying videos.
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Affiliation(s)
- Nicoline Schiess
- a Department of Neurology , Johns Hopkins Hospital , Baltimore , MD , USA
| | - David S Zee
- a Department of Neurology , Johns Hopkins Hospital , Baltimore , MD , USA
| | - Khurram A Siddiqui
- b Department of Neurology , Al Ain Hospital , Al Ain , United Arab Emirates
| | - Miklos Szolics
- c Department of Neurology , Tawam Hospital , Al Ain , United Arab Emirates
| | - Ayman W El-Hattab
- d Division of Clinical Genetics and Metabolic Disorders , Tawam Hospital , Al-Ain , United Arab Emirates
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Abstract
A 23-year-old woman had presented initially to a podiatrist complaining of poorly fitting shoes during her adolescence. After extensive neurological review, she was diagnosed with ataxia with oculomotor apraxia type 2. This is a progressive autosomal recessive ataxia associated with cerebellar atrophy, peripheral neuropathy and an elevated serum α-fetoprotein. Within Europe, it is the most frequent autosomal recessive ataxia after Friedreich's ataxia and is due to mutations in the senataxin (SETX) gene. The age of onset is approximately 15 years.The diagnosis of oculomotor apraxia type 2 is often challenging. We provide a framework for assessing a young ataxic patient with or without oculomotor apraxia and review clues that will aid diagnosis. The prognosis, level of disability, cancer and immunosuppression risk all markedly differ between the conditions. Patients and their families need the correct diagnosis for genetic counselling, management and long-term surveillance with appropriate subspecialty services.
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Affiliation(s)
| | | | - Graham Lennox
- Department of Neurology, John Radcliffe Hospital, Oxford, UK
| | - Henry Houlden
- Reta Lila Weston Laboratories and Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK
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Brugger F, Schüpbach M, Koenig M, Müri R, Bohlhalter S, Kaelin-Lang A, Kamm CP, Kägi G. The Clinical Spectrum of Ataxia with Oculomotor Apraxia Type 2. Mov Disord Clin Pract 2014; 1:106-109. [PMID: 30363866 DOI: 10.1002/mdc3.12021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 03/10/2014] [Accepted: 03/12/2014] [Indexed: 11/07/2022] Open
Abstract
Ataxia with oculomotor apraxia type 2 (AOA2) is an inherited disorder caused by mutations within both alleles of the senataxin gene. First symptoms are usually recognized before the age of 30. Unlike several other autosomal recessive cerebellar ataxia syndromes, levels of alpha-fetoprotein are nearly always elevated in AOA2 and thus narrowing down the differential diagnosis list. We present 3 video cases illustrating and expanding the clinical spectrum of AOA2, with 1 case bearing a novel mutation with cervical dystonia as the first symptom, the absence of neuropathy, and a disease onset beyond the age of 40. Furthermore, all patients were assessed by oculographic analysis, which revealed distinct patterns of oculomotor abnormalities. The clinical spectrum of AOA2 might be even broader than previously described in larger series. Oculography might be a useful tool to detect subclinical oculomotor apraxia in this disorder.
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Affiliation(s)
- Florian Brugger
- Movement Disorders Center of Eastern Switzerland Department of Neurology Kantonsspital St.Gallen St.Gallen Switzerland
| | - Michael Schüpbach
- Movement Disorders Center Department of Neurology University Hospital Berne University of Berne Berne Switzerland
| | - Michel Koenig
- Laboratoire de Diagnostic Génétique Nouvel Hôpital Civil Strasbourg France
- Institut de Génétique et de Biologie Moléculaire et Cellulaire CNRS/Université de Strasbourg/INSERM Illkirch France
| | - René Müri
- Perception and Eye Movement Laboratory Departments of Neurology and Clinical Research Inselspital, University Hospital Berne Berne Switzerland
| | - Stephan Bohlhalter
- Perception and Eye Movement Laboratory Departments of Neurology and Clinical Research Inselspital, University Hospital Berne Berne Switzerland
- Neurology and Neurorehabilitation Center Department of Internal Medicine Luzerner Kantonsspital Lucerne Switzerland
| | - Alain Kaelin-Lang
- Movement Disorders Center Department of Neurology University Hospital Berne University of Berne Berne Switzerland
| | - Christian P Kamm
- Perception and Eye Movement Laboratory Departments of Neurology and Clinical Research Inselspital, University Hospital Berne Berne Switzerland
| | - Georg Kägi
- Movement Disorders Center of Eastern Switzerland Department of Neurology Kantonsspital St.Gallen St.Gallen Switzerland
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Abstract
We report a case of intracardiac calcification associated with oculomotor apraxia and corneal deposits in a 12-year-old girl, who presented with dyspnea on exertion, sinusitis, and epistaxis since the age of 6 years. Unusual presentation with multiorgan involvement prompted us to evaluate her in terms of metabolic/storage disorder. The bone marrow aspirate confirmed the diagnosis of Gaucher's disease.
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Affiliation(s)
- Sejal Shah
- Department of Pediatric Cardiology, Narayana Hrudayalaya Institute of Medical Sciences, Bangalore, India
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