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Renaud M, Moreira MC, Ben Monga B, Rodriguez D, Debs R, Charles P, Chaouch M, Ferrat F, Laurencin C, Vercueil L, Mallaret M, M'Zahem A, Pacha LA, Tazir M, Tilikete C, Ollagnon E, Ochsner F, Kuntzer T, Jung HH, Beis JM, Netter JC, Djamshidian A, Bower M, Bottani A, Walsh R, Murphy S, Reiley T, Bieth É, Roelens F, Poll-The BT, Lourenço CM, Jardim LB, Straussberg R, Landrieu P, Roze E, Thobois S, Pouget J, Guissart C, Goizet C, Dürr A, Tranchant C, Koenig M, Anheim M. Clinical, Biomarker, and Molecular Delineations and Genotype-Phenotype Correlations of Ataxia With Oculomotor Apraxia Type 1. JAMA Neurol 2019; 75:495-502. [PMID: 29356829 DOI: 10.1001/jamaneurol.2017.4373] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Importance Ataxia with oculomotor apraxia type 1 (AOA1) is an autosomal recessive cerebellar ataxia due to mutations in the aprataxin gene (APTX) that is characterized by early-onset cerebellar ataxia, oculomotor apraxia, axonal motor neuropathy, and eventual decrease of albumin serum levels. Objectives To improve the clinical, biomarker, and molecular delineation of AOA1 and provide genotype-phenotype correlations. Design, Setting, and Participants This retrospective analysis included the clinical, biological (especially regarding biomarkers of the disease), electrophysiologic, imaging, and molecular data of all patients consecutively diagnosed with AOA1 in a single genetics laboratory from January 1, 2002, through December 31, 2014. Data were analyzed from January 1, 2015, through January 31, 2016. Main Outcomes and Measures The clinical, biological, and molecular spectrum of AOA1 and genotype-phenotype correlations. Results The diagnosis of AOA1 was confirmed in 80 patients (46 men [58%] and 34 women [42%]; mean [SD] age at onset, 7.7 [7.4] years) from 51 families, including 57 new (with 8 new mutations) and 23 previously described patients. Elevated levels of α-fetoprotein (AFP) were found in 33 patients (41%); hypoalbuminemia, in 50 (63%). Median AFP level was higher in patients with AOA1 (6.0 ng/mL; range, 1.1-17.0 ng/mL) than in patients without ataxia (3.4 ng/mL; range, 0.8-17.2 ng/mL; P < .01). Decreased albumin levels (ρ = -0.532) and elevated AFP levels (ρ = 0.637) were correlated with disease duration. The p.Trp279* mutation, initially reported as restricted to the Portuguese founder haplotype, was discovered in 53 patients with AOA1 (66%) with broad white racial origins. Oculomotor apraxia was found in 49 patients (61%); polyneuropathy, in 74 (93%); and cerebellar atrophy, in 78 (98%). Oculomotor apraxia correlated with the severity of ataxia and mutation type, being more frequent with deletion or truncating mutations (83%) than with presence of at least 1 missense variant (17%; P < .01). Mean (SD) age at onset was higher for patients with at least 1 missense mutation (17.7 [11.4] vs 5.2 [2.6] years; P < .001). Conclusions and Relevance The AFP level, slightly elevated in a substantial fraction of patients, may constitute a new biomarker for AOA1. Oculomotor apraxia may be an optional finding in AOA1 and correlates with more severe disease. The p.Trp279* mutation is the most frequent APTX mutation in the white population. APTX missense mutations may be associated with a milder phenotype.
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Affiliation(s)
- Mathilde Renaud
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Institut de Génétique et de Biologie Moléculaire et Cellulaire, Institut National de la Santé et de la Recherche Medicale (INSERM)-U964, Centre National de la Recherche Scientifique (CNRS)-Unité Mixte de Recherché (UMR) 7104, Université de Strasbourg, Illkirch, France.,Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Maria-Céu Moreira
- Institut de Génétique et de Biologie Moléculaire et Cellulaire, Institut National de la Santé et de la Recherche Medicale (INSERM)-U964, Centre National de la Recherche Scientifique (CNRS)-Unité Mixte de Recherché (UMR) 7104, Université de Strasbourg, Illkirch, France
| | - Bondo Ben Monga
- Faculté de Médecine et Ecole de Santé Publique, Université de Lubumbashi, Lubumbashi, République Démocratique du Congo
| | - Diana Rodriguez
- Service de Neuropédiatrie, Hôpital d'Enfants Armand-Trousseau, Paris, France.,Centre de Référence de Neurogénétique, Hôpital Armand-Trousseau, Hôpitaux Universitaires Est Parisien, Assistance Publique-Hôpitaux de Paris, Paris, France.,Groupe de Recherch Clinique ConCer-LD, Sorbonne Universités, l'Université Pierre-et-Marie-Curie, Université Paris 06, Paris, France.,Neuroprotection du Cerveau en Développement, INSERM U1141, Paris, France
| | - Rabab Debs
- Département de Génétique, Hôpital de La Pitié-Salpétrière, Paris, France
| | - Perrine Charles
- Département de Génétique, Hôpital de La Pitié-Salpétrière, Paris, France
| | - Malika Chaouch
- Service de Neurologie, Etablissement Hospitalier Spécialisé, Algers, Algeria
| | - Farida Ferrat
- Service de Neurologie, Etablissement Hospitalier Spécialisé de Ben Aknoun, Algers, Algeria
| | - Chloé Laurencin
- Service de Neurologie C, Hopital Neurologique, Hospices Civils de Lyon, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France.,CNRS, Institut des Sciences Cognitives, UMR 5229, Bron, France
| | - Laurent Vercueil
- Exploration Fonctionnelle du Système Nerveux, Pôle de Psychiatrie, Neurologie et Rééducation Neurologique, Centre Hospitalier Universitaire (CHU) Grenoble, Grenoble, France.,INSERM U836, Grenoble Institut des Neurosciences, Bâtiment Edmond J. Safra, Chemin Fortuné Ferrini, La Tronche, France
| | - Martial Mallaret
- Exploration Fonctionnelle du Système Nerveux, Pôle de Psychiatrie, Neurologie et Rééducation Neurologique, Centre Hospitalier Universitaire (CHU) Grenoble, Grenoble, France
| | | | | | - Meriem Tazir
- Service de Neurologie, CHU Mustapha, Algers, Algeria
| | - Caroline Tilikete
- Service de Neuro-ophtalmologie, Hôpital Neurologique, CHU Lyon, Bron, France
| | | | | | | | - Hans H Jung
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Jean-Marie Beis
- Institut Régional de Médecine Physique et de Réadaptation, Centre de Lay-Saint-Christophe, France
| | | | - Atbin Djamshidian
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Mattew Bower
- Department of Neurology, University of Minnesota Health, Minneapolis, Minnesota
| | - Armand Bottani
- Service de Génétique, Hôpitaux Universitaires de Genève, Genève, Suisse
| | - Richard Walsh
- Academic Unit of Neurology, Trinity College Dublin, Dublin, Ireland.,National Ataxia Clinic, Adelaide and Meath Hospital Dublin, National Children's Hospital, Dublin, Ireland
| | - Sinead Murphy
- National Ataxia Clinic, Adelaide and Meath Hospital Dublin, National Children's Hospital, Dublin, Ireland
| | - Thomas Reiley
- Department of Public Health and Environment, Greeley, Colorado
| | - Éric Bieth
- Service de Génétique Médicale, Hopital Purpan, Toulouse, France
| | | | - Bwee Tien Poll-The
- Pediatric Neurology, Emma Children's Hospital, University of Amsterdam, Amsterdam, the Netherlands
| | - Charles Marques Lourenço
- Neurogenetics Unit, School of Medicine of Ribeirao Preto, University of São Paulo, São Paulo, Brazil
| | - Laura Bannach Jardim
- Medical Genetics Service, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Rachel Straussberg
- Neurogenetics Clinic, Department of Child Neurology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler School of Medicine Tel Aviv University, Ramat Aviv, Israel
| | - Pierre Landrieu
- Service de Neurologie Pédiatrique, Hôpital Bicêtre, Paris, France
| | - Emmanuel Roze
- Département de Génétique, Hôpital de La Pitié-Salpétrière, Paris, France
| | - Stéphane Thobois
- Service de Neurologie C, Hopital Neurologique, Hospices Civils de Lyon, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France.,CNRS, Institut des Sciences Cognitives, UMR 5229, Bron, France
| | - Jean Pouget
- Service de Neurologie, Hôpital de la Timone, Marseille, France
| | - Claire Guissart
- Laboratoire de Génétique de Maladies Rares EA7402, Institut Universitaire de Recherche Clinique, Université de Montpellier, CHU Montpellier, Montpellier, France
| | - Cyril Goizet
- Service de Génétique Médicale, CHU Bordeaux, Bordeaux, France.,INSERM U1211, Laboratoire Maladies Rares Génétique et Métabolisme, Université de Bordeaux, Bordeaux, France
| | - Alexandra Dürr
- Département de Génétique, Hôpital de La Pitié-Salpétrière, Paris, France
| | - Christine Tranchant
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Institut de Génétique et de Biologie Moléculaire et Cellulaire, Institut National de la Santé et de la Recherche Medicale (INSERM)-U964, Centre National de la Recherche Scientifique (CNRS)-Unité Mixte de Recherché (UMR) 7104, Université de Strasbourg, Illkirch, France.,Fédération de Médecine Translationnelle de Strasbourg, 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, Institut National de la Santé et de la Recherche Medicale (INSERM)-U964, Centre National de la Recherche Scientifique (CNRS)-Unité Mixte de Recherché (UMR) 7104, Université de Strasbourg, Illkirch, France.,Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, Strasbourg, France
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Anheim M, Monga B, Fleury M, Charles P, Barbot C, Salih M, Delaunoy JP, Fritsch M, Arning L, Synofzik M, Schöls L, Sequeiros J, Goizet C, Marelli C, Le Ber I, Koht J, Gazulla J, De Bleecker J, Mukhtar M, Drouot N, Ali-Pacha L, Benhassine T, Chbicheb M, M'Zahem A, Hamri A, Chabrol B, Pouget J, Murphy R, Watanabe M, Coutinho P, Tazir M, Durr A, Brice A, Tranchant C, Koenig M. Ataxia with oculomotor apraxia type 2: clinical, biological and genotype/phenotype correlation study of a cohort of 90 patients. ACTA ACUST UNITED AC 2009; 132:2688-98. [PMID: 19696032 DOI: 10.1093/brain/awp211] [Citation(s) in RCA: 166] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Ataxia with oculomotor apraxia type 2 (AOA2) is an autosomal recessive disease due to mutations in the senataxin gene, causing progressive cerebellar ataxia with peripheral neuropathy, cerebellar atrophy, occasional oculomotor apraxia and elevated alpha-feto-protein (AFP) serum level. We compiled a series of 67 previously reported and 58 novel ataxic patients who underwent senataxin gene sequencing because of suspected AOA2. An AOA2 diagnosis was established for 90 patients, originating from 15 countries worldwide, and 25 new senataxin gene mutations were found. In patients with AOA2, median AFP serum level was 31.0 microg/l at diagnosis, which was higher than the median AFP level of AOA2 negative patients: 13.8 microg/l, P = 0.0004; itself higher than the normal level (3.4 microg/l, range from 0.5 to 17.2 microg/l) because elevated AFP was one of the possible selection criteria. Polyneuropathy was found in 97.5% of AOA2 patients, cerebellar atrophy in 96%, occasional oculomotor apraxia in 51%, pyramidal signs in 20.5%, head tremor in 14%, dystonia in 13.5%, strabismus in 12.3% and chorea in 9.5%. No patient was lacking both peripheral neuropathy and cerebellar atrophy. The age at onset and presence of occasional oculomotor apraxia were negatively correlated to the progression rate of the disease (P = 0.03 and P = 0.009, respectively), whereas strabismus was positively correlated to the progression rate (P = 0.03). An increased AFP level as well as cerebellar atrophy seem to be stable in the course of the disease and to occur mostly at or before the onset of the disease. One of the two patients with a normal AFP level at diagnosis had high AFP levels 4 years later, while the other had borderline levels. The probability of missing AOA2 diagnosis, in case of sequencing senataxin gene only in non-Friedreich ataxia non-ataxia-telangiectasia ataxic patients with AFP level > or =7 microg/l, is 0.23% and the probability for a non-Friedreich ataxia non-ataxia-telangiectasia ataxic patient to be affected with AOA2 with AFP levels > or =7 microg/l is 46%. Therefore, selection of patients with an AFP level above 7 microg/l for senataxin gene sequencing is a good strategy for AOA2 diagnosis. Pyramidal signs and dystonia were more frequent and disease was less severe with missense mutations in the helicase domain of senataxin gene than with missense mutations out of helicase domain and deletion and nonsense mutations (P = 0.001, P = 0.008 and P = 0.01, respectively). The lack of pyramidal signs in most patients may be explained by masking due to severe motor neuropathy.
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Affiliation(s)
- M Anheim
- Institut de Génétique et de Biologie Moléculaire et Cellulaire, CNRS, Université de Strasbourg, INSERM, Illkirch, France.
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