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Cabal-Herrera AM, Saldarriaga-Gil W, Salcedo-Arellano MJ, Hagerman RJ. Fragile X associated neuropsychiatric disorders in a male without FXTAS. Intractable Rare Dis Res 2020; 9:113-118. [PMID: 32494560 PMCID: PMC7263992 DOI: 10.5582/irdr.2020.01028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/13/2020] [Accepted: 05/16/2020] [Indexed: 11/05/2022] Open
Abstract
Fragile X syndrome (FXS) is the most common inherited cause of intellectual disability and autism spectrum disorder. In most cases, it is due to an expansion of the CGG triplet to more than 200 repeats within the promoter region of the FMR1 gene. In the premutation (PM) the trinucleotide is expanded to 55-200 repeats. PM carriers can present with disorders associated with the PM including fragile X-associated tremor/ataxia syndrome (FXTAS) and fragile X-associated ovarian insufficiency (FXPOI). Recently fragile X-associated neuropsychiatric disorders (FXAND) was proposed as an umbrella term to include the neuropsychiatric disorders that are more prevalent in PM carriers compared to the general population such as anxiety, depression, chronic fatigue, alcohol abuse, and psychosis, among others. The patient in our study was evaluated by a team of clinicians from the University del Valle in Cali who traveled to Ricaurte, a Colombian town known for being a genetic geographic cluster of FXS. A detailed medical history was collected and complete physical, neurological and psychiatric evaluations were performed in addition to molecular and neuroradiological studies. We report the case of a 78-year-old man, PM carrier, without FXTAS whose main clinical presentation consists of behavioral changes and psychosis. Brain imaging revealed white matter lesions in the periventricular region and mild cerebral atrophy. Although anxiety and depression are the most common neuropsychiatric manifestations in PM carriers, it is important to perform a complete psychiatric evaluation since some patients may present with behavioral changes and psychosis.
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Affiliation(s)
- Ana María Cabal-Herrera
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis Health, Sacramento, CA, USA
- School of Medicine, Universidad del Valle, Cali, Colombia
| | | | - Maria Jimena Salcedo-Arellano
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis Health, Sacramento, CA, USA
- Department of Pediatrics, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Randi J Hagerman
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis Health, Sacramento, CA, USA
- Department of Pediatrics, University of California Davis School of Medicine, Sacramento, CA, USA
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Salcedo‐Arellano MJ, Wolf‐Ochoa MW, Hong T, Amina S, Tassone F, Lechpammer M, Hagerman R, Martínez‐Cerdeño V. Parkinsonism Versus Concomitant Parkinson's Disease in Fragile X-Associated Tremor/Ataxia Syndrome. Mov Disord Clin Pract 2020; 7:413-418. [PMID: 32373658 PMCID: PMC7197312 DOI: 10.1002/mdc3.12942] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/10/2020] [Accepted: 03/09/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Fragile X-associated tremor/ataxia syndrome (FXTAS) is a late-onset neurodegenerative disorder associated with premutation alleles (55-200 CGG repeats) of the fragile X mental retardation 1 (FMR1) gene. FXTAS is characterized by the presence of ubiquitin-positive inclusions in neurons and astrocytes and by cerebellar tremor and ataxia. Parkinsonism has been reported in FXTAS, but most patients lack the characteristic rest tremor and severe rigidity seen in idiopathic Parkinson's disease (PD). OBJECTIVE To describe the frequency of concomitant PD in FXTAS. METHODS We reviewed the medical record of 40 deceased patients diagnosed with FXTAS and performed a pathology analysis to confirm both FXTAS and PD. RESULTS Clinical histories indicated that 5 FXTAS patients were diagnosed with idiopathic PD and 2 with atypical parkinsonian syndrome. After pathological examination, we found that 7 patients in the PD clinical diagnosis group had dopaminergic neuronal loss; however, only 2 of 7 presented Lewy bodies (LBs) in the substantia nigra. Therefore, a total of 5% of the 40 cohort patients met the pathologic criteria for the concomitant diagnosis of FXTAS and PD. In addition, 2 patients not clinically diagnosed with PD also had nigral neuronal loss with LBs in substantia nigra. In total 10% of these 40 patients had LBs. CONCLUSION This report expands our understanding of clinical symptoms and unusual presentations in patients with FXTAS and the concept that the parkinsonism found in FXTAS is sometimes indistinguishable from PD. We propose that FMR1 should be recognized as one of the exceptional genetic causes of parkinsonism with presynaptic dopaminergic loss and LBs.
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Affiliation(s)
- María Jimena Salcedo‐Arellano
- Department of PediatricsUniversity of CaliforniaDavis, School of Medicine, SacramentoCaliforniaUSA
- Medical Investigation of Neurodevelopmental Disorders Institute (MIND)University of CaliforniaDavis, SacramentoCaliforniaUSA
- Institute for Pediatric Regenerative Medicine and Shriners Hospitals for Children Northern CaliforniaSacramentoCaliforniaUSA
- Department of Pathology and Laboratory MedicineUniversity of California, Davis, School of MedicineSacramentoCaliforniaUSA
| | - Marisol Wendy Wolf‐Ochoa
- Institute for Pediatric Regenerative Medicine and Shriners Hospitals for Children Northern CaliforniaSacramentoCaliforniaUSA
- Department of Pathology and Laboratory MedicineUniversity of California, Davis, School of MedicineSacramentoCaliforniaUSA
| | - Tiffany Hong
- Institute for Pediatric Regenerative Medicine and Shriners Hospitals for Children Northern CaliforniaSacramentoCaliforniaUSA
- Department of Pathology and Laboratory MedicineUniversity of California, Davis, School of MedicineSacramentoCaliforniaUSA
| | - Sarwat Amina
- Institute for Pediatric Regenerative Medicine and Shriners Hospitals for Children Northern CaliforniaSacramentoCaliforniaUSA
- Department of Pathology and Laboratory MedicineUniversity of California, Davis, School of MedicineSacramentoCaliforniaUSA
| | - Flora Tassone
- Medical Investigation of Neurodevelopmental Disorders Institute (MIND)University of CaliforniaDavis, SacramentoCaliforniaUSA
- Department of Biochemistry and Molecular MedicineUniversity of CaliforniaDavis, SacramentoCaliforniaUSA
| | - Mirna Lechpammer
- Department of Pathology and Laboratory MedicineUniversity of California, Davis, School of MedicineSacramentoCaliforniaUSA
| | - Randi Hagerman
- Department of PediatricsUniversity of CaliforniaDavis, School of Medicine, SacramentoCaliforniaUSA
- Medical Investigation of Neurodevelopmental Disorders Institute (MIND)University of CaliforniaDavis, SacramentoCaliforniaUSA
| | - Verónica Martínez‐Cerdeño
- Medical Investigation of Neurodevelopmental Disorders Institute (MIND)University of CaliforniaDavis, SacramentoCaliforniaUSA
- Institute for Pediatric Regenerative Medicine and Shriners Hospitals for Children Northern CaliforniaSacramentoCaliforniaUSA
- Department of Pathology and Laboratory MedicineUniversity of California, Davis, School of MedicineSacramentoCaliforniaUSA
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Hall D, Todorova-Koteva K, Pandya S, Bernard B, Ouyang B, Walsh M, Pounardjian T, Deburghraeve C, Zhou L, Losh M, Leehey M, Berry-Kravis E. Neurological and endocrine phenotypes of fragile X carrier women. Clin Genet 2015. [PMID: 26212380 DOI: 10.1111/cge.12646] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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: 11/30/2022]
Abstract
Women who carry fragile X mental retardation 1 (FMR1)gene premutation expansions frequently report neurological or endocrine symptoms and prior studies have predominantly focused on questionnaire report of medical issues. Premutation carrier (PMC) women (n = 33) and non-carrier controls (n = 13) were recruited and evaluated by a neurologist, neuropsychologist, and endocrinologist. Blood and skin biopsies were collected for molecular measures. Scales for movement disorders, neuropathy, cognitive function, psychiatric symptoms, sleep, and quality of life were completed. The average age of the women was 51 years (n = 46) and average CGG repeat size was 91 ± 24.9 in the FMR1 PMC women. Seventy percent of the PMC women had an abnormal neurological examination. PMC women had significantly higher scores on the Fragile X-Associated Tremor Ataxia Syndrome (FXTAS) rating scale, more neuropathy, and difficulty with tandem gait compared to controls. Central sensitivity syndromes, a neuroticism profile on the NEO Personality Profile, and sleep disorders were also prevalent. Discrepancies between subject report and examination findings were also seen. This pilot study suggests that women with the FMR1 premutation may have a phenotype that overlaps with that seen in FXTAS. Additional research with larger sample sizes is warranted to better delineate the clinical features.
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Affiliation(s)
- D Hall
- Department of Neurological Sciences, Rush University, Chicago, IL, USA
| | | | - S Pandya
- Rush Medical College, Rush University, Chicago, IL, USA
| | - B Bernard
- Department of Neurological Sciences, Rush University, Chicago, IL, USA
| | - B Ouyang
- Department of Neurological Sciences, Rush University, Chicago, IL, USA
| | - M Walsh
- Rush Medical College, Rush University, Chicago, IL, USA
| | - T Pounardjian
- Rush Medical College, Rush University, Chicago, IL, USA
| | - C Deburghraeve
- Department of Anesthesia, University of Illinois, Chicago, IL, USA
| | - L Zhou
- Department of Biochemistry, Rush University, Chicago, IL, USA
| | - M Losh
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, USA
| | - M Leehey
- Department of Neurology, University of Colorado, Aurora, CO, USA
| | - E Berry-Kravis
- Department of Neurological Sciences, Rush University, Chicago, IL, USA.,Department of Biochemistry, Rush University, Chicago, IL, USA.,Department of Pediatrics, Rush University, Chicago, IL, USA
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Abstract
Fragile X syndrome (FXS) is a monogenic disorder that is caused by the absence of FMR1 protein (FMRP). FXS serves as an excellent model disorder for studies investigating disturbed molecular mechanisms and synapse function underlying cognitive impairment, autism, and behavioral disturbance. Abnormalities in dendritic spines and synaptic transmission in the brain of FXS individuals and mouse models for FXS indicate perturbations in the development, maintenance, and plasticity of neuronal network connectivity. However, numerous alterations are found during the early development in FXS, including abnormal differentiation of neural progenitors and impaired migration of newly born neurons. Several aspects of FMRP function are modulated by brain-derived neurotrophic factor (BDNF) signaling. Here, we review the evidence of the role for BDNF in the developing and adult FXS brain. This article is part of the Special Issue entitled 'BDNF Regulation of Synaptic Structure, Function, and Plasticity'.
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Affiliation(s)
- Maija L Castrén
- Institute of Biomedicine/Physiology, University of Helsinki, P.O. Box 63, FIN-00014 Helsinki, Finland; Rinnekoti Foundation, Rinnekodintie 10, FIN-02980 Espoo, Finland.
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