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Paucar M, Wincent J, Rubin C, Peikert K, Kyhle J, Hertegård S, Möller R, Beshara S, Svenningsson P. Case report: Neuroacanthocytosis associated with novel variants in the VPS13A gene with concomitant nucleotide expansion for CANVAS and assessment with osmotic gradient ektacytometry. Front Neurosci 2024; 18:1409366. [PMID: 39416949 PMCID: PMC11480079 DOI: 10.3389/fnins.2024.1409366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 09/02/2024] [Indexed: 10/19/2024] Open
Abstract
Background and objectives The diseases historically known as neuroacanthocytosis (NA) conditions include VPS13A disease (formerly chorea-acanthocytosis) and XK disease (formerly McLeod syndrome). Here we report a patient with a hyperkinetic syndrome associated with variants in VPS13A with a concomitant homozygous nucleotide expansion in Replication factor C, subunit 1 (RFC1) and evaluate the role of ektacytometry for the assessment of acanthocytes. Methods Investigations included clinical assessments, neuroimaging studies, laboratory analyses, blood smears, ektacytometry, psychometric evaluation, and genetic analyses. Using ektacytometry, an osmoscan curve is obtained yielding a diffraction pattern as a measure of average erythrocyte deformability from circular at rest to elliptical at a high shear stress. The pattern allows the derivation of several parameters (mainly EI-max, O-min and O-Hyper points). Samples from two other patients with genetically proven VPS13A disorder and XK disease and varying numbers of acanthocytes as well as from a fourth with acanthocytosis due to liver failure were also analyzed. Case presentation The patient has impulsivity, chorea and disabling feeding dystonia refractory to treatment and 15% acanthocytes in peripheral blood. Genetic workup revealed compound heterozygous variants c.1732_1733del; p.(V578Ffs*9) and c.8282C > A, p.(S2761*) in VPS13A with absence of chorein in the blood, the latter variant is novel. In addition, he harbors a homozygous nucleotide expansion in the RFC1 gene, reported in cerebellar ataxia, neuropathy, vestibular areflexia syndrome (CANVAS). However, the patient does not display ataxia yet. Ektacytometry revealed significantly reduced erythrocyte deformability in this patient and in another man with VPS13A disease. In contrast, the patient with XK disease had 2% acanthocytes and mild abnormalities on ektacytometry. In the three cases, ektacytometry yielded a specific pattern, different from acanthocytosis due to liver failure. Conclusion Pathogenicity of the VPS13A variants is confirmed by absence of chorein, long-term follow up is required to evaluate any synergistic impact of for the underlying CANVAS mutation. New generation ektacytometry provides an objective measurement of erythrocytes' rheological properties and may serve as a complement to blood smears. Finally, ektacytometry's ability to detect deformability of erythrocytes in NA seems to depend on the degree of acanthocytosis.
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Affiliation(s)
- Martin Paucar
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Josephine Wincent
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Charlotta Rubin
- Department of Clinical Nutrition, Karolinska University Hospital, Stockholm, Sweden
| | - Kevin Peikert
- Translational Neurodegeneration Section “Albrecht Kossel,” Department of Neurology, University Medical Center Rostock, University of Rostock, Rostock, Germany
- Center for Transdisciplinary Neurosciences Rostock, University Medical Center Rostock, Rostock, Germany
- United Neuroscience Campus Lund-Rostock, Rostock, Germany
| | - Josefin Kyhle
- Department of Speech and Language, Karolinska University Hospital, Stockholm, Sweden
| | - Stellan Hertegård
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Otolaryngology, Karolinska University Hospital, Stockholm, Sweden
| | - Riita Möller
- Department of Otolaryngology, Karolinska University Hospital, Stockholm, Sweden
- Department of Medical Biology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Soheir Beshara
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Chemistry, Karolinska University Hospital, Stockholm, Sweden
| | - Per Svenningsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
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Walker RH, Barreto M, Bateman JR, Bustamante ML, Chiu G, Feitell S, Frey BM, Guerra P, Guerrero S, Jung HH, Maldonado F, Meyer E, Miranda M, McFarland E, Oates P, Ochoa G, Olsson K, Paucar M, Proschle JA, Sammler EM, Troncoso M, Wu-Wallace R, Young L, Vege S, Westhoff CM, Danek A. The protean presentations of XK disease (McLeod syndrome): a case series with new observations and updates on previously reported families. Front Neurosci 2024; 18:1408105. [PMID: 39315078 PMCID: PMC11417094 DOI: 10.3389/fnins.2024.1408105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 08/09/2024] [Indexed: 09/25/2024] Open
Abstract
XK disease is a very rare, multi-system disease, which can present with a wide spectrum of symptoms. This disorder can also be identified pre-symptomatically with the incidental detection of serological abnormalities when typing erythrocytes in peripheral blood, or on other routine laboratory testing. Increasing awareness of this disorder and improved access to genetic testing are resulting in increasing identification of affected patients and families. Here we provide updates to some previously-reported families and patients and provide additional clinical details. We also report four new cases with a variety of presentations, one of whom had a novel mutation.
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Affiliation(s)
- Ruth H Walker
- Department of Neurology, James J. Peters Veterans Affairs Medical Center, New York, NY, United States
- Department of Neurology, Mount Sinai School of Medicine, New York, NY, United States
| | | | - James R Bateman
- Mental Health Service Line and the Mental Illness Research, Education, and Clinical Center, W.G. (Bill) Hefner Salisbury Veterans Affairs Medical Center, Salisbury, NC, United States
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - M Leonor Bustamante
- Diagnosis Foundation, Santiago, Chile
- Human Genetics Program, Faculty of Medicine, Biomedical Sciences Institute, University of Chile, Santiago, Chile
| | - Graham Chiu
- Rheumatologist, Palmerston North, New Zealand
| | - Scott Feitell
- Rochester Regional Health, Sands-Constellation Heart Institute, Rochester, NY, United States
| | - Beat M Frey
- Regional Blood Transfusion Service, Swiss Red Cross, Zurich, Switzerland
| | - Patricio Guerra
- School of Medicine, University San Sebastián, Puerto Montt, Chile
| | | | - Hans H Jung
- Department of Neurology, University Hospital, Zurich, Switzerland
| | | | - Eduardo Meyer
- Regional Blood Transfusion Service, Swiss Red Cross, Zurich, Switzerland
| | - Marcelo Miranda
- Diagnosis Foundation, Santiago, Chile
- Clínica Meds, Lo Barnechea, Chile
| | - Emelie McFarland
- Mental Health Service Line and the Mental Illness Research, Education, and Clinical Center, W.G. (Bill) Hefner Salisbury Veterans Affairs Medical Center, Salisbury, NC, United States
| | - Patricia Oates
- Rochester Regional Health, Sands-Constellation Heart Institute, Rochester, NY, United States
| | - Gorka Ochoa
- New York Blood Center Enterprises, New York, NY, United States
| | - Karin Olsson
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Martin Paucar
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Monica Troncoso
- Hospital San Borja Arriaran, University of Chile, Santiago, Chile
| | - Rachel Wu-Wallace
- Mental Health Service Line and the Mental Illness Research, Education, and Clinical Center, W.G. (Bill) Hefner Salisbury Veterans Affairs Medical Center, Salisbury, NC, United States
- UCLA Semel Institute for Neuroscience & Human Behavior, Los Angeles, CA, United States
| | - Leo Young
- Mental Health Service Line and the Mental Illness Research, Education, and Clinical Center, W.G. (Bill) Hefner Salisbury Veterans Affairs Medical Center, Salisbury, NC, United States
| | - Sunitha Vege
- New York Blood Center Enterprises, New York, NY, United States
| | | | - Adrian Danek
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany
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3
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Braun AA, Jung HH. Systematic review of phenotypes in McLeod syndrome and case report of a progressive supranuclear palsy in a female carrier. Orphanet J Rare Dis 2024; 19:312. [PMID: 39183347 PMCID: PMC11346192 DOI: 10.1186/s13023-024-03309-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 08/06/2024] [Indexed: 08/27/2024] Open
Abstract
INTRODUCTION We present a systematic review of phenotypes of McLeod syndrome (MLS) and a case of a 73-year-old female carrier of the genetic alteration leading to MLS with the typical progressive supranuclear palsy (PSP) phenotype. METHODS To facilitate clinical reasoning and enable targeted diagnosis, we conducted a systematic review of the papers describing symptomatic cases of confirmed McLeod syndrome. This review follows the PRISMA 2020 statement: an updated guideline for reporting systematic reviews (Page et al in Syst Rev 10(1):89, 2021). RESULTS The average onset of MLS was at 40.2 years of age with chorea (46%), seizures and psychiatric changes (each 13%). Very common are weakened Kell antigen (100%), changes in muscle biopsy (100%), genetic alterations in XK (100%), elevated creatine kinase (97%), acanthocytes (96%), MRI changes (95%), chorea (84%) and hyporeflexia (82%). CONCLUSION This review of 65 males and 11 females gives a concise overview of clinical phenotypes in MLS, reinforcing our view that this female patient had PSP independent of MLS carrier status. This report highlights the pitfalls of anchoring in medical decision-making, particularly the possible diagnostic bias of a known genetic carrier status of a very rare disease.
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Affiliation(s)
- Andreas Albert Braun
- Department of Neurology, University Hospital Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland.
| | - Hans Heinrich Jung
- Department of Neurology, University Hospital Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland
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Torres V, Painous C, Santacruz P, Sánchez A, Sanz C, Grau‐Junyent JM, Muñoz E. Very Long Time Persistent
HyperCKemia
as the First Manifestation of
McLeod
Syndrome: A Case Report. Mov Disord Clin Pract 2022; 9:821-824. [DOI: 10.1002/mdc3.13502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/24/2022] [Accepted: 06/02/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Viviana Torres
- Parkinson's Disease and Movement Disorders Unit, Neurology Service, Institut de Neurociencies Hospital Clínic of Barcelona Barcelona Spain
| | - Cèlia Painous
- Parkinson's Disease and Movement Disorders Unit, Neurology Service, Institut de Neurociencies Hospital Clínic of Barcelona Barcelona Spain
| | - Pilar Santacruz
- Parkinson's Disease and Movement Disorders Unit, Neurology Service, Institut de Neurociencies Hospital Clínic of Barcelona Barcelona Spain
| | - Aurora Sánchez
- Biochemistry and Molecular Genetics Department Centre de Diagnòstic Biomèdic, Hospital Clínic of Barcelona Barcelona Spain
| | - Cristina Sanz
- Blood Bank and Transfusion Service Banc de Sang i Teixits, Hospital Clínic of Barcelona Barcelona Spain
| | - Josep M. Grau‐Junyent
- Laboratory of Muscle Research and Mitochondrial Function, Department of Internal Medicine Hospital Clínic of Barcelona Barcelona Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Barcelona Spain
- University of Barcelona Barcelona Spain
| | - Esteban Muñoz
- Parkinson's Disease and Movement Disorders Unit, Neurology Service, Institut de Neurociencies Hospital Clínic of Barcelona Barcelona Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Barcelona Spain
- University of Barcelona Barcelona Spain
- European Reference Network‐Rare Neurological Diseases (ERN‐RND) Barcelona Spain
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Murakami T, Abe D, Matsumoto H, Tokimura R, Abe M, Tiksnadi A, Kobayashi S, Kaneko C, Urata Y, Nakamura M, Sano A, Ugawa Y. A patient with McLeod syndrome showing involvement of the central sensorimotor tracts for the legs. BMC Neurol 2019; 19:301. [PMID: 31775676 PMCID: PMC6882147 DOI: 10.1186/s12883-019-1526-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 11/12/2019] [Indexed: 11/17/2022] Open
Abstract
Background McLeod syndrome is a rare X-linked recessive acanthocytosis associated with neurological manifestations including progressive chorea, cognitive impairment, psychiatric disturbances, seizures, and sensorimotor axonal polyneuropathy. However, no studies have investigated the functioning of central sensorimotor tracts in patients with McLeod syndrome. Case presentation A 66-year-old man had experienced slowly progressive chorea and gait disturbance due to lower limb muscle weakness since his early fifties. Blood examinations showed erythrocyte acanthocytosis and the reduction of Kell antigens in red blood cells. Brain magnetic resonance imaging showed atrophy of the bilateral caudate nuclei and putamen. The diagnosis of McLeod syndrome was confirmed by the presence of a mutation of the XK gene on the X chromosome. Somatosensory-evoked potential and transcranial magnetic stimulation studies demonstrated that the central sensory and motor conduction times were abnormally prolonged for the lower extremity but normal for the upper extremity. Conclusions This is the first report of the involvement of the central sensorimotor tracts for the legs in a patient with McLeod syndrome. The clinical neurophysiological technique revealed the central sensorimotor tracts involvements clinically masked by neuropathy.
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Affiliation(s)
- Takenobu Murakami
- Department of Neurology, Fukushima Medical University, Fukushima, Japan. .,Department of Neurology, Tottori Prefectural Kousei Hospital, Kurayoshi, Japan.
| | - Dan Abe
- Department of Neurology, Fukushima Medical University, Fukushima, Japan
| | | | - Ryo Tokimura
- Department of Neurology, Fukushima Medical University, Fukushima, Japan
| | - Mitsunari Abe
- Center for Neurological Disorders, Fukushima Medical University, Fukushima, Japan
| | - Amanda Tiksnadi
- Department of Neurology, Fukushima Medical University, Fukushima, Japan
| | | | - Chikako Kaneko
- Department of Neurology, Southern Tohoku General Hospital, Koriyama, Japan
| | - Yuka Urata
- Department of Psychiatry, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Masayuki Nakamura
- Department of Psychiatry, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Akira Sano
- Department of Psychiatry, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Yoshikazu Ugawa
- Department of Neurology, Fukushima Medical University, Fukushima, Japan.,Department of Neuro-regeneration, Fukushima Medical University, Fukushima, Japan
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Díaz-Manera J, Sotoca-Fernández J, Alonso-Jiménez A, Marzo ME, Gallardo E, Segovia-Simón S, Siles AM, Illa I, Pagonabarraga J. Mcleod syndrome is a new cause of axial muscle weakness. Muscle Nerve 2018; 58. [PMID: 29381810 DOI: 10.1002/mus.26086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 01/22/2018] [Accepted: 01/24/2018] [Indexed: 11/07/2022]
Affiliation(s)
- Jordi Díaz-Manera
- Neurology Department, Universitat Autònoma de Barcelona, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Valencia, Spain
| | - Javier Sotoca-Fernández
- Neurology Department, Universitat Autònoma de Barcelona, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - Alicia Alonso-Jiménez
- Neurology Department, Universitat Autònoma de Barcelona, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Valencia, Spain
| | | | - Eduard Gallardo
- Neurology Department, Universitat Autònoma de Barcelona, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Valencia, Spain
| | - Sonia Segovia-Simón
- Neurology Department, Universitat Autònoma de Barcelona, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Valencia, Spain
| | - Ana María Siles
- Neurology Department, Universitat Autònoma de Barcelona, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Valencia, Spain
| | - Isabel Illa
- Neurology Department, Universitat Autònoma de Barcelona, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Valencia, Spain
| | - Javier Pagonabarraga
- Neurology Department, Universitat Autònoma de Barcelona, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
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7
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Zhu X, Cho ES, Sha Q, Peng J, Oksov Y, Kam SY, Ho M, Walker RH, Lee S. Giant axon formation in mice lacking Kell, XK, or Kell and XK: animal models of McLeod neuroacanthocytosis syndrome. THE AMERICAN JOURNAL OF PATHOLOGY 2014; 184:800-7. [PMID: 24405768 DOI: 10.1016/j.ajpath.2013.11.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 10/21/2013] [Accepted: 11/13/2013] [Indexed: 01/07/2023]
Abstract
McLeod neuroacanthocytosis syndrome (MLS) is a rare X-linked multisystem disease caused by XK gene mutations and characterized by hematological and neurological abnormalities. XK, a putative membrane transporter, is expressed ubiquitously and is covalently linked to Kell, an endothelin-3-converting enzyme (ECE-3). Absence of XK results in reduction of Kell at sites where both proteins are coexpressed. To elucidate the functional roles of XK, Kell, and the XK-Kell complex associated with pathogenesis in MLS, we studied the pathology of the spinal cord, anterior roots, sciatic nerve, and skeletal muscle from knockout mouse models, using Kel(-/-), Xk(-/-), Kel(-/-)Xk(-/-), and wild-type mice aged 6 to 18 months. A striking finding was that giant axons were frequently associated with paranodal demyelination. The pathology suggests probable anterograde progression from the spinal cord to the sciatic nerve. The neuropathological abnormalities were found in all three genotypes, but were more marked in the double-knockout Kel(-/-)Xk(-/-) mice than in either Kel(-/-) or Xk(-/-) mice. Skeletal muscles from Xk(-/-) and Kel(-/-)Xk(-/-) mice showed mild abnormalities, but those from Kel(-/-) mice were similar to the wild type. The more marked neuropathological abnormalities in Kel(-/-)Xk(-/-) mice suggest a possible functional association between XK and Kell in nonerythroid tissues.
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Affiliation(s)
- Xiang Zhu
- Department of Pathology, Peking University Health Science Center, Beijing, China; New York Blood Center, New York, New York.
| | - Eun-Sook Cho
- Department of Pathology and Laboratory Medicine (Neuropathology), Rutgers University-New Jersey Medical School, Newark, New Jersey
| | - Quan Sha
- New York Blood Center, New York, New York; Department of Cell Line Development, Immunomedics, Morris Plains, New Jersey
| | | | | | - Siok Yuen Kam
- Division of Medical Sciences, National Cancer Center, Singapore
| | - Mengfatt Ho
- Division of Medical Sciences, National Cancer Center, Singapore
| | - Ruth H Walker
- Department of Neurology, James J. Peters VAMC, Bronx, New York; Department of Neurology, Mount Sinai School of Medicine, New York, New York
| | - Soohee Lee
- New York Blood Center, New York, New York
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Hayhow BD, Hassan I, Looi JCL, Gaillard F, Velakoulis D, Walterfang M. The neuropsychiatry of hyperkinetic movement disorders: insights from neuroimaging into the neural circuit bases of dysfunction. Tremor Other Hyperkinet Mov (N Y) 2013; 3:tre-03-175-4242-1. [PMID: 24032090 PMCID: PMC3760049 DOI: 10.7916/d8sn07pk] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 07/08/2013] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Movement disorders, particularly those associated with basal ganglia disease, have a high rate of comorbid neuropsychiatric illness. METHODS We consider the pathophysiological basis of the comorbidity between movement disorders and neuropsychiatric illness by 1) reviewing the epidemiology of neuropsychiatric illness in a range of hyperkinetic movement disorders, and 2) correlating findings to evidence from studies that have utilized modern neuroimaging techniques to investigate these disorders. In addition to diseases classically associated with basal ganglia pathology, such as Huntington disease, Wilson disease, the neuroacanthocytoses, and diseases of brain iron accumulation, we include diseases associated with pathology of subcortical white matter tracts, brain stem nuclei, and the cerebellum, such as metachromatic leukodystrophy, dentatorubropallidoluysian atrophy, and the spinocerebellar ataxias. CONCLUSIONS Neuropsychiatric symptoms are integral to a thorough phenomenological account of hyperkinetic movement disorders. Drawing on modern theories of cortico-subcortical circuits, we argue that these disorders can be conceptualized as disorders of complex subcortical networks with distinct functional architectures. Damage to any component of these complex information-processing networks can have variable and often profound consequences for the function of more remote neural structures, creating a diverse but nonetheless rational pattern of clinical symptomatology.
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Affiliation(s)
- Bradleigh D. Hayhow
- Neuropsychiatry Unit, Royal Melbourne Hospital, Parkville, Australia
- Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Parkville, Australia
| | - Islam Hassan
- Neuropsychiatry Unit, Royal Melbourne Hospital, Parkville, Australia
| | - Jeffrey C. L. Looi
- Academic Unit of Psychiatry & Addiction Medicine, Australian National University Medical School, Canberra Hospital, Canberra, Australia
| | | | - Dennis Velakoulis
- Neuropsychiatry Unit, Royal Melbourne Hospital, Parkville, Australia
- Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Parkville, Australia
| | - Mark Walterfang
- Neuropsychiatry Unit, Royal Melbourne Hospital, Parkville, Australia
- Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Parkville, Australia
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9
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Zhang L, Wang S, Lin J. Clinical and molecular research of neuroacanthocytosis. Neural Regen Res 2013; 8:833-42. [PMID: 25206731 PMCID: PMC4146083 DOI: 10.3969/j.issn.1673-5374.2013.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Accepted: 12/23/2012] [Indexed: 11/18/2022] Open
Abstract
Neuroacanthocytosis is an autosomal recessive or dominant inherited disease characterized by widespread, non-specific nervous system symptoms, or spiculated "acanthocytic" red blood cells. The clinical manifestations typically involve chorea and dystonia, or a range of other movement disorders. Psychiatric and cognitive symptoms may also be present. The two core neuroacanthocytosis syndromes, in which acanthocytosis is atypical, are autosomal recessive chorea-acanthocytosis and X-linked McLeod syndrome. Acanthocytes are found in a smaller proportion of patients with Huntington's disease-like 2 and pantothenate kinase-associated neurodegeneration. Because the clinical manifestations are diverse and complicated, in this review we present features of inheritance, age of onset, neuroimaging and laboratory findings, as well as the spectrum of central and peripheral neurological abnormalities and extraneuronal involvement to help distinguish the four specific syndromes.
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Affiliation(s)
- Lihong Zhang
- Department of Neurology, Dalian Municipal Central Hospital, Affiliated Hospital of Dalian Medical University, Dalian 116033, Liaoning Province, China
| | - Suping Wang
- Department of Neurology, Dalian Municipal Central Hospital, Affiliated Hospital of Dalian Medical University, Dalian 116033, Liaoning Province, China
| | - Jianwen Lin
- Department of Neurology, Dalian Municipal Central Hospital, Affiliated Hospital of Dalian Medical University, Dalian 116033, Liaoning Province, China
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10
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The neuropsychiatry of neuroacanthocytosis syndromes. Neurosci Biobehav Rev 2011; 35:1275-83. [DOI: 10.1016/j.neubiorev.2011.01.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Revised: 12/28/2010] [Accepted: 01/05/2011] [Indexed: 11/18/2022]
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11
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Klempír J, Roth J, Zárubová K, Písacka M, Spacková N, Tilley L. The McLeod syndrome without acanthocytes. Parkinsonism Relat Disord 2008; 14:364-6. [PMID: 17870653 DOI: 10.1016/j.parkreldis.2007.07.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2006] [Revised: 07/10/2007] [Accepted: 07/31/2007] [Indexed: 10/22/2022]
Abstract
A 45-year-old man developed chorea, behavioural changes, moderate amyotrophy and polyneuropathy. Hypertrophic cardiomyopathy and increased serum lactate dehydrogenase and creatine kinase (CK) were found. Acanthocytes were not detected. The absence of XK protein and faintly expressed Kell antigens on erythrocytes were found. Genetic test revealed a R133X mutation of the XK gene, confirming the McLeod syndrome. After 7 years he suddenly developed delirium followed by severe hypoglycaemia, hyperthermia, rhabdomyolysis, hepatic and renal failure. Malignant arrhythmia caused death.
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Affiliation(s)
- Jirí Klempír
- Department of Neurology, 1st Medical Faculty, Charles University, Katerinská 30, 12000 Prague 2, Czech Republic.
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13
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Neuroacanthocytosis. NEURODEGENER DIS 2005. [DOI: 10.1017/cbo9780511544873.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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14
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Wendel S, Fontão-Wendel R, Levi JE, Aravechia MG, Bordokan RFS, Russo D, Haddad MS. A McLeod phenotype detected by random screening for K:-4 [Kp(b-)] blood donors in Brazil. Transfusion 2004; 44:1579-87. [PMID: 15504163 DOI: 10.1111/j.1537-2995.2004.03259.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The red blood cells of the McLeod phenotype have weak expression of Kell System antigens due to no expression of XK protein. STUDY DESIGN AND METHODS One blood donor reacted as K:-4 [Kp(b-)] during a screening assay. Subsequent serologic studies demonstrated weak expression of K:4 and all other high-incidence Kell system antigens tested; however, no expression of Kx antigen was observed. RESULTS One apparently healthy blood donor demonstrated low expression of K:2, K:4, K:5, K:7, K:14, K:22, and no Kx antigen in his red blood cells. His brother and mother showed the same weak expression, and his father showed normal expression of antigens tested. Flow cytometry studies confirmed the mother's status as a McLeod carrier female. Genotyping determined the presence of KEL2 and KEL4 alleles in mother and siblings. Southern blot with an exon-1 probe showed fragments shorter than predicted for the siblings and the mother, suggesting a deletion. Polymerase chain reaction with primers spanning exon 1 and flanking regions displayed a similar pattern. Deoxyribonucleic acid sequence allowed the precise characterization of a deletion of 392 bp, beginning at the 5' of the coding region up to nucleotide 201 of exon 1, which putatively abrogates the production of XK protein. CONCLUSION Two brothers with McLeod phenotype in a Brazilian blood-donor population were identified. The molecular basis for this phenotype is a 392-bp deletion spanning from 5' of the coding region to exon 1 of the XK gene, never described before.
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Affiliation(s)
- Silvano Wendel
- Hospital Sírio Libanês Blood Bank, the Centro de Imunologia e Imunogenética, Hospital das Clínicas da Faculdade de Medicina da USP, São Paulo, Brazil.
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15
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Danek A, Rubio JP, Rampoldi L, Ho M, Dobson-Stone C, Tison F, Symmans WA, Oechsner M, Kalckreuth W, Watt JM, Corbett AJ, Hamdalla HH, Marshall AG, Sutton I, Dotti MT, Malandrini A, Walker RH, Daniels G, Monaco AP. McLeod neuroacanthocytosis: genotype and phenotype. Ann Neurol 2001; 50:755-64. [PMID: 11761473 DOI: 10.1002/ana.10035] [Citation(s) in RCA: 124] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
McLeod syndrome is caused by mutations of XK, an X-chromosomal gene of unknown function. Originally defined as a peculiar Kell blood group variant, the disease affects multiple organs, including the nervous system, but is certainly underdiagnosed. We analyzed the mutations and clinical findings of 22 affected men, aged 27 to 72 years. Fifteen different XK mutations were found, nine of which were novel, including the one of the eponymous case McLeod. Their common result is predicted absence or truncation of the XK protein. All patients showed elevated levels of muscle creatine phosphokinase, but clinical myopathy was less common. A peripheral neuropathy with areflexia was found in all but 2 patients. The central nervous system was affected in 15 patients, as obvious from the occurrence of seizures, cognitive impairment, psychopathology, and choreatic movements. Neuroimaging emphasized the particular involvement of the basal ganglia, which was also detected in 1 asymptomatic young patient. Most features develop with age, mainly after the fourth decade. The resemblance of McLeod syndrome with Huntington's disease and with autosomal recessive chorea-acanthocytosis suggests that the corresponding proteins--XK, huntingtin, and chorein--might belong to a common pathway, the dysfunction of which causes degeneration of the basal ganglia.
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Affiliation(s)
- A Danek
- Neurologische Klinik, Ludwig-Maximilians-Universität, München, Germany.
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16
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Supple SG, Iland HJ, Barnett MH, Pollard JD. A spontaneous novel XK gene mutation in a patient with McLeod syndrome. Br J Haematol 2001; 115:369-72. [PMID: 11703337 DOI: 10.1046/j.1365-2141.2001.03121.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 29-year-old man with a history of elevated creatine kinase and necrotizing myopathy was reviewed. Prominent red cell acanthocytosis in association with reduced Kell antigen expression was present, findings consistent with the McLeod syndrome. Investigation of the patient's XK gene revealed a novel TGG- to-TAG transition at position 1023 in exon 3. This point mutation creates an in-frame stop codon (W314X), and predicts a truncated XK protein of 313 amino acids, compared with 444 amino acids in the normal XK protein. The mutation was not identified in the patient's mother or sister indicating that this mutation was spontaneous.
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Affiliation(s)
- S G Supple
- The Kanematsu Laboratories, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
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