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Guilleminault L, Mazzone SB, Chazelas P, Frachet S, Lia AS, Magy L. Cerebellar ataxia, neuropathy and vestibular areflexia syndrome: a neurogenic cough prototype. ERJ Open Res 2024; 10:00024-2024. [PMID: 39076534 PMCID: PMC11284589 DOI: 10.1183/23120541.00024-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 02/08/2024] [Indexed: 07/31/2024] Open
Abstract
Chronic cough is a frequent disorder that is defined by cough of more than 8 weeks duration. Despite extensive investigation, some patients exhibit no aetiology and others do not respond to specific treatments directed against apparent causes of cough. Such patients are identified as having unexplained or refractory chronic cough. Recently, a high proportion of patients with chronic cough in the context of cerebellar ataxia, neuropathy and vestibular areflexia syndrome (CANVAS) was highlighted. CANVAS is a rare neurological disorder with a biallelic variation in the replication factor C subunit 1 (RFC1) gene corresponding mostly to an intronic AAGGG repeat expansion. Chronic cough in patients with CANVAS shares similar characteristics with cough hypersensitivity syndrome. The high prevalence of chronic cough in CANVAS gives the opportunity to better understand the neurogenic mechanism of chronic cough. In this review, we will describe the characteristics and mechanisms of CANVAS. We will also address the potential mechanisms responsible for chronic cough in CANVAS. Finally, we will address chronic cough management in the context of CANVAS.
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Affiliation(s)
- Laurent Guilleminault
- Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), INSERM UMR1291, CNRS UMR5051, University Toulouse III, Toulouse, France
- Department of Respiratory Medicine, Faculty of Medicine, Toulouse University Hospital, Toulouse, France
- These authors contributed equally to this work
| | - Stuart B. Mazzone
- Department of Anatomy and Physiology, University of Melbourne, Victoria, Australia
- These authors contributed equally to this work
| | - Pauline Chazelas
- Service de Biochimie et Génétique Moléculaire, CHU Limoges, Limoges, France
- NeurIT-UR20218, Université de Limoges, Limoges, France
| | - Simon Frachet
- NeurIT-UR20218, Université de Limoges, Limoges, France
- Service et Laboratoire de Neurologie, Centre de Référence “Neuropathies Périphériques Rares (NNerf)”, CHU Limoges, Limoges, France
| | - Anne-Sophie Lia
- Service de Biochimie et Génétique Moléculaire, CHU Limoges, Limoges, France
- NeurIT-UR20218, Université de Limoges, Limoges, France
- Service de Bioinformatique, CHU Limoges, Limoges, France
| | - Laurent Magy
- NeurIT-UR20218, Université de Limoges, Limoges, France
- Service et Laboratoire de Neurologie, Centre de Référence “Neuropathies Périphériques Rares (NNerf)”, CHU Limoges, Limoges, France
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Dujardin K, Tard C, Diglé E, Herlin V, Mutez E, Davion JB, Wissocq A, Delforge V, Kuchcinski G, Huin V. Cognitive Impairment Is Part of the Phenotype of Cerebellar Ataxia, Neuropathy, Vestibular Areflexia Syndrome (CANVAS). Mov Disord 2024; 39:892-897. [PMID: 38480525 DOI: 10.1002/mds.29750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/13/2024] [Accepted: 02/05/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Little is known about the impact of the cerebellar ataxia, neuropathy, vestibular areflexia syndrome (CANVAS) on cognition. OBJECTIVE Our objective was to determine the frequency and severity of cognitive impairment in RFC1-positive patients and describe the pattern of deficits. METHODS Participants underwent a comprehensive neuropsychological assessment. Volume of the cerebellum and its lobules was measured in those who underwent a 3 Tesla-magnetic resonance scan. RESULTS Twenty-one patients underwent a complete assessment, including 71% scoring lower than the cutoff at the Montreal Cognitive assessment and 71% having a definite cerebellar cognitive affective/Schmahmann syndrome. Three patients had dementia and seven met the criteria of mild cognitive impairment. Severity of cognitive impairment did not correlate with severity of clinical manifestations. Performance at memory and visuospatial functions tests negatively correlated with the severity of cerebellar manifestations. CONCLUSION Cognitive manifestations are frequent in RFC1-related disorders. They should be included in the phenotype and screened systematically. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Kathy Dujardin
- University Lille, Inserm, CHU Lille, U1172-LilNCog-Lille Neuroscience and Cognition, Lille, France
- CHU-Lille, Neurology and Movement Disorders Department, Lille, France
| | - Céline Tard
- University Lille, Inserm, CHU Lille, U1172-LilNCog-Lille Neuroscience and Cognition, Lille, France
- CHU-Lille, Center of Reference for Neuromuscular Diseases, Lille, France
| | - Emily Diglé
- CHU-Lille, Neurology and Movement Disorders Department, Lille, France
| | - Virginie Herlin
- CHU-Lille, Neurology and Movement Disorders Department, Lille, France
| | - Eugénie Mutez
- University Lille, Inserm, CHU Lille, U1172-LilNCog-Lille Neuroscience and Cognition, Lille, France
- CHU-Lille, Neurology and Movement Disorders Department, Lille, France
| | - Jean-Baptiste Davion
- University Lille, Inserm, CHU Lille, U1172-LilNCog-Lille Neuroscience and Cognition, Lille, France
- CHU-Lille, Center of Reference for Neuromuscular Diseases, Lille, France
| | - Anna Wissocq
- CHU Lille, Department of Toxicology and Genopathies, UF Neurobiology, Lille, France
| | - Violette Delforge
- University Lille, Inserm, CHU Lille, U1172-LilNCog-Lille Neuroscience and Cognition, Lille, France
| | - Gregory Kuchcinski
- University Lille, Inserm, CHU Lille, U1172-LilNCog-Lille Neuroscience and Cognition, Lille, France
- Neuroradiology Department, CHU-Lille, Lille, France
| | - Vincent Huin
- University Lille, Inserm, CHU Lille, U1172-LilNCog-Lille Neuroscience and Cognition, Lille, France
- CHU Lille, Department of Toxicology and Genopathies, UF Neurobiology, Lille, France
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Delforge V, Tard C, Davion JB, Dujardin K, Wissocq A, Dhaenens CM, Mutez E, Huin V. RFC1: Motifs and phenotypes. Rev Neurol (Paris) 2024; 180:393-409. [PMID: 38627134 DOI: 10.1016/j.neurol.2024.03.006] [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: 01/30/2024] [Revised: 03/22/2024] [Accepted: 03/25/2024] [Indexed: 05/28/2024]
Abstract
Biallelic intronic expansions (AAGGG)exp in intron 2 of the RFC1 gene have been shown to be a common cause of late-onset ataxia. Since their first description, the phenotypes, neurological damage, and pathogenic variants associated with the RFC1 gene have been frequently updated. Here, we review the various motifs, genetic variants, and phenotypes associated with the RFC1 gene. We searched PubMed for scientific articles published between March 1st, 2019, and January 15th, 2024. The motifs and phenotypes associated with the RFC1 gene are highly heterogeneous, making molecular diagnosis and clinical screening and investigation challenging. In this review we will provide clues to give a better understanding of RFC1 disease. We briefly discuss new methods for molecular diagnosis, the origin of cough in RFC1 disease, and research perspectives.
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Affiliation(s)
- V Delforge
- Inserm, U1172 - LilNCog - Lille Neuroscience & Cognition, CHU de Lille, University Lille, 59000 Lille, France
| | - C Tard
- Inserm, U1172 - LilNCog - Lille Neuroscience & Cognition, CHU de Lille, University Lille, 59000 Lille, France; Department of Neurology and Movement disorders, CHU de Lille, 59000 Lille, France
| | - J-B Davion
- Inserm, U1172 - LilNCog - Lille Neuroscience & Cognition, CHU de Lille, University Lille, 59000 Lille, France; Department of Neurology and Movement disorders, CHU de Lille, 59000 Lille, France
| | - K Dujardin
- Inserm, U1172 - LilNCog - Lille Neuroscience & Cognition, CHU de Lille, University Lille, 59000 Lille, France; Department of Neurology and Movement disorders, CHU de Lille, 59000 Lille, France
| | - A Wissocq
- Department of Toxicology and Genopathies, UF Neurobiology, CHU de Lille, 59000 Lille, France
| | - C-M Dhaenens
- Inserm, U1172 - LilNCog - Lille Neuroscience & Cognition, CHU de Lille, University Lille, 59000 Lille, France; Department of Toxicology and Genopathies, UF Neurobiology, CHU de Lille, 59000 Lille, France
| | - E Mutez
- Inserm, U1172 - LilNCog - Lille Neuroscience & Cognition, CHU de Lille, University Lille, 59000 Lille, France; Department of Neurology and Movement disorders, CHU de Lille, 59000 Lille, France
| | - V Huin
- Inserm, U1172 - LilNCog - Lille Neuroscience & Cognition, CHU de Lille, University Lille, 59000 Lille, France; Department of Toxicology and Genopathies, UF Neurobiology, CHU de Lille, 59000 Lille, France.
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Quartesan I, Vegezzi E, Currò R, Heslegrave A, Pisciotta C, Iruzubieta P, Salvalaggio A, Fernández‐Eulate G, Dominik N, Rugginini B, Manini A, Abati E, Facchini S, Manso K, Albajar I, Laban R, Rossor AM, Pichiecchio A, Cosentino G, Saveri P, Salsano E, Andreetta F, Valente EM, Zetterberg H, Giunti P, Stojkovic T, Briani C, López de Munain A, Pareyson D, Reilly MM, Houlden H, Tassorelli C, Cortese A. Serum Neurofilament Light Chain in Replication Factor Complex Subunit 1 CANVAS and Disease Spectrum. Mov Disord 2024; 39:209-214. [PMID: 38054570 PMCID: PMC10953432 DOI: 10.1002/mds.29680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 11/07/2023] [Accepted: 11/15/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Biallelic intronic AAGGG repeat expansions in the replication factor complex subunit 1 (RFC1) gene were identified as the leading cause of cerebellar ataxia, neuropathy, vestibular areflexia syndrome. Patients exhibit significant clinical heterogeneity and variable disease course, but no potential biomarker has been identified to date. OBJECTIVES In this multicenter cross-sectional study, we aimed to evaluate neurofilament light (NfL) chain serum levels in a cohort of RFC1 disease patients and to correlate NfL serum concentrations with clinical phenotype and disease severity. METHODS Sixty-one patients with genetically confirmed RFC1 disease and 48 healthy controls (HCs) were enrolled from six neurological centers. Serum NfL concentration was measured using the single molecule array assay technique. RESULTS Serum NfL concentration was significantly higher in patients with RFC1 disease compared to age- and-sex-matched HCs (P < 0.0001). NfL level showed a moderate correlation with age in both HCs (r = 0.4353, P = 0.0020) and patients (r = 0.4092, P = 0.0011). Mean NfL concentration appeared to be significantly higher in patients with cerebellar involvement compared to patients without cerebellar dysfunction (27.88 vs. 21.84 pg/mL, P = 0.0081). The association between cerebellar involvement and NfL remained significant after controlling for age and sex (β = 0.260, P = 0.034). CONCLUSIONS Serum NfL levels are significantly higher in patients with RFC1 disease compared to HCs and correlate with cerebellar involvement. Longitudinal studies are warranted to assess its change over time.
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Affiliation(s)
- Ilaria Quartesan
- Department of Brain and Behavioral SciencesUniversity of PaviaPaviaItaly
- IRCCS Mondino FoundationPaviaItaly
| | - Elisa Vegezzi
- Department of Brain and Behavioral SciencesUniversity of PaviaPaviaItaly
- IRCCS Mondino FoundationPaviaItaly
| | - Riccardo Currò
- Department of Brain and Behavioral SciencesUniversity of PaviaPaviaItaly
- Department of Neuromuscular DiseasesUCL Queen Square Institute of NeurologyLondonUnited Kingdom
| | - Amanda Heslegrave
- Department of Neurodegenerative DiseaseUCL Queen Square Institute of NeurologyLondonUnited Kingdom
- UK Dementia Research Institute at UCLLondonUnited Kingdom
| | | | - Pablo Iruzubieta
- Neurology Department, Donostia University HospitalOsakidetza, and Biodonostia Health Research Institute‐UPV‐EHUSan SebastiánSpain
| | | | - Gorka Fernández‐Eulate
- Neuro‐myology Department, Institut de Myologie, Pitié‐Salpêtriére HospitalAPHP, Sorbonne UniversityParisFrance
| | - Natalia Dominik
- Department of Neuromuscular DiseasesUCL Queen Square Institute of NeurologyLondonUnited Kingdom
| | - Bianca Rugginini
- Department of Brain and Behavioral SciencesUniversity of PaviaPaviaItaly
| | - Arianna Manini
- Department of Neuromuscular DiseasesUCL Queen Square Institute of NeurologyLondonUnited Kingdom
- Department of Neurology and Laboratory of NeuroscienceIRCCS Istituto Auxologico ItalianoMilanItaly
| | - Elena Abati
- Department of Neuromuscular DiseasesUCL Queen Square Institute of NeurologyLondonUnited Kingdom
- Department of Pathophysiology and Transplantation (DEPT)University of MilanMilanItaly
| | | | - Katarina Manso
- Clinical Neurochemistry LaboratorySahlgrenska University HospitalMölndalSweden
| | - Ines Albajar
- Neurology Department, Donostia University HospitalOsakidetza, and Biodonostia Health Research Institute‐UPV‐EHUSan SebastiánSpain
| | - Rhiannon Laban
- UK Dementia Research Institute at UCLLondonUnited Kingdom
| | - Alexander M. Rossor
- Department of Neuromuscular DiseasesUCL Queen Square Institute of NeurologyLondonUnited Kingdom
| | - Anna Pichiecchio
- Department of Brain and Behavioral SciencesUniversity of PaviaPaviaItaly
- IRCCS Mondino FoundationPaviaItaly
| | - Giuseppe Cosentino
- Department of Brain and Behavioral SciencesUniversity of PaviaPaviaItaly
- IRCCS Mondino FoundationPaviaItaly
| | - Paola Saveri
- Fondazione IRCCS Istituto Neurologico Carlo BestaMilanItaly
| | - Ettore Salsano
- Fondazione IRCCS Istituto Neurologico Carlo BestaMilanItaly
| | | | - Enza M. Valente
- Department of Brain and Behavioral SciencesUniversity of PaviaPaviaItaly
- IRCCS Mondino FoundationPaviaItaly
| | - Henrik Zetterberg
- Department of Neurodegenerative DiseaseUCL Queen Square Institute of NeurologyLondonUnited Kingdom
- UK Dementia Research Institute at UCLLondonUnited Kingdom
- Clinical Neurochemistry LaboratorySahlgrenska University HospitalMölndalSweden
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and PhysiologyThe Sahlgrenska Academy at the University of GothenburgMölndalSweden
- Hong Kong Center for Neurodegenerative DiseasesClear Water BayHong KongChina
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Paola Giunti
- Department of Clinical and Movement NeuroscienceUCL Queen Square Institute of NeurologyLondonUnited Kingdom
| | - Tanya Stojkovic
- Neuro‐myology Department, Institut de Myologie, Pitié‐Salpêtriére HospitalAPHP, Sorbonne UniversityParisFrance
| | - Chiara Briani
- Department of NeuroscienceUniversity of PadovaPadovaItaly
| | - Adolfo López de Munain
- Neurology Department, Donostia University HospitalOsakidetza, and Biodonostia Health Research Institute‐UPV‐EHUSan SebastiánSpain
| | | | - Mary M. Reilly
- Department of Neuromuscular DiseasesUCL Queen Square Institute of NeurologyLondonUnited Kingdom
| | - Henry Houlden
- Department of Neuromuscular DiseasesUCL Queen Square Institute of NeurologyLondonUnited Kingdom
| | - Cristina Tassorelli
- Department of Brain and Behavioral SciencesUniversity of PaviaPaviaItaly
- IRCCS Mondino FoundationPaviaItaly
| | - Andrea Cortese
- Department of Brain and Behavioral SciencesUniversity of PaviaPaviaItaly
- Department of Neuromuscular DiseasesUCL Queen Square Institute of NeurologyLondonUnited Kingdom
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Lobo CC, Wertheimer GS, Schmitt GS, Matos PC, Rezende TJ, Silva JM, Borba FC, Lima FD, Martinez AR, Barsottini OG, Pedroso JL, Marques W, França MC. Cranial Nerve Thinning Distinguishes RFC1-Related Disorder from Other Late-Onset Ataxias. Mov Disord Clin Pract 2024; 11:45-52. [PMID: 38291837 PMCID: PMC10828611 DOI: 10.1002/mdc3.13930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 10/11/2023] [Accepted: 11/04/2023] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND RFC1-related disorder (RFC1/CANVAS) shares clinical features with other late-onset ataxias, such as spinocerebellar ataxias (SCA) and multiple system atrophy cerebellar type (MSA-C). Thinning of cranial nerves V (CNV) and VIII (CNVIII) has been reported in magnetic resonance imaging (MRI) scans of RFC1/CANVAS, but its specificity remains unclear. OBJECTIVES To assess the usefulness of CNV and CNVIII thinning to differentiate RFC1/CANVAS from SCA and MSA-C. METHODS Seventeen individuals with RFC1/CANVAS, 57 with SCA (types 2, 3 and 6), 11 with MSA-C and 15 healthy controls were enrolled. The Balanced Fast Field Echo sequence was used for assessment of cranial nerves. Images were reviewed by a neuroradiologist, who classified these nerves as atrophic or normal, and subsequently the CNV was segmented manually by an experienced neurologist. Both assessments were blinded to patient and clinical data. Non-parametric tests were used to assess between-group comparisons. RESULTS Atrophy of CNV and CNVIII, both alone and in combination, was significantly more frequent in the RFC1/CANVAS group than in healthy controls and all other ataxia groups. Atrophy of CNV had the highest sensitivity (82%) and combined CNV and CNVIII atrophy had the best specificity (92%) for diagnosing RFC1/CANVAS. In the quantitative analyses, CNV was significantly thinner in the RFC1/CANVAS group relative to all other groups. The cutoff CNV diameter that best identified RFC1/CANVAS was ≤2.2 mm (AUC = 0.91; sensitivity 88.2%, specificity 95.6%). CONCLUSION MRI evaluation of CNV and CNVIII using a dedicated sequence is an easy-to-use tool that helps to distinguish RFC1/CANVAS from SCA and MSA-C.
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Affiliation(s)
- Camila C. Lobo
- Department of Neurology, School of Medical SciencesUniversity of Campinas (UNICAMP)CampinasBrazil
| | | | - Gabriel S. Schmitt
- Department of Neurology, School of Medical SciencesUniversity of Campinas (UNICAMP)CampinasBrazil
| | - Paula C.A.A.P. Matos
- Department of Neurology and Neurosurgery, School of MedicineFederal University of São Paulo (UNIFESP)São PauloBrazil
| | - Thiago J.R. Rezende
- Department of Neurology, School of Medical SciencesUniversity of Campinas (UNICAMP)CampinasBrazil
| | - Joyce M. Silva
- Department of Neurology, School of Medical SciencesUniversity of Campinas (UNICAMP)CampinasBrazil
| | - Fabrício C. Borba
- Department of Neurology, School of Medical SciencesUniversity of Campinas (UNICAMP)CampinasBrazil
| | - Fabrício D. Lima
- Department of Neurology, School of Medical SciencesUniversity of Campinas (UNICAMP)CampinasBrazil
| | - Alberto R.M. Martinez
- Department of Neurology, School of Medical SciencesUniversity of Campinas (UNICAMP)CampinasBrazil
| | - Orlando G.P. Barsottini
- Department of Neurology and Neurosurgery, School of MedicineFederal University of São Paulo (UNIFESP)São PauloBrazil
| | - José Luiz Pedroso
- Department of Neurology and Neurosurgery, School of MedicineFederal University of São Paulo (UNIFESP)São PauloBrazil
| | - Wilson Marques
- Department of Neurosciences, School of MedicineUniversity of São Paulo at Ribeirão Preto (USP‐RP)Ribeirão PretoBrazil
| | - Marcondes C. França
- Department of Neurology, School of Medical SciencesUniversity of Campinas (UNICAMP)CampinasBrazil
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Abreu VS, Silva JS, Igreja L, Malaquias MJ, Pinto CM. Pseudo-eye-of-the-tiger sign in cerebellar ataxia with neuropathy and vestibular areflexia syndrome (CANVAS). Am J Med Genet A 2024; 194:103-106. [PMID: 37747091 DOI: 10.1002/ajmg.a.63419] [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: 05/25/2023] [Revised: 09/11/2023] [Accepted: 09/15/2023] [Indexed: 09/26/2023]
Abstract
The well-known eye-of-the-tiger sign features bilateral and symmetrical changes in the globus pallidus, with a central area of high signal and peripheral low signal on T2-weighted MRI. Although formally considered pathognomonic of pantothenate kinase-associated neurodegeneration (PKAN), there are other neurodegenerative or genetic diseases showing similar findings. Cerebellar ataxia with neuropathy and vestibular areflexia syndrome (CANVAS) is a late-onset ataxia, that was recently associated with biallelic AAGGG repeat expansion in the RFC1 gene. Although its predominant MRI finding is cerebellar atrophy, there may be other less common associated findings. Our aim is to present two cases of CANVAS with associated (pseudo-)eye-of-the-tiger sign, highlighting the possibility of yet another differential diagnosis for this imaging sign.
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Affiliation(s)
- Vasco Sousa Abreu
- Neuroradiology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - José Sá Silva
- Neuroradiology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Liliana Igreja
- Neuroradiology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | | | - Catarina Mendes Pinto
- Neuroradiology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
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Zysman M, Mahay G, Guibert N, Barnig C, Leroy S, Guilleminault L. Impact of pharmacological and non-pharmacological interventions on mortality in chronic obstructive pulmonary disease (COPD) patients. Respir Med Res 2023; 84:101035. [PMID: 37651981 DOI: 10.1016/j.resmer.2023.101035] [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: 03/02/2023] [Revised: 06/15/2023] [Accepted: 06/16/2023] [Indexed: 09/02/2023]
Abstract
PURPOSE This review aimed to summarise evidence about the impact of pharmacological and non-pharmacological interventions on survival in COPD patients. METHODS We performed a narrative literature review on the effect of pharmacological and non-pharmacological interventions on survival in COPD patients. RESULTS Inhaled therapies are central to reduce symptoms in COPD. In particular, inhaled steroids seem to have the greatest effect on mortality. Despite the anti-inflammatory effects attributed to statins, their benefit in COPD has been shown only in cases of combined cardiovascular diseases. The use of beta-blockers in COPD has not been associated with increased COPD-related mortality and a beneficial effect on all-cause mortality has even been shown in COPD patients with cardiovascular diseases. Influenza and pneumococcal vaccination reduced the occurrence of exacerbations and mortality due to COPD. In addition, long-term oxygen therapy (LTOT) (≥15h/day) in COPD patients with severe hypoxemia had a positive effect on survival. Regarding non-pharmacological interventions, it has been demonstrated that smoking cessation, treatment compliance and nutritional supplementation for underweight patients also have a positive effect on survival. Non-invasive ventilation results were dependent on patient PaCO2 levels. In patients with advanced COPD, further prospective studies are needed to know the effect of bronchoscopic lung volume reduction and lung transplant on COPD survival. Regarding lung transplant, a survival benefit in patients with a pre-transplant BODE score of ≥7 has been shown in retrospective studies. CONCLUSION Most of the studies did not evaluate survival as the main criteria and further long-term studies on the global management of COPD are required.
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Affiliation(s)
- Maeva Zysman
- Service de Pneumologie, CHU Haut-Lévèque, Bordeaux, France; Univ. Bordeaux, Centre de Recherche cardio-thoracique, INSERM U1045, CIC 1401, Pessac, France
| | - Guillaume Mahay
- Service de Pneumologie, Oncologie thoracique et soins intensifs respiratoires, CHU Rouen, Rouen, France
| | - Nicolas Guibert
- Pôle des voies respiratoires, CHU de Toulouse, Toulouse, France
| | - Cindy Barnig
- INSERM, EFS BFC, LabEx LipSTIC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Univ. Bourgogne Franche-Comté, Besançon, France; Service de Pneumologie, Oncologie thoracique et allergologie respiratoire, CHRU Besançon, Besançon, France
| | - Sylvie Leroy
- Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, CNRS UMR 7275 - FHU OncoAge, Service de Pneumologie Oncologie Thoracique et Soins Intensifs Respiratoires, CHU de Nice, Hôpital Pasteur, Nice, France
| | - Laurent Guilleminault
- Pôle des voies respiratoires, CHU de Toulouse, Toulouse, France; Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity) INSERM UMR1291 - CNRS UMR5051 - Université Toulouse III, CRISALIS F-CRIN, Toulouse, France.
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Malaquias MJ, Braz L, Santos Silva C, Damásio J, Jorge A, Lemos JM, Campos CF, Garcez D, Oliveira Santos M, Velon AG, Caetano A, Calejo M, Fernandes P, Rego Â, Castro S, Sousa AP, Cardoso MN, Fernandes M, Pinto MM, Taipa R, Lopes AM, Oliveira J, Magalhães M. Multisystemic RFC1-Related Disorder: Expanding the Phenotype Beyond Cerebellar Ataxia, Neuropathy, and Vestibular Areflexia Syndrome. Neurol Clin Pract 2023; 13:e200190. [PMID: 37674869 PMCID: PMC10479936 DOI: 10.1212/cpj.0000000000200190] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 07/19/2023] [Indexed: 09/08/2023]
Abstract
Background and Objectives The RFC1 spectrum has become considerably expanded as multisystemic features beyond the triad of cerebellar ataxia, neuropathy, and vestibular areflexia syndrome (CANVAS) have started to be unveiled, although many still require clinical replication. Here, we aimed to clinically characterize a cohort of RFC1-positive patients by addressing both classic and multisystemic features. In a second part of this study, we prospectively assessed small nerve fibers (SNF) and autonomic function in a subset of these RFC1-related patients. Methods We retrospectively enrolled 67 RFC1-positive patients from multiple neurologic centers in Portugal. All patients underwent full neurologic and vestibular evaluation, as well as neuroimaging and neurophysiologic studies. For SNF and autonomic testing (n = 15), we performed skin biopsies, quantitative sensory testing, sudoscan, sympathetic skin response, heart rate deep breathing, and tilt test. Results Multisystemic features beyond CANVAS were present in 82% of the patients, mainly chronic cough (66%) and dysautonomia (43%). Other features included motor neuron (MN) affection and motor neuropathy (18%), hyperkinetic movement disorders (16%), sleep apnea (6%), REM and non-REM sleep disorders (5%), and cranial neuropathy (5%). Ten patients reported an inverse association between cough and ataxia severity. A very severe epidermal denervation was found in skin biopsies of all patients. Autonomic dysfunction comprised cardiovascular (67%), cardiovagal (54%), and/or sudomotor (50%) systems. Discussion The presence of MN involvement, motor neuropathy, small fiber neuropathy, or extrapyramidal signs should not preclude RFC1 testing in cases of sensory neuronopathy. Indeed, the RFC1 spectrum can overlap not only with multiple system atrophy but also with hereditary motor and sensory neuropathy, hereditary sensory and autonomic neuropathy, and feeding dystonia phenotypes. Some clinical-paraclinical dissociations can pose diagnostic challenges, namely large and small fiber neuropathy and sudomotor dysfunction which are usually subclinical.
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Affiliation(s)
- Maria João Malaquias
- Department of Neurology (MJM, LB), Centro Hospitalar Universitário de São João, Porto; Department of Neurology (CSS, CFC, MOS), Centro Hospitalar Universitário Lisboa Norte; Centro de Estudos Egas Moniz (CSS), Faculdade de Medicina da Universidade de Lisboa; Department of Neurology (JD, MCM), Centro Hospitalar Universitário do Porto; Department of Neurology (AJ, JML), Centro Hospitalar Universitário de Coimbra; Department of Neurology (DG), Instituto Português de Oncologia de Lisboa Francisco Gentil; Department of Neurology (AGV), Centro Hospitalar De Trás-Os-Montes e Alto Douro, Vila Real; Department of Neurology (AC, MF), Centro Hospitalar de Lisboa Ocidental; Department of Neurology (MC), Unidade Local de Saúde de Matosinhos, Porto; Department of Cardiology (PF), Centro Hospitalar Universitário Lisboa Central; Department of Otolaryngology, Head and Neck Surgery (ÂR, SC); Department of Neurophysiology (APS, MNC); Neuropathology Unit (MMP, RT), Centro Hospitalar Universitário do Porto; Center for Predictive and Preventive Genetics (CGPP) (AML, JO), Institute for Molecular and Cell Biology (IBMC), Instituto de Investigacão e Inovação em Saúde (i3S), Universidade do Porto; and Department of Neurology (MCM), Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Luis Braz
- Department of Neurology (MJM, LB), Centro Hospitalar Universitário de São João, Porto; Department of Neurology (CSS, CFC, MOS), Centro Hospitalar Universitário Lisboa Norte; Centro de Estudos Egas Moniz (CSS), Faculdade de Medicina da Universidade de Lisboa; Department of Neurology (JD, MCM), Centro Hospitalar Universitário do Porto; Department of Neurology (AJ, JML), Centro Hospitalar Universitário de Coimbra; Department of Neurology (DG), Instituto Português de Oncologia de Lisboa Francisco Gentil; Department of Neurology (AGV), Centro Hospitalar De Trás-Os-Montes e Alto Douro, Vila Real; Department of Neurology (AC, MF), Centro Hospitalar de Lisboa Ocidental; Department of Neurology (MC), Unidade Local de Saúde de Matosinhos, Porto; Department of Cardiology (PF), Centro Hospitalar Universitário Lisboa Central; Department of Otolaryngology, Head and Neck Surgery (ÂR, SC); Department of Neurophysiology (APS, MNC); Neuropathology Unit (MMP, RT), Centro Hospitalar Universitário do Porto; Center for Predictive and Preventive Genetics (CGPP) (AML, JO), Institute for Molecular and Cell Biology (IBMC), Instituto de Investigacão e Inovação em Saúde (i3S), Universidade do Porto; and Department of Neurology (MCM), Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Cláudia Santos Silva
- Department of Neurology (MJM, LB), Centro Hospitalar Universitário de São João, Porto; Department of Neurology (CSS, CFC, MOS), Centro Hospitalar Universitário Lisboa Norte; Centro de Estudos Egas Moniz (CSS), Faculdade de Medicina da Universidade de Lisboa; Department of Neurology (JD, MCM), Centro Hospitalar Universitário do Porto; Department of Neurology (AJ, JML), Centro Hospitalar Universitário de Coimbra; Department of Neurology (DG), Instituto Português de Oncologia de Lisboa Francisco Gentil; Department of Neurology (AGV), Centro Hospitalar De Trás-Os-Montes e Alto Douro, Vila Real; Department of Neurology (AC, MF), Centro Hospitalar de Lisboa Ocidental; Department of Neurology (MC), Unidade Local de Saúde de Matosinhos, Porto; Department of Cardiology (PF), Centro Hospitalar Universitário Lisboa Central; Department of Otolaryngology, Head and Neck Surgery (ÂR, SC); Department of Neurophysiology (APS, MNC); Neuropathology Unit (MMP, RT), Centro Hospitalar Universitário do Porto; Center for Predictive and Preventive Genetics (CGPP) (AML, JO), Institute for Molecular and Cell Biology (IBMC), Instituto de Investigacão e Inovação em Saúde (i3S), Universidade do Porto; and Department of Neurology (MCM), Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Joana Damásio
- Department of Neurology (MJM, LB), Centro Hospitalar Universitário de São João, Porto; Department of Neurology (CSS, CFC, MOS), Centro Hospitalar Universitário Lisboa Norte; Centro de Estudos Egas Moniz (CSS), Faculdade de Medicina da Universidade de Lisboa; Department of Neurology (JD, MCM), Centro Hospitalar Universitário do Porto; Department of Neurology (AJ, JML), Centro Hospitalar Universitário de Coimbra; Department of Neurology (DG), Instituto Português de Oncologia de Lisboa Francisco Gentil; Department of Neurology (AGV), Centro Hospitalar De Trás-Os-Montes e Alto Douro, Vila Real; Department of Neurology (AC, MF), Centro Hospitalar de Lisboa Ocidental; Department of Neurology (MC), Unidade Local de Saúde de Matosinhos, Porto; Department of Cardiology (PF), Centro Hospitalar Universitário Lisboa Central; Department of Otolaryngology, Head and Neck Surgery (ÂR, SC); Department of Neurophysiology (APS, MNC); Neuropathology Unit (MMP, RT), Centro Hospitalar Universitário do Porto; Center for Predictive and Preventive Genetics (CGPP) (AML, JO), Institute for Molecular and Cell Biology (IBMC), Instituto de Investigacão e Inovação em Saúde (i3S), Universidade do Porto; and Department of Neurology (MCM), Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - André Jorge
- Department of Neurology (MJM, LB), Centro Hospitalar Universitário de São João, Porto; Department of Neurology (CSS, CFC, MOS), Centro Hospitalar Universitário Lisboa Norte; Centro de Estudos Egas Moniz (CSS), Faculdade de Medicina da Universidade de Lisboa; Department of Neurology (JD, MCM), Centro Hospitalar Universitário do Porto; Department of Neurology (AJ, JML), Centro Hospitalar Universitário de Coimbra; Department of Neurology (DG), Instituto Português de Oncologia de Lisboa Francisco Gentil; Department of Neurology (AGV), Centro Hospitalar De Trás-Os-Montes e Alto Douro, Vila Real; Department of Neurology (AC, MF), Centro Hospitalar de Lisboa Ocidental; Department of Neurology (MC), Unidade Local de Saúde de Matosinhos, Porto; Department of Cardiology (PF), Centro Hospitalar Universitário Lisboa Central; Department of Otolaryngology, Head and Neck Surgery (ÂR, SC); Department of Neurophysiology (APS, MNC); Neuropathology Unit (MMP, RT), Centro Hospitalar Universitário do Porto; Center for Predictive and Preventive Genetics (CGPP) (AML, JO), Institute for Molecular and Cell Biology (IBMC), Instituto de Investigacão e Inovação em Saúde (i3S), Universidade do Porto; and Department of Neurology (MCM), Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - João M Lemos
- Department of Neurology (MJM, LB), Centro Hospitalar Universitário de São João, Porto; Department of Neurology (CSS, CFC, MOS), Centro Hospitalar Universitário Lisboa Norte; Centro de Estudos Egas Moniz (CSS), Faculdade de Medicina da Universidade de Lisboa; Department of Neurology (JD, MCM), Centro Hospitalar Universitário do Porto; Department of Neurology (AJ, JML), Centro Hospitalar Universitário de Coimbra; Department of Neurology (DG), Instituto Português de Oncologia de Lisboa Francisco Gentil; Department of Neurology (AGV), Centro Hospitalar De Trás-Os-Montes e Alto Douro, Vila Real; Department of Neurology (AC, MF), Centro Hospitalar de Lisboa Ocidental; Department of Neurology (MC), Unidade Local de Saúde de Matosinhos, Porto; Department of Cardiology (PF), Centro Hospitalar Universitário Lisboa Central; Department of Otolaryngology, Head and Neck Surgery (ÂR, SC); Department of Neurophysiology (APS, MNC); Neuropathology Unit (MMP, RT), Centro Hospitalar Universitário do Porto; Center for Predictive and Preventive Genetics (CGPP) (AML, JO), Institute for Molecular and Cell Biology (IBMC), Instituto de Investigacão e Inovação em Saúde (i3S), Universidade do Porto; and Department of Neurology (MCM), Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Catarina F Campos
- Department of Neurology (MJM, LB), Centro Hospitalar Universitário de São João, Porto; Department of Neurology (CSS, CFC, MOS), Centro Hospitalar Universitário Lisboa Norte; Centro de Estudos Egas Moniz (CSS), Faculdade de Medicina da Universidade de Lisboa; Department of Neurology (JD, MCM), Centro Hospitalar Universitário do Porto; Department of Neurology (AJ, JML), Centro Hospitalar Universitário de Coimbra; Department of Neurology (DG), Instituto Português de Oncologia de Lisboa Francisco Gentil; Department of Neurology (AGV), Centro Hospitalar De Trás-Os-Montes e Alto Douro, Vila Real; Department of Neurology (AC, MF), Centro Hospitalar de Lisboa Ocidental; Department of Neurology (MC), Unidade Local de Saúde de Matosinhos, Porto; Department of Cardiology (PF), Centro Hospitalar Universitário Lisboa Central; Department of Otolaryngology, Head and Neck Surgery (ÂR, SC); Department of Neurophysiology (APS, MNC); Neuropathology Unit (MMP, RT), Centro Hospitalar Universitário do Porto; Center for Predictive and Preventive Genetics (CGPP) (AML, JO), Institute for Molecular and Cell Biology (IBMC), Instituto de Investigacão e Inovação em Saúde (i3S), Universidade do Porto; and Department of Neurology (MCM), Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Daniela Garcez
- Department of Neurology (MJM, LB), Centro Hospitalar Universitário de São João, Porto; Department of Neurology (CSS, CFC, MOS), Centro Hospitalar Universitário Lisboa Norte; Centro de Estudos Egas Moniz (CSS), Faculdade de Medicina da Universidade de Lisboa; Department of Neurology (JD, MCM), Centro Hospitalar Universitário do Porto; Department of Neurology (AJ, JML), Centro Hospitalar Universitário de Coimbra; Department of Neurology (DG), Instituto Português de Oncologia de Lisboa Francisco Gentil; Department of Neurology (AGV), Centro Hospitalar De Trás-Os-Montes e Alto Douro, Vila Real; Department of Neurology (AC, MF), Centro Hospitalar de Lisboa Ocidental; Department of Neurology (MC), Unidade Local de Saúde de Matosinhos, Porto; Department of Cardiology (PF), Centro Hospitalar Universitário Lisboa Central; Department of Otolaryngology, Head and Neck Surgery (ÂR, SC); Department of Neurophysiology (APS, MNC); Neuropathology Unit (MMP, RT), Centro Hospitalar Universitário do Porto; Center for Predictive and Preventive Genetics (CGPP) (AML, JO), Institute for Molecular and Cell Biology (IBMC), Instituto de Investigacão e Inovação em Saúde (i3S), Universidade do Porto; and Department of Neurology (MCM), Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Miguel Oliveira Santos
- Department of Neurology (MJM, LB), Centro Hospitalar Universitário de São João, Porto; Department of Neurology (CSS, CFC, MOS), Centro Hospitalar Universitário Lisboa Norte; Centro de Estudos Egas Moniz (CSS), Faculdade de Medicina da Universidade de Lisboa; Department of Neurology (JD, MCM), Centro Hospitalar Universitário do Porto; Department of Neurology (AJ, JML), Centro Hospitalar Universitário de Coimbra; Department of Neurology (DG), Instituto Português de Oncologia de Lisboa Francisco Gentil; Department of Neurology (AGV), Centro Hospitalar De Trás-Os-Montes e Alto Douro, Vila Real; Department of Neurology (AC, MF), Centro Hospitalar de Lisboa Ocidental; Department of Neurology (MC), Unidade Local de Saúde de Matosinhos, Porto; Department of Cardiology (PF), Centro Hospitalar Universitário Lisboa Central; Department of Otolaryngology, Head and Neck Surgery (ÂR, SC); Department of Neurophysiology (APS, MNC); Neuropathology Unit (MMP, RT), Centro Hospitalar Universitário do Porto; Center for Predictive and Preventive Genetics (CGPP) (AML, JO), Institute for Molecular and Cell Biology (IBMC), Instituto de Investigacão e Inovação em Saúde (i3S), Universidade do Porto; and Department of Neurology (MCM), Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Ana G Velon
- Department of Neurology (MJM, LB), Centro Hospitalar Universitário de São João, Porto; Department of Neurology (CSS, CFC, MOS), Centro Hospitalar Universitário Lisboa Norte; Centro de Estudos Egas Moniz (CSS), Faculdade de Medicina da Universidade de Lisboa; Department of Neurology (JD, MCM), Centro Hospitalar Universitário do Porto; Department of Neurology (AJ, JML), Centro Hospitalar Universitário de Coimbra; Department of Neurology (DG), Instituto Português de Oncologia de Lisboa Francisco Gentil; Department of Neurology (AGV), Centro Hospitalar De Trás-Os-Montes e Alto Douro, Vila Real; Department of Neurology (AC, MF), Centro Hospitalar de Lisboa Ocidental; Department of Neurology (MC), Unidade Local de Saúde de Matosinhos, Porto; Department of Cardiology (PF), Centro Hospitalar Universitário Lisboa Central; Department of Otolaryngology, Head and Neck Surgery (ÂR, SC); Department of Neurophysiology (APS, MNC); Neuropathology Unit (MMP, RT), Centro Hospitalar Universitário do Porto; Center for Predictive and Preventive Genetics (CGPP) (AML, JO), Institute for Molecular and Cell Biology (IBMC), Instituto de Investigacão e Inovação em Saúde (i3S), Universidade do Porto; and Department of Neurology (MCM), Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - André Caetano
- Department of Neurology (MJM, LB), Centro Hospitalar Universitário de São João, Porto; Department of Neurology (CSS, CFC, MOS), Centro Hospitalar Universitário Lisboa Norte; Centro de Estudos Egas Moniz (CSS), Faculdade de Medicina da Universidade de Lisboa; Department of Neurology (JD, MCM), Centro Hospitalar Universitário do Porto; Department of Neurology (AJ, JML), Centro Hospitalar Universitário de Coimbra; Department of Neurology (DG), Instituto Português de Oncologia de Lisboa Francisco Gentil; Department of Neurology (AGV), Centro Hospitalar De Trás-Os-Montes e Alto Douro, Vila Real; Department of Neurology (AC, MF), Centro Hospitalar de Lisboa Ocidental; Department of Neurology (MC), Unidade Local de Saúde de Matosinhos, Porto; Department of Cardiology (PF), Centro Hospitalar Universitário Lisboa Central; Department of Otolaryngology, Head and Neck Surgery (ÂR, SC); Department of Neurophysiology (APS, MNC); Neuropathology Unit (MMP, RT), Centro Hospitalar Universitário do Porto; Center for Predictive and Preventive Genetics (CGPP) (AML, JO), Institute for Molecular and Cell Biology (IBMC), Instituto de Investigacão e Inovação em Saúde (i3S), Universidade do Porto; and Department of Neurology (MCM), Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Margarida Calejo
- Department of Neurology (MJM, LB), Centro Hospitalar Universitário de São João, Porto; Department of Neurology (CSS, CFC, MOS), Centro Hospitalar Universitário Lisboa Norte; Centro de Estudos Egas Moniz (CSS), Faculdade de Medicina da Universidade de Lisboa; Department of Neurology (JD, MCM), Centro Hospitalar Universitário do Porto; Department of Neurology (AJ, JML), Centro Hospitalar Universitário de Coimbra; Department of Neurology (DG), Instituto Português de Oncologia de Lisboa Francisco Gentil; Department of Neurology (AGV), Centro Hospitalar De Trás-Os-Montes e Alto Douro, Vila Real; Department of Neurology (AC, MF), Centro Hospitalar de Lisboa Ocidental; Department of Neurology (MC), Unidade Local de Saúde de Matosinhos, Porto; Department of Cardiology (PF), Centro Hospitalar Universitário Lisboa Central; Department of Otolaryngology, Head and Neck Surgery (ÂR, SC); Department of Neurophysiology (APS, MNC); Neuropathology Unit (MMP, RT), Centro Hospitalar Universitário do Porto; Center for Predictive and Preventive Genetics (CGPP) (AML, JO), Institute for Molecular and Cell Biology (IBMC), Instituto de Investigacão e Inovação em Saúde (i3S), Universidade do Porto; and Department of Neurology (MCM), Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Preza Fernandes
- Department of Neurology (MJM, LB), Centro Hospitalar Universitário de São João, Porto; Department of Neurology (CSS, CFC, MOS), Centro Hospitalar Universitário Lisboa Norte; Centro de Estudos Egas Moniz (CSS), Faculdade de Medicina da Universidade de Lisboa; Department of Neurology (JD, MCM), Centro Hospitalar Universitário do Porto; Department of Neurology (AJ, JML), Centro Hospitalar Universitário de Coimbra; Department of Neurology (DG), Instituto Português de Oncologia de Lisboa Francisco Gentil; Department of Neurology (AGV), Centro Hospitalar De Trás-Os-Montes e Alto Douro, Vila Real; Department of Neurology (AC, MF), Centro Hospitalar de Lisboa Ocidental; Department of Neurology (MC), Unidade Local de Saúde de Matosinhos, Porto; Department of Cardiology (PF), Centro Hospitalar Universitário Lisboa Central; Department of Otolaryngology, Head and Neck Surgery (ÂR, SC); Department of Neurophysiology (APS, MNC); Neuropathology Unit (MMP, RT), Centro Hospitalar Universitário do Porto; Center for Predictive and Preventive Genetics (CGPP) (AML, JO), Institute for Molecular and Cell Biology (IBMC), Instituto de Investigacão e Inovação em Saúde (i3S), Universidade do Porto; and Department of Neurology (MCM), Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Ângela Rego
- Department of Neurology (MJM, LB), Centro Hospitalar Universitário de São João, Porto; Department of Neurology (CSS, CFC, MOS), Centro Hospitalar Universitário Lisboa Norte; Centro de Estudos Egas Moniz (CSS), Faculdade de Medicina da Universidade de Lisboa; Department of Neurology (JD, MCM), Centro Hospitalar Universitário do Porto; Department of Neurology (AJ, JML), Centro Hospitalar Universitário de Coimbra; Department of Neurology (DG), Instituto Português de Oncologia de Lisboa Francisco Gentil; Department of Neurology (AGV), Centro Hospitalar De Trás-Os-Montes e Alto Douro, Vila Real; Department of Neurology (AC, MF), Centro Hospitalar de Lisboa Ocidental; Department of Neurology (MC), Unidade Local de Saúde de Matosinhos, Porto; Department of Cardiology (PF), Centro Hospitalar Universitário Lisboa Central; Department of Otolaryngology, Head and Neck Surgery (ÂR, SC); Department of Neurophysiology (APS, MNC); Neuropathology Unit (MMP, RT), Centro Hospitalar Universitário do Porto; Center for Predictive and Preventive Genetics (CGPP) (AML, JO), Institute for Molecular and Cell Biology (IBMC), Instituto de Investigacão e Inovação em Saúde (i3S), Universidade do Porto; and Department of Neurology (MCM), Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Sandra Castro
- Department of Neurology (MJM, LB), Centro Hospitalar Universitário de São João, Porto; Department of Neurology (CSS, CFC, MOS), Centro Hospitalar Universitário Lisboa Norte; Centro de Estudos Egas Moniz (CSS), Faculdade de Medicina da Universidade de Lisboa; Department of Neurology (JD, MCM), Centro Hospitalar Universitário do Porto; Department of Neurology (AJ, JML), Centro Hospitalar Universitário de Coimbra; Department of Neurology (DG), Instituto Português de Oncologia de Lisboa Francisco Gentil; Department of Neurology (AGV), Centro Hospitalar De Trás-Os-Montes e Alto Douro, Vila Real; Department of Neurology (AC, MF), Centro Hospitalar de Lisboa Ocidental; Department of Neurology (MC), Unidade Local de Saúde de Matosinhos, Porto; Department of Cardiology (PF), Centro Hospitalar Universitário Lisboa Central; Department of Otolaryngology, Head and Neck Surgery (ÂR, SC); Department of Neurophysiology (APS, MNC); Neuropathology Unit (MMP, RT), Centro Hospitalar Universitário do Porto; Center for Predictive and Preventive Genetics (CGPP) (AML, JO), Institute for Molecular and Cell Biology (IBMC), Instituto de Investigacão e Inovação em Saúde (i3S), Universidade do Porto; and Department of Neurology (MCM), Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Ana P Sousa
- Department of Neurology (MJM, LB), Centro Hospitalar Universitário de São João, Porto; Department of Neurology (CSS, CFC, MOS), Centro Hospitalar Universitário Lisboa Norte; Centro de Estudos Egas Moniz (CSS), Faculdade de Medicina da Universidade de Lisboa; Department of Neurology (JD, MCM), Centro Hospitalar Universitário do Porto; Department of Neurology (AJ, JML), Centro Hospitalar Universitário de Coimbra; Department of Neurology (DG), Instituto Português de Oncologia de Lisboa Francisco Gentil; Department of Neurology (AGV), Centro Hospitalar De Trás-Os-Montes e Alto Douro, Vila Real; Department of Neurology (AC, MF), Centro Hospitalar de Lisboa Ocidental; Department of Neurology (MC), Unidade Local de Saúde de Matosinhos, Porto; Department of Cardiology (PF), Centro Hospitalar Universitário Lisboa Central; Department of Otolaryngology, Head and Neck Surgery (ÂR, SC); Department of Neurophysiology (APS, MNC); Neuropathology Unit (MMP, RT), Centro Hospitalar Universitário do Porto; Center for Predictive and Preventive Genetics (CGPP) (AML, JO), Institute for Molecular and Cell Biology (IBMC), Instituto de Investigacão e Inovação em Saúde (i3S), Universidade do Porto; and Department of Neurology (MCM), Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Marcio Neves Cardoso
- Department of Neurology (MJM, LB), Centro Hospitalar Universitário de São João, Porto; Department of Neurology (CSS, CFC, MOS), Centro Hospitalar Universitário Lisboa Norte; Centro de Estudos Egas Moniz (CSS), Faculdade de Medicina da Universidade de Lisboa; Department of Neurology (JD, MCM), Centro Hospitalar Universitário do Porto; Department of Neurology (AJ, JML), Centro Hospitalar Universitário de Coimbra; Department of Neurology (DG), Instituto Português de Oncologia de Lisboa Francisco Gentil; Department of Neurology (AGV), Centro Hospitalar De Trás-Os-Montes e Alto Douro, Vila Real; Department of Neurology (AC, MF), Centro Hospitalar de Lisboa Ocidental; Department of Neurology (MC), Unidade Local de Saúde de Matosinhos, Porto; Department of Cardiology (PF), Centro Hospitalar Universitário Lisboa Central; Department of Otolaryngology, Head and Neck Surgery (ÂR, SC); Department of Neurophysiology (APS, MNC); Neuropathology Unit (MMP, RT), Centro Hospitalar Universitário do Porto; Center for Predictive and Preventive Genetics (CGPP) (AML, JO), Institute for Molecular and Cell Biology (IBMC), Instituto de Investigacão e Inovação em Saúde (i3S), Universidade do Porto; and Department of Neurology (MCM), Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Marco Fernandes
- Department of Neurology (MJM, LB), Centro Hospitalar Universitário de São João, Porto; Department of Neurology (CSS, CFC, MOS), Centro Hospitalar Universitário Lisboa Norte; Centro de Estudos Egas Moniz (CSS), Faculdade de Medicina da Universidade de Lisboa; Department of Neurology (JD, MCM), Centro Hospitalar Universitário do Porto; Department of Neurology (AJ, JML), Centro Hospitalar Universitário de Coimbra; Department of Neurology (DG), Instituto Português de Oncologia de Lisboa Francisco Gentil; Department of Neurology (AGV), Centro Hospitalar De Trás-Os-Montes e Alto Douro, Vila Real; Department of Neurology (AC, MF), Centro Hospitalar de Lisboa Ocidental; Department of Neurology (MC), Unidade Local de Saúde de Matosinhos, Porto; Department of Cardiology (PF), Centro Hospitalar Universitário Lisboa Central; Department of Otolaryngology, Head and Neck Surgery (ÂR, SC); Department of Neurophysiology (APS, MNC); Neuropathology Unit (MMP, RT), Centro Hospitalar Universitário do Porto; Center for Predictive and Preventive Genetics (CGPP) (AML, JO), Institute for Molecular and Cell Biology (IBMC), Instituto de Investigacão e Inovação em Saúde (i3S), Universidade do Porto; and Department of Neurology (MCM), Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Miguel M Pinto
- Department of Neurology (MJM, LB), Centro Hospitalar Universitário de São João, Porto; Department of Neurology (CSS, CFC, MOS), Centro Hospitalar Universitário Lisboa Norte; Centro de Estudos Egas Moniz (CSS), Faculdade de Medicina da Universidade de Lisboa; Department of Neurology (JD, MCM), Centro Hospitalar Universitário do Porto; Department of Neurology (AJ, JML), Centro Hospitalar Universitário de Coimbra; Department of Neurology (DG), Instituto Português de Oncologia de Lisboa Francisco Gentil; Department of Neurology (AGV), Centro Hospitalar De Trás-Os-Montes e Alto Douro, Vila Real; Department of Neurology (AC, MF), Centro Hospitalar de Lisboa Ocidental; Department of Neurology (MC), Unidade Local de Saúde de Matosinhos, Porto; Department of Cardiology (PF), Centro Hospitalar Universitário Lisboa Central; Department of Otolaryngology, Head and Neck Surgery (ÂR, SC); Department of Neurophysiology (APS, MNC); Neuropathology Unit (MMP, RT), Centro Hospitalar Universitário do Porto; Center for Predictive and Preventive Genetics (CGPP) (AML, JO), Institute for Molecular and Cell Biology (IBMC), Instituto de Investigacão e Inovação em Saúde (i3S), Universidade do Porto; and Department of Neurology (MCM), Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Ricardo Taipa
- Department of Neurology (MJM, LB), Centro Hospitalar Universitário de São João, Porto; Department of Neurology (CSS, CFC, MOS), Centro Hospitalar Universitário Lisboa Norte; Centro de Estudos Egas Moniz (CSS), Faculdade de Medicina da Universidade de Lisboa; Department of Neurology (JD, MCM), Centro Hospitalar Universitário do Porto; Department of Neurology (AJ, JML), Centro Hospitalar Universitário de Coimbra; Department of Neurology (DG), Instituto Português de Oncologia de Lisboa Francisco Gentil; Department of Neurology (AGV), Centro Hospitalar De Trás-Os-Montes e Alto Douro, Vila Real; Department of Neurology (AC, MF), Centro Hospitalar de Lisboa Ocidental; Department of Neurology (MC), Unidade Local de Saúde de Matosinhos, Porto; Department of Cardiology (PF), Centro Hospitalar Universitário Lisboa Central; Department of Otolaryngology, Head and Neck Surgery (ÂR, SC); Department of Neurophysiology (APS, MNC); Neuropathology Unit (MMP, RT), Centro Hospitalar Universitário do Porto; Center for Predictive and Preventive Genetics (CGPP) (AML, JO), Institute for Molecular and Cell Biology (IBMC), Instituto de Investigacão e Inovação em Saúde (i3S), Universidade do Porto; and Department of Neurology (MCM), Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Ana M Lopes
- Department of Neurology (MJM, LB), Centro Hospitalar Universitário de São João, Porto; Department of Neurology (CSS, CFC, MOS), Centro Hospitalar Universitário Lisboa Norte; Centro de Estudos Egas Moniz (CSS), Faculdade de Medicina da Universidade de Lisboa; Department of Neurology (JD, MCM), Centro Hospitalar Universitário do Porto; Department of Neurology (AJ, JML), Centro Hospitalar Universitário de Coimbra; Department of Neurology (DG), Instituto Português de Oncologia de Lisboa Francisco Gentil; Department of Neurology (AGV), Centro Hospitalar De Trás-Os-Montes e Alto Douro, Vila Real; Department of Neurology (AC, MF), Centro Hospitalar de Lisboa Ocidental; Department of Neurology (MC), Unidade Local de Saúde de Matosinhos, Porto; Department of Cardiology (PF), Centro Hospitalar Universitário Lisboa Central; Department of Otolaryngology, Head and Neck Surgery (ÂR, SC); Department of Neurophysiology (APS, MNC); Neuropathology Unit (MMP, RT), Centro Hospitalar Universitário do Porto; Center for Predictive and Preventive Genetics (CGPP) (AML, JO), Institute for Molecular and Cell Biology (IBMC), Instituto de Investigacão e Inovação em Saúde (i3S), Universidade do Porto; and Department of Neurology (MCM), Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Jorge Oliveira
- Department of Neurology (MJM, LB), Centro Hospitalar Universitário de São João, Porto; Department of Neurology (CSS, CFC, MOS), Centro Hospitalar Universitário Lisboa Norte; Centro de Estudos Egas Moniz (CSS), Faculdade de Medicina da Universidade de Lisboa; Department of Neurology (JD, MCM), Centro Hospitalar Universitário do Porto; Department of Neurology (AJ, JML), Centro Hospitalar Universitário de Coimbra; Department of Neurology (DG), Instituto Português de Oncologia de Lisboa Francisco Gentil; Department of Neurology (AGV), Centro Hospitalar De Trás-Os-Montes e Alto Douro, Vila Real; Department of Neurology (AC, MF), Centro Hospitalar de Lisboa Ocidental; Department of Neurology (MC), Unidade Local de Saúde de Matosinhos, Porto; Department of Cardiology (PF), Centro Hospitalar Universitário Lisboa Central; Department of Otolaryngology, Head and Neck Surgery (ÂR, SC); Department of Neurophysiology (APS, MNC); Neuropathology Unit (MMP, RT), Centro Hospitalar Universitário do Porto; Center for Predictive and Preventive Genetics (CGPP) (AML, JO), Institute for Molecular and Cell Biology (IBMC), Instituto de Investigacão e Inovação em Saúde (i3S), Universidade do Porto; and Department of Neurology (MCM), Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Marina Magalhães
- Department of Neurology (MJM, LB), Centro Hospitalar Universitário de São João, Porto; Department of Neurology (CSS, CFC, MOS), Centro Hospitalar Universitário Lisboa Norte; Centro de Estudos Egas Moniz (CSS), Faculdade de Medicina da Universidade de Lisboa; Department of Neurology (JD, MCM), Centro Hospitalar Universitário do Porto; Department of Neurology (AJ, JML), Centro Hospitalar Universitário de Coimbra; Department of Neurology (DG), Instituto Português de Oncologia de Lisboa Francisco Gentil; Department of Neurology (AGV), Centro Hospitalar De Trás-Os-Montes e Alto Douro, Vila Real; Department of Neurology (AC, MF), Centro Hospitalar de Lisboa Ocidental; Department of Neurology (MC), Unidade Local de Saúde de Matosinhos, Porto; Department of Cardiology (PF), Centro Hospitalar Universitário Lisboa Central; Department of Otolaryngology, Head and Neck Surgery (ÂR, SC); Department of Neurophysiology (APS, MNC); Neuropathology Unit (MMP, RT), Centro Hospitalar Universitário do Porto; Center for Predictive and Preventive Genetics (CGPP) (AML, JO), Institute for Molecular and Cell Biology (IBMC), Instituto de Investigacão e Inovação em Saúde (i3S), Universidade do Porto; and Department of Neurology (MCM), Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
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Traschütz A, Heindl F, Bilal M, Hartmann AM, Dufke C, Riess O, Zwergal A, Rujescu D, Haack T, Synofzik M, Strupp M. Frequency and Phenotype of RFC1 Repeat Expansions in Bilateral Vestibulopathy. Neurology 2023; 101:e1001-e1013. [PMID: 37460231 PMCID: PMC10491447 DOI: 10.1212/wnl.0000000000207553] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/08/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Bilateral vestibulopathy (BVP) is a chronic debilitating neurologic disorder with no monogenic cause established so far despite familiar presentations. We hypothesized that replication factor complex subunit 1 (RFC1) repeat expansions might present a recurrent monogenic cause of BVP. METHODS The study involved RFC1 screening and in-depth neurologic, vestibulo-oculomotor, and disease evolution phenotyping of 168 consecutive patients with idiopathic at least "probable BVP" from a tertiary referral center for balance disorders, with127 of them meeting current diagnostic criteria of BVP (Bárány Society Classification). RESULTS Biallelic AAGGG repeat expansions in RFC1 were identified in 10/127 patients (8%) with BVP and 1/41 with probable BVP. Heterozygous expansions in 10/127 patients were enriched compared with those in reference populations. RFC1-related BVP manifested at a median age of 60 years (range 34-72 years) and co-occurred predominantly with mild polyneuropathy (10/11). Additional cerebellar involvement (7/11) was subtle and limited to oculomotor signs in early stages, below recognition of classic cerebellar ataxia, neuropathy, and vestibular areflexia syndrome. Clear dysarthria, appendicular ataxia, or cerebellar atrophy developed 6-8 years after onset. Dysarthria, absent patellar reflexes, and downbeat nystagmus best discriminated RFC1-positive BVP from RFC1-negative BVP, but neither sensory symptoms nor fine motor problems. Video head impulse gains of patients with RFC1-positive BVP were lower relative to those of patients with RFC1-negative BVP and decreased until 10 years disease duration, indicating a potential progression and outcome marker for RFC1-disease. DISCUSSION This study identifies RFC1 as the first-and frequent-monogenic cause of BVP. It characterizes RFC1-related BVP as part of the multisystemic evolution of RFC1 spectrum disease, with implications for designing natural history studies and future treatment trials. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that RFC1 repeat expansions cause BVP.
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Affiliation(s)
- Andreas Traschütz
- From the Research Division Translational Genomics of Neurodegenerative Diseases (A.T., M. Synofzik), Hertie-Institute for Clinical Brain Research and Center of Neurology, and German Center for Neurodegenerative Diseases (DZNE) (A.T., M. Synofzik), University of Tübingen; Department of Neurology and German Center for Vertigo and Balance Disorders (F.H., A.Z., M. Strupp), University Hospital, Ludwig-Maximilians University, Munich, Germany; Department of Biochemistry (M.B.), Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan; Institute of Medical Genetics and Applied Genomics (A.M.H., D.R.), University of Tübingen, Germany; Department of Psychiatry and Psychotherapy (M.B., C.D., O.R., T.H.), Comprehensive Center for Clinical Neurosciences and Mental Health (C3NMH), Medical University of Vienna, Austria; and Center for Rare Diseases (C.D., O.R., T.H.), University of Tübingen, Germany
| | - Felix Heindl
- From the Research Division Translational Genomics of Neurodegenerative Diseases (A.T., M. Synofzik), Hertie-Institute for Clinical Brain Research and Center of Neurology, and German Center for Neurodegenerative Diseases (DZNE) (A.T., M. Synofzik), University of Tübingen; Department of Neurology and German Center for Vertigo and Balance Disorders (F.H., A.Z., M. Strupp), University Hospital, Ludwig-Maximilians University, Munich, Germany; Department of Biochemistry (M.B.), Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan; Institute of Medical Genetics and Applied Genomics (A.M.H., D.R.), University of Tübingen, Germany; Department of Psychiatry and Psychotherapy (M.B., C.D., O.R., T.H.), Comprehensive Center for Clinical Neurosciences and Mental Health (C3NMH), Medical University of Vienna, Austria; and Center for Rare Diseases (C.D., O.R., T.H.), University of Tübingen, Germany
| | - Muhammad Bilal
- From the Research Division Translational Genomics of Neurodegenerative Diseases (A.T., M. Synofzik), Hertie-Institute for Clinical Brain Research and Center of Neurology, and German Center for Neurodegenerative Diseases (DZNE) (A.T., M. Synofzik), University of Tübingen; Department of Neurology and German Center for Vertigo and Balance Disorders (F.H., A.Z., M. Strupp), University Hospital, Ludwig-Maximilians University, Munich, Germany; Department of Biochemistry (M.B.), Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan; Institute of Medical Genetics and Applied Genomics (A.M.H., D.R.), University of Tübingen, Germany; Department of Psychiatry and Psychotherapy (M.B., C.D., O.R., T.H.), Comprehensive Center for Clinical Neurosciences and Mental Health (C3NMH), Medical University of Vienna, Austria; and Center for Rare Diseases (C.D., O.R., T.H.), University of Tübingen, Germany
| | - Annette M Hartmann
- From the Research Division Translational Genomics of Neurodegenerative Diseases (A.T., M. Synofzik), Hertie-Institute for Clinical Brain Research and Center of Neurology, and German Center for Neurodegenerative Diseases (DZNE) (A.T., M. Synofzik), University of Tübingen; Department of Neurology and German Center for Vertigo and Balance Disorders (F.H., A.Z., M. Strupp), University Hospital, Ludwig-Maximilians University, Munich, Germany; Department of Biochemistry (M.B.), Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan; Institute of Medical Genetics and Applied Genomics (A.M.H., D.R.), University of Tübingen, Germany; Department of Psychiatry and Psychotherapy (M.B., C.D., O.R., T.H.), Comprehensive Center for Clinical Neurosciences and Mental Health (C3NMH), Medical University of Vienna, Austria; and Center for Rare Diseases (C.D., O.R., T.H.), University of Tübingen, Germany
| | - Claudia Dufke
- From the Research Division Translational Genomics of Neurodegenerative Diseases (A.T., M. Synofzik), Hertie-Institute for Clinical Brain Research and Center of Neurology, and German Center for Neurodegenerative Diseases (DZNE) (A.T., M. Synofzik), University of Tübingen; Department of Neurology and German Center for Vertigo and Balance Disorders (F.H., A.Z., M. Strupp), University Hospital, Ludwig-Maximilians University, Munich, Germany; Department of Biochemistry (M.B.), Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan; Institute of Medical Genetics and Applied Genomics (A.M.H., D.R.), University of Tübingen, Germany; Department of Psychiatry and Psychotherapy (M.B., C.D., O.R., T.H.), Comprehensive Center for Clinical Neurosciences and Mental Health (C3NMH), Medical University of Vienna, Austria; and Center for Rare Diseases (C.D., O.R., T.H.), University of Tübingen, Germany
| | - Olaf Riess
- From the Research Division Translational Genomics of Neurodegenerative Diseases (A.T., M. Synofzik), Hertie-Institute for Clinical Brain Research and Center of Neurology, and German Center for Neurodegenerative Diseases (DZNE) (A.T., M. Synofzik), University of Tübingen; Department of Neurology and German Center for Vertigo and Balance Disorders (F.H., A.Z., M. Strupp), University Hospital, Ludwig-Maximilians University, Munich, Germany; Department of Biochemistry (M.B.), Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan; Institute of Medical Genetics and Applied Genomics (A.M.H., D.R.), University of Tübingen, Germany; Department of Psychiatry and Psychotherapy (M.B., C.D., O.R., T.H.), Comprehensive Center for Clinical Neurosciences and Mental Health (C3NMH), Medical University of Vienna, Austria; and Center for Rare Diseases (C.D., O.R., T.H.), University of Tübingen, Germany
| | - Andreas Zwergal
- From the Research Division Translational Genomics of Neurodegenerative Diseases (A.T., M. Synofzik), Hertie-Institute for Clinical Brain Research and Center of Neurology, and German Center for Neurodegenerative Diseases (DZNE) (A.T., M. Synofzik), University of Tübingen; Department of Neurology and German Center for Vertigo and Balance Disorders (F.H., A.Z., M. Strupp), University Hospital, Ludwig-Maximilians University, Munich, Germany; Department of Biochemistry (M.B.), Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan; Institute of Medical Genetics and Applied Genomics (A.M.H., D.R.), University of Tübingen, Germany; Department of Psychiatry and Psychotherapy (M.B., C.D., O.R., T.H.), Comprehensive Center for Clinical Neurosciences and Mental Health (C3NMH), Medical University of Vienna, Austria; and Center for Rare Diseases (C.D., O.R., T.H.), University of Tübingen, Germany
| | - Dan Rujescu
- From the Research Division Translational Genomics of Neurodegenerative Diseases (A.T., M. Synofzik), Hertie-Institute for Clinical Brain Research and Center of Neurology, and German Center for Neurodegenerative Diseases (DZNE) (A.T., M. Synofzik), University of Tübingen; Department of Neurology and German Center for Vertigo and Balance Disorders (F.H., A.Z., M. Strupp), University Hospital, Ludwig-Maximilians University, Munich, Germany; Department of Biochemistry (M.B.), Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan; Institute of Medical Genetics and Applied Genomics (A.M.H., D.R.), University of Tübingen, Germany; Department of Psychiatry and Psychotherapy (M.B., C.D., O.R., T.H.), Comprehensive Center for Clinical Neurosciences and Mental Health (C3NMH), Medical University of Vienna, Austria; and Center for Rare Diseases (C.D., O.R., T.H.), University of Tübingen, Germany
| | - Tobias Haack
- From the Research Division Translational Genomics of Neurodegenerative Diseases (A.T., M. Synofzik), Hertie-Institute for Clinical Brain Research and Center of Neurology, and German Center for Neurodegenerative Diseases (DZNE) (A.T., M. Synofzik), University of Tübingen; Department of Neurology and German Center for Vertigo and Balance Disorders (F.H., A.Z., M. Strupp), University Hospital, Ludwig-Maximilians University, Munich, Germany; Department of Biochemistry (M.B.), Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan; Institute of Medical Genetics and Applied Genomics (A.M.H., D.R.), University of Tübingen, Germany; Department of Psychiatry and Psychotherapy (M.B., C.D., O.R., T.H.), Comprehensive Center for Clinical Neurosciences and Mental Health (C3NMH), Medical University of Vienna, Austria; and Center for Rare Diseases (C.D., O.R., T.H.), University of Tübingen, Germany
| | - Matthis Synofzik
- From the Research Division Translational Genomics of Neurodegenerative Diseases (A.T., M. Synofzik), Hertie-Institute for Clinical Brain Research and Center of Neurology, and German Center for Neurodegenerative Diseases (DZNE) (A.T., M. Synofzik), University of Tübingen; Department of Neurology and German Center for Vertigo and Balance Disorders (F.H., A.Z., M. Strupp), University Hospital, Ludwig-Maximilians University, Munich, Germany; Department of Biochemistry (M.B.), Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan; Institute of Medical Genetics and Applied Genomics (A.M.H., D.R.), University of Tübingen, Germany; Department of Psychiatry and Psychotherapy (M.B., C.D., O.R., T.H.), Comprehensive Center for Clinical Neurosciences and Mental Health (C3NMH), Medical University of Vienna, Austria; and Center for Rare Diseases (C.D., O.R., T.H.), University of Tübingen, Germany
| | - Michael Strupp
- From the Research Division Translational Genomics of Neurodegenerative Diseases (A.T., M. Synofzik), Hertie-Institute for Clinical Brain Research and Center of Neurology, and German Center for Neurodegenerative Diseases (DZNE) (A.T., M. Synofzik), University of Tübingen; Department of Neurology and German Center for Vertigo and Balance Disorders (F.H., A.Z., M. Strupp), University Hospital, Ludwig-Maximilians University, Munich, Germany; Department of Biochemistry (M.B.), Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan; Institute of Medical Genetics and Applied Genomics (A.M.H., D.R.), University of Tübingen, Germany; Department of Psychiatry and Psychotherapy (M.B., C.D., O.R., T.H.), Comprehensive Center for Clinical Neurosciences and Mental Health (C3NMH), Medical University of Vienna, Austria; and Center for Rare Diseases (C.D., O.R., T.H.), University of Tübingen, Germany.
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10
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Fonte J, Machado C, Oliveira J, Magalhães M. Lower Facial Dystonia: An Unexpected Presentation Associated with Pathogenic RFC1 Repeat Expansions. Mov Disord Clin Pract 2023; 10:1150-1151. [PMID: 37476326 PMCID: PMC10354605 DOI: 10.1002/mdc3.13730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 02/27/2023] [Accepted: 03/13/2023] [Indexed: 07/22/2023] Open
Affiliation(s)
- Joana Fonte
- Neurology DepartmentCentro Hospitalar Universitário de Santo AntónioPortoPortugal
| | | | - Jorge Oliveira
- CGPP‐ Centro de Genética Preditiva e PreventivaIBMC‐ Instituto de Biologia Molecular e Celular, Universidade do PortoPortoPortugal
- i3S‐ Instituto de Investigação e Inovação em Saúde, Universidade do PortoPortoPortugal
| | - Marina Magalhães
- Neurology DepartmentCentro Hospitalar Universitário de Santo AntónioPortoPortugal
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11
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Ylikotila P, Sipilä J, Alapirtti T, Ahmasalo R, Koshimizu E, Miyatake S, Hurme-Niiranen A, Siitonen A, Doi H, Tanaka F, Matsumoto N, Majamaa K, Kytövuori L. Association of biallelic RFC1 expansion with early-onset Parkinson's disease. Eur J Neurol 2023; 30:1256-1261. [PMID: 36705320 DOI: 10.1111/ene.15717] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/19/2023] [Accepted: 01/23/2023] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND PURPOSE The biallelic repeat expansion (AAGGG)exp in the replication factor C subunit 1 gene (RFC1) is a frequent cause of cerebellar ataxia, neuropathy and vestibular areflexia syndrome (CANVAS) as well as late-onset ataxia. The clinical spectrum of RFC1 disease has expanded since the first identification of biallelic (AAGGG)exp and includes now various nonclassical phenotypes. Biallelic (AAGGG)exp in RFC1 in patients with clinically confirmed Parkinson's disease (PD) has recently been found. METHODS A nationwide cohort of 273 Finnish patients with early-onset PD was examined for the biallelic intronic expansion in RFC1. The expansion (AAGGG)exp was first screened using extra long polymerase chain reactions (Extra Large-PCRs) and flanking multiplex PCR. The presence of biallelic (AAGGG)exp was then confirmed by repeat-primed PCR and, finally, the repeat length was determined by long-read sequencing. RESULTS Three patients were found with the biallelic (AAGGG)exp in RFC1 giving a frequency of 1.10% (0.23%-3.18%; 95% confidence interval). The three patients fulfilled the diagnostic criteria of PD, none of them had ataxia or neuropathy, and only one patient had a mild vestibular dysfunction. The age at onset of PD symptoms was 40-48 years and their disease course had been unremarkable apart from the early onset. CONCLUSIONS Our results suggest that (AAGGG)exp in RFC1 is a rare cause of early-onset PD. Other populations should be examined in order to determine whether our findings are specific to the Finnish population.
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Affiliation(s)
- Pauli Ylikotila
- Clinical Neurosciences, University of Turku, Turku, Finland.,Neurocenter Turku University Hospital, Turku, Finland
| | - Jussi Sipilä
- Clinical Neurosciences, University of Turku, Turku, Finland.,Department of Neurology, Siun Sote North Karelia Central Hospital, Joensuu, Finland
| | - Tiina Alapirtti
- Department of Neurology, Kanta-Häme Central Hospital, Hämeenlinna, Finland
| | - Riitta Ahmasalo
- Department of Neurology, Lapland Central Hospital, Rovaniemi, Finland
| | - Eriko Koshimizu
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Satoko Miyatake
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama, Japan.,Department of Clinical Genetics, Yokohama City University Hospital, Yokohama, Japan
| | - Anri Hurme-Niiranen
- Research Unit of Clinical Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland.,Neurocenter, Neurology, Oulu University Hospital, Oulu, Finland
| | - Ari Siitonen
- Research Unit of Clinical Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland.,Neurocenter, Neurology, Oulu University Hospital, Oulu, Finland
| | - Hiroshi Doi
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Fumiaki Tanaka
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Naomichi Matsumoto
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Kari Majamaa
- Research Unit of Clinical Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland.,Neurocenter, Neurology, Oulu University Hospital, Oulu, Finland
| | - Laura Kytövuori
- Research Unit of Clinical Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland.,Neurocenter, Neurology, Oulu University Hospital, Oulu, Finland
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12
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Roberts LJ, McVeigh M, Seiderer L, Harding IH, Corben LA, Delatycki M, Szmulewicz DJ. Overview of the Clinical Approach to Individuals With Cerebellar Ataxia and Neuropathy. Neurol Genet 2022; 8:e200021. [PMID: 36187726 PMCID: PMC9520343 DOI: 10.1212/nxg.0000000000200021] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 07/06/2022] [Indexed: 06/16/2023]
Abstract
Increasingly, cerebellar syndromes are recognized as affecting multiple systems. Extracerebellar features include peripheral neuropathies affecting proprioception; cranial neuropathies such as auditory and vestibular; and neuronopathies, for example, dorsal root and vestibular. The presence of such features, which in and of themselves may cause ataxia, likely contribute to key disabilities such as gait instability and falls. Based on the evolving available literature and experience, we outline a clinical approach to the diagnosis of adult-onset ataxia where a combination of cerebellar and peripheral or cranial nerve pathology exists. Objective diagnostic modalities including electrophysiology, oculomotor, and vestibular function testing are invaluable in accurately defining an individual's phenotype. Advances in MRI techniques have led to an increased recognition of disease-specific patterns of cerebellar pathology, including those conditions where neuronopathies may be involved. Depending on availability, a stepwise approach to genetic testing is suggested. This is guided by factors such as pattern of inheritance and age at disease onset, and genetic testing may range from specific genetic panels through to whole-exome and whole-genome sequencing. Management is best performed with the involvement of a multidisciplinary team, aiming at minimization of complications such as falls and aspiration pneumonia and maximizing functional status.
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13
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Colucci F, Di Bella D, Pisciotta C, Sarto E, Gualandi F, Neri M, Ferlini A, Contaldi E, Pugliatti M, Pareyson D, Sensi M. Beyond canvas: behavioral onset of rfc1-expansion disease in an Italian family-causal or casual? Neurol Sci 2022; 43:5095-5098. [PMID: 35585435 DOI: 10.1007/s10072-022-06137-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 05/08/2022] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Biallelic intronic AAGGG repeat expansion in the replication factor C subunit 1 (RFC1) gene was recently identified in two/third of patients with cerebellar ataxia, sensory neuropathy, and bilateral vestibular areflexia syndrome (CANVAS). The phenotypic spectrum has expanded since (i.e., parkinsonism, motor neuron involvement, cognitive decline); no behavioral symptoms have been reported yet. CASE REPORT We report an Italian family that met the diagnostic criteria for CANVAS, and RFC1-expansion was detected in five of seven. All the affected members presented behavioral-psychiatric symptoms (anxiety, panic attacks, alcohol abuse) before the multisystemic RFC1-expansion manifestation. The disease course was progressive, with ataxia and behavioral-cognitive aspects as the most disabling symptoms. CONCLUSION These behavioral-cognitive observations may broaden the RFC1-expansion phenotypic spectrum and highlight the importance of investigating the whole non-motor symptoms in ataxic patients.
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Affiliation(s)
- Fabiana Colucci
- Department of Biomedical and Specialist Surgical Sciences, Section of Neurological, Psychiatric and Psychological Sciences, University of Ferrara, Ferrara, Italy.
| | - Daniela Di Bella
- Unit of Medical Genetics and Neurogenetics, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Chiara Pisciotta
- Unit of Rare Neurodegenerative and Neurometabolic Diseases, Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Elisa Sarto
- Unit of Medical Genetics and Neurogenetics, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Francesca Gualandi
- Unit of Medical Genetics, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Marcella Neri
- Unit of Medical Genetics, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Alessandra Ferlini
- Unit of Medical Genetics, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Elena Contaldi
- Department of Neurology and Movement Disorders Centre, Translational Medicine, University of Piemonte Orientale and "Maggiore della Carità" University Hospital, Novara, Italy
| | - Maura Pugliatti
- Department of Biomedical and Specialist Surgical Sciences, Section of Neurological, Psychiatric and Psychological Sciences, University of Ferrara, Ferrara, Italy.,Interdepartmental Research Center for the Study of Multiple Sclerosis and Inflammatory and Degenerative Diseases of the Nervous System, University of Ferrara, Ferrara, Italy
| | - Davide Pareyson
- Unit of Medical Genetics, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Mariachiara Sensi
- Department of Neuroscience and Rehabilitation, AziendaOspedaliera-Universitaria S. Anna, Ferrara, Italy
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Rezende TJR, Schmitt GS, de Lima FD, de Brito MR, Matos PCAAP, Bonadia LC, Martinez ARM, Cendes F, Pedroso JL, Barsottini OGP, Marques W, França MC. RFC1-Related Disorder: In Vivo Evaluation of Spinal Cord Damage. Mov Disord 2022; 37:2122-2128. [PMID: 35877029 DOI: 10.1002/mds.29169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/10/2022] [Accepted: 07/05/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND RFC1-related disorder is a novel heredodegenerative condition with a broad phenotypic spectrum. Its neuropathological bases are not yet fully understood, particularly regarding the pattern, extent, and clinical relevance of spinal cord (SC) damage. OBJECTIVES The objectives were to determine the SC structural signature in RFC1-related disorder in vivo and to identify potential clinical correlates for these imaging abnormalities. METHODS We enrolled 17 subjects with biallelic RFC1 (AAGGG)n expansions and 11 age- and sex-matched healthy controls that underwent multimodal magnetic resonance imaging SC acquisitions in a 3T Philips Achieva scanner. Both global morphometry and tract-specific analyses were then performed across all cervical levels. Between-group comparisons were assessed using nonparametric tests. RESULTS In the patient group, mean age and disease duration were 62.9 ± 9.3 and 9.3 ± 4.0, respectively. Compared to controls, patients had remarkable SC cross-sectional area reduction along all cervical levels but anteroposterior flattening only in the lower cervical levels. There was also prominent SC gray matter atrophy. Diffusivity abnormalities were identified in the dorsal columns but not in the lateral corticospinal tracts. Disease severity did not correlate with these imaging parameters. CONCLUSION SC damage is a hallmark of RFC1-related disorder and characterized by gray as well as white matter involvement. In particular, dorsal columns are severely and diffusely affected. The clinical correlates of these imaging abnormalities still deserve additional investigations. © 2022 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Thiago J R Rezende
- Department of Neurology, School of Medical Sciences-University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Gabriel S Schmitt
- Department of Neurology, School of Medical Sciences-University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Fabricio D de Lima
- Department of Neurology, School of Medical Sciences-University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Mariana Rabelo de Brito
- Department of Neurology, School of Medical Sciences-University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Paula Camila A A P Matos
- Ataxia Unit, Department of Neurology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Luciana Cardoso Bonadia
- Department of Medical Genetics, School of Medical Sciences-University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Alberto R M Martinez
- Department of Neurology, School of Medical Sciences-University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Fernando Cendes
- Department of Neurology, School of Medical Sciences-University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - José Luiz Pedroso
- Ataxia Unit, Department of Neurology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Orlando G P Barsottini
- Ataxia Unit, Department of Neurology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Wilson Marques
- Department of Neuroscience and Behavioral Science, School of Medicine-University of São Paulo (USP) of Ribeirão Preto, Ribeirão Preto, Brazil
| | - Marcondes Cavalcante França
- Department of Neurology, School of Medical Sciences-University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
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15
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Unravelling the etiology of sporadic late-onset cerebellar ataxia in a cohort of 205 patients: a prospective study. J Neurol 2022; 269:6354-6365. [DOI: 10.1007/s00415-022-11253-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 06/22/2022] [Accepted: 06/23/2022] [Indexed: 10/16/2022]
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16
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Screening for RFC-1 pathological expansion in late-onset ataxias: a contribution to the differential diagnosis. J Neurol 2022; 269:5431-5435. [PMID: 35633373 DOI: 10.1007/s00415-022-11192-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/10/2022] [Accepted: 05/12/2022] [Indexed: 10/18/2022]
Abstract
We screened 62 late-onset ataxia patients for the AAGGG pathological expansion in the RFC-1 gene that, when biallelic, causes Cerebellar Ataxia, Neuropathy, Vestibular Areflexia Syndrome (CANVAS). Nine patients tested positive. Six had a previous diagnosis of sporadic adult-onset ataxia (SAOA) and three of multisystem atrophy type C (MSA-C). Further six patients were heterozygous for the pathological RFC-1 expansion, four with an initial diagnosis of MSA-C and two of SAOA. In comparison with CANVAS, MSA-C patients had faster progression and shorter disease duration to walking with aids. An abnormal DaTscan does not seem to contribute to differential diagnosis between CANVAS and MSA-C.
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17
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Watanabe K, Nakashima M, Wakatsuki R, Bunai T, Ouchi Y, Nakamura T, Miyajima H, Saitsu H. Cognitive Impairment in a Complex Family With AAGGG and ACAGG Repeat Expansions in RFC1 Detected by ExpansionHunter Denovo. NEUROLOGY GENETICS 2022; 8:e682. [PMID: 36381255 PMCID: PMC9641967 DOI: 10.1212/nxg.0000000000000682] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 04/07/2022] [Indexed: 11/25/2022]
Abstract
Background and Objectives We investigated the genetic basis and brain metabolism and blood flow of a Japanese family with spinocerebellar degeneration (SCD), with multiple affected members for 3 generations. Methods After excluding DNA repeat expansion (RE) of common SCD genes by fragment analysis, we performed whole-exome sequencing (WES) and whole-genome sequencing (WGS). Homozygosity mapping was performed using these data. REs were investigated with WGS data using ExpansionHunter Denovo and Expansion Hunter. Results WES and WGS were unable to identify likely pathogenic variants, and homozygosity mapping failed to narrow down the locus. However, ExpansionHunter Denovo detected REs in intron 2 of the RFC1 gene and led us to the diagnosis of RFC1-related disorders. Subsequent repeat-primed PCR and Southern blot hybridization analyses revealed that 3 of 6 patients and 1 suspected individual had expansions of AAGGG ((AAGGG)exp) and (ACAGG)exp repeats in a compound heterozygous state and 3 had a homozygous (ACAGG)exp. The patients showed a variety of clinical features, including adult-onset ataxia, sensorimotor neuropathy, head tremor, parkinsonism, dystonia, and cognitive impairment. A comparison of previous reports with those of the family in study suggested that motor neuropathy could be a feature of compound heterozygous patients and biallelic (ACAGG)exp patients. Cognitive function tests showed cognitive impairment with a predominance of frontal lobe dysfunction. Examination of MRI, SPECT, and 18F-fluorodeoxyglucose-PET showed clear cortical damage with frontal lobe predominance in 1 case, but no cerebral damage was evident in the other 2 cases. Discussion Our report shows the usefulness of WGS and RE detection tools for SCD of unknown cause. The studied family with RFC1-related disorders included patients with (ACAGG)exp and (AAGGG)exp in a compound heterozygous state and was characterized by motor neuropathy. Based on the results of cognitive function tests and imaging studies, 1 patient presented with cognitive impairment due to frontal lobe metabolic changes, but there were also patients who presented with cognitive impairment without apparent cerebral metabolic or blood flow, suggesting that other factors are also associated with cognitive impairment.
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18
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Mascalchi M, Santorelli FM. The Strange Case of the Multiple MRI Phenotypes of RFC1 Mutation. THE CEREBELLUM 2022; 22:478-481. [PMID: 35359253 DOI: 10.1007/s12311-022-01401-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/28/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Mario Mascalchi
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence, Viale Pieraccini 6, 50130, Florence, Italy.
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19
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OUP accepted manuscript. Brain 2022; 145:e6-e9. [DOI: 10.1093/brain/awac003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/25/2021] [Accepted: 12/20/2021] [Indexed: 11/12/2022] Open
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20
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Huin V, Coarelli G, Guemy C, Boluda S, Debs R, Mochel F, Stojkovic T, Grabli D, Maisonobe T, Gaymard B, Lenglet T, Tard C, Davion JB, Sablonnière B, Monin ML, Ewenczyk C, Viala K, Charles P, Le Ber I, Reilly MM, Houlden H, Cortese A, Seilhean D, Brice A, Durr A. Motor neuron pathology in CANVAS due to RFC1 expansions. Brain 2021; 145:2121-2132. [DOI: 10.1093/brain/awab449] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/03/2021] [Accepted: 11/18/2021] [Indexed: 11/14/2022] Open
Abstract
Abstract
CANVAS caused by RFC1 biallelic expansions is a major cause of inherited sensory neuronopathy. Detection of RFC1 expansion is challenging and CANVAS can be associated with atypical features.
We clinically and genetically characterized 50 patients, selected based on the presence of sensory neuronopathy confirmed by EMG. We screened RFC1 expansion by PCR, repeat-primed PCR, and Southern blotting of long-range PCR products, a newly developed method. Neuropathological characterization was performed on the brain and spinal cord of one patient.
Most patients (88%) carried a biallelic (AAGGG)n expansion in RFC1. In addition to the core CANVAS phenotype (sensory neuronopathy, cerebellar syndrome, and vestibular impairment), we observed chronic cough (97%), oculomotor signs (85%), motor neuron involvement (55%), dysautonomia (50%), and parkinsonism (10%). Motor neuron involvement was found for 24 of 38 patients (63.1%). First motor neuron signs, such as brisk reflexes, extensor plantar responses, and/or spasticity, were present in 29% of patients, second motor neuron signs, such as fasciculations, wasting, weakness, or a neurogenic pattern on EMG in 18%, and both in 16%. Mixed motor and sensory neuronopathy was observed in 19% of patients. Among six non-RFC1 patients, one carried a heterozygous AAGGG expansion and a pathogenic variant in GRM1. Neuropathological examination of one RFC1 patient with an enriched phenotype, including parkinsonism, dysautonomia, and cognitive decline, showed posterior column and lumbar posterior root atrophy. Degeneration of the vestibulospinal and spinocerebellar tracts was mild. We observed marked astrocytic gliosis and axonal swelling of the synapse between first and second motor neurons in the anterior horn at the lumbar level. The cerebellum showed mild depletion of Purkinje cells, with empty baskets, torpedoes, and astrogliosis characterized by a disorganization of the Bergmann's radial glia. We found neuronal loss in the vagal nucleus. The pars compacta of the substantia nigra was depleted, with widespread Lewy bodies in the locus coeruleus, substantia nigra, hippocampus, entorhinal cortex, and amygdala.
We propose new guidelines for the screening of RFC1 expansion, considering different expansion motifs. Here, we developed a new method to more easily detect pathogenic RFC1 expansions. We report frequent motor neuron involvement and different neuronopathy subtypes. Parkinsonism was more prevalent in this cohort than in the general population, 10% versus the expected 1% (p < 0.001). We describe, for the first time, the spinal cord pathology in CANVAS, showing the alteration of posterior columns and roots, astrocytic gliosis and axonal swelling, suggesting motor neuron synaptic dysfunction.
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Affiliation(s)
- Vincent Huin
- Sorbonne Université, Paris Brain Institute, APHP, INSERM, CNRS, Paris, France
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog (JPARC) - Lille Neuroscience & Cognition, F-59000 Lille, France
| | - Giulia Coarelli
- Sorbonne Université, Paris Brain Institute, APHP, INSERM, CNRS, Paris, France
- AP-HP, Pitié Salpêtrière University Hospital, Genetics Department, Sorbonne University, Paris, France
| | - Clément Guemy
- Sorbonne Université, Paris Brain Institute, APHP, INSERM, CNRS, Paris, France
| | - Susana Boluda
- Sorbonne Université, Paris Brain Institute, APHP, INSERM, CNRS, Paris, France
- Laboratoire Neuropathologie Raymond Escourolle, AP-HP, Pitié Salpêtrière University Hospital, Sorbonne University, Paris, France
| | - Rabab Debs
- AP-HP, Pitié Salpêtrière University Hospital, Department of Neurology, Sorbonne University, Paris, France
| | - Fanny Mochel
- Sorbonne Université, Paris Brain Institute, APHP, INSERM, CNRS, Paris, France
- AP-HP, Pitié Salpêtrière University Hospital, Genetics Department, Sorbonne University, Paris, France
| | - Tanya Stojkovic
- Institut de Myologie, Centre de Référence de Pathologie Neuromusculaire Paris-Est, AP-HP, Pitié Salpêtrière University Hospital, Sorbonne University, Paris, France
| | - David Grabli
- AP-HP, Pitié Salpêtrière University Hospital, Department of Neurology, Sorbonne University, Paris, France
| | - Thierry Maisonobe
- Institut de Myologie, Centre de Référence de Pathologie Neuromusculaire Paris-Est, AP-HP, Pitié Salpêtrière University Hospital, Sorbonne University, Paris, France
| | - Bertrand Gaymard
- AP-HP, Pitié Salpêtrière University Hospital, Department of Neurophysiology, Sorbonne University, Paris, France
| | - Timothée Lenglet
- AP-HP, Pitié Salpêtrière University Hospital, Department of Neurophysiology, Sorbonne University, Paris, France
| | - Céline Tard
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog (JPARC) - Lille Neuroscience & Cognition, F-59000 Lille, France
- Centre de Référence des Maladies Neuromusculaires, CHU Lille, F-59000 Lille, France
| | - Jean-Baptiste Davion
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog (JPARC) - Lille Neuroscience & Cognition, F-59000 Lille, France
- Centre de Référence des Maladies Neuromusculaires, CHU Lille, F-59000 Lille, France
| | - Bernard Sablonnière
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog (JPARC) - Lille Neuroscience & Cognition, F-59000 Lille, France
| | | | - Claire Ewenczyk
- Sorbonne Université, Paris Brain Institute, APHP, INSERM, CNRS, Paris, France
- AP-HP, Pitié Salpêtrière University Hospital, Genetics Department, Sorbonne University, Paris, France
| | - Karine Viala
- Institut de Myologie, Centre de Référence de Pathologie Neuromusculaire Paris-Est, AP-HP, Pitié Salpêtrière University Hospital, Sorbonne University, Paris, France
| | - Perrine Charles
- Sorbonne Université, Paris Brain Institute, APHP, INSERM, CNRS, Paris, France
- AP-HP, Pitié Salpêtrière University Hospital, Genetics Department, Sorbonne University, Paris, France
| | - Isabelle Le Ber
- Sorbonne Université, Paris Brain Institute, APHP, INSERM, CNRS, Paris, France
- AP-HP, National Reference Center for “Rare and Young Dementia”, IM2A, Pitié-Salpêtrière University Hospital, Sorbonne University, Paris, France
| | - Mary M Reilly
- Department of Neuromuscular Disease, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
| | - Henry Houlden
- Department of Neuromuscular Disease, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
| | - Andrea Cortese
- Department of Neuromuscular Disease, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
| | - Danielle Seilhean
- Sorbonne Université, Paris Brain Institute, APHP, INSERM, CNRS, Paris, France
- Laboratoire Neuropathologie Raymond Escourolle, AP-HP, Pitié Salpêtrière University Hospital, Sorbonne University, Paris, France
| | - Alexis Brice
- Sorbonne Université, Paris Brain Institute, APHP, INSERM, CNRS, Paris, France
| | - Alexandra Durr
- Sorbonne Université, Paris Brain Institute, APHP, INSERM, CNRS, Paris, France
- AP-HP, Pitié Salpêtrière University Hospital, Genetics Department, Sorbonne University, Paris, France
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21
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Thieme A, Depienne C, Timmann D. Cerebellar ataxia, neuropathy and vestibular areflexia syndrome (CANVAS): from clinical diagnosis towards genetic testing. MED GENET-BERLIN 2021; 33:301-310. [PMID: 38835435 PMCID: PMC11006361 DOI: 10.1515/medgen-2021-2098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 11/12/2021] [Indexed: 06/06/2024]
Abstract
The cerebellar ataxia, neuropathy and vestibular areflexia syndrome (CANVAS) is a late-onset and recessively inherited ataxia. For many years, CANVAS has been diagnosed based on the clinical phenotype. Only recently, a large biallelic pentanucleotide repeat expansion in the replication factor C subunit 1 (RFC1) gene has been identified as the underlying genetic cause for the large majority of CANVAS cases. Subsequently, other phenotypes such as ataxia with chronic cough, incomplete CANVAS and MSA-C-like phenotypes have been associated with biallelic RFC1 repeat expansions. Because of this heterogeneity it has been suggested to change the name of the disease to "RFC1 disease". Chronic cough is characteristic and can precede neurological symptoms by years or decades. In the neurological examination signs of cerebellar, sensory, and vestibular ataxia are frequently observed. Nerve conduction studies usually show absent or markedly reduced sensory nerve action potentials. On brain MRI cerebellar degeneration and spinal cord alterations are common. In later disease stages more widespread neurodegeneration with additional involvement of the brainstem and basal ganglia is possible. As yet, the exact incidence of RFC1-associated neurological diseases remains uncertain although first studies suggest that RFC1-related ataxia is common. Moreover, the pathophysiological mechanisms caused by the large biallelic pentanucleotide repeat expansions in RFC1 remain elusive. Future molecular and genetic research as well as natural history studies are highly desirable to pave the way towards personalized treatment approaches.
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Affiliation(s)
- Andreas Thieme
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), Essen University Hospital, Hufelandstraße 55, 45147 Essen, Germany
| | - Christel Depienne
- Institute for Human Genetics, Essen University Hospital, Hufelandstraße 55, 45147 Essen, Germany
| | - Dagmar Timmann
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), Essen University Hospital, Hufelandstraße 55, 45147 Essen, Germany
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