Fragile X-associated tremor ataxia syndrome presenting as chronic fatigue syndrome

Pathological Study of a FMR1 Premutation Carrier With Progressive Supranuclear Palsy

Dual pathology in fragile X mental retardation 1 (FMR1) premutation carriers and fragile X–associated tremor/ataxia syndrome (FXTAS) patients is an emerging phenomenon. Although it includes atypical parkinsonism, neuropathological confirmation is very scarce. Here, we describe neuropathological findings for a female who suffered a severe parkinsonian syndrome with apraxia and supranuclear palsy. She died at the age of 50, six years after the initial diagnosis. Prominent neuronal loss was found in the pallidum, subthalamic nucleus, and tectum, but the loss of Purkinje cells was rather mild. Intranuclear inclusions containing ubiquitin and FMRpolyglycine, a pathological hallmark of FXTAS, were detected in neurons and astrocytes. However, this inclusion pathology was overshadowed by a very prominent four repeat tau accumulation in tufted astrocytes, oligodendroglial coiled bodies, thread structures, and neurons. This is, to best of our knowledge, the first report describing a pathologically confirmed progressive supranuclear palsy – corticobasal syndrome (PSP-CBS) variant case in a FMR1 premutation carrier.

Fragile X–tremor/ataxia syndrome: five areas of new development

Fragile X–tremor/ataxia syndrome is a relatively newly discovered movement disorder usually affecting patients over the age of 50 who have a FMR1 gene with 55–200 CGG repeats. Patients present with tremor and ataxia and possibly executive dysfunction and peripheral neuropathy. Fragile X–tremor/ataxia syndrome patients have several unique MRI findings including white matter lesions of the middle cerebellar peduncle and splenium of the corpus callosum. The genetics and treatment of this condition are co-developing rapidly as we search for more therapeutic modalities to offer these patients. We will present the latest information available regarding this fascinating syndrome and provide our hypothesis regarding the future focus of research.