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Braun AA, Jung HH. Systematic review of phenotypes in McLeod syndrome and case report of a progressive supranuclear palsy in a female carrier. Orphanet J Rare Dis 2024; 19:312. [PMID: 39183347 PMCID: PMC11346192 DOI: 10.1186/s13023-024-03309-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 08/06/2024] [Indexed: 08/27/2024] Open
Abstract
INTRODUCTION We present a systematic review of phenotypes of McLeod syndrome (MLS) and a case of a 73-year-old female carrier of the genetic alteration leading to MLS with the typical progressive supranuclear palsy (PSP) phenotype. METHODS To facilitate clinical reasoning and enable targeted diagnosis, we conducted a systematic review of the papers describing symptomatic cases of confirmed McLeod syndrome. This review follows the PRISMA 2020 statement: an updated guideline for reporting systematic reviews (Page et al in Syst Rev 10(1):89, 2021). RESULTS The average onset of MLS was at 40.2 years of age with chorea (46%), seizures and psychiatric changes (each 13%). Very common are weakened Kell antigen (100%), changes in muscle biopsy (100%), genetic alterations in XK (100%), elevated creatine kinase (97%), acanthocytes (96%), MRI changes (95%), chorea (84%) and hyporeflexia (82%). CONCLUSION This review of 65 males and 11 females gives a concise overview of clinical phenotypes in MLS, reinforcing our view that this female patient had PSP independent of MLS carrier status. This report highlights the pitfalls of anchoring in medical decision-making, particularly the possible diagnostic bias of a known genetic carrier status of a very rare disease.
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Affiliation(s)
- Andreas Albert Braun
- Department of Neurology, University Hospital Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland.
| | - Hans Heinrich Jung
- Department of Neurology, University Hospital Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland
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Dieter M, Kevin P, Tobias V, Andreas H, Lorenz N, Kathrin K, Nikolaus K, Juergen B, Jan R, Adrian D. Polysomnographic findings in the ultra-rare McLeod syndrome: further documentation of sleep apnea as a possible feature. J Clin Sleep Med 2024; 20:339-344. [PMID: 37811906 PMCID: PMC11019222 DOI: 10.5664/jcsm.10854] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 10/10/2023]
Abstract
STUDY OBJECTIVES McLeod syndrome is a very rare multisystemic neurodegenerative disease linked to mutations in the XK gene. It has cardiac, neurologic, and neuromuscular manifestations and shares similarities with Huntington's disease. The aim of this study was to evaluate sleep patterns of patients affected by McLeod syndrome. METHODS This retrospective case series of four males who underwent diagnostic polysomnography (mean age 53.8 ± 2.5 years) includes self-reported and objective evaluation of sleep using the Epworth Sleepiness Scale, genetic tests, documentation of clinical course and features, and laboratory-based full-night attended video-polysomnography. RESULTS In three out of four patients, an Epworth Sleepiness Scale score ≥ 7 was evident. The average apnea-hypopnea index was 45.0 ± 19.0, with predominantly obstructive phenotype in three patients and predominant central events (central sleep apnea syndrome) in one patient. A significantly increased periodic limb movement index during sleep was observed in all patients. All patients tolerated continuous positive airway pressure or pressure controlled therapy. CONCLUSIONS Polysomnography of all patients confirmed sleep apnea syndrome as a feature of McLeod syndrome. Three patients were diagnosed with obstructive sleep apnea and one with central sleep apnea syndrome. In addition, periodic limb movement index was increased in all patients. CITATION Dieter M, Kevin P, Tobias V, et al. Polysomnographic findings in the ultra-rare McLeod syndrome: further documentation of sleep apnea as a possible feature. J Clin Sleep Med. 2024;20(3):339-344.
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Affiliation(s)
- Munker Dieter
- Department of Medicine V, University Hospital, LMU Munich, Member of the German Center for Lung Research (DZL), Comprehensive Pneumology Center Munich, Munich, Germany
| | - Peikert Kevin
- Translational Neurodegeneration Section “Albrecht-Kossel,” Department of Neurology, University Medical Center, University of Rostock, Rostock, Germany
- Deutsches Zentrum für Neurodegenerative Erkrankungen Rostock/Greifswald, Rostock, Germany
- United Neuroscience Campus Lund-Rostock, Rostock Site, Rostock, Germany
| | - Veit Tobias
- Department of Medicine V, University Hospital, LMU Munich, Member of the German Center for Lung Research (DZL), Comprehensive Pneumology Center Munich, Munich, Germany
| | - Hermann Andreas
- Translational Neurodegeneration Section “Albrecht-Kossel,” Department of Neurology, University Medical Center, University of Rostock, Rostock, Germany
- Deutsches Zentrum für Neurodegenerative Erkrankungen Rostock/Greifswald, Rostock, Germany
- Center for Transdisciplinary Neurosciences Rostock, University Medical Center, Rostock, Germany
| | - Nowak Lorenz
- Department of Sleep Medicine, Asklepios Lung Clinic, Gauting, Germany
| | - Kahnert Kathrin
- Department of Medicine V, University Hospital, LMU Munich, Member of the German Center for Lung Research (DZL), Comprehensive Pneumology Center Munich, Munich, Germany
| | - Kneidinger Nikolaus
- Department of Medicine V, University Hospital, LMU Munich, Member of the German Center for Lung Research (DZL), Comprehensive Pneumology Center Munich, Munich, Germany
| | - Behr Juergen
- Department of Medicine V, University Hospital, LMU Munich, Member of the German Center for Lung Research (DZL), Comprehensive Pneumology Center Munich, Munich, Germany
| | - Remi Jan
- Department of Neurology, University Hospital of LMU Munich, Munich, Germany
| | - Danek Adrian
- Department of Neurology, University Hospital of LMU Munich, Munich, Germany
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Jiménez-Jiménez FJ, Alonso-Navarro H, García-Martín E, Agúndez JAG. Sleep Disorders in Patients with Choreic Syndromes. Curr Neurol Neurosci Rep 2023; 23:361-379. [PMID: 37269451 DOI: 10.1007/s11910-023-01274-2] [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] [Accepted: 05/16/2023] [Indexed: 06/05/2023]
Abstract
PURPOSE OF REVIEW Patients with different types of choreic syndromes, specially those with Huntington's (HD) and Wilson's (WD) diseases, report frequent sleep complaints. This review focuses on the main findings of studies addressing the sleep features in these diseases, and other less frequent causes of chorea associated with sleep disorders, including a new syndrome described in the last decade associated with IgLON5 antibodies. RECENT FINDINGS Patients with HD and WD showed a bad quality of sleep and high frequency of insomnia and excessive daytime somnolence. WD patients also showed high scores on a specific scale for rapid eye movement sleep behavior disorders. HD and WD share decreased sleep efficiency and increased REM sleep latencies, percentage of sleep stage N1, and wake after sleep onset (WASO) among their polysomnographic features. Patients with HD and WD showed a high prevalence of different sleep disorders. Patients with other causes of chorea, including neuroacanthocytosis, parasomnia with sleep breathing disorder associated with antibodies to IgLON5, Sydenham's chorea, and choreic syndromes associated to certain genetic mutations show sleep disorders as well.
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Affiliation(s)
- Félix Javier Jiménez-Jiménez
- Section of Neurology, Hospital Universitario del Sureste, Ronda del Sur 10 E-28500, Arganda del Rey, Madrid, Spain.
| | - Hortensia Alonso-Navarro
- Section of Neurology, Hospital Universitario del Sureste, Ronda del Sur 10 E-28500, Arganda del Rey, Madrid, Spain
| | - Elena García-Martín
- Universidad de Extremadura, University Institute of Molecular Pathology Biomarkers, Cáceres, Spain
| | - José A G Agúndez
- Universidad de Extremadura, University Institute of Molecular Pathology Biomarkers, Cáceres, Spain
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Lim MM, Sarva H, Hiller A, Feitell S, Oates P, Barone D, Walker RH. Sleep disorders in McLeod syndrome: A case series. Parkinsonism Relat Disord 2022; 102:86-88. [PMID: 35977449 DOI: 10.1016/j.parkreldis.2022.07.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 07/12/2022] [Accepted: 07/17/2022] [Indexed: 10/15/2022]
Affiliation(s)
- Miranda M Lim
- VA Portland Health Care System, Portland, OR, USA; Oregon Health & Science University, Department of Neurology, Portland, OR, USA; Oregon Health & Science University, Department of Behavioral Neuroscience, Portland, OR, USA; Oregon Health & Science University, Oregon Institute of Occupational Health Sciences, Portland, OR, USA; VA Portland Health Care System, National Center for Rehabilitative Auditory Research, Portland, OR, USA
| | - Harini Sarva
- Parkinson's Disease and Movement Disorders Institute, Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Amie Hiller
- Oregon Health & Science University, Department of Neurology, Portland, OR, USA; Parkinson's Disease Research, Education, and Clinical Center, VA Portland Health Care System, Portland, OR, USA
| | - Scott Feitell
- Sands-Constellation Heart Institute, Rochester Regional Health, Rochester, NY, USA
| | - Patricia Oates
- Sands-Constellation Heart Institute, Rochester Regional Health, Rochester, NY, USA
| | - Daniel Barone
- Division of Sleep Medicine, Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Ruth H Walker
- Department of Neurology, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA; Department of Neurology, Mount Sinai School of Medicine, New York, NY, USA.
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Floch A, Lomas-Francis C, Vege S, Westhoff CM. Three new XK alleles; two associated with a McLeod RBC phenotype. Transfusion 2021; 61:E69-E70. [PMID: 34487382 DOI: 10.1111/trf.16650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/04/2021] [Accepted: 08/11/2021] [Indexed: 12/27/2022]
Affiliation(s)
- Aline Floch
- Immunohematology and Genomics Laboratory, New York Blood Center, New York, USA.,Etablissement francais du sang Ile-de-France, Creteil, France.,Univ Paris Est Creteil, INSERM U955 Equipe 2 « Transfusion et maladies du globule rouge », IMRB, Creteil, France
| | | | - Sunitha Vege
- Immunohematology and Genomics Laboratory, New York Blood Center, New York, USA
| | - Connie M Westhoff
- Immunohematology and Genomics Laboratory, New York Blood Center, New York, USA
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Vaisfeld A, Bruno G, Petracca M, Bentivoglio AR, Servidei S, Vita MG, Bove F, Straccia G, Dato C, Di Iorio G, Sampaolo S, Peluso S, De Rosa A, De Michele G, Barghigiani M, Galatolo D, Tessa A, Santorelli F, Chiurazzi P, Melone MAB. Neuroacanthocytosis Syndromes in an Italian Cohort: Clinical Spectrum, High Genetic Variability and Muscle Involvement. Genes (Basel) 2021; 12:genes12030344. [PMID: 33652783 PMCID: PMC7996727 DOI: 10.3390/genes12030344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/17/2021] [Accepted: 02/22/2021] [Indexed: 01/12/2023] Open
Abstract
Neuroacanthocytosis (NA) syndromes are a group of genetically defined diseases characterized by the association of red blood cell acanthocytosis, progressive degeneration of the basal ganglia and neuromuscular features with characteristic persistent hyperCKemia. The main NA syndromes include autosomal recessive chorea-acanthocytosis (ChAc) and X-linked McLeod syndrome (MLS). A series of Italian patients selected through a multicenter study for these specific neurological phenotypes underwent DNA sequencing of the VPS13A and XK genes to search for causative mutations. Where it has been possible, muscle biopsies were obtained and thoroughly investigated with histochemical assays. A total of nine patients from five different families were diagnosed with ChAC and had mostly biallelic changes in the VPS13A gene (three nonsense, two frameshift, three splicing), while three patients from a single X-linked family were diagnosed with McLeod syndrome and had a deletion in the XK gene. Despite a very low incidence (only one thousand cases of ChAc and a few hundred MLS cases reported worldwide), none of the 8 VPS13A variants identified in our patients is shared by two families, suggesting the high genetic variability of ChAc in the Italian population. In our series, in line with epidemiological data, McLeod syndrome occurs less frequently than ChAc, although it can be easily suspected because of its X-linked mode of inheritance. Finally, histochemical studies strongly suggest that muscle pathology is not simply secondary to the axonal neuropathy, frequently seen in these patients, but primary myopathic alterations can be detected in both NA syndromes.
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Affiliation(s)
- Alessandro Vaisfeld
- Istituto di Medicina Genomica, Università Cattolica del Sacro Cuore, 00168 Roma, Italy;
| | - Giorgia Bruno
- Department of Advanced Medical and Surgical Sciences, 2nd Division of Neurology, Center for Rare Diseases and Interuniversity Center for Research in Neurosciences, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (G.B.); (G.S.); (C.D.); (G.D.I.); (S.S.); (M.A.B.M.)
| | - Martina Petracca
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Neurologia, 00168 Roma, Italy; (M.P.); (A.R.B.); (M.G.V.); (F.B.)
| | - Anna Rita Bentivoglio
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Neurologia, 00168 Roma, Italy; (M.P.); (A.R.B.); (M.G.V.); (F.B.)
- Dipartimento Universitario di Neuroscienze, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Serenella Servidei
- Dipartimento Universitario di Neuroscienze, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Neurofisiopatologia, 00168 Rome, Italy
| | - Maria Gabriella Vita
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Neurologia, 00168 Roma, Italy; (M.P.); (A.R.B.); (M.G.V.); (F.B.)
| | - Francesco Bove
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Neurologia, 00168 Roma, Italy; (M.P.); (A.R.B.); (M.G.V.); (F.B.)
- Dipartimento Universitario di Neuroscienze, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Giulia Straccia
- Department of Advanced Medical and Surgical Sciences, 2nd Division of Neurology, Center for Rare Diseases and Interuniversity Center for Research in Neurosciences, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (G.B.); (G.S.); (C.D.); (G.D.I.); (S.S.); (M.A.B.M.)
| | - Clemente Dato
- Department of Advanced Medical and Surgical Sciences, 2nd Division of Neurology, Center for Rare Diseases and Interuniversity Center for Research in Neurosciences, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (G.B.); (G.S.); (C.D.); (G.D.I.); (S.S.); (M.A.B.M.)
| | - Giuseppe Di Iorio
- Department of Advanced Medical and Surgical Sciences, 2nd Division of Neurology, Center for Rare Diseases and Interuniversity Center for Research in Neurosciences, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (G.B.); (G.S.); (C.D.); (G.D.I.); (S.S.); (M.A.B.M.)
| | - Simone Sampaolo
- Department of Advanced Medical and Surgical Sciences, 2nd Division of Neurology, Center for Rare Diseases and Interuniversity Center for Research in Neurosciences, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (G.B.); (G.S.); (C.D.); (G.D.I.); (S.S.); (M.A.B.M.)
| | - Silvio Peluso
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Federico II University, 80138 Naples, Italy; (S.P.); (A.D.R.); (G.D.M.)
| | - Anna De Rosa
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Federico II University, 80138 Naples, Italy; (S.P.); (A.D.R.); (G.D.M.)
| | - Giuseppe De Michele
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Federico II University, 80138 Naples, Italy; (S.P.); (A.D.R.); (G.D.M.)
| | - Melissa Barghigiani
- Molecular Medicine, IRCCS Fondazione Stella Maris, 56128 Pisa, Italy; (M.B.); (D.G.); (A.T.); (F.S.)
| | - Daniele Galatolo
- Molecular Medicine, IRCCS Fondazione Stella Maris, 56128 Pisa, Italy; (M.B.); (D.G.); (A.T.); (F.S.)
| | - Alessandra Tessa
- Molecular Medicine, IRCCS Fondazione Stella Maris, 56128 Pisa, Italy; (M.B.); (D.G.); (A.T.); (F.S.)
| | - Filippo Santorelli
- Molecular Medicine, IRCCS Fondazione Stella Maris, 56128 Pisa, Italy; (M.B.); (D.G.); (A.T.); (F.S.)
| | - Pietro Chiurazzi
- Istituto di Medicina Genomica, Università Cattolica del Sacro Cuore, 00168 Roma, Italy;
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC Genetica Medica, 00168 Roma, Italy
- Correspondence: ; Tel.: +39-338-8361006
| | - Mariarosa Anna Beatrice Melone
- Department of Advanced Medical and Surgical Sciences, 2nd Division of Neurology, Center for Rare Diseases and Interuniversity Center for Research in Neurosciences, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (G.B.); (G.S.); (C.D.); (G.D.I.); (S.S.); (M.A.B.M.)
- Sbarro Institute for Cancer Research and Molecular Medicine, Center for Biotechnology, Temple University, Philadelphia, PA 19122-6078, USA
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