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Lv S, Tai H, Sun J, Zhuo Z, Duan Y, Liu S, Wang A, Zhang Z, Liu Y. Mapping macrostructural and microstructural brain alterations in patients with neuronal intranuclear inclusion disease. Neuroradiology 2024; 66:1373-1382. [PMID: 38866958 DOI: 10.1007/s00234-024-03406-y] [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: 03/14/2024] [Accepted: 06/09/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND AND PURPOSE Neuronal intranuclear inclusion disease (NIID) is a rare complex neurodegenerative disorder presents with various radiological features. The study aimed to investigate the structural abnormalities in NIID using multi-shell diffusion MR. MATERIALS AND METHODS Twenty-eight patients with adult-onset NIID and 32 healthy controls were included. Volumetric and diffusion MRI measures, including volume, fractional anisotropy (FA), mean diffusivity (MD), intracellular volume fraction (ICVF), orientation dispersion index (ODI), and isotropic volume fraction (ISOVF) of six brain structures, including cortex, subcortical GM, cerebral WM, cerebellar GM and WM, and brainstem, were obtained and compared between NIID and healthy controls. Associations between MRI measures and clinical variables were investigated. RESULTS Brain lesions of NIID included corticomedullary junction lesions on DWI, confluent leukoencephalopathy, lesions on callosum, cerebellar middle peduncle, cerebellar paravermal area and brainstem, and brain atrophy. Compared to healthy controls, NIID showed extensive volume loss of all the six brain regions (all p < 0.001); lower FA in cerebral WM (p < 0.001); higher MD in all WM regions; lower ODI in cortex (p < 0.001); higher ODI in subcortical GM (p < 0.001) and brainstem (p = 0.016); lower ICVF in brainstem (p = 0.001), and cerebral WM (p < 0.001); higher ISOVF in all the brain regions (p < 0.001). Higher MD of cerebellar WM was associated with worse cognitive level as evaluated by MoCA scores (p = 0.011). CONCLUSIONS NIID patients demonstrated widespread brain atrophy but heterogeneous diffusion alterations. Cerebellar WM integrity impairment was correlated with the cognitive decline. The findings of the current study offer a sophisticated picture of brain structural alterations in NIID.
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Affiliation(s)
- Shan Lv
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
- Tiantan Image Research Center, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Hongfei Tai
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jun Sun
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
- Tiantan Image Research Center, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Zhizheng Zhuo
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
- Tiantan Image Research Center, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yunyun Duan
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
- Tiantan Image Research Center, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Shaocheng Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - An Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Zaiqiang Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.
- China National Clinical Research Center for Neurological Diseases, Beijing, China.
| | - Yaou Liu
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.
- Tiantan Image Research Center, China National Clinical Research Center for Neurological Diseases, Beijing, China.
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Vegezzi E, Ishiura H, Bragg DC, Pellerin D, Magrinelli F, Currò R, Facchini S, Tucci A, Hardy J, Sharma N, Danzi MC, Zuchner S, Brais B, Reilly MM, Tsuji S, Houlden H, Cortese A. Neurological disorders caused by novel non-coding repeat expansions: clinical features and differential diagnosis. Lancet Neurol 2024; 23:725-739. [PMID: 38876750 DOI: 10.1016/s1474-4422(24)00167-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 04/04/2024] [Accepted: 04/09/2024] [Indexed: 06/16/2024]
Abstract
Nucleotide repeat expansions in the human genome are a well-known cause of neurological disease. In the past decade, advances in DNA sequencing technologies have led to a better understanding of the role of non-coding DNA, that is, the DNA that is not transcribed into proteins. These techniques have also enabled the identification of pathogenic non-coding repeat expansions that cause neurological disorders. Mounting evidence shows that adult patients with familial or sporadic presentations of epilepsy, cognitive dysfunction, myopathy, neuropathy, ataxia, or movement disorders can be carriers of non-coding repeat expansions. The description of the clinical, epidemiological, and molecular features of these recently identified non-coding repeat expansion disorders should guide clinicians in the diagnosis and management of these patients, and help in the genetic counselling for patients and their families.
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Affiliation(s)
| | - Hiroyuki Ishiura
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - D Cristopher Bragg
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - David Pellerin
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK; Department of Neurology and Neurosurgery, Montreal Neurological Hospital and Institute, McGill University, Montreal, QC, Canada
| | - Francesca Magrinelli
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
| | - Riccardo Currò
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Stefano Facchini
- IRCCS Mondino Foundation, Pavia, Italy; Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
| | - Arianna Tucci
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK; William Harvey Research Institute, Queen Mary University of London, London, UK
| | - John Hardy
- Department of Neurogedengerative Disease, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
| | - Nutan Sharma
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Matt C Danzi
- Department of Human Genetics and Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Stephan Zuchner
- Department of Human Genetics and Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Bernard Brais
- Department of Neurology and Neurosurgery, Montreal Neurological Hospital and Institute, McGill University, Montreal, QC, Canada
| | - Mary M Reilly
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
| | - Shoji Tsuji
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Institute of Medical Genomics, International University of Health and Welfare, Chiba, Japan
| | - Henry Houlden
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
| | - Andrea Cortese
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
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Jih KY, Lan MY, Liu YH, Tsai YS, Lin PY, Lai KL, Liao YC, Lee YC. Nerve conduction features may serve as a diagnostic clue for neuronal intranuclear inclusion disease. Brain Commun 2024; 6:fcae221. [PMID: 38978725 PMCID: PMC11229697 DOI: 10.1093/braincomms/fcae221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 05/30/2024] [Accepted: 06/25/2024] [Indexed: 07/10/2024] Open
Abstract
Neuronal intranuclear inclusion disease is a neurodegenerative disorder with a wide phenotypic spectrum, including peripheral neuropathy. This study aims to characterize the nerve conduction features and proposes an electrophysiological criterion to assist the diagnosis of neuronal intranuclear inclusion disease. In this study, nerve conduction studies were performed in 50 genetically confirmed neuronal intranuclear inclusion disease patients, 200 age- and sex-matched healthy controls and 40 patients with genetically unsolved leukoencephalopathy. Abnormal electrophysiological parameters were defined as mean values plus or minus two standardized deviations of the healthy controls or failure to evoke a response on the examined nerves. Compared to controls, neuronal intranuclear inclusion disease patients had significantly slower motor and sensory nerve conduction velocities, as well as lower amplitudes of compound motor action potentials and sensory nerve action potentials in all tested nerves (P < 0.05). Forty-eight of the 50 neuronal intranuclear inclusion disease patients (96%) had at least one abnormal electrophysiological parameter, with slowing of motor nerve conduction velocities being the most prevalent characteristic. The motor nerve conduction velocities of median, ulnar, peroneal and tibial nerves were 44.2 ± 5.5, 45.3 ± 6.1, 37.3 ± 5.3 and 35.6 ± 5.1 m/s, respectively, which were 12.4-13.6 m/s slower than those of the controls. The electrophysiological features were similar between neuronal intranuclear inclusion disease patients manifesting with CNS symptoms and those with PNS-predominant presentations. Thirteen of the 14 patients (93%) who underwent nerve conduction study within the first year of symptom onset exhibited abnormal findings, indicating that clinical or subclinical peripheral neuropathy is an early disease marker of neuronal intranuclear inclusion disease. We then assessed the feasibility of using motor nerve conduction velocity as a diagnostic tool of neuronal intranuclear inclusion disease and evaluated the diagnostic performance of various combinations of nerve conduction parameters using receiver operating characteristic curve analysis. The criterion of having at least two nerves with motor nerve conduction velocity ranging from 35 to 50 m/s in median/ulnar nerves and 30-40 m/s in tibial/peroneal nerves demonstrated high sensitivity (90%) and specificity (99%), with an area under the curve of 0.95, to distinguish neuronal intranuclear inclusion disease patients from healthy controls. The criterion's diagnostic performance was validated on an independent cohort of 56 literature reported neuronal intranuclear inclusion disease cases (area under the curve = 0.93, sensitivity = 87.5%, specificity = 99.0%), and in distinguishing neuronal intranuclear inclusion disease from genetically unresolved leukoencephalopathy cases (sensitivity = 90.0%, specificity = 80.0%). In conclusion, mildly to moderately decreased motor nerve conduction velocity in multiple nerves is a significant electrophysiological hallmark assisting the diagnosis of neuronal intranuclear inclusion disease, regardless of CNS- or PNS-predominant manifestations.
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Affiliation(s)
- Kang-Yang Jih
- Department of Neurology, Taipei Veterans General Hospital, Taipei 112, Taiwan
- Department of Neurology, National Yang Ming Chiao Tung University School of Medicine, Taipei 112, Taiwan
- Department of Physiology, National Yang Ming Chiao Tung University School of Medicine, Taipei 112, Taiwan
| | - Min-Yu Lan
- Department of Neurology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
- Center for Parkinson’s Disease, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
| | - Yi-Hong Liu
- Department of Neurology, Taipei Veterans General Hospital, Taipei 112, Taiwan
- Department of Neurology, National Yang Ming Chiao Tung University School of Medicine, Taipei 112, Taiwan
| | - Yu-Shuen Tsai
- Cancer and Immunology Research Center, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - Po-Yu Lin
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Kuan-Lin Lai
- Department of Neurology, Taipei Veterans General Hospital, Taipei 112, Taiwan
- Department of Neurology, National Yang Ming Chiao Tung University School of Medicine, Taipei 112, Taiwan
| | - Yi-Chu Liao
- Department of Neurology, Taipei Veterans General Hospital, Taipei 112, Taiwan
- Department of Neurology, National Yang Ming Chiao Tung University School of Medicine, Taipei 112, Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - Yi-Chung Lee
- Department of Neurology, Taipei Veterans General Hospital, Taipei 112, Taiwan
- Department of Neurology, National Yang Ming Chiao Tung University School of Medicine, Taipei 112, Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Center for Intelligent Drug Systems and Smart Bio-devices (IDS2B), National Yang Ming Chiao Tung University, Hsinchu 300, Taiwan
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Lee S, Yoon JG, Hong J, Kim T, Kim N, Vandrovcova J, Yau WY, Cho J, Kim S, Kim MJ, Kim SY, Lee ST, Chu K, Lee SK, Kim HJ, Choi J, Moon J, Chae JH. Prevalence and Characterization of NOTCH2NLC GGC Repeat Expansions in Koreans: From a Hospital Cohort Analysis to a Population-Wide Study. Neurol Genet 2024; 10:e200147. [PMID: 38779172 PMCID: PMC11110025 DOI: 10.1212/nxg.0000000000200147] [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: 10/31/2023] [Accepted: 02/16/2024] [Indexed: 05/25/2024]
Abstract
Background and Objectives GGC repeat expansions in the NOTCH2NLC gene are associated with a broad spectrum of progressive neurologic disorders, notably, neuronal intranuclear inclusion disease (NIID). We aimed to investigate the population-wide prevalence and clinical manifestations of NOTCH2NLC-related disorders in Koreans. Methods We conducted a study using 2 different cohorts from the Korean population. Patients with available brain MRI scans from Seoul National University Hospital (SNUH) were thoroughly reviewed, and NIID-suspected patients presenting the zigzag edging signs underwent genetic evaluation for NOTCH2NLC repeats by Cas9-mediated nanopore sequencing. In addition, we analyzed whole-genome sequencing data from 3,887 individuals in the Korea Biobank cohort to estimate the distribution of the repeat counts in Koreans and to identify putative patients with expanded alleles and neurologic phenotypes. Results In the SNUH cohort, among 90 adult-onset leukoencephalopathy patients with unknown etiologies, we found 20 patients with zigzag edging signs. Except for 2 diagnosed with fragile X-associated tremor/ataxia syndrome and 2 with unavailable samples, all 16 patients (17.8%) were diagnosed with NIID (repeat range: 87-217). By analyzing the Korea Biobank cohort, we estimated the distribution of repeat counts and threshold (>64) for Koreans, identifying 6 potential patients with NIID. Furthermore, long-read sequencing enabled the elucidation of transmission and epigenetic patterns of NOTCH2NLC repeats within a family affected by pediatric-onset NIID. Discussion This study presents the population-wide distribution of NOTCH2NLC repeats and the estimated prevalence of NIID in Koreans, providing valuable insights into the association between repeat counts and disease manifestations in diverse neurologic disorders.
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Affiliation(s)
| | | | | | - Taekeun Kim
- From the Department of Genomic Medicine (S.L., J.G.Y., Jaeso Cho, S.K., M.J.K., S.Y.K., J.M., J.-H.C.), Seoul National University Hospital; Department of Pediatrics (S.L., Jaeso Cho, S.Y.K., J.-H.C.), Seoul National University College of Medicine, Seoul National University Children's Hospital; Department of Biomedical Sciences (J.H., T.K., Jungmin Choi), Korea University College of Medicine; Department of Neurology (N.K., S.-T.L., K.C., S.K.L., H.-J.K., J.M.), Seoul National University Hospital, Korea; Department of Neuromuscular Diseases (J.V.), Institute of Neurology, University College London, United Kingdom; Perron Institute for Neurological and Translational Science (W.Y.Y.), the University of Western Australia, Nedlands, Australia; and Department of Laboratory Medicine (M.J.K.), Seoul National University Hospital, Korea
| | - Narae Kim
- From the Department of Genomic Medicine (S.L., J.G.Y., Jaeso Cho, S.K., M.J.K., S.Y.K., J.M., J.-H.C.), Seoul National University Hospital; Department of Pediatrics (S.L., Jaeso Cho, S.Y.K., J.-H.C.), Seoul National University College of Medicine, Seoul National University Children's Hospital; Department of Biomedical Sciences (J.H., T.K., Jungmin Choi), Korea University College of Medicine; Department of Neurology (N.K., S.-T.L., K.C., S.K.L., H.-J.K., J.M.), Seoul National University Hospital, Korea; Department of Neuromuscular Diseases (J.V.), Institute of Neurology, University College London, United Kingdom; Perron Institute for Neurological and Translational Science (W.Y.Y.), the University of Western Australia, Nedlands, Australia; and Department of Laboratory Medicine (M.J.K.), Seoul National University Hospital, Korea
| | - Jana Vandrovcova
- From the Department of Genomic Medicine (S.L., J.G.Y., Jaeso Cho, S.K., M.J.K., S.Y.K., J.M., J.-H.C.), Seoul National University Hospital; Department of Pediatrics (S.L., Jaeso Cho, S.Y.K., J.-H.C.), Seoul National University College of Medicine, Seoul National University Children's Hospital; Department of Biomedical Sciences (J.H., T.K., Jungmin Choi), Korea University College of Medicine; Department of Neurology (N.K., S.-T.L., K.C., S.K.L., H.-J.K., J.M.), Seoul National University Hospital, Korea; Department of Neuromuscular Diseases (J.V.), Institute of Neurology, University College London, United Kingdom; Perron Institute for Neurological and Translational Science (W.Y.Y.), the University of Western Australia, Nedlands, Australia; and Department of Laboratory Medicine (M.J.K.), Seoul National University Hospital, Korea
| | - Wai Yan Yau
- From the Department of Genomic Medicine (S.L., J.G.Y., Jaeso Cho, S.K., M.J.K., S.Y.K., J.M., J.-H.C.), Seoul National University Hospital; Department of Pediatrics (S.L., Jaeso Cho, S.Y.K., J.-H.C.), Seoul National University College of Medicine, Seoul National University Children's Hospital; Department of Biomedical Sciences (J.H., T.K., Jungmin Choi), Korea University College of Medicine; Department of Neurology (N.K., S.-T.L., K.C., S.K.L., H.-J.K., J.M.), Seoul National University Hospital, Korea; Department of Neuromuscular Diseases (J.V.), Institute of Neurology, University College London, United Kingdom; Perron Institute for Neurological and Translational Science (W.Y.Y.), the University of Western Australia, Nedlands, Australia; and Department of Laboratory Medicine (M.J.K.), Seoul National University Hospital, Korea
| | - Jaeso Cho
- From the Department of Genomic Medicine (S.L., J.G.Y., Jaeso Cho, S.K., M.J.K., S.Y.K., J.M., J.-H.C.), Seoul National University Hospital; Department of Pediatrics (S.L., Jaeso Cho, S.Y.K., J.-H.C.), Seoul National University College of Medicine, Seoul National University Children's Hospital; Department of Biomedical Sciences (J.H., T.K., Jungmin Choi), Korea University College of Medicine; Department of Neurology (N.K., S.-T.L., K.C., S.K.L., H.-J.K., J.M.), Seoul National University Hospital, Korea; Department of Neuromuscular Diseases (J.V.), Institute of Neurology, University College London, United Kingdom; Perron Institute for Neurological and Translational Science (W.Y.Y.), the University of Western Australia, Nedlands, Australia; and Department of Laboratory Medicine (M.J.K.), Seoul National University Hospital, Korea
| | - Sheehyun Kim
- From the Department of Genomic Medicine (S.L., J.G.Y., Jaeso Cho, S.K., M.J.K., S.Y.K., J.M., J.-H.C.), Seoul National University Hospital; Department of Pediatrics (S.L., Jaeso Cho, S.Y.K., J.-H.C.), Seoul National University College of Medicine, Seoul National University Children's Hospital; Department of Biomedical Sciences (J.H., T.K., Jungmin Choi), Korea University College of Medicine; Department of Neurology (N.K., S.-T.L., K.C., S.K.L., H.-J.K., J.M.), Seoul National University Hospital, Korea; Department of Neuromuscular Diseases (J.V.), Institute of Neurology, University College London, United Kingdom; Perron Institute for Neurological and Translational Science (W.Y.Y.), the University of Western Australia, Nedlands, Australia; and Department of Laboratory Medicine (M.J.K.), Seoul National University Hospital, Korea
| | - Man Jin Kim
- From the Department of Genomic Medicine (S.L., J.G.Y., Jaeso Cho, S.K., M.J.K., S.Y.K., J.M., J.-H.C.), Seoul National University Hospital; Department of Pediatrics (S.L., Jaeso Cho, S.Y.K., J.-H.C.), Seoul National University College of Medicine, Seoul National University Children's Hospital; Department of Biomedical Sciences (J.H., T.K., Jungmin Choi), Korea University College of Medicine; Department of Neurology (N.K., S.-T.L., K.C., S.K.L., H.-J.K., J.M.), Seoul National University Hospital, Korea; Department of Neuromuscular Diseases (J.V.), Institute of Neurology, University College London, United Kingdom; Perron Institute for Neurological and Translational Science (W.Y.Y.), the University of Western Australia, Nedlands, Australia; and Department of Laboratory Medicine (M.J.K.), Seoul National University Hospital, Korea
| | - Soo Yeon Kim
- From the Department of Genomic Medicine (S.L., J.G.Y., Jaeso Cho, S.K., M.J.K., S.Y.K., J.M., J.-H.C.), Seoul National University Hospital; Department of Pediatrics (S.L., Jaeso Cho, S.Y.K., J.-H.C.), Seoul National University College of Medicine, Seoul National University Children's Hospital; Department of Biomedical Sciences (J.H., T.K., Jungmin Choi), Korea University College of Medicine; Department of Neurology (N.K., S.-T.L., K.C., S.K.L., H.-J.K., J.M.), Seoul National University Hospital, Korea; Department of Neuromuscular Diseases (J.V.), Institute of Neurology, University College London, United Kingdom; Perron Institute for Neurological and Translational Science (W.Y.Y.), the University of Western Australia, Nedlands, Australia; and Department of Laboratory Medicine (M.J.K.), Seoul National University Hospital, Korea
| | - Soon-Tae Lee
- From the Department of Genomic Medicine (S.L., J.G.Y., Jaeso Cho, S.K., M.J.K., S.Y.K., J.M., J.-H.C.), Seoul National University Hospital; Department of Pediatrics (S.L., Jaeso Cho, S.Y.K., J.-H.C.), Seoul National University College of Medicine, Seoul National University Children's Hospital; Department of Biomedical Sciences (J.H., T.K., Jungmin Choi), Korea University College of Medicine; Department of Neurology (N.K., S.-T.L., K.C., S.K.L., H.-J.K., J.M.), Seoul National University Hospital, Korea; Department of Neuromuscular Diseases (J.V.), Institute of Neurology, University College London, United Kingdom; Perron Institute for Neurological and Translational Science (W.Y.Y.), the University of Western Australia, Nedlands, Australia; and Department of Laboratory Medicine (M.J.K.), Seoul National University Hospital, Korea
| | - Kon Chu
- From the Department of Genomic Medicine (S.L., J.G.Y., Jaeso Cho, S.K., M.J.K., S.Y.K., J.M., J.-H.C.), Seoul National University Hospital; Department of Pediatrics (S.L., Jaeso Cho, S.Y.K., J.-H.C.), Seoul National University College of Medicine, Seoul National University Children's Hospital; Department of Biomedical Sciences (J.H., T.K., Jungmin Choi), Korea University College of Medicine; Department of Neurology (N.K., S.-T.L., K.C., S.K.L., H.-J.K., J.M.), Seoul National University Hospital, Korea; Department of Neuromuscular Diseases (J.V.), Institute of Neurology, University College London, United Kingdom; Perron Institute for Neurological and Translational Science (W.Y.Y.), the University of Western Australia, Nedlands, Australia; and Department of Laboratory Medicine (M.J.K.), Seoul National University Hospital, Korea
| | - Sang Kun Lee
- From the Department of Genomic Medicine (S.L., J.G.Y., Jaeso Cho, S.K., M.J.K., S.Y.K., J.M., J.-H.C.), Seoul National University Hospital; Department of Pediatrics (S.L., Jaeso Cho, S.Y.K., J.-H.C.), Seoul National University College of Medicine, Seoul National University Children's Hospital; Department of Biomedical Sciences (J.H., T.K., Jungmin Choi), Korea University College of Medicine; Department of Neurology (N.K., S.-T.L., K.C., S.K.L., H.-J.K., J.M.), Seoul National University Hospital, Korea; Department of Neuromuscular Diseases (J.V.), Institute of Neurology, University College London, United Kingdom; Perron Institute for Neurological and Translational Science (W.Y.Y.), the University of Western Australia, Nedlands, Australia; and Department of Laboratory Medicine (M.J.K.), Seoul National University Hospital, Korea
| | - Han-Joon Kim
- From the Department of Genomic Medicine (S.L., J.G.Y., Jaeso Cho, S.K., M.J.K., S.Y.K., J.M., J.-H.C.), Seoul National University Hospital; Department of Pediatrics (S.L., Jaeso Cho, S.Y.K., J.-H.C.), Seoul National University College of Medicine, Seoul National University Children's Hospital; Department of Biomedical Sciences (J.H., T.K., Jungmin Choi), Korea University College of Medicine; Department of Neurology (N.K., S.-T.L., K.C., S.K.L., H.-J.K., J.M.), Seoul National University Hospital, Korea; Department of Neuromuscular Diseases (J.V.), Institute of Neurology, University College London, United Kingdom; Perron Institute for Neurological and Translational Science (W.Y.Y.), the University of Western Australia, Nedlands, Australia; and Department of Laboratory Medicine (M.J.K.), Seoul National University Hospital, Korea
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Zhang T, Chancellor A, Liem B, Turner C, Hutchinson D, Wong E, Glamuzina E, Hong JB, Cleland J, Child N, Roxburgh RH, Patel S, Lee YC, Liao YC, Anderson NE. Neuronal intranuclear inclusion disease in New Zealand: A novel discovery. J Neurol Sci 2024; 460:122987. [PMID: 38579412 DOI: 10.1016/j.jns.2024.122987] [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: 01/16/2024] [Revised: 02/24/2024] [Accepted: 03/31/2024] [Indexed: 04/07/2024]
Abstract
Neuronal intranuclear inclusion disease, caused by a GGC repeat expansion in the 5'-untranslated region of NOTCH2NLC, is a rare neurodegenerative condition with highly variable clinical manifestations. In recent years, the number of reported cases have increased dramatically in East Asia. We report the first four genetically confirmed cases of neuronal intranuclear inclusion disease in New Zealand, all having Polynesian ancestry (three New Zealand Māori and one Cook Island Māori). Phenotypically, they resemble cases reported from recent large East Asian cohorts.
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Affiliation(s)
- Tony Zhang
- Department of Neurology, Auckland City Hospital, Te Whatu Ora Te Toka Tumai, Auckland, New Zealand.
| | - Andrew Chancellor
- Tauranga Hospital, New Zealand Te Whatu Ora Hauora a Toi, Bay of Plenty, New Zealand
| | - Bernard Liem
- Department of Neurology, Auckland City Hospital, Te Whatu Ora Te Toka Tumai, Auckland, New Zealand
| | - Clinton Turner
- Department of Anatomical Pathology and Cytology, Auckland City Hospital, Te Whatu Ora Te Toka Tumai, Auckland, New Zealand
| | - David Hutchinson
- Department of Neurology, Auckland City Hospital, Te Whatu Ora Te Toka Tumai, Auckland, New Zealand
| | - Edward Wong
- Department of Neurology, Auckland City Hospital, Te Whatu Ora Te Toka Tumai, Auckland, New Zealand
| | - Emma Glamuzina
- Adult and Paediatric Metabolic Service, Auckland City Hospital, Te Whatu Ora Te Toka Tumai, Auckland, New Zealand
| | - Jae Beom Hong
- Department of Neurology, Auckland City Hospital, Te Whatu Ora Te Toka Tumai, Auckland, New Zealand
| | - James Cleland
- Tauranga Hospital, New Zealand Te Whatu Ora Hauora a Toi, Bay of Plenty, New Zealand
| | - Nicholas Child
- Department of Neurology, Auckland City Hospital, Te Whatu Ora Te Toka Tumai, Auckland, New Zealand
| | - Richard H Roxburgh
- Department of Neurology, Auckland City Hospital, Te Whatu Ora Te Toka Tumai, Auckland, New Zealand
| | - Shilpan Patel
- Department of Neurology, Auckland City Hospital, Te Whatu Ora Te Toka Tumai, Auckland, New Zealand
| | - Yi-Chung Lee
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Neurology and Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Chu Liao
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Neurology and Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Neil E Anderson
- Department of Neurology, Auckland City Hospital, Te Whatu Ora Te Toka Tumai, Auckland, New Zealand
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Lu Y, Chen Y, Huang J, Jiang Z, Ge Y, Yao R, Zhang J, Geng S, Chen F, Jin Q, Chen G, Yang D. Advances of NOTCH2NLC Repeat Expansions and Associated Diseases: A Bibliometric and Meta-analysis. Mol Neurobiol 2024:10.1007/s12035-024-04193-6. [PMID: 38709391 DOI: 10.1007/s12035-024-04193-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/19/2024] [Indexed: 05/07/2024]
Abstract
The unclear pathogenic mechanisms of neurodegenerative disorders stemming from NOTCH2NLC GGC repeat expansions drive focused research. Thus, a bibliometric and meta-analysis was conducted to uncover research trends and positivity rates in NOTCH2NLC. We conducted systematic searches in the Web of Science, PubMed, Embase, and Scopus databases for studies related to NOTCH2NLC up until August 2, 2023. Information regarding countries, institutions, authors, journals, and keywords of studies included in the Web of Science was analyzed and visualized. The positivity rates of NOTCH2NLC GGC repeat expansions across all screened patients and patients' families were pooled under the random-effects model. Publication bias and its impact were examined using funnel plots, Egger's linear regression, and trim-and-fill method. The bibliometric analysis, revealing pronounced publication growth, comprised 119 studies, which came from China and Japan particularly. "Neuronal intranuclear inclusion disease" emerged as a frequently used keyword. The meta-analysis comprised 36 studies, indicating global positivity rates of 1.79% (95% CI, 0.75-3.17) for all patients and 2.00% (95% CI, 0.26-4.78) for patients' families. Subgroup analyses based on region and phenotype suggested the highest NOTCH2NLC positivity rates in Taiwan population (5.42%, 95% CI 0.08-16.89) and in leukoencephalopathy-dominant patients (8.25%, 95% CI, 3.01-15.60). Sensitivity analysis affirmed the robustness of results. In conclusion, NOTCH2NLC GGC repeat expansions exhibit rare globally, primarily in East Asia, and leukoencephalopathy-dominant patients, emphasizing regional and phenotypic distinctions. Emerging focal points in NOTCH2NLC researches underscore the need for collaborative exploration.
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Affiliation(s)
- Yangguang Lu
- The First School of Medicine, School of Information and Engineering, Wenzhou Medical University, Wenzhou, 325035, Zhejiang, China
| | - Yiqun Chen
- The First School of Medicine, School of Information and Engineering, Wenzhou Medical University, Wenzhou, 325035, Zhejiang, China
| | - Jiaqi Huang
- The First School of Medicine, School of Information and Engineering, Wenzhou Medical University, Wenzhou, 325035, Zhejiang, China
| | - Zihan Jiang
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, 325035, Zhejiang, China
| | - Yaoying Ge
- The First School of Medicine, School of Information and Engineering, Wenzhou Medical University, Wenzhou, 325035, Zhejiang, China
| | - Ruotong Yao
- The First School of Medicine, School of Information and Engineering, Wenzhou Medical University, Wenzhou, 325035, Zhejiang, China
| | - Jinxiu Zhang
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, 325035, Zhejiang, China
| | - Shangze Geng
- The First School of Medicine, School of Information and Engineering, Wenzhou Medical University, Wenzhou, 325035, Zhejiang, China
| | - Feng Chen
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, 325035, Zhejiang, China
| | - Qiaoqiao Jin
- The First School of Medicine, School of Information and Engineering, Wenzhou Medical University, Wenzhou, 325035, Zhejiang, China
| | - Guangyong Chen
- Department of Neurology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China.
| | - Dehao Yang
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, Zhejiang, China.
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De Santis T, Politi LS, Valente EM, Albanese A. MRI Abnormalities Identify Neuronal Intranuclear Inclusion Disease. Ann Neurol 2024; 95:1009-1010. [PMID: 38065672 DOI: 10.1002/ana.26853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/01/2023] [Accepted: 12/06/2023] [Indexed: 12/20/2023]
Affiliation(s)
- Tiziana De Santis
- Department of Neurology, IRCCS Humanitas Research Hospital, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Letterio S Politi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Department of Neuroradiology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Enza Maria Valente
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
- Neurogenetics Research Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Alberto Albanese
- Department of Neurology, IRCCS Humanitas Research Hospital, Rozzano, Italy
- Department of Neuroscience, Catholic University, Milano, Italy
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Lakhani DA, Agarwal AK, Middlebrooks EH. Ultra-high-field 7-Tesla magnetic resonance imaging in fragile X tremor/ataxia syndrome (FXTAS). Neuroradiol J 2024:19714009241247464. [PMID: 38644331 DOI: 10.1177/19714009241247464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2024] Open
Abstract
Fragile X tremor/ataxia syndrome (FXTAS) is an adult-onset neurodegenerative disorder characterized by premutation expansion of fragile X mental retardation 1 (FMR1) gene. It is a common single-gene cause of tremor, ataxia, and cognitive decline in adults. FXTAS affects the central, peripheral and autonomic nervous systems, leading to a range of neurological symptoms from dementia to dysautonomia. A characteristic imaging feature of FXTAS is symmetric T2 hyperintensity in the deep white matter of the cerebellar hemispheres and middle cerebral peduncle. However, recent studies have reported additional findings on diffusion weighted images (DWI), such as a symmetric high-intensity band-like signal at the cerebral corticomedullary junction. These findings, along with the characteristic cerebellar signal alterations, overlap with imaging findings seen in adult-onset neuronal intranuclear inclusion disease (NIID). Importantly, recent pathology studies have shown that both FXTAS and NIID can manifest intranuclear inclusion bodies, posing a diagnostic challenge and potential for misdiagnosis. We describe a 58-year-old man with FXTAS who received an erroneous diagnosis based on imaging and histopathology results. We emphasize the potential pitfalls in distinguishing NIID from FXTAS and stress the importance of genetic analysis in all cases with suspected NIID and FXTAS for confirmation. Additionally, we present the 7T MRI brain findings of FXTAS.
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Affiliation(s)
- Dhairya A Lakhani
- Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, USA
- Department of Radiology, Mayo Clinic, USA
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9
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Zhang J, Ling L, Xiang L, Li W, Bao P, Yue W. Clinical features of neuronal intranuclear inclusion disease with seizures: a systematic literature review. Front Neurol 2024; 15:1387399. [PMID: 38707999 PMCID: PMC11069311 DOI: 10.3389/fneur.2024.1387399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 04/08/2024] [Indexed: 05/07/2024] Open
Abstract
Background Infant, junior, and adult patients with neuronal intranuclear inclusion disease (NIID) present with various types of seizures. We aimed to conduct a systematic literature review on the clinical characteristics of NIID with seizures to provide novel insight for early diagnosis and treatment and to improve prognosis of these patients. Methods We used keywords to screen articles related to NIID and seizures, and data concerning the clinical characteristics of patients, including demographic features, disease characteristics of the seizures, treatment responses, imaging examinations, and other auxiliary examination results were extracted. Results The included studies comprised 21 patients with NIID with seizures. The most common clinical phenotypes were cognitive impairment (76.20%) and impaired consciousness (57.14%), and generalized onset motor seizures (46.15%) represented the most common type. Compared with infantile and juvenile cases, the use of antiepileptic drugs in adults led to significant seizure control and symptom improvement, in addition to providing a better prognosis. The number of GGC sequence repeats in the NOTCH2NLC gene in six NIID patients with seizures who underwent genetic testing ranged 72-134. Conclusion The most common clinical phenotypes in patients with NIID with seizures were cognitive impairment and consciousness disorders. Patients with NIID presented with various types of seizures, with the most common being generalized onset motor seizures. Adult patients had a better prognosis and were relatively stable. The early diagnosis of NIID with seizures is of great significance for treatment and to improve prognosis.
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Affiliation(s)
- Jinwei Zhang
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
| | - Ling Ling
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Lei Xiang
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Wenxia Li
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
| | - Pengnan Bao
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
| | - Wei Yue
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
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10
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Zhang T, Bao L, Chen H. Review of Phenotypic Heterogeneity of Neuronal Intranuclear Inclusion Disease and NOTCH2NLC-Related GGC Repeat Expansion Disorders. Neurol Genet 2024; 10:e200132. [PMID: 38586597 PMCID: PMC10997217 DOI: 10.1212/nxg.0000000000200132] [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: 09/14/2023] [Accepted: 01/05/2024] [Indexed: 04/09/2024]
Abstract
Neuronal intranuclear inclusion disease (NIID) is an underdiagnosed neurodegenerative disorder caused by pathogenic GGC expansions in NOTCH2NLC. However, an increasing number of reports of NOTCH2NLC GGC expansions in patients with Alzheimer disease, essential tremor, Parkinson disease, amyotrophic lateral sclerosis, and oculopharyngodistal myopathy have led to the proposal of a new concept known as NOTCH2NLC-related GGC repeat expansion disorders (NREDs). The majority of studies have mainly focused on screening for NOTCH2NLC GGC repeat variation in populations previously diagnosed with the associated disease, subsequently presenting it as a novel causative gene for the condition. These studies appear to be clinically relevant but do have their limitations because they may incorrectly regard the lack of MRI abnormalities as an exclusion criterion for NIID or overlook concomitant clinical presentations not typically observed in the associated diseases. Besides, in many instances within these reports, patients lack pathologic evidence or undergo long-term follow-up to conclusively rule out NIID. In this review, we will systematically review the research on NOTCH2NLC 5' untranslated region GGC repeat expansions and their association with related neurologic disorders, explaining the limitations of the relevant reports. Furthermore, we will integrate subsequent studies to further demonstrate that these patients actually experienced distinct clinical phenotypes of NIID.
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Affiliation(s)
- Tao Zhang
- From the Department of Neurology (T.Z., L.B., H.C.), the Affiliated Hospital of Xuzhou Medical University; and Department of Neurology (L.B.), Xuzhou Medical University, China
| | - Lei Bao
- From the Department of Neurology (T.Z., L.B., H.C.), the Affiliated Hospital of Xuzhou Medical University; and Department of Neurology (L.B.), Xuzhou Medical University, China
| | - Hao Chen
- From the Department of Neurology (T.Z., L.B., H.C.), the Affiliated Hospital of Xuzhou Medical University; and Department of Neurology (L.B.), Xuzhou Medical University, China
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11
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Shen Y, Jiang K, Liang H, Xiong Y, Song Z, Wang B, Zhu M, Qiu Y, Tan D, Wu C, Deng J, Wang Z, Hong D. Encephalitis-like episodes with cortical edema and enhancement in patients with neuronal intranuclear inclusion disease. Neurol Sci 2024:10.1007/s10072-024-07492-x. [PMID: 38532189 DOI: 10.1007/s10072-024-07492-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 03/21/2024] [Indexed: 03/28/2024]
Abstract
OBJECTIVES Neuronal intranuclear inclusion disease (NIID) exhibited significant clinical heterogeneities. However, the clinical features, radiographic changes, and prognosis of patients with encephalitis-like NIID have yet to be systematically elucidated. METHODS Clinical data including medical history, physical examination, and laboratory examinations were collected and analyzed. Skin and sural nerve biopsies were conducted on the patient. Repeat-primed PCR (RP-PCR) and fluorescence amplicon length PCR (AL-PCR) were used to detect the expansion of CGG repeat. We also reviewed the clinical and genetic data of NIID patients with cortical enhancement. RESULTS A 54-year-old woman presented with encephalitis-like NIID, characterized by severe headache and agitative psychiatric symptoms. The brain MRI showed cortical swelling in the temporo-occipital lobes and significant enhancement of the cortical surface and dura, but without hyperintensities along the corticomedullary junction on diffusion-weighted image (DWI). A biopsy of the sural nerve revealed a demyelinating pathological change. The intranuclear inclusions were detected in nerve and skin tissues using the p62 antibody and electron microscopy. RP-PCR and AL-PCR unveiled the pathogenic expansion of CGG repeats in the NOTCH2NLC gene. A review of the literature indicated that nine out of the 16 patients with cortical lesions and linear enhancement exhibited encephalitis-like NIID. CONCLUSION This study indicated that patients with encephalitis-like NIID typically exhibited headache and excitatory psychiatric symptoms, often accompanied by cortical edema and enhancement of posterior lobes, and responded well to glucocorticoid treatment. Furthermore, some patients may not exhibit hyperintensities along the corticomedullary junction on DWI, potentially leading to misdiagnosis.
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Affiliation(s)
- Yu Shen
- Department of Neurology, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Yong Wai Zheng Street 17#, Nanchang, 330006, People's Republic of China
| | - Kaiyan Jiang
- Department of Neurology, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Yong Wai Zheng Street 17#, Nanchang, 330006, People's Republic of China
| | - Hanlin Liang
- Queen Mary College, Nanchang University, Nanchang, China
| | - Ying Xiong
- Department of Neurology, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Yong Wai Zheng Street 17#, Nanchang, 330006, People's Republic of China
| | - Ziwei Song
- Department of Neurology, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Yong Wai Zheng Street 17#, Nanchang, 330006, People's Republic of China
- Rare Disease Center, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Bo Wang
- Department of Neurology, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Yong Wai Zheng Street 17#, Nanchang, 330006, People's Republic of China
- Rare Disease Center, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Min Zhu
- Department of Neurology, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Yong Wai Zheng Street 17#, Nanchang, 330006, People's Republic of China
- Rare Disease Center, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Yusen Qiu
- Department of Neurology, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Yong Wai Zheng Street 17#, Nanchang, 330006, People's Republic of China
- Rare Disease Center, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
- Key Laboratory of Rare, Neurological Diseases of Jiangxi Provincial Health Commission, Nanchang, China
| | - Dandan Tan
- Department of Neurology, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Yong Wai Zheng Street 17#, Nanchang, 330006, People's Republic of China
- Rare Disease Center, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
- Key Laboratory of Rare, Neurological Diseases of Jiangxi Provincial Health Commission, Nanchang, China
| | - Chengsi Wu
- Department of Neurology, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Yong Wai Zheng Street 17#, Nanchang, 330006, People's Republic of China
- Key Laboratory of Rare, Neurological Diseases of Jiangxi Provincial Health Commission, Nanchang, China
| | - Jianwen Deng
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Zhaoxia Wang
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Daojun Hong
- Department of Neurology, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Yong Wai Zheng Street 17#, Nanchang, 330006, People's Republic of China.
- Rare Disease Center, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China.
- Key Laboratory of Rare, Neurological Diseases of Jiangxi Provincial Health Commission, Nanchang, China.
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12
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Ishizawa K, Komori T, Homma T, Sone J, Nakata Y, Nakazato Y, Takahashi K, Yamamoto T, Sasaki A. The predominance of "astrocytic" intranuclear inclusions in neuronal intranuclear inclusion disease manifesting encephalopathy-like symptoms: A case series with brain biopsy. Neuropathology 2024. [PMID: 38477063 DOI: 10.1111/neup.12971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 02/19/2024] [Accepted: 02/26/2024] [Indexed: 03/14/2024]
Abstract
Neuronal intranuclear inclusion disease (NIID) is a neurodegenerative disorder represented by eosinophilic intranuclear inclusions (EIIs) and GGC/CGG repeat expansion in the NOTCH2NLC gene. We report here two adult cases of NIID, genetically confirmed, with manifestation of encephalopathy-like symptoms and address the histopathologic findings obtained by brain biopsies, with a focus on "astrocytic" intranuclear inclusions (AIIs). Case 1 presented with paroxysmal restlessness, vertigo, or fever and was later involved in severe dementia and tetraparesis. Case 2 presented with forgetfulness and then with paroxysmal fever and headache. In both cases, delimited areas with gadolinium enhancement on magnetic resonance imaging and corresponding hyperperfusion were detected, leading to brain biopsies of the cortex. On histology, Case 1 showed an abnormal lamination, where the thickness of layers was different from usual. Both neurons and astrocytes showed some dysmorphologic features. Notably, astrocytes rather than neurons harbored EIIs. Case 2 showed a cortex, where neurons tended to be arrayed in a columnar fashion. Astrocytes showed some dysmorphologic features. Notably, much more astrocytes than neurons harbored EIIs. By a double-labeling immunofluorescence study for p62/NeuN and p62/glial fibrillary acidic protein, the predominance of AIIs was confirmed in both cases. Considering the physiological functions of astrocytes for the development and maintenance of the cortex, the encephalopathy-like symptoms, dynamic change of cerebral blood flow, and cortical dysmorphology can reasonably be explained by the dysfunction of EII-bearing astrocytes rather than EII-bearing neurons. This study suggests the presence of a subtype of NIID where AIIs rather than "neuronal" intranuclear inclusions are likely a key player in the pathogenesis of NIID, particularly in cases with encephalopathy-like symptoms. The importance of AIIs ("gliopathy") should be more appreciated in future studies of NIID.
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Affiliation(s)
- Keisuke Ishizawa
- Department of Pathology, Saitama Medical University, Saitama, Japan
- Department of Neurology, Saitama Medical University, Saitama, Japan
- Department of Laboratory Medicine, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Takashi Komori
- Department of Laboratory Medicine, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Taku Homma
- Department of Laboratory Medicine, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
- Department of Diagnostic Pathology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Jun Sone
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Aichi, Japan
| | - Yasuhiro Nakata
- Department of Neuroradiology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | | | - Kazushi Takahashi
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | | | - Atsushi Sasaki
- Department of Pathology, Saitama Medical University, Saitama, Japan
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13
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Zeng T, Chen Y, Huang H, Li S, Huang J, Xie H, Lin S, Chen S, Chen G, Yang D. Neuronal Intranuclear Inclusion Disease with NOTCH2NLC GGC Repeat Expansion: A Systematic Review and Challenges of Phenotypic Characterization. Aging Dis 2024:AD.2024.0131-1. [PMID: 38377026 DOI: 10.14336/ad.2024.0131-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/31/2024] [Indexed: 02/22/2024] Open
Abstract
Neuronal intranuclear inclusion disease (NIID) is a highly clinically heterogeneous neurodegenerative disorder primarily attributed to abnormal GGC repeat expansions in the NOTCH2NLC gene. This study aims to comprehensively explore its phenotypic characteristics and genotype-phenotype correlation. A literature search was conducted in PubMed, Embase, and the Cochrane Library from September 1, 2019, to December 31, 2022, encompassing reported NIID cases confirmed by pathogenic NOTCH2NLC mutations. Linear regressions and trend analyses were performed. Analyzing 635 cases from 85 included studies revealed that familial cases exhibited significantly larger GGC repeat expansions than sporadic cases (p < 0.001), and this frequency significantly increased with expanding GGC repeats (p trend < 0.001). Age at onset (AAO) showed a negative correlation with GGC repeat expansions (p < 0.001). The predominant initial symptoms included tremor (31.70%), cognitive impairment (14.12%), and muscle weakness (10.66%). The decreased or absent tendon reflex (DTR/ATR) emerged as a notable clinical indicator of NIID due to its high prevalence. U-fiber was observed in 79.11% of patients, particularly prominent in paroxysmal disease-dominant (87.50%) and dementia-dominant cases (81.08%). Peripheral neuropathy-dominant cases exhibited larger GGC repeat expansions (median = 123.00) and an earlier AAO (median = 33.00) than other phenotypes. Moreover, a significant genetic anticipation of 3.5 years was observed (p = 0.039). This study provides a comprehensive and up-to-date compilation of genotypic and phenotypic information on NIID since the identification of the causative gene NOTCH2NLC. We contribute a novel diagnostic framework for NIID to support clinical practice.
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Affiliation(s)
- Tian Zeng
- The First School of Medicine, School of Information and Engineering, Wenzhou Medical University, Wenzhou, China
| | - Yiqun Chen
- The First School of Medicine, School of Information and Engineering, Wenzhou Medical University, Wenzhou, China
| | - Honghao Huang
- Department of Cardiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shengqi Li
- The First School of Medicine, School of Information and Engineering, Wenzhou Medical University, Wenzhou, China
| | - Jiaqi Huang
- The First School of Medicine, School of Information and Engineering, Wenzhou Medical University, Wenzhou, China
| | - Haobo Xie
- The First School of Medicine, School of Information and Engineering, Wenzhou Medical University, Wenzhou, China
| | - Shenyi Lin
- The First School of Medicine, School of Information and Engineering, Wenzhou Medical University, Wenzhou, China
| | - Siyao Chen
- The First School of Medicine, School of Information and Engineering, Wenzhou Medical University, Wenzhou, China
| | - Guangyong Chen
- Department of Neurology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Dehao Yang
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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14
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Lee GH, Jung E, Jung NY, Mizuguchi T, Matsumoto N, Kim EJ. Case report: Neuronal intranuclear inclusion disease initially mimicking reversible cerebral vasoconstriction syndrome: serial neuroimaging findings during an 11-year follow-up. Front Neurol 2024; 15:1347646. [PMID: 38405405 PMCID: PMC10884197 DOI: 10.3389/fneur.2024.1347646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/16/2024] [Indexed: 02/27/2024] Open
Abstract
Neuronal intranuclear inclusion disease (NIID) is a rare, progressive neurodegenerative disorder known for its diverse clinical manifestations. Although episodic neurogenic events can be associated with NIID, no reported cases have demonstrated concurrent clinical features or MRI findings resembling reversible cerebral vasoconstriction syndrome (RCVS). Here, we present the inaugural case of an adult-onset NIID patient who initially displayed symptoms reminiscent of RCVS. The 59-year-old male patient's initial presentation included a thunderclap headache, right visual field deficit, and confusion. Although his brain MRI appeared normal, MR angiography unveiled left posterior cerebral artery occlusion, subsequently followed by recanalization, culminating in an RCVS diagnosis. Over an 11-year period, the patient encountered 10 additional episodes, each escalating in duration and intensity, accompanied by seizures. Simultaneously, cognitive impairment progressed. Genetic testing for NIID revealed an abnormal expansion of GGC repeats in NOTCH2NLC, with a count of 115 (normal range, <60), and this patient was diagnosed with NIID. Our report highlights that NIID can clinically and radiologically mimic RCVS. Therefore, in the differential diagnosis of RCVS, particularly in cases with atypical features or recurrent episodes, consideration of NIID is warranted. Additionally, the longitudinal neuroimaging findings provided the course of NIID over an 11-year follow-up period.
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Affiliation(s)
- Gha-Hyun Lee
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Pusan, Republic of Korea
| | - Eugene Jung
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Pusan, Republic of Korea
| | - Na-Yeon Jung
- Department of Neurology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine and Medical Research Institute, Yangsan, Republic of Korea
| | - Takeshi Mizuguchi
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Naomichi Matsumoto
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Eun-Joo Kim
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Pusan, Republic of Korea
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15
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Neo S, Kaur J, Ng AS, Lim TC. Elderly woman with psychosis and unsteadiness. Pract Neurol 2023; 23:547-551. [PMID: 37419675 DOI: 10.1136/pn-2023-003731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2023] [Indexed: 07/09/2023]
Affiliation(s)
- Shermyn Neo
- Department of Neurology, National Neuroscience Institute, Singapore
| | | | - Adeline Sl Ng
- Department of Neurology, National Neuroscience Institute, Singapore
| | - Tchoyoson Cc Lim
- Department of Neuroradiology, National Neuroscience Institute, Singapore
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16
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Liu M, Gao Y, Yuan Y, Liu X, Wang Y, Li L, Zhang X, Jiang C, Wang Q, Wang Y, Shi C, Xu Y, Yang J. A comprehensive study of clinicopathological and genetic features of neuronal intranuclear inclusion disease. Neurol Sci 2023; 44:3545-3556. [PMID: 37184590 DOI: 10.1007/s10072-023-06845-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 05/07/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND The discovery of skin intranuclear inclusions and GGC repeat expansion of NOTCH2NLC has greatly promoted the diagnosis of neuronal intranuclear inclusion disease (NIID). With highly heterogeneous clinical manifestations, NIID patients tend to be underdiagnosed at early stages. METHODS This study comprehensively studied clinical manifestations, magnetic resonance imaging (MRI), and peripheral nerve conduction in 24 NIID and 166 other neurodegenerative disease (ND) subjects. The nomogram was plotted using the "rms" package, and the t-distributed stochastic neighbor embedding algorithm was performed. Associations between skin intranuclear inclusions and NOTCH2NLC GGC repeats were further analyzed. RESULTS The clinical, MRI, and peripheral nerve conduction features seriously overlapped in NIID and ND patients; they were assigned variables according to their frequency and specificity in NIID patients. A nomogram that could distinguish NIID from ND was constructed according to the assigned variables and cutoff values of the above features. The occurrence of skin intranuclear inclusions and NOTCH2NLC GGC repeats ≥ 60 showed 100% consistency, and intranuclear inclusion frequency positively correlated with NOTCH2NLC GGC repeats. A hierarchical diagnostic flowchart for definite NIID was further established. CONCLUSION We provide a novel nomogram with the potential to realize early identification and update the diagnostic flowchart for definitive diagnosis. Moreover, this is the first study to define the association between skin pathology and NOTCH2NLC genetics in NIID.
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Affiliation(s)
- Minglei Liu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China
| | - Yuan Gao
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Disease, Zhengzhou, Henan, China
- Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou University, Zhengzhou, Henan, China
- Institute of Neuroscience, Zhengzhou University, Zhengzhou, Henan, China
| | - Yanpeng Yuan
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Disease, Zhengzhou, Henan, China
- Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou University, Zhengzhou, Henan, China
- Institute of Neuroscience, Zhengzhou University, Zhengzhou, Henan, China
| | - Xiaojing Liu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Disease, Zhengzhou, Henan, China
- Institute of Neuroscience, Zhengzhou University, Zhengzhou, Henan, China
| | - Yangyang Wang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Disease, Zhengzhou, Henan, China
- Institute of Neuroscience, Zhengzhou University, Zhengzhou, Henan, China
| | - Lanjun Li
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Disease, Zhengzhou, Henan, China
- Institute of Neuroscience, Zhengzhou University, Zhengzhou, Henan, China
| | - Xiaoyun Zhang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China
| | - Chenyang Jiang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China
- Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou University, Zhengzhou, Henan, China
| | - Qingzhi Wang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China
| | - Yanlin Wang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Disease, Zhengzhou, Henan, China
- Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou University, Zhengzhou, Henan, China
- Institute of Neuroscience, Zhengzhou University, Zhengzhou, Henan, China
| | - Changhe Shi
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China.
- Institute of Neuroscience, Zhengzhou University, Zhengzhou, Henan, China.
| | - Yuming Xu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China.
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Disease, Zhengzhou, Henan, China.
- Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou University, Zhengzhou, Henan, China.
- Institute of Neuroscience, Zhengzhou University, Zhengzhou, Henan, China.
| | - Jing Yang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China.
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Disease, Zhengzhou, Henan, China.
- Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou University, Zhengzhou, Henan, China.
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17
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Zhang Z, Xu Q, Li J, Zhang C, Bai Z, Chai X, Xu K, Xiao C, Chen F, Liu T, Gu H, Xing W, Lu G, Zhang Z. MRI features of neuronal intranuclear inclusion disease, combining visual and quantitative imaging investigations. J Neuroradiol 2023:S0150-9861(23)00245-6. [PMID: 37758172 DOI: 10.1016/j.neurad.2023.09.004] [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: 06/27/2023] [Revised: 09/08/2023] [Accepted: 09/24/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE To observe the radiological characteristics of Neuronal Intranuclear Inclusion Disease (NIID) on lesion locations and diffusion property using quantitative imaging analysis. METHODS Visual inspection and quantitative analyses were performed on MRI data from 31 retrospectively included patients with NIID. Frequency heatmaps of lesion locations on T2WI and DWI were generated using voxel-wise analysis. Gray matter volume (GMV), white matter volume (WMV) and diffusion property of apparent diffusion coefficient (ADC) values of patients were voxel-wisely compared with healthy controls. Moreover, the ADC values within the DWI-detected lesion were compared with those within the adjacent cortical gray matter and white matter. Voxel-based lesion symptom mapping (VLSM) techniques, were used to determine the relationship between DWI lesion location and disease durations. RESULTS By visual inspection on the imaging findings, we proposed an "cockscomb flower sign" for describing the radiological feature of DWI hyperintensity within the corticomedullary junction. A "T2WI-DWI mismatch of spatial distribution" pattern was also revealed with visual inspection and frequency heatmaps, for describing the feature of a wider lesion distribution covering white matter shown on T2WI than that on DWI. Voxel-based morphometry comparison revealed that wildly reduced GMV and WMV, both the lesion areas detected by DWI and T2WI demonstrated ADC increase in patients. Furthermore, the ADC values within the DWI-detected lesion were intermediate between the adjacent cortex and the deep white matter with highest ADC. VLSM analysis revealed that frontal lobe, parietal lobe and internal capsule damage were associated with higher NIID durations. CONCLUSION NIID features with "cockscomb flower-like" DWI hyperintensity in area of corticomedullary junction, based on a "T2WI-DWI mismatch of spatial distribution" of lesion locations. The pathological substrate of corticomedullary junction hyperintensity on DWI, can not be explained as diffusion restriction. These typical radiological features of brain MRI would be helpful for diagnosis of NIID.
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Affiliation(s)
- Zixuan Zhang
- Department of Diagnostic Radiology, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China; School of Medical Imaging, Xuzhou Medical University, Xuzhou 221004, China
| | - Qiang Xu
- Department of Diagnostic Radiology, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Jianrui Li
- Department of Diagnostic Radiology, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Chao Zhang
- School of Medical Imaging, Xuzhou Medical University, Xuzhou 221004, China; Department of Medical Imaging, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221004, China
| | - Zhuojie Bai
- Department of Medical Imaging, Nanjing Jiangbei Hospital, Nanjing 210000, China
| | - Xue Chai
- Department of Medical Imaging, Nanjing Brain Hospital, Nanjing 210029, China
| | - Kai Xu
- School of Medical Imaging, Xuzhou Medical University, Xuzhou 221004, China; Department of Medical Imaging, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221004, China
| | - Chaoyong Xiao
- Department of Medical Imaging, Nanjing Brain Hospital, Nanjing 210029, China
| | - Feng Chen
- Department of Medical Imaging, Hainan General Hospital, Hainan 570311, China
| | - Tao Liu
- Department of Neurology, Hainan General Hospital, Haikou 570311, China
| | - Hongmei Gu
- Department of Medical Imaging, Affiliated Hospital of Nantong University, Nantong 226001, China
| | - Wei Xing
- Department of Medical Imaging, The first people's hospital of Changzhou. Changzhou 213200, China
| | - Guangming Lu
- Department of Diagnostic Radiology, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China; School of Medical Imaging, Xuzhou Medical University, Xuzhou 221004, China
| | - Zhiqiang Zhang
- Department of Diagnostic Radiology, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China; School of Medical Imaging, Xuzhou Medical University, Xuzhou 221004, China.
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18
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Morita K, Shinzato T, Endo Y, Suzuki M, Yoshida H, Sone J, Nagai K. A case of unusual renal manifestation in a patient with neuronal intranuclear inclusion disease treated with steroids. Clin Case Rep 2023; 11:e7730. [PMID: 37564608 PMCID: PMC10410123 DOI: 10.1002/ccr3.7730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/12/2023] [Accepted: 07/06/2023] [Indexed: 08/12/2023] Open
Abstract
Neuronal intranuclear inclusion disease (NIID) is a progressive neurodegenerative disorder characterized by intranuclear inclusions. Kidney injury involvement and successful treatment for NIID have rarely been reported. A NIID patient developed crescentic IgA nephropathy. Steroid therapy resolved digestive symptoms and recovered renal function. Steroids are considered for concomitant symptoms of NIID.
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Affiliation(s)
- Keisuke Morita
- Department of NephrologyShizuoka General HospitalShizuokaJapan
| | | | - Yuzo Endo
- Department of Diagnostic PathologyShizuoka General HospitalShizuokaJapan
| | - Makoto Suzuki
- Department of Diagnostic PathologyShizuoka General HospitalShizuokaJapan
| | | | - Jun Sone
- Department of Neuropathology, Institute for Medical Science of AgingAichi Medical UniversityAichiJapan
| | - Kojiro Nagai
- Department of NephrologyShizuoka General HospitalShizuokaJapan
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19
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Muthusamy K, Sivadasan A, Dixon L, Sudhakar S, Thomas M, Danda S, Wszolek ZK, Wierenga K, Dhamija R, Gavrilova R. Adult-onset leukodystrophies: a practical guide, recent treatment updates, and future directions. Front Neurol 2023; 14:1219324. [PMID: 37564735 PMCID: PMC10410460 DOI: 10.3389/fneur.2023.1219324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 06/19/2023] [Indexed: 08/12/2023] Open
Abstract
Adult-onset leukodystrophies though individually rare are not uncommon. This group includes several disorders with isolated adult presentations, as well as several childhood leukodystrophies with attenuated phenotypes that present at a later age. Misdiagnoses often occur due to the clinical and radiological overlap with common acquired disorders such as infectious, immune, inflammatory, vascular, metabolic, and toxic etiologies. Increased prevalence of non-specific white matter changes in adult population poses challenges during diagnostic considerations. Clinico-radiological spectrum and molecular landscape of adult-onset leukodystrophies have not been completely elucidated at this time. Diagnostic approach is less well-standardized when compared to the childhood counterpart. Absence of family history and reduced penetrance in certain disorders frequently create a dilemma. Comprehensive evaluation and molecular confirmation when available helps in prognostication, early initiation of treatment in certain disorders, enrollment in clinical trials, and provides valuable information for the family for reproductive counseling. In this review article, we aimed to formulate an approach to adult-onset leukodystrophies that will be useful in routine practice, discuss common adult-onset leukodystrophies with usual and unusual presentations, neuroimaging findings, recent advances in treatment, acquired mimics, and provide an algorithm for comprehensive clinical, radiological, and genetic evaluation that will facilitate early diagnosis and consider active treatment options when available. A high index of suspicion, awareness of the clinico-radiological presentations, and comprehensive genetic evaluation are paramount because treatment options are available for several disorders when diagnosed early in the disease course.
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Affiliation(s)
- Karthik Muthusamy
- Department of Clinical Genomics, Mayo Clinic, Jacksonville, FL, United States
| | - Ajith Sivadasan
- Department of Neurological Sciences, Christian Medical College, Tamil Nadu, Vellore, India
| | - Luke Dixon
- Department of Radiology, Imperial College, NHS Trust, London, United Kingdom
| | - Sniya Sudhakar
- Department of Radiology, Great Ormond Street Hospital, London, United Kingdom
| | - Maya Thomas
- Department of Neurological Sciences, Christian Medical College, Tamil Nadu, Vellore, India
| | - Sumita Danda
- Department of Medical Genetics, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Klaas Wierenga
- Department of Clinical Genomics, Mayo Clinic, Jacksonville, FL, United States
| | - Radhika Dhamija
- Department of Clinical Genomics and Neurology, Mayo Clinic, Phoenix, AZ, United States
| | - Ralitza Gavrilova
- Department of Clinical Genomics and Neurology, Mayo Clinic, Rochester, MN, United States
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20
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Wang M, Li L. A case report of neuronal intranuclear inclusion disease (NIID) with MELAS-like imaging findings. Acta Neurol Belg 2023:10.1007/s13760-023-02313-y. [PMID: 37382852 DOI: 10.1007/s13760-023-02313-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 06/20/2023] [Indexed: 06/30/2023]
Affiliation(s)
- Mingyue Wang
- Department of Neurology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China.
| | - Lingjuan Li
- Department of Neurology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
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21
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Nakagawa Y, Sugiyama A, Hirano S, Ishige T, Kuwabara S. Isolated paravermal T2 high-intensity lesions in dentatorubral-pallidoluysian atrophy. J Neurol Sci 2023; 451:120717. [PMID: 37385028 DOI: 10.1016/j.jns.2023.120717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/05/2023] [Accepted: 06/17/2023] [Indexed: 07/01/2023]
Affiliation(s)
- Yuki Nakagawa
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Atsuhiko Sugiyama
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan.
| | - Shigeki Hirano
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takayuki Ishige
- Division of Laboratory Medicine, Chiba University Hospital, Chiba, Japan
| | - Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
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22
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Fitrah YA, Higuchi Y, Hara N, Tokutake T, Kanazawa M, Sanpei K, Taneda T, Nakajima A, Koide S, Tsuboguchi S, Watanabe M, Fukumoto J, Ando S, Sato T, Iwafuchi Y, Sato A, Hayashi H, Ishiguro T, Takeda H, Takahashi T, Fukuhara N, Kasuga K, Miyashita A, Onodera O, Ikeuchi T. Heterogenous Genetic, Clinical, and Imaging Features in Patients with Neuronal Intranuclear Inclusion Disease Carrying NOTCH2NLC Repeat Expansion. Brain Sci 2023; 13:955. [PMID: 37371433 DOI: 10.3390/brainsci13060955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
Neuronal intranuclear inclusion disease (NIID) is a neurodegenerative disorder that is caused by the abnormal expansion of non-coding trinucleotide GGC repeats in NOTCH2NLC. NIID is clinically characterized by a broad spectrum of clinical presentations. To date, the relationship between expanded repeat lengths and clinical phenotype in patients with NIID remains unclear. Thus, we aimed to clarify the genetic and clinical spectrum and their association in patients with NIID. For this purpose, we genetically analyzed Japanese patients with adult-onset NIID with characteristic clinical and neuroimaging findings. Trinucleotide repeat expansions of NOTCH2NLC were examined by repeat-primed and amplicon-length PCR. In addition, long-read sequencing was performed to determine repeat size and sequence. The expanded GGC repeats ranging from 94 to 361 in NOTCH2NLC were found in all 15 patients. Two patients carried biallelic repeat expansions. There were marked heterogenous clinical and imaging features in NIID patients. Patients presenting with cerebellar ataxia or urinary dysfunction had a significantly larger GGC repeat size than those without. This significant association disappeared when these parameters were compared with the total trinucleotide repeat number. ARWMC score was significantly higher in patients who had a non-glycine-type trinucleotide interruption within expanded poly-glycine motifs than in those with a pure poly-glycine expansion. These results suggested that the repeat length and sequence in NOTCH2NLC may partly modify some clinical and imaging features of NIID.
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Affiliation(s)
- Yusran Ady Fitrah
- Department of Molecular Genetics, Brain Research Institute, Niigata University, Niigata 951-8585, Japan
| | - Yo Higuchi
- Department of Molecular Genetics, Brain Research Institute, Niigata University, Niigata 951-8585, Japan
- Department of Neurology, Brain Research Institute, Niigata University, Niigata 951-8585, Japan
- Department of Neurology, Joetsu General Hospital, Joetsu 943-0172, Japan
| | - Norikazu Hara
- Department of Molecular Genetics, Brain Research Institute, Niigata University, Niigata 951-8585, Japan
| | - Takayoshi Tokutake
- Department of Neurology, Brain Research Institute, Niigata University, Niigata 951-8585, Japan
| | - Masato Kanazawa
- Department of Neurology, Brain Research Institute, Niigata University, Niigata 951-8585, Japan
| | - Kazuhiro Sanpei
- Department of Neurology, Sado General Hospital, Sado 952-1209, Japan
| | - Tomone Taneda
- Department of Neurology, Brain Research Institute, Niigata University, Niigata 951-8585, Japan
| | - Akihiko Nakajima
- Department of Neurology, Brain Research Institute, Niigata University, Niigata 951-8585, Japan
| | - Shin Koide
- Department of Neurology, Brain Research Institute, Niigata University, Niigata 951-8585, Japan
| | - Shintaro Tsuboguchi
- Department of Neurology, Brain Research Institute, Niigata University, Niigata 951-8585, Japan
| | - Midori Watanabe
- Department of Neurology, Brain Research Institute, Niigata University, Niigata 951-8585, Japan
| | - Junki Fukumoto
- Department of Neurology, Brain Research Institute, Niigata University, Niigata 951-8585, Japan
| | - Shoichiro Ando
- Department of Neurology, Brain Research Institute, Niigata University, Niigata 951-8585, Japan
| | - Tomoe Sato
- Department of Neurology, Tsubame Rosai Hospital, Tsubame 959-1228, Japan
| | - Yohei Iwafuchi
- Department of Neurology, Niigata City General Hospital, Niigata 950-1197, Japan
| | - Aki Sato
- Department of Neurology, Niigata City General Hospital, Niigata 950-1197, Japan
| | - Hideki Hayashi
- Department of Neurology, Brain Research Institute, Niigata University, Niigata 951-8585, Japan
- Department of Neurology, Sado General Hospital, Sado 952-1209, Japan
| | - Takanobu Ishiguro
- Department of Neurology, Brain Research Institute, Niigata University, Niigata 951-8585, Japan
- Department of Neurology, Sado General Hospital, Sado 952-1209, Japan
| | - Hayato Takeda
- Department of Neurology, Tsukuba University, Tsukuba 950-1197, Japan
| | | | - Nobuyoshi Fukuhara
- Department of Neurology, Joetsu General Hospital, Joetsu 943-0172, Japan
| | - Kensaku Kasuga
- Department of Molecular Genetics, Brain Research Institute, Niigata University, Niigata 951-8585, Japan
| | - Akinori Miyashita
- Department of Molecular Genetics, Brain Research Institute, Niigata University, Niigata 951-8585, Japan
| | - Osamu Onodera
- Department of Neurology, Brain Research Institute, Niigata University, Niigata 951-8585, Japan
| | - Takeshi Ikeuchi
- Department of Molecular Genetics, Brain Research Institute, Niigata University, Niigata 951-8585, Japan
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23
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Jagota P, Lim S, Pal PK, Lee J, Kukkle PL, Fujioka S, Shang H, Phokaewvarangkul O, Bhidayasiri R, Mohamed Ibrahim N, Ugawa Y, Aldaajani Z, Jeon B, Diesta C, Shambetova C, Lin C. Genetic Movement Disorders Commonly Seen in Asians. Mov Disord Clin Pract 2023; 10:878-895. [PMID: 37332644 PMCID: PMC10272919 DOI: 10.1002/mdc3.13737] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 02/27/2023] [Accepted: 03/21/2023] [Indexed: 11/21/2023] Open
Abstract
The increasing availability of molecular genetic testing has changed the landscape of both genetic research and clinical practice. Not only is the pace of discovery of novel disease-causing genes accelerating but also the phenotypic spectra associated with previously known genes are expanding. These advancements lead to the awareness that some genetic movement disorders may cluster in certain ethnic populations and genetic pleiotropy may result in unique clinical presentations in specific ethnic groups. Thus, the characteristics, genetics and risk factors of movement disorders may differ between populations. Recognition of a particular clinical phenotype, combined with information about the ethnic origin of patients could lead to early and correct diagnosis and assist the development of future personalized medicine for patients with these disorders. Here, the Movement Disorders in Asia Task Force sought to review genetic movement disorders that are commonly seen in Asia, including Wilson's disease, spinocerebellar ataxias (SCA) types 12, 31, and 36, Gerstmann-Sträussler-Scheinker disease, PLA2G6-related parkinsonism, adult-onset neuronal intranuclear inclusion disease (NIID), and paroxysmal kinesigenic dyskinesia. We also review common disorders seen worldwide with specific mutations or presentations that occur frequently in Asians.
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Affiliation(s)
- Priya Jagota
- Chulalongkorn Centre of Excellence for Parkinson's Disease and Related Disorders, Department of Medicine, Faculty of MedicineChulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross SocietyBangkokThailand
| | - Shen‐Yang Lim
- Division of Neurology, Department of Medicine, Faculty of MedicineUniversity of MalayaKuala LumpurMalaysia
- The Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Faculty of MedicineUniversity of MalayaKuala LumpurMalaysia
| | - Pramod Kumar Pal
- Department of NeurologyNational Institute of Mental Health & Neurosciences (NIMHANS)BengaluruIndia
| | - Jee‐Young Lee
- Department of NeurologySeoul Metropolitan Government‐Seoul National University Boramae Medical Center & Seoul National University College of MedicineSeoulRepublic of Korea
| | - Prashanth Lingappa Kukkle
- Center for Parkinson's Disease and Movement DisordersManipal HospitalBangaloreIndia
- Parkinson's Disease and Movement Disorders ClinicBangaloreIndia
| | - Shinsuke Fujioka
- Department of Neurology, Fukuoka University, Faculty of MedicineFukuokaJapan
| | - Huifang Shang
- Department of Neurology, Laboratory of Neurodegenerative Disorders, Rare Diseases CenterWest China Hospital, Sichuan UniversityChengduChina
| | - Onanong Phokaewvarangkul
- Chulalongkorn Centre of Excellence for Parkinson's Disease and Related Disorders, Department of Medicine, Faculty of MedicineChulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross SocietyBangkokThailand
| | - Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson's Disease and Related Disorders, Department of Medicine, Faculty of MedicineChulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross SocietyBangkokThailand
- The Academy of Science, The Royal Society of ThailandBangkokThailand
| | - Norlinah Mohamed Ibrahim
- Neurology Unit, Department of Medicine, Faculty of MedicineUniversiti Kebangsaan MalaysiaKuala LumpurMalaysia
| | - Yoshikazu Ugawa
- Deprtment of Human Neurophysiology, Faculty of MedicineFukushima Medical UniversityFukushimaJapan
| | - Zakiyah Aldaajani
- Neurology Unit, King Fahad Military Medical ComplexDhahranSaudi Arabia
| | - Beomseok Jeon
- Department of NeurologySeoul National University College of MedicineSeoulRepublic of Korea
- Movement Disorder CenterSeoul National University HospitalSeoulRepublic of Korea
| | - Cid Diesta
- Section of Neurology, Department of NeuroscienceMakati Medical Center, NCRMakatiPhilippines
| | | | - Chin‐Hsien Lin
- Department of NeurologyNational Taiwan University HospitalTaipeiTaiwan
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24
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Tai H, Wang A, Zhang Y, Liu S, Pan Y, Li K, Zhao G, Wang M, Wu G, Niu S, Pan H, Chen B, Li W, Wang X, Dong G, Li W, Zhang Y, Guo S, Liu X, Li M, Liang H, Huang M, Chen W, Zhang Z. Clinical Features and Classification of Neuronal Intranuclear Inclusion Disease. NEUROLOGY GENETICS 2023; 9:e200057. [PMID: 37090934 PMCID: PMC10117695 DOI: 10.1212/nxg.0000000000200057] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/20/2022] [Indexed: 03/04/2023]
Abstract
Background and ObjectivesNeuronal intranuclear inclusion body disease (NIID) is a neurodegenerative disease with highly heterogeneous clinical manifestations. The present study aimed to characterize clinical features and propose a classification system based on a large cohort of NIID in China.MethodsThe Chinese NIID registry was launched from 2017, and participants' demographics and clinical features were recorded. Brain MRI, skin pathologies, and the number of GGC repeat expansions in the 5′ untranslated region of theNOTCH2NLCgene were evaluated in all patients.ResultsIn total, 223 patients (64.6% female) were recruited; the mean (SD) onset age was 56.7 (10.3) years. The most common manifestations were cognitive impairment (78.5%) and autonomic dysfunction (70.9%), followed by episodic symptoms (51.1%), movement disorders (50.7%), and muscle weakness (25.6%). Imaging markers included hyperintensity signals along the corticomedullary junction on diffusion-weighted imaging (96.6%), white matter lesions (98.1%), paravermis (55.0%), and focal cortical lesions (10.1%). The median size of the expanded GGC repeats in these patients was 115 (range, 70–525), with 2 patients carrying >300 GGC repeats. A larger number of GGC repeats was associated with younger age at onset (r= −0.329,p< 0.0001). According to the proposed clinical classification based on the most prominent manifestations, the patients were designated into 5 distinct types: cognitive impairment-dominant type (34.1%, n = 76), episodic neurogenic event-dominant type (32.3%, n = 72), movement disorder-dominant type (17.5%, n = 39), autonomic dysfunction-dominant type (8.5%, n = 19), and neuromuscular disease-dominant type (7.6%, n = 17). Notably, 32.3% of the episodic neurogenic event-dominant type of NIID has characteristic focal cortical lesions on brain MRI presenting localized cortical edema or atrophy. The mean onset age of the neuromuscular disease-dominant type was 47.2 (17.6) years, younger than the other types (p< 0.001). There was no significant difference in the sizes of GGC repeats among the patients in the 5 types (p= 0.547, Kruskal-Wallis test).DiscussionThis observational study of NIID establishes an overall picture of the disease regarding clinical, imaging, and genetic characteristics. The proposed clinical classification of NIID based on the most prominent manifestation divides patients into 5 types.
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Affiliation(s)
- Hongfei Tai
- Department of Neurology (H.T., A.W., S.L., Y.P., S.N., H.P., B.C., X.W., Z.Z.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (H.T., A.W., Yumei Zhang, S.L., Y.P., S.N., H.P., B.C., X.W., G.D., Z.Z.), Beijing; Monogenic Disease Research Center for Neurological Disorders (Yumei Zhang), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (K.L.), Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences; Department of Neurology (G.Z.), Huashan Hospital, Shanghai Medical College, Fudan University; Department of Neurology (M.W.), The First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou; Department of Neurology (G.W.), Lanzhou University Second Hospital; Department of Pathology (G.D.), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (W.L.), Army Medical Center of People's Liberation Army, Chongqing; Department of Neurology (Ying Zhang), The First People's Hospital of Shangqiu; Department of Neurology (S.G.), The First Affiliated Hospital of Xinxiang Medical University; Department of Neurology (X.L.), Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan; Department of Neurology (M.L.), The First People's Hospital of Huaihua City; Department of Neurology (H.L.), The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou; Department of Neurology (M.H.), Hubei Provincial Hospital of Integrated Chinese & Western Medicine, Wuhan; and Department of Neurology (W.C.), First Affiliated Hospital of Wenzhou Medical University, China
| | - An Wang
- Department of Neurology (H.T., A.W., S.L., Y.P., S.N., H.P., B.C., X.W., Z.Z.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (H.T., A.W., Yumei Zhang, S.L., Y.P., S.N., H.P., B.C., X.W., G.D., Z.Z.), Beijing; Monogenic Disease Research Center for Neurological Disorders (Yumei Zhang), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (K.L.), Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences; Department of Neurology (G.Z.), Huashan Hospital, Shanghai Medical College, Fudan University; Department of Neurology (M.W.), The First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou; Department of Neurology (G.W.), Lanzhou University Second Hospital; Department of Pathology (G.D.), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (W.L.), Army Medical Center of People's Liberation Army, Chongqing; Department of Neurology (Ying Zhang), The First People's Hospital of Shangqiu; Department of Neurology (S.G.), The First Affiliated Hospital of Xinxiang Medical University; Department of Neurology (X.L.), Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan; Department of Neurology (M.L.), The First People's Hospital of Huaihua City; Department of Neurology (H.L.), The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou; Department of Neurology (M.H.), Hubei Provincial Hospital of Integrated Chinese & Western Medicine, Wuhan; and Department of Neurology (W.C.), First Affiliated Hospital of Wenzhou Medical University, China
| | - Yumei Zhang
- Department of Neurology (H.T., A.W., S.L., Y.P., S.N., H.P., B.C., X.W., Z.Z.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (H.T., A.W., Yumei Zhang, S.L., Y.P., S.N., H.P., B.C., X.W., G.D., Z.Z.), Beijing; Monogenic Disease Research Center for Neurological Disorders (Yumei Zhang), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (K.L.), Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences; Department of Neurology (G.Z.), Huashan Hospital, Shanghai Medical College, Fudan University; Department of Neurology (M.W.), The First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou; Department of Neurology (G.W.), Lanzhou University Second Hospital; Department of Pathology (G.D.), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (W.L.), Army Medical Center of People's Liberation Army, Chongqing; Department of Neurology (Ying Zhang), The First People's Hospital of Shangqiu; Department of Neurology (S.G.), The First Affiliated Hospital of Xinxiang Medical University; Department of Neurology (X.L.), Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan; Department of Neurology (M.L.), The First People's Hospital of Huaihua City; Department of Neurology (H.L.), The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou; Department of Neurology (M.H.), Hubei Provincial Hospital of Integrated Chinese & Western Medicine, Wuhan; and Department of Neurology (W.C.), First Affiliated Hospital of Wenzhou Medical University, China
| | - Shaocheng Liu
- Department of Neurology (H.T., A.W., S.L., Y.P., S.N., H.P., B.C., X.W., Z.Z.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (H.T., A.W., Yumei Zhang, S.L., Y.P., S.N., H.P., B.C., X.W., G.D., Z.Z.), Beijing; Monogenic Disease Research Center for Neurological Disorders (Yumei Zhang), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (K.L.), Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences; Department of Neurology (G.Z.), Huashan Hospital, Shanghai Medical College, Fudan University; Department of Neurology (M.W.), The First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou; Department of Neurology (G.W.), Lanzhou University Second Hospital; Department of Pathology (G.D.), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (W.L.), Army Medical Center of People's Liberation Army, Chongqing; Department of Neurology (Ying Zhang), The First People's Hospital of Shangqiu; Department of Neurology (S.G.), The First Affiliated Hospital of Xinxiang Medical University; Department of Neurology (X.L.), Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan; Department of Neurology (M.L.), The First People's Hospital of Huaihua City; Department of Neurology (H.L.), The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou; Department of Neurology (M.H.), Hubei Provincial Hospital of Integrated Chinese & Western Medicine, Wuhan; and Department of Neurology (W.C.), First Affiliated Hospital of Wenzhou Medical University, China
| | - Yunzhu Pan
- Department of Neurology (H.T., A.W., S.L., Y.P., S.N., H.P., B.C., X.W., Z.Z.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (H.T., A.W., Yumei Zhang, S.L., Y.P., S.N., H.P., B.C., X.W., G.D., Z.Z.), Beijing; Monogenic Disease Research Center for Neurological Disorders (Yumei Zhang), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (K.L.), Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences; Department of Neurology (G.Z.), Huashan Hospital, Shanghai Medical College, Fudan University; Department of Neurology (M.W.), The First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou; Department of Neurology (G.W.), Lanzhou University Second Hospital; Department of Pathology (G.D.), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (W.L.), Army Medical Center of People's Liberation Army, Chongqing; Department of Neurology (Ying Zhang), The First People's Hospital of Shangqiu; Department of Neurology (S.G.), The First Affiliated Hospital of Xinxiang Medical University; Department of Neurology (X.L.), Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan; Department of Neurology (M.L.), The First People's Hospital of Huaihua City; Department of Neurology (H.L.), The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou; Department of Neurology (M.H.), Hubei Provincial Hospital of Integrated Chinese & Western Medicine, Wuhan; and Department of Neurology (W.C.), First Affiliated Hospital of Wenzhou Medical University, China
| | - Kai Li
- Department of Neurology (H.T., A.W., S.L., Y.P., S.N., H.P., B.C., X.W., Z.Z.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (H.T., A.W., Yumei Zhang, S.L., Y.P., S.N., H.P., B.C., X.W., G.D., Z.Z.), Beijing; Monogenic Disease Research Center for Neurological Disorders (Yumei Zhang), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (K.L.), Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences; Department of Neurology (G.Z.), Huashan Hospital, Shanghai Medical College, Fudan University; Department of Neurology (M.W.), The First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou; Department of Neurology (G.W.), Lanzhou University Second Hospital; Department of Pathology (G.D.), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (W.L.), Army Medical Center of People's Liberation Army, Chongqing; Department of Neurology (Ying Zhang), The First People's Hospital of Shangqiu; Department of Neurology (S.G.), The First Affiliated Hospital of Xinxiang Medical University; Department of Neurology (X.L.), Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan; Department of Neurology (M.L.), The First People's Hospital of Huaihua City; Department of Neurology (H.L.), The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou; Department of Neurology (M.H.), Hubei Provincial Hospital of Integrated Chinese & Western Medicine, Wuhan; and Department of Neurology (W.C.), First Affiliated Hospital of Wenzhou Medical University, China
| | - Guixian Zhao
- Department of Neurology (H.T., A.W., S.L., Y.P., S.N., H.P., B.C., X.W., Z.Z.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (H.T., A.W., Yumei Zhang, S.L., Y.P., S.N., H.P., B.C., X.W., G.D., Z.Z.), Beijing; Monogenic Disease Research Center for Neurological Disorders (Yumei Zhang), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (K.L.), Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences; Department of Neurology (G.Z.), Huashan Hospital, Shanghai Medical College, Fudan University; Department of Neurology (M.W.), The First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou; Department of Neurology (G.W.), Lanzhou University Second Hospital; Department of Pathology (G.D.), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (W.L.), Army Medical Center of People's Liberation Army, Chongqing; Department of Neurology (Ying Zhang), The First People's Hospital of Shangqiu; Department of Neurology (S.G.), The First Affiliated Hospital of Xinxiang Medical University; Department of Neurology (X.L.), Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan; Department of Neurology (M.L.), The First People's Hospital of Huaihua City; Department of Neurology (H.L.), The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou; Department of Neurology (M.H.), Hubei Provincial Hospital of Integrated Chinese & Western Medicine, Wuhan; and Department of Neurology (W.C.), First Affiliated Hospital of Wenzhou Medical University, China
| | - Mengwen Wang
- Department of Neurology (H.T., A.W., S.L., Y.P., S.N., H.P., B.C., X.W., Z.Z.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (H.T., A.W., Yumei Zhang, S.L., Y.P., S.N., H.P., B.C., X.W., G.D., Z.Z.), Beijing; Monogenic Disease Research Center for Neurological Disorders (Yumei Zhang), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (K.L.), Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences; Department of Neurology (G.Z.), Huashan Hospital, Shanghai Medical College, Fudan University; Department of Neurology (M.W.), The First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou; Department of Neurology (G.W.), Lanzhou University Second Hospital; Department of Pathology (G.D.), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (W.L.), Army Medical Center of People's Liberation Army, Chongqing; Department of Neurology (Ying Zhang), The First People's Hospital of Shangqiu; Department of Neurology (S.G.), The First Affiliated Hospital of Xinxiang Medical University; Department of Neurology (X.L.), Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan; Department of Neurology (M.L.), The First People's Hospital of Huaihua City; Department of Neurology (H.L.), The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou; Department of Neurology (M.H.), Hubei Provincial Hospital of Integrated Chinese & Western Medicine, Wuhan; and Department of Neurology (W.C.), First Affiliated Hospital of Wenzhou Medical University, China
| | - Guode Wu
- Department of Neurology (H.T., A.W., S.L., Y.P., S.N., H.P., B.C., X.W., Z.Z.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (H.T., A.W., Yumei Zhang, S.L., Y.P., S.N., H.P., B.C., X.W., G.D., Z.Z.), Beijing; Monogenic Disease Research Center for Neurological Disorders (Yumei Zhang), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (K.L.), Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences; Department of Neurology (G.Z.), Huashan Hospital, Shanghai Medical College, Fudan University; Department of Neurology (M.W.), The First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou; Department of Neurology (G.W.), Lanzhou University Second Hospital; Department of Pathology (G.D.), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (W.L.), Army Medical Center of People's Liberation Army, Chongqing; Department of Neurology (Ying Zhang), The First People's Hospital of Shangqiu; Department of Neurology (S.G.), The First Affiliated Hospital of Xinxiang Medical University; Department of Neurology (X.L.), Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan; Department of Neurology (M.L.), The First People's Hospital of Huaihua City; Department of Neurology (H.L.), The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou; Department of Neurology (M.H.), Hubei Provincial Hospital of Integrated Chinese & Western Medicine, Wuhan; and Department of Neurology (W.C.), First Affiliated Hospital of Wenzhou Medical University, China
| | - Songtao Niu
- Department of Neurology (H.T., A.W., S.L., Y.P., S.N., H.P., B.C., X.W., Z.Z.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (H.T., A.W., Yumei Zhang, S.L., Y.P., S.N., H.P., B.C., X.W., G.D., Z.Z.), Beijing; Monogenic Disease Research Center for Neurological Disorders (Yumei Zhang), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (K.L.), Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences; Department of Neurology (G.Z.), Huashan Hospital, Shanghai Medical College, Fudan University; Department of Neurology (M.W.), The First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou; Department of Neurology (G.W.), Lanzhou University Second Hospital; Department of Pathology (G.D.), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (W.L.), Army Medical Center of People's Liberation Army, Chongqing; Department of Neurology (Ying Zhang), The First People's Hospital of Shangqiu; Department of Neurology (S.G.), The First Affiliated Hospital of Xinxiang Medical University; Department of Neurology (X.L.), Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan; Department of Neurology (M.L.), The First People's Hospital of Huaihua City; Department of Neurology (H.L.), The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou; Department of Neurology (M.H.), Hubei Provincial Hospital of Integrated Chinese & Western Medicine, Wuhan; and Department of Neurology (W.C.), First Affiliated Hospital of Wenzhou Medical University, China
| | - Hua Pan
- Department of Neurology (H.T., A.W., S.L., Y.P., S.N., H.P., B.C., X.W., Z.Z.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (H.T., A.W., Yumei Zhang, S.L., Y.P., S.N., H.P., B.C., X.W., G.D., Z.Z.), Beijing; Monogenic Disease Research Center for Neurological Disorders (Yumei Zhang), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (K.L.), Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences; Department of Neurology (G.Z.), Huashan Hospital, Shanghai Medical College, Fudan University; Department of Neurology (M.W.), The First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou; Department of Neurology (G.W.), Lanzhou University Second Hospital; Department of Pathology (G.D.), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (W.L.), Army Medical Center of People's Liberation Army, Chongqing; Department of Neurology (Ying Zhang), The First People's Hospital of Shangqiu; Department of Neurology (S.G.), The First Affiliated Hospital of Xinxiang Medical University; Department of Neurology (X.L.), Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan; Department of Neurology (M.L.), The First People's Hospital of Huaihua City; Department of Neurology (H.L.), The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou; Department of Neurology (M.H.), Hubei Provincial Hospital of Integrated Chinese & Western Medicine, Wuhan; and Department of Neurology (W.C.), First Affiliated Hospital of Wenzhou Medical University, China
| | - Bin Chen
- Department of Neurology (H.T., A.W., S.L., Y.P., S.N., H.P., B.C., X.W., Z.Z.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (H.T., A.W., Yumei Zhang, S.L., Y.P., S.N., H.P., B.C., X.W., G.D., Z.Z.), Beijing; Monogenic Disease Research Center for Neurological Disorders (Yumei Zhang), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (K.L.), Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences; Department of Neurology (G.Z.), Huashan Hospital, Shanghai Medical College, Fudan University; Department of Neurology (M.W.), The First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou; Department of Neurology (G.W.), Lanzhou University Second Hospital; Department of Pathology (G.D.), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (W.L.), Army Medical Center of People's Liberation Army, Chongqing; Department of Neurology (Ying Zhang), The First People's Hospital of Shangqiu; Department of Neurology (S.G.), The First Affiliated Hospital of Xinxiang Medical University; Department of Neurology (X.L.), Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan; Department of Neurology (M.L.), The First People's Hospital of Huaihua City; Department of Neurology (H.L.), The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou; Department of Neurology (M.H.), Hubei Provincial Hospital of Integrated Chinese & Western Medicine, Wuhan; and Department of Neurology (W.C.), First Affiliated Hospital of Wenzhou Medical University, China
| | - Wei Li
- Department of Neurology (H.T., A.W., S.L., Y.P., S.N., H.P., B.C., X.W., Z.Z.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (H.T., A.W., Yumei Zhang, S.L., Y.P., S.N., H.P., B.C., X.W., G.D., Z.Z.), Beijing; Monogenic Disease Research Center for Neurological Disorders (Yumei Zhang), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (K.L.), Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences; Department of Neurology (G.Z.), Huashan Hospital, Shanghai Medical College, Fudan University; Department of Neurology (M.W.), The First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou; Department of Neurology (G.W.), Lanzhou University Second Hospital; Department of Pathology (G.D.), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (W.L.), Army Medical Center of People's Liberation Army, Chongqing; Department of Neurology (Ying Zhang), The First People's Hospital of Shangqiu; Department of Neurology (S.G.), The First Affiliated Hospital of Xinxiang Medical University; Department of Neurology (X.L.), Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan; Department of Neurology (M.L.), The First People's Hospital of Huaihua City; Department of Neurology (H.L.), The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou; Department of Neurology (M.H.), Hubei Provincial Hospital of Integrated Chinese & Western Medicine, Wuhan; and Department of Neurology (W.C.), First Affiliated Hospital of Wenzhou Medical University, China
| | - Xingao Wang
- Department of Neurology (H.T., A.W., S.L., Y.P., S.N., H.P., B.C., X.W., Z.Z.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (H.T., A.W., Yumei Zhang, S.L., Y.P., S.N., H.P., B.C., X.W., G.D., Z.Z.), Beijing; Monogenic Disease Research Center for Neurological Disorders (Yumei Zhang), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (K.L.), Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences; Department of Neurology (G.Z.), Huashan Hospital, Shanghai Medical College, Fudan University; Department of Neurology (M.W.), The First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou; Department of Neurology (G.W.), Lanzhou University Second Hospital; Department of Pathology (G.D.), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (W.L.), Army Medical Center of People's Liberation Army, Chongqing; Department of Neurology (Ying Zhang), The First People's Hospital of Shangqiu; Department of Neurology (S.G.), The First Affiliated Hospital of Xinxiang Medical University; Department of Neurology (X.L.), Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan; Department of Neurology (M.L.), The First People's Hospital of Huaihua City; Department of Neurology (H.L.), The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou; Department of Neurology (M.H.), Hubei Provincial Hospital of Integrated Chinese & Western Medicine, Wuhan; and Department of Neurology (W.C.), First Affiliated Hospital of Wenzhou Medical University, China
| | - Gehong Dong
- Department of Neurology (H.T., A.W., S.L., Y.P., S.N., H.P., B.C., X.W., Z.Z.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (H.T., A.W., Yumei Zhang, S.L., Y.P., S.N., H.P., B.C., X.W., G.D., Z.Z.), Beijing; Monogenic Disease Research Center for Neurological Disorders (Yumei Zhang), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (K.L.), Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences; Department of Neurology (G.Z.), Huashan Hospital, Shanghai Medical College, Fudan University; Department of Neurology (M.W.), The First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou; Department of Neurology (G.W.), Lanzhou University Second Hospital; Department of Pathology (G.D.), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (W.L.), Army Medical Center of People's Liberation Army, Chongqing; Department of Neurology (Ying Zhang), The First People's Hospital of Shangqiu; Department of Neurology (S.G.), The First Affiliated Hospital of Xinxiang Medical University; Department of Neurology (X.L.), Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan; Department of Neurology (M.L.), The First People's Hospital of Huaihua City; Department of Neurology (H.L.), The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou; Department of Neurology (M.H.), Hubei Provincial Hospital of Integrated Chinese & Western Medicine, Wuhan; and Department of Neurology (W.C.), First Affiliated Hospital of Wenzhou Medical University, China
| | - Wei Li
- Department of Neurology (H.T., A.W., S.L., Y.P., S.N., H.P., B.C., X.W., Z.Z.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (H.T., A.W., Yumei Zhang, S.L., Y.P., S.N., H.P., B.C., X.W., G.D., Z.Z.), Beijing; Monogenic Disease Research Center for Neurological Disorders (Yumei Zhang), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (K.L.), Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences; Department of Neurology (G.Z.), Huashan Hospital, Shanghai Medical College, Fudan University; Department of Neurology (M.W.), The First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou; Department of Neurology (G.W.), Lanzhou University Second Hospital; Department of Pathology (G.D.), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (W.L.), Army Medical Center of People's Liberation Army, Chongqing; Department of Neurology (Ying Zhang), The First People's Hospital of Shangqiu; Department of Neurology (S.G.), The First Affiliated Hospital of Xinxiang Medical University; Department of Neurology (X.L.), Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan; Department of Neurology (M.L.), The First People's Hospital of Huaihua City; Department of Neurology (H.L.), The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou; Department of Neurology (M.H.), Hubei Provincial Hospital of Integrated Chinese & Western Medicine, Wuhan; and Department of Neurology (W.C.), First Affiliated Hospital of Wenzhou Medical University, China
| | - Ying Zhang
- Department of Neurology (H.T., A.W., S.L., Y.P., S.N., H.P., B.C., X.W., Z.Z.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (H.T., A.W., Yumei Zhang, S.L., Y.P., S.N., H.P., B.C., X.W., G.D., Z.Z.), Beijing; Monogenic Disease Research Center for Neurological Disorders (Yumei Zhang), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (K.L.), Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences; Department of Neurology (G.Z.), Huashan Hospital, Shanghai Medical College, Fudan University; Department of Neurology (M.W.), The First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou; Department of Neurology (G.W.), Lanzhou University Second Hospital; Department of Pathology (G.D.), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (W.L.), Army Medical Center of People's Liberation Army, Chongqing; Department of Neurology (Ying Zhang), The First People's Hospital of Shangqiu; Department of Neurology (S.G.), The First Affiliated Hospital of Xinxiang Medical University; Department of Neurology (X.L.), Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan; Department of Neurology (M.L.), The First People's Hospital of Huaihua City; Department of Neurology (H.L.), The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou; Department of Neurology (M.H.), Hubei Provincial Hospital of Integrated Chinese & Western Medicine, Wuhan; and Department of Neurology (W.C.), First Affiliated Hospital of Wenzhou Medical University, China
| | - Sheng Guo
- Department of Neurology (H.T., A.W., S.L., Y.P., S.N., H.P., B.C., X.W., Z.Z.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (H.T., A.W., Yumei Zhang, S.L., Y.P., S.N., H.P., B.C., X.W., G.D., Z.Z.), Beijing; Monogenic Disease Research Center for Neurological Disorders (Yumei Zhang), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (K.L.), Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences; Department of Neurology (G.Z.), Huashan Hospital, Shanghai Medical College, Fudan University; Department of Neurology (M.W.), The First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou; Department of Neurology (G.W.), Lanzhou University Second Hospital; Department of Pathology (G.D.), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (W.L.), Army Medical Center of People's Liberation Army, Chongqing; Department of Neurology (Ying Zhang), The First People's Hospital of Shangqiu; Department of Neurology (S.G.), The First Affiliated Hospital of Xinxiang Medical University; Department of Neurology (X.L.), Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan; Department of Neurology (M.L.), The First People's Hospital of Huaihua City; Department of Neurology (H.L.), The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou; Department of Neurology (M.H.), Hubei Provincial Hospital of Integrated Chinese & Western Medicine, Wuhan; and Department of Neurology (W.C.), First Affiliated Hospital of Wenzhou Medical University, China
| | - Xiaoyun Liu
- Department of Neurology (H.T., A.W., S.L., Y.P., S.N., H.P., B.C., X.W., Z.Z.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (H.T., A.W., Yumei Zhang, S.L., Y.P., S.N., H.P., B.C., X.W., G.D., Z.Z.), Beijing; Monogenic Disease Research Center for Neurological Disorders (Yumei Zhang), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (K.L.), Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences; Department of Neurology (G.Z.), Huashan Hospital, Shanghai Medical College, Fudan University; Department of Neurology (M.W.), The First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou; Department of Neurology (G.W.), Lanzhou University Second Hospital; Department of Pathology (G.D.), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (W.L.), Army Medical Center of People's Liberation Army, Chongqing; Department of Neurology (Ying Zhang), The First People's Hospital of Shangqiu; Department of Neurology (S.G.), The First Affiliated Hospital of Xinxiang Medical University; Department of Neurology (X.L.), Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan; Department of Neurology (M.L.), The First People's Hospital of Huaihua City; Department of Neurology (H.L.), The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou; Department of Neurology (M.H.), Hubei Provincial Hospital of Integrated Chinese & Western Medicine, Wuhan; and Department of Neurology (W.C.), First Affiliated Hospital of Wenzhou Medical University, China
| | - Mingxia Li
- Department of Neurology (H.T., A.W., S.L., Y.P., S.N., H.P., B.C., X.W., Z.Z.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (H.T., A.W., Yumei Zhang, S.L., Y.P., S.N., H.P., B.C., X.W., G.D., Z.Z.), Beijing; Monogenic Disease Research Center for Neurological Disorders (Yumei Zhang), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (K.L.), Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences; Department of Neurology (G.Z.), Huashan Hospital, Shanghai Medical College, Fudan University; Department of Neurology (M.W.), The First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou; Department of Neurology (G.W.), Lanzhou University Second Hospital; Department of Pathology (G.D.), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (W.L.), Army Medical Center of People's Liberation Army, Chongqing; Department of Neurology (Ying Zhang), The First People's Hospital of Shangqiu; Department of Neurology (S.G.), The First Affiliated Hospital of Xinxiang Medical University; Department of Neurology (X.L.), Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan; Department of Neurology (M.L.), The First People's Hospital of Huaihua City; Department of Neurology (H.L.), The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou; Department of Neurology (M.H.), Hubei Provincial Hospital of Integrated Chinese & Western Medicine, Wuhan; and Department of Neurology (W.C.), First Affiliated Hospital of Wenzhou Medical University, China
| | - Hui Liang
- Department of Neurology (H.T., A.W., S.L., Y.P., S.N., H.P., B.C., X.W., Z.Z.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (H.T., A.W., Yumei Zhang, S.L., Y.P., S.N., H.P., B.C., X.W., G.D., Z.Z.), Beijing; Monogenic Disease Research Center for Neurological Disorders (Yumei Zhang), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (K.L.), Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences; Department of Neurology (G.Z.), Huashan Hospital, Shanghai Medical College, Fudan University; Department of Neurology (M.W.), The First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou; Department of Neurology (G.W.), Lanzhou University Second Hospital; Department of Pathology (G.D.), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (W.L.), Army Medical Center of People's Liberation Army, Chongqing; Department of Neurology (Ying Zhang), The First People's Hospital of Shangqiu; Department of Neurology (S.G.), The First Affiliated Hospital of Xinxiang Medical University; Department of Neurology (X.L.), Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan; Department of Neurology (M.L.), The First People's Hospital of Huaihua City; Department of Neurology (H.L.), The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou; Department of Neurology (M.H.), Hubei Provincial Hospital of Integrated Chinese & Western Medicine, Wuhan; and Department of Neurology (W.C.), First Affiliated Hospital of Wenzhou Medical University, China
| | - Ming Huang
- Department of Neurology (H.T., A.W., S.L., Y.P., S.N., H.P., B.C., X.W., Z.Z.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (H.T., A.W., Yumei Zhang, S.L., Y.P., S.N., H.P., B.C., X.W., G.D., Z.Z.), Beijing; Monogenic Disease Research Center for Neurological Disorders (Yumei Zhang), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (K.L.), Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences; Department of Neurology (G.Z.), Huashan Hospital, Shanghai Medical College, Fudan University; Department of Neurology (M.W.), The First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou; Department of Neurology (G.W.), Lanzhou University Second Hospital; Department of Pathology (G.D.), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (W.L.), Army Medical Center of People's Liberation Army, Chongqing; Department of Neurology (Ying Zhang), The First People's Hospital of Shangqiu; Department of Neurology (S.G.), The First Affiliated Hospital of Xinxiang Medical University; Department of Neurology (X.L.), Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan; Department of Neurology (M.L.), The First People's Hospital of Huaihua City; Department of Neurology (H.L.), The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou; Department of Neurology (M.H.), Hubei Provincial Hospital of Integrated Chinese & Western Medicine, Wuhan; and Department of Neurology (W.C.), First Affiliated Hospital of Wenzhou Medical University, China
| | - Wei'an Chen
- Department of Neurology (H.T., A.W., S.L., Y.P., S.N., H.P., B.C., X.W., Z.Z.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (H.T., A.W., Yumei Zhang, S.L., Y.P., S.N., H.P., B.C., X.W., G.D., Z.Z.), Beijing; Monogenic Disease Research Center for Neurological Disorders (Yumei Zhang), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (K.L.), Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences; Department of Neurology (G.Z.), Huashan Hospital, Shanghai Medical College, Fudan University; Department of Neurology (M.W.), The First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou; Department of Neurology (G.W.), Lanzhou University Second Hospital; Department of Pathology (G.D.), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (W.L.), Army Medical Center of People's Liberation Army, Chongqing; Department of Neurology (Ying Zhang), The First People's Hospital of Shangqiu; Department of Neurology (S.G.), The First Affiliated Hospital of Xinxiang Medical University; Department of Neurology (X.L.), Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan; Department of Neurology (M.L.), The First People's Hospital of Huaihua City; Department of Neurology (H.L.), The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou; Department of Neurology (M.H.), Hubei Provincial Hospital of Integrated Chinese & Western Medicine, Wuhan; and Department of Neurology (W.C.), First Affiliated Hospital of Wenzhou Medical University, China
| | - Zaiqiang Zhang
- Department of Neurology (H.T., A.W., S.L., Y.P., S.N., H.P., B.C., X.W., Z.Z.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (H.T., A.W., Yumei Zhang, S.L., Y.P., S.N., H.P., B.C., X.W., G.D., Z.Z.), Beijing; Monogenic Disease Research Center for Neurological Disorders (Yumei Zhang), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (K.L.), Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences; Department of Neurology (G.Z.), Huashan Hospital, Shanghai Medical College, Fudan University; Department of Neurology (M.W.), The First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou; Department of Neurology (G.W.), Lanzhou University Second Hospital; Department of Pathology (G.D.), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (W.L.), Army Medical Center of People's Liberation Army, Chongqing; Department of Neurology (Ying Zhang), The First People's Hospital of Shangqiu; Department of Neurology (S.G.), The First Affiliated Hospital of Xinxiang Medical University; Department of Neurology (X.L.), Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan; Department of Neurology (M.L.), The First People's Hospital of Huaihua City; Department of Neurology (H.L.), The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou; Department of Neurology (M.H.), Hubei Provincial Hospital of Integrated Chinese & Western Medicine, Wuhan; and Department of Neurology (W.C.), First Affiliated Hospital of Wenzhou Medical University, China
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Kong Y, Chen H, Zhang J. Neuronal intranuclear inclusion disease with neuroimaging mimicking MELAS. Neurol Sci 2023:10.1007/s10072-023-06725-9. [PMID: 36913146 DOI: 10.1007/s10072-023-06725-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 03/01/2023] [Indexed: 03/14/2023]
Affiliation(s)
- Yu Kong
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing, China
| | - Hao Chen
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, No. 99, Huaihai West Road, Quanshan District, Xuzhou, China.
| | - Jing Zhang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing, China.
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26
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Ishiura H, Tsuji S, Toda T. Recent advances in CGG repeat diseases and a proposal of fragile X-associated tremor/ataxia syndrome, neuronal intranuclear inclusion disease, and oculophryngodistal myopathy (FNOP) spectrum disorder. J Hum Genet 2023; 68:169-174. [PMID: 36670296 PMCID: PMC9968658 DOI: 10.1038/s10038-022-01116-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 12/21/2022] [Accepted: 12/21/2022] [Indexed: 01/22/2023]
Abstract
While whole genome sequencing and long-read sequencing have become widely available, more and more focuses are on noncoding expanded repeats. Indeed, more than half of noncoding repeat expansions related to diseases have been identified in the five years. An exciting aspect of the progress in this field is an identification of a phenomenon called repeat motif-phenotype correlation. Repeat motif-phenotype correlation in noncoding repeat expansion diseases is first found in benign adult familial myoclonus epilepsy. The concept is extended in the research of CGG repeat expansion diseases. In this review, we focus on newly identified CGG repeat expansion diseases, update the concept of repeat motif-phenotype correlation in CGG repeat expansion diseases, and propose a clinical concept of FNOP (fragile X-associated tremor/ataxia syndrome, neuronal intranuclear inclusion disease, and oculopharyngodistal myopathy)-spectrum disorder, which shares clinical features and thus probably share some common disease pathophysiology, to further facilitate discussion and progress in this field.
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Affiliation(s)
- Hiroyuki Ishiura
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
- Department of Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
| | - Shoji Tsuji
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Institute of Medical Genomics, International University of Health and Welfare, Narita, Japan
| | - Tatsushi Toda
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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27
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NOTCH2NLC GGC repeats are not expanded in Italian amyotrophic lateral sclerosis patients. Sci Rep 2023; 13:3187. [PMID: 36823368 PMCID: PMC9950471 DOI: 10.1038/s41598-023-30393-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 02/22/2023] [Indexed: 02/25/2023] Open
Abstract
Repeat expansions in genes other than C9orf72 and ATXN2 have been recently associated with Amyotrophic Lateral Sclerosis (ALS). Indeed, an abnormal number of GGC repeats in NOTCH2NLC has been recently reported in 0.7% of sporadic ALS patients from mainland China. This finding was not confirmed in an ALS cohort of subjects from Taiwan. As the involvement of expanded NOTCH2NLC alleles in ALS is debated, we addressed this point by evaluating NOTCH2NLC repeat expansions in an Italian cohort of ALS patients. A screening analysis of NOTCH2NLC GGC repeats was performed by repeat-primed polymerase chain reaction (RP-PCR) in a cohort of 385 probable/definite ALS Italian patients. Mean age at onset was 60.5 years (SD 13.7), and 60.9% were males. Sporadic cases were 357 (92.7%), and most patients had a spinal onset (71.8%). None of our patients showed the typical sawtooth tail pattern on RP-PCR, thus excluding abnormal repeat expansion in NOTCH2NLC. Overall, we suggest that NOTCH2NLC expanded alleles might be absent or at least extremely rare in ALS Italian patients. Further investigations in larger cohorts with different ethnic backgrounds are required to support the involvement of NOTCH2NLC in ALS.
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28
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Current advances in neuronal intranuclear inclusion disease. Neurol Sci 2023; 44:1881-1889. [PMID: 36795299 DOI: 10.1007/s10072-023-06677-0] [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: 12/07/2022] [Accepted: 02/10/2023] [Indexed: 02/17/2023]
Abstract
Neuronal intranuclear inclusion disease (NIID) is a rare but probably underdiagnosed neurodegenerative disorder due to pathogenic GGC expansions in the NOTCH2NLC gene. In this review, we summarize recent developments in the inheritance features, pathogenesis, and histopathologic and radiologic features of NIID that subvert the previous perceptions of NIID. GGC repeat sizes determine the age of onset and clinical phenotypes of NIID patients. Anticipation may be absent in NIID but paternal bias is observed in NIID pedigrees. Eosinophilic intranuclear inclusions in skin tissues once considered pathological hallmarks of NIID can also present in other GGC repeat diseases. Diffusion-weighted imaging (DWI) hyperintensity along the corticomedullary junction once considered the imaging hallmark of NIID can frequently be absent in muscle weakness and parkinsonism phenotype of NIID. Besides, DWI abnormalities can appear years after the onset of predominant symptoms and may even disappear completely with disease progression. Moreover, continuous reports of NOTCH2NLC GGC expansions in patients with other neurodegenerative diseases lead to the proposal of a new concept of NOTCH2NLC-related GGC repeat expansion disorders (NRED). However, by reviewing the previous literature, we point out the limitations of these studies and provide evidence that these patients are actually suffering from neurodegenerative phenotypes of NIID.
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29
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Hong D, Wang H, Zhu M, Peng Y, Huang P, Zheng Y, Yu M, Meng L, Li F, Yu J, Zhou M, Deng J, Wang Z, Yuan Y. Subclinical peripheral neuropathy is common in neuronal intranuclear inclusion disease with dominant encephalopathy. Eur J Neurol 2023; 30:527-537. [PMID: 36263606 DOI: 10.1111/ene.15606] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/05/2022] [Accepted: 10/13/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND PURPOSE Neuronal intranuclear inclusion disease (NIID) is associated with CGG repeat expansion in the NOTCH2NLC gene. Although pure or dominant peripheral neuropathy has been described as a subtype of NIID in a few patients, most NIID patients predominantly show involvements of the central nervous system (CNS). It is necessary to further explore whether these patients have subclinical peripheral neuropathy. METHODS Twenty-eight NIID patients, clinically characterized by CNS-dominant involvements, were recruited from two tertiary hospitals. Standard nerve conduction studies were performed in all patients. Skin and sural nerve biopsies were performed in 28 and 15 patients, respectively. Repeat-primed polymerase chain reaction and amplicon length polymerase chain reaction were used to screen the CGG repeat expansion in NOTCH2NLC. RESULTS All 28 patients can be diagnosed with NIID based on skin pathological and genetic changes. All patients predominantly showed CNS symptoms mainly characterized by episodic encephalopathy and cognitive impairments, but no clinical symptoms of peripheral neuropathy could be observed initially. Electrophysiological abnormalities were found in 96.4% (27/28) of these patients, indicating that subclinical peripheral neuropathy is common in NIID patients with CNS-dominant type. Electrophysiological and neuropathological studies revealed that demyelinating degeneration was the main pathological pattern in these patients, although mild axonal degeneration was also observed in some patients. No significant association between CGG repeat size and the change of nerve conduction velocity was found in these patients. CONCLUSIONS This study demonstrated that most patients with CNS-dominant NIID had subclinical peripheral neuropathy. Electrophysiological examination should be the routinely diagnostic workflow for every NIID patient.
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Affiliation(s)
- Daojun Hong
- Department of Neurology, First Affiliated Hospital of Nanchang University, Nanchang, China
- Department of Medical Genetics, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Hui Wang
- Department of Neurology, Peking University First Hospital, Beijing, China
- Beijing Key Laboratory of Neurovascular Disease Discovery, Beijing, China
| | - Min Zhu
- Department of Neurology, First Affiliated Hospital of Nanchang University, Nanchang, China
- Department of Medical Genetics, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yun Peng
- Department of Neurology, First Affiliated Hospital of Nanchang University, Nanchang, China
- Department of Medical Genetics, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Pengcheng Huang
- Department of Neurology, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yilei Zheng
- Department of Neurology, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Meng Yu
- Department of Neurology, Peking University First Hospital, Beijing, China
- Beijing Key Laboratory of Neurovascular Disease Discovery, Beijing, China
| | - Lingchao Meng
- Department of Neurology, Peking University First Hospital, Beijing, China
- Beijing Key Laboratory of Neurovascular Disease Discovery, Beijing, China
| | - Fan Li
- Department of Neurology, Peking University First Hospital, Beijing, China
- Beijing Key Laboratory of Neurovascular Disease Discovery, Beijing, China
| | - Jiaxi Yu
- Department of Neurology, Peking University First Hospital, Beijing, China
- Beijing Key Laboratory of Neurovascular Disease Discovery, Beijing, China
| | - Meihong Zhou
- Department of Neurology, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jianwen Deng
- Department of Neurology, Peking University First Hospital, Beijing, China
- Beijing Key Laboratory of Neurovascular Disease Discovery, Beijing, China
| | - Zhaoxia Wang
- Department of Neurology, Peking University First Hospital, Beijing, China
- Beijing Key Laboratory of Neurovascular Disease Discovery, Beijing, China
| | - Yun Yuan
- Department of Neurology, Peking University First Hospital, Beijing, China
- Beijing Key Laboratory of Neurovascular Disease Discovery, Beijing, China
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30
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Wang YC, Fan Y, Yu WK, Shen S, Li JD, Gao Y, Ji Y, Li YS, Yu LL, Zhao ZC, Li SS, Ding Y, Shi CH, Xu YM. NOTCH2NLC expanded GGC repeats in patients with cerebral small vessel disease. Stroke Vasc Neurol 2022; 8:161-168. [PMID: 36207023 PMCID: PMC10176980 DOI: 10.1136/svn-2022-001631] [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: 04/07/2022] [Accepted: 09/21/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE GGC repeat expansions in the human-specific NOTCH2NLC gene have been reported as the cause of neuronal intranuclear inclusion disease (NIID). Given the clinical overlap of cognitive impairment in NIID and cerebral small vessel disease (CSVD), both diseases have white matter hyperintensity on T2-fluid-attenuated inversion recovery sequences of brain MRI, and white matter hyperintensity is a primary neuroimaging marker of CSVD on MRI. Therefore, we hypothesised that the GGC repeat expansions might also contribute to CSVD. To further investigate the relationship between NOTCH2NLC GGC repeat expansions and CSVD, we performed a genetic analysis of 814 patients with the disease. METHODS We performed a comprehensive GGC repeat expansion screening in NOTCH2NLC from 814 patients with sporadic CSVD. Their Fazekas score was greater than or equal to 3 points. Repeat-primed PCR and fluorescence amplicon length analyses were performed to identify GGC repeat expansions, and whole-exome sequencing was used to detect any pathogenic mutation in previously reported genes associated with CSVD. RESULTS We identified nine (1.11%) patients with pathogenic GGC repeat expansions ranging from 41 to 98 repeats. The minor allele frequency of expanded GGC repeats in NOTCH2NLC was 0.55%. CONCLUSION Our findings suggest that intermediate-length and longer-length GGC repeat expansions in NOTCH2NLC are associated with sporadic CSVD. This provides new thinking for studying the pathogenesis of CSVD.
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Affiliation(s)
- Yun-Chao Wang
- Department of Neurology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Diseases, Zhengzhou, Henan, China
| | - Yu Fan
- Department of Neurology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Diseases, Zhengzhou, Henan, China
| | - Wen-Kai Yu
- Department of Neurology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Si Shen
- Department of Neurology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Diseases, Zhengzhou, Henan, China
| | - Jia-Di Li
- Department of Neurology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Diseases, Zhengzhou, Henan, China
| | - Yuan Gao
- Department of Neurology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Diseases, Zhengzhou, Henan, China
| | - Yan Ji
- Department of Neurology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Diseases, Zhengzhou, Henan, China
| | - Yu-Sheng Li
- Department of Neurology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Diseases, Zhengzhou, Henan, China
| | - Lu-Lu Yu
- Department of Neurology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Zi-Chen Zhao
- Department of Neurology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Shan-Shan Li
- Department of Neurology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yao Ding
- Department of Neurology, Xinxiang Medical University, Xinxiang, Henan, China
| | - Chang-He Shi
- Department of Neurology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Diseases, Zhengzhou, Henan, China
| | - Yu-Ming Xu
- Department of Neurology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Diseases, Zhengzhou, Henan, China
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31
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Kinoshita M, Mutoh S, Kasai A, Kawanishi R, Tanaka K. General Anesthesia in a Patient With Neuronal Intranuclear Inclusion Disease: A Case Report. A A Pract 2022; 16:e01633. [PMID: 36599032 DOI: 10.1213/xaa.0000000000001633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Neuronal intranuclear inclusion disease (NIID) is a progressive neurodegenerative disease with diverse clinical manifestations, including dementia and muscle weakness. We summarize anesthetic considerations in reporting general anesthesia for a 58-year-old man with bladder dysfunction and cerebellar ataxia who was diagnosed with NIID. The patient developed postinduction hypotension relevant to autonomic neuropathy. The potential risks, such as prolonged reaction to neuromuscular blocking agent, postoperative delirium, and worsening of NIID-related symptoms, were also considered. The responsiveness to anesthetics may vary widely from case t case. As the number of NIID cases increases, a better understanding of NIID is needed.
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Affiliation(s)
- Michiko Kinoshita
- From the Department of Anesthesiology, Tokushima University Hospital, Tokushima, Japan
| | - Sarara Mutoh
- From the Department of Anesthesiology, Tokushima University Hospital, Tokushima, Japan
| | - Asuka Kasai
- Surgical Center, Tokushima University Hospital, Tokushima, Japan
| | | | - Katsuya Tanaka
- From the Department of Anesthesiology, Tokushima University Hospital, Tokushima, Japan
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32
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Zhou Y, Huang P, Huang Z, Peng Y, Zheng Y, Yu Y, Zhu M, Deng J, Wang Z, Hong D. Urine cytological study in patients with clinicopathologically confirmed neuronal intranuclear inclusion disease. Front Aging Neurosci 2022; 14:977604. [PMID: 36172483 PMCID: PMC9510843 DOI: 10.3389/fnagi.2022.977604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/25/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveThe diagnosis of neuronal intranuclear inclusion disease (NIID) is currently based on CGG repeat expansion in the 5′UTR of the NOTCH2NLC gene, or p62-positive intranuclear inclusions in skin biopsy. The purpose of this study is to explore the value of non-invasive pathological findings in urine sediment cells from NIID patients.Materials and methodsTen patients with clinically suspected NIID were enrolled for skin biopsy and gene screening. Morning urine (500 ml) was collected from each patient, and cell sediment was obtained by centrifugation. Urine cytology, including Giemsa staining, p62 immunostaining, and electron microscopic examination, were conducted on cell sediment.ResultsThe main clinical symptoms of 10 patients included episodic disturbance of consciousness, cognitive impairment, tremor, limb weakness, and so on. Cerebral MRI showed that 9 patients had linear DWI high signal in the corticomedullary junction. Genetic testing found that the number of CGG repeat ranged from 96 to 158 in the NOTCH2NLC gene. Skin biopsy revealed that all patients showed p62-positive intranuclear inclusions in 18.5 ± 6.3% of the duct epithelial cells of sweat gland. In contrast, urine sediment smears revealed that only 3 patients had p62 positive intranuclear inclusions in 3.5 ± 1.2% of the sedimentary cells. Ultrastructural examinations showed that intranuclear inclusions were also identified in the cell sediment of the 3 patients.ConclusionUrine cytology may be a new and non-invasive pathological diagnosis technique for some NIID patients, although the positive rate is not as high as that of skin biopsy, which is a sensitive and reliable pathological method for NIID.
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Affiliation(s)
- Yiyi Zhou
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Pengcheng Huang
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zhaojun Huang
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yun Peng
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yilei Zheng
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yaqing Yu
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Min Zhu
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jianwen Deng
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Zhaoxia Wang
- Department of Neurology, Peking University First Hospital, Beijing, China
- *Correspondence: Daojun Hong,
| | - Daojun Hong
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Department of Medical Genetics, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Zhaoxia Wang,
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