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Beaudin M, Dupre N, Manto M. The importance of synthetic pharmacotherapy for recessive cerebellar ataxias. Expert Rev Neurother 2024; 24:897-912. [PMID: 38980086 DOI: 10.1080/14737175.2024.2376840] [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: 04/19/2024] [Accepted: 07/02/2024] [Indexed: 07/10/2024]
Abstract
INTRODUCTION The last decade has witnessed major breakthroughs in identifying novel genetic causes of hereditary ataxias, deepening our understanding of disease mechanisms, and developing therapies for these debilitating disorders. AREAS COVERED This article reviews the currently approved and most promising candidate pharmacotherapies in relation to the known disease mechanisms of the most prevalent autosomal recessive ataxias. Omaveloxolone is an Nrf2 activator that increases antioxidant defense and was recently approved for treatment of Friedreich ataxia. Its therapeutic effect is modest, and further research is needed to find synergistic treatments that would halt or reverse disease progression. Promising approaches include upregulation of frataxin expression by epigenetic mechanisms, direct protein replacement, and gene replacement therapy. For ataxia-telangiectasia, promising approaches include splice-switching antisense oligonucleotides and small molecules targeting oxidative stress, inflammation, and mitochondrial function. Rare recessive ataxias for which disease-modifying therapies exist are also reviewed, emphasizing recently approved therapies. Evidence supporting the use of riluzole and acetyl-leucine in recessive ataxias is discussed. EXPERT OPINION Advances in genetic therapies for other neurogenetic conditions have paved the way to implement feasible approaches with potential dramatic benefits. Particularly, as we develop effective treatments for these conditions, we may need to combine therapies, consider newborn testing for pre-symptomatic treatment, and optimize non-pharmacological approaches.
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Affiliation(s)
- Marie Beaudin
- Department of Neurology and Neurological Sciences, Stanford School of Medicine, Stanford, CA, USA
| | - Nicolas Dupre
- Neuroscience axis, CHU de Québec-Université Laval, Québec, QC, Canada
- Department of Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | - Mario Manto
- Service des Neurosciences, Université de Mons, Mons, Belgique
- Unité des Ataxies Cérébelleuses, Service de Neurologie, CHU-Charleroi, Charleroi, Belgique
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Satolli S, Rossi S, Vegezzi E, Pellerin D, Manca ML, Barghigiani M, Battisti C, Bilancieri G, Bruno G, Capacci E, Casali C, Ceravolo R, Cocozza S, Cotti Piccinelli S, Criscuolo C, Danzi MC, De Micco R, De Michele G, Dicaire MJ, Falcone GMI, Fancellu R, Ferchichi Y, Ferrari C, Filla A, Fini N, Govoni A, Lo Vecchio F, Malandrini A, Mignarri A, Musumeci O, Nesti C, Pappatà S, Pellecchia MT, Perna A, Petrucci A, Pomponi MG, Ravenni R, Ricca I, Rufa A, Tabolacci E, Tessa A, Tessitore A, Zuchner S, Silvestri G, Cortese A, Brais B, Santorelli FM. Spinocerebellar ataxia 27B: a frequent and slowly progressive autosomal-dominant cerebellar ataxia-experience from an Italian cohort. J Neurol 2024; 271:5478-5488. [PMID: 38886208 DOI: 10.1007/s00415-024-12506-x] [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: 04/22/2024] [Revised: 06/01/2024] [Accepted: 06/07/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Autosomal-dominant spinocerebellar ataxia (ADCA) due to intronic GAA repeat expansion in FGF14 (SCA27B) is a recent, relatively common form of late-onset ataxia. OBJECTIVE Here, we aimed to: (1) investigate the relative frequency of SCA27B in different clinically defined disease subgroups with late-onset ataxia collected among 16 tertiary Italian centers; (2) characterize phenotype and diagnostic findings of patients with SCA27B; (3) compare the Italian cohort with other cohorts reported in recent studies. METHODS We screened 396 clinically diagnosed late-onset cerebellar ataxias of unknown cause, subdivided in sporadic cerebellar ataxia, ADCA, and multisystem atrophy cerebellar type. We identified 72 new genetically defined subjects with SCA27B. Then, we analyzed the clinical, neurophysiological, and imaging features of 64 symptomatic cases. RESULTS In our cohort, the prevalence of SCA27B was 13.4% (53/396) with as high as 38.5% (22/57) in ADCA. The median age of onset of SCA27B patients was 62 years. All symptomatic individuals showed evidence of impaired balance and gait; cerebellar ocular motor signs were also frequent. Episodic manifestations at onset occurred in 31% of patients. Extrapyramidal features (17%) and cognitive impairment (25%) were also reported. Brain magnetic resonance imaging showed cerebellar atrophy in most cases (78%). Pseudo-longitudinal assessments indicated slow progression of ataxia and minimal functional impairment. CONCLUSION Patients with SCA27B in Italy present as an adult-onset, slowly progressive cerebellar ataxia with predominant axial involvement and frequent cerebellar ocular motor signs. The high consistency of clinical features in SCA27B cohorts in multiple populations paves the way toward large-scale, multicenter studies.
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Affiliation(s)
- Sara Satolli
- Molecular Medicine for Neurodegenerative and Neuromuscular Diseases Unit, IRCCS Fondazione Stella Maris, via dei Giacinti 2, Calambrone, 56128, Pisa, Italy
| | - Salvatore Rossi
- Department of Neurosciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Elisa Vegezzi
- Department of Brain and Behavioral Sciences, University of Pavia, 27100, Pavia, Italy
- IRCCS Mondino Foundation, 27100, Pavia, Italy
| | - David Pellerin
- Department of Neurology and Neurosurgery, Montreal Neurological Hospital and Institute, McGill University, Montreal, Canada
| | - Maria Laura Manca
- Department of Clinical and Experimental Medicine, Department of Mathematics, University of Pisa, Pisa, Italy
| | - Melissa Barghigiani
- Molecular Medicine for Neurodegenerative and Neuromuscular Diseases Unit, IRCCS Fondazione Stella Maris, via dei Giacinti 2, Calambrone, 56128, Pisa, Italy
| | - Carla Battisti
- Department of Medicine, Surgery and Neurosciences, Unit of Neurology and Neurometabolic Disorders, Azienda Ospedaliera Universitaria Senese, Università Di Siena, Siena, Italy
| | - Giusi Bilancieri
- Molecular Medicine for Neurodegenerative and Neuromuscular Diseases Unit, IRCCS Fondazione Stella Maris, via dei Giacinti 2, Calambrone, 56128, Pisa, Italy
| | - Giorgia Bruno
- Department of Neurosciences, Division of Pediatric Neurology, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Elena Capacci
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Carlo Casali
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Roberto Ceravolo
- Department of Clinical and Experimental Medicine, Center for Neurodegenerative Diseases-Parkinson's Disease and Movement Disorders, University of Pisa, Pisa, Italy
| | - Sirio Cocozza
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Stefano Cotti Piccinelli
- Department of Clinical and Experimental Sciences, NeMO-Brescia Clinical Center for Neuromuscular Diseases, University of Brescia, Brescia, Italy
| | - Chiara Criscuolo
- Department of Neurosciences Reproductive and Odontostomatological Sciences, CDCD Neurology, "Federico II" University Hospital, Naples, Italy
- CDCD Neurology, "Federico II" University Hospital, Naples, Italy
| | - Matt C Danzi
- Macdonald Foundation, Department of Human Genetics, Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Rosa De Micco
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giuseppe De Michele
- Department of Neurosciences Reproductive and Odontostomatological Sciences, CDCD Neurology, "Federico II" University Hospital, Naples, Italy
| | - Marie-Josée Dicaire
- Department of Neurology and Neurosurgery, Montreal Neurological Hospital and Institute, McGill University, Montreal, Canada
| | - Grazia Maria Igea Falcone
- Unit of Neurology and Neuromuscular Disorders, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Roberto Fancellu
- UO Neurologia, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Yasmine Ferchichi
- Molecular Medicine for Neurodegenerative and Neuromuscular Diseases Unit, IRCCS Fondazione Stella Maris, via dei Giacinti 2, Calambrone, 56128, Pisa, Italy
| | - Camilla Ferrari
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Alessandro Filla
- Department of Neurosciences Reproductive and Odontostomatological Sciences, CDCD Neurology, "Federico II" University Hospital, Naples, Italy
| | - Nicola Fini
- Department of Neurosciences, Neurology Unit, Azienda Ospedaliero Universitaria Di Modena, Modena, Italy
| | - Alessandra Govoni
- Neuromuscular-Skeletal and Sensory Organs Department, AOU Careggi, Florence, Italy
| | - Filomena Lo Vecchio
- UOC Genetica Medica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168, Rome, Italy
| | - Alessandro Malandrini
- Department of Medicine, Surgery and Neurosciences, Unit of Neurology and Neurometabolic Disorders, Azienda Ospedaliera Universitaria Senese, Università Di Siena, Siena, Italy
| | - Andrea Mignarri
- Department of Medicine, Surgery and Neurosciences, Unit of Neurology and Neurometabolic Disorders, Azienda Ospedaliera Universitaria Senese, Università Di Siena, Siena, Italy
| | - Olimpia Musumeci
- Unit of Neurology and Neuromuscular Disorders, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Claudia Nesti
- Molecular Medicine for Neurodegenerative and Neuromuscular Diseases Unit, IRCCS Fondazione Stella Maris, via dei Giacinti 2, Calambrone, 56128, Pisa, Italy
| | - Sabina Pappatà
- Institute of Biostructure and Bioimaging, National Research Council, Via T. De Amicis 95, 80145, Naples, Italy
| | - Maria Teresa Pellecchia
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Neuroscience Section, University of Salerno, Salerno, Italy
| | - Alessia Perna
- Center for Neuromuscular and Neurological Rare Diseases, San Camillo Forlanini Hospital, Rome, Italy
| | - Antonio Petrucci
- Center for Neuromuscular and Neurological Rare Diseases, San Camillo Forlanini Hospital, Rome, Italy
| | - Maria Grazia Pomponi
- UOC Genetica Medica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168, Rome, Italy
| | - Roberta Ravenni
- Unità Operativa Complessa Di Neurologia E Neuroriabilitazione, Presidio Ospedaliero Di Abano Terme - Azienda ULSS, 6 Euganea, Padua, Italy
| | - Ivana Ricca
- Molecular Medicine for Neurodegenerative and Neuromuscular Diseases Unit, IRCCS Fondazione Stella Maris, via dei Giacinti 2, Calambrone, 56128, Pisa, Italy
| | - Alessandra Rufa
- Department of Medicine, Surgery and Neurosciences, Unit of Neurology and Neurometabolic Disorders, Azienda Ospedaliera Universitaria Senese, Università Di Siena, Siena, Italy
| | - Elisabetta Tabolacci
- Dipartimento Universitario Scienze Della Vita E Sanità Pubblica, Sezione Di Medicina Genomica, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168, Rome, Italy
| | - Alessandra Tessa
- Molecular Medicine for Neurodegenerative and Neuromuscular Diseases Unit, IRCCS Fondazione Stella Maris, via dei Giacinti 2, Calambrone, 56128, Pisa, Italy
| | - Alessandro Tessitore
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Stephan Zuchner
- Macdonald Foundation, Department of Human Genetics, Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Gabriella Silvestri
- Department of Neurosciences, Università Cattolica del Sacro Cuore, Rome, Italy
- UOC Neurologia Dipartimento Neuroscienze, Organi Di Senso E Torace, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Andrea Cortese
- Department of Brain and Behavioral Sciences, University of Pavia, 27100, Pavia, Italy
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Bernard Brais
- Department of Neurology and Neurosurgery, Montreal Neurological Hospital and Institute, McGill University, Montreal, Canada
| | - Filippo M Santorelli
- Molecular Medicine for Neurodegenerative and Neuromuscular Diseases Unit, IRCCS Fondazione Stella Maris, via dei Giacinti 2, Calambrone, 56128, Pisa, Italy.
- Department of Clinical and Experimental Medicine, Department of Mathematics, University of Pisa, Pisa, Italy.
- CDCD Neurology, "Federico II" University Hospital, Naples, Italy.
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Pellerin D, Méreaux JL, Boluda S, Danzi MC, Dicaire MJ, Davoine CS, Genis D, Spurdens G, Ashton C, Hammond JM, Gerhart BJ, Chelban V, Le PU, Safisamghabadi M, Yanick C, Lee H, Nageshwaran SK, Matos-Rodrigues G, Jaunmuktane Z, Petrecca K, Akbarian S, Nussenzweig A, Usdin K, Renaud M, Bonnet C, Ravenscroft G, Saporta MA, Napierala JS, Houlden H, Deveson IW, Napierala M, Brice A, Molina Porcel L, Seilhean D, Zuchner S, Durr A, Brais B. Somatic instability of the FGF14 -SCA27B GAA•TTC repeat reveals a marked expansion bias in the cerebellum. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.07.01.24309777. [PMID: 39006414 PMCID: PMC11245061 DOI: 10.1101/2024.07.01.24309777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/16/2024]
Abstract
Spinocerebellar ataxia 27B (SCA27B) is a common autosomal dominant ataxia caused by an intronic GAA•TTC repeat expansion in FGF14 . Neuropathological studies have shown that neuronal loss is largely restricted to the cerebellum. Although the repeat locus is highly unstable during intergenerational transmission, it remains unknown whether it exhibits cerebral mosaicism and progressive instability throughout life. We conducted an analysis of the FGF14 GAA•TTC repeat somatic instability across 156 serial blood samples from 69 individuals, fibroblasts, induced pluripotent stem cells, and post-mortem brain tissues from six controls and six patients with SCA27B, alongside methylation profiling using targeted long-read sequencing. Peripheral tissues exhibited minimal somatic instability, which did not significantly change over periods of more than 20 years. In post-mortem brains, the GAA•TTC repeat was remarkably stable across all regions, except in the cerebellar hemispheres and vermis. The levels of somatic expansion in the cerebellar hemispheres and vermis were, on average, 3.15 and 2.72 times greater relative to other examined brain regions, respectively. Additionally, levels of somatic expansion in the brain increased with repeat length and tissue expression of FGF14 . We found no significant difference in methylation of wild-type and expanded FGF14 alleles in post-mortem cerebellar hemispheres between patients and controls. In conclusion, our study revealed that the FGF14 GAA•TTC repeat exhibits a cerebellar-specific expansion bias, which may explain the pure and late-onset cerebellar involvement in SCA27B.
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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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Zheng ZH, Cao CY, Cheng B, Yuan RY, Zeng YH, Guo ZB, Qiu YS, Lv WQ, Liang H, Li JL, Zhang WX, Fang MK, Sun YH, Lin W, Hong JM, Gan SR, Wang N, Chen WJ, Du GQ, Fang L. Characteristics of tandem repeat inheritance and sympathetic nerve involvement in GAA-FGF14 ataxia. J Hum Genet 2024:10.1038/s10038-024-01262-5. [PMID: 38866925 DOI: 10.1038/s10038-024-01262-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 05/12/2024] [Accepted: 05/28/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Intronic GAA repeat expansion ([GAA] ≥250) in FGF14 is associated with the late-onset neurodegenerative disorder, spinocerebellar ataxia 27B (SCA27B, GAA-FGF14 ataxia). We aim to determine the prevalence of the GAA repeat expansion in FGF14 in Chinese populations presenting late-onset cerebellar ataxia (LOCA) and evaluate the characteristics of tandem repeat inheritance, radiological features and sympathetic nerve involvement. METHODS GAA-FGF14 repeat expansion was screened in an undiagnosed LOCA cohort (n = 664) and variations in repeat-length were analyzed in families of confirmed GAA-FGF14 ataxia patients. Brain magnetic resonance imaging (MRI) was used to evaluate the radiological feature in GAA-FGF14 ataxia patients. Clinical examinations and sympathetic skin response (SSR) recordings in GAA-FGF14 patients (n = 16) were used to quantify sympathetic nerve involvement. RESULTS Two unrelated probands (2/664) were identified. Genetic screening for GAA-FGF14 repeat expansion was performed in 39 family members, 16 of whom were genetically diagnosed with GAA-FGF14 ataxia. Familial screening revealed expansion of GAA repeats in maternal transmissions, but contraction upon paternal transmission. Brain MRI showed slight to moderate cerebellar atrophy. SSR amplitude was lower in GAA-FGF14 patients in pre-symptomatic stage compared to healthy controls, and further decreased in the symptomatic stage. CONCLUSIONS GAA-FGF14 ataxia was rare among Chinese LOCA cases. Parental gender appears to affect variability in GAA repeat number between generations. Reduced SSR amplitude is a prominent feature in GAA-FGF14 patients, even in the pre-symptomatic stage.
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Affiliation(s)
- Ze-Hong Zheng
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, 350005, China
| | - Chun-Yan Cao
- The First Affiliated Hospital, College of Clinical Medicine of Henan University of Science and Technology, Luoyang, 471003, China
| | - Bi Cheng
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, 350005, China
| | - Ru-Ying Yuan
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, 350005, China
| | - Yi-Heng Zeng
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, 350005, China
| | - Zhang-Bao Guo
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, 350005, China
| | - Yu-Sen Qiu
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, 350005, China
| | - Wen-Qi Lv
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, 350005, China
| | - Hui Liang
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, 350005, China
| | - Jin-Lan Li
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, 350005, China
| | - Wei-Xiong Zhang
- The First Affiliated Hospital, College of Clinical Medicine of Henan University of Science and Technology, Luoyang, 471003, China
| | - Min-Kun Fang
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, 350005, China
| | - Yu-Hao Sun
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, 350005, China
| | - Wei Lin
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, 350005, China
| | - Jing-Mei Hong
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, 350005, China
| | - Shi-Rui Gan
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, 350005, China
| | - Ning Wang
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, 350005, China
| | - Wan-Jin Chen
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, 350005, China
| | - Gan-Qin Du
- The First Affiliated Hospital, College of Clinical Medicine of Henan University of Science and Technology, Luoyang, 471003, China.
| | - Ling Fang
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, 350005, China.
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6
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Milovanović A, Dragaševic‐Mišković N, Thomsen M, Borsche M, Hinrichs F, Westenberger A, Klein C, Brüggemann N, Branković M, Marjanović A, Svetel M, Kostić VS, Lohmann K. RFC1 and FGF14 Repeat Expansions in Serbian Patients with Cerebellar Ataxia. Mov Disord Clin Pract 2024; 11:626-633. [PMID: 38487929 PMCID: PMC11145142 DOI: 10.1002/mdc3.14020] [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: 10/06/2023] [Revised: 01/26/2024] [Accepted: 02/21/2024] [Indexed: 06/04/2024] Open
Abstract
BACKGROUND The newly discovered intronic repeat expansions in the genes encoding replication factor C subunit 1 (RFC1) and fibroblast growth factor 14 (FGF14) frequently cause late-onset cerebellar ataxia. OBJECTIVES To investigate the presence of RFC1 and FGF14 pathogenic repeat expansions in Serbian patients with adult-onset cerebellar ataxia. METHODS The study included 167 unrelated patients with sporadic or familial cerebellar ataxia. The RFC1 repeat expansion analysis was performed by duplex PCR and Sanger sequencing, while the FGF14 repeat expansion was tested for by long-range PCR, repeat-primed PCR, and Sanger sequencing. RESULTS We identified pathogenic repeat expansions in RFC1 in seven patients (7/167; 4.2%) with late-onset sporadic ataxia with neuropathy and chronic cough. Two patients also had bilateral vestibulopathy. Repeat expansions in FGF14 were found in nine unrelated patients (9/167; 5.4%) with ataxia, less than half of whom presented with neuropathy and two-thirds with global brain atrophy. Tremor and episodic features were the most frequent additional characteristics in carriers of uninterrupted FGF14 repeat expansions. Among the 122 sporadic cases, 12 (9.8%) carried an expansion in either RFC1 or FGF14, comparable to 4/45 (8.9%) among the patients with a positive family history. CONCLUSIONS Pathogenic repeat expansions in RFC1 and FGF14 are relatively frequent causes of adult-onset cerebellar ataxia, especially among sporadic patients, indicating that family history should not be considered when prioritizing ataxia patients for testing of RFC1 or FGF14 repeat expansions.
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Affiliation(s)
| | - Nataša Dragaševic‐Mišković
- Neurology ClinicUniversity Clinical Center of SerbiaBelgradeSerbia
- Medical FacultyUniversity BelgradeBelgradeSerbia
| | - Mirja Thomsen
- Institute of NeurogeneticsUniversity of LübeckLübeckGermany
| | - Max Borsche
- Institute of NeurogeneticsUniversity of LübeckLübeckGermany
- Department of NeurologyUniversity of Lübeck and University Hospital Schleswig‐Holstein, Campus LübeckLübeckGermany
| | | | | | | | - Norbert Brüggemann
- Institute of NeurogeneticsUniversity of LübeckLübeckGermany
- Department of NeurologyUniversity of Lübeck and University Hospital Schleswig‐Holstein, Campus LübeckLübeckGermany
| | - Marija Branković
- Neurology ClinicUniversity Clinical Center of SerbiaBelgradeSerbia
| | - Ana Marjanović
- Neurology ClinicUniversity Clinical Center of SerbiaBelgradeSerbia
| | - Marina Svetel
- Neurology ClinicUniversity Clinical Center of SerbiaBelgradeSerbia
- Medical FacultyUniversity BelgradeBelgradeSerbia
| | - Vladimir S. Kostić
- Neurology ClinicUniversity Clinical Center of SerbiaBelgradeSerbia
- Medical FacultyUniversity BelgradeBelgradeSerbia
| | - Katja Lohmann
- Institute of NeurogeneticsUniversity of LübeckLübeckGermany
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7
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Marcelli V, Giannoni B, Volpe G, Faralli M, Fetoni AR, Pettorossi VE. Downbeat nystagmus: a clinical and pathophysiological review. Front Neurol 2024; 15:1394859. [PMID: 38854962 PMCID: PMC11157062 DOI: 10.3389/fneur.2024.1394859] [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: 03/02/2024] [Accepted: 04/29/2024] [Indexed: 06/11/2024] Open
Abstract
Downbeat nystagmus (DBN) is a neuro-otological finding frequently encountered by clinicians dealing with patients with vertigo. Since DBN is a finding that should be understood because of central vestibular dysfunction, it is necessary to know how to frame it promptly to suggest the correct diagnostic-therapeutic pathway to the patient. As knowledge of its pathophysiology has progressed, the importance of this clinical sign has been increasingly understood. At the same time, clinical diagnostic knowledge has increased, and it has been recognized that this sign may occur sporadically or in association with others within defined clinical syndromes. Thus, in many cases, different therapeutic solutions have become possible. In our work, we have attempted to systematize current knowledge about the origin of this finding, the clinical presentation and current treatment options, to provide an overview that can be used at different levels, from the general practitioner to the specialist neurologist or neurotologist.
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Affiliation(s)
- Vincenzo Marcelli
- Audiology and Vestibology Unit, Department of ENT, Ospedale del Mare, ASL Napoli 1 Centro, Napoli, Italy
- Department of Neuroscience, Reproductive Science and Dentistry, Section of Audiology, University of Naples ‘’Federico II’’, Napoli, Italy
| | - Beatrice Giannoni
- Department of Neuroscience, Psychology, Drug’s Area and Child’s Health, University of Florence, Florence, Italy
| | - Giampiero Volpe
- Department of Neurology, Ospedale San Luca di Vallo della Lucania, ASL Salerno, Salerno, Italy
| | - Mario Faralli
- Department of ENT, University of Perugia, Perugia, Italy
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Anna Rita Fetoni
- Department of Neuroscience, Reproductive Science and Dentistry, Section of Audiology, University of Naples ‘’Federico II’’, Napoli, Italy
| | - Vito E. Pettorossi
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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8
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Parmar JM, Laing NG, Kennerson ML, Ravenscroft G. Genetics of inherited peripheral neuropathies and the next frontier: looking backwards to progress forwards. J Neurol Neurosurg Psychiatry 2024:jnnp-2024-333436. [PMID: 38744462 DOI: 10.1136/jnnp-2024-333436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 04/10/2024] [Indexed: 05/16/2024]
Abstract
Inherited peripheral neuropathies (IPNs) encompass a clinically and genetically heterogeneous group of disorders causing length-dependent degeneration of peripheral autonomic, motor and/or sensory nerves. Despite gold-standard diagnostic testing for pathogenic variants in over 100 known associated genes, many patients with IPN remain genetically unsolved. Providing patients with a diagnosis is critical for reducing their 'diagnostic odyssey', improving clinical care, and for informed genetic counselling. The last decade of massively parallel sequencing technologies has seen a rapid increase in the number of newly described IPN-associated gene variants contributing to IPN pathogenesis. However, the scarcity of additional families and functional data supporting variants in potential novel genes is prolonging patient diagnostic uncertainty and contributing to the missing heritability of IPNs. We review the last decade of IPN disease gene discovery to highlight novel genes, structural variation and short tandem repeat expansions contributing to IPN pathogenesis. From the lessons learnt, we provide our vision for IPN research as we anticipate the future, providing examples of emerging technologies, resources and tools that we propose that will expedite the genetic diagnosis of unsolved IPN families.
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Affiliation(s)
- Jevin M Parmar
- Rare Disease Genetics and Functional Genomics, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia
- Centre for Medical Research, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Nigel G Laing
- Centre for Medical Research, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
- Preventive Genetics, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia
| | - Marina L Kennerson
- Northcott Neuroscience Laboratory, ANZAC Research Institute, Concord, New South Wales, Australia
- Molecular Medicine Laboratory, Concord Hospital, Concord, New South Wales, Australia
| | - Gianina Ravenscroft
- Rare Disease Genetics and Functional Genomics, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia
- Centre for Medical Research, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
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9
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Rudaks LI, Yeow D, Ng K, Deveson IW, Kennerson ML, Kumar KR. An Update on the Adult-Onset Hereditary Cerebellar Ataxias: Novel Genetic Causes and New Diagnostic Approaches. CEREBELLUM (LONDON, ENGLAND) 2024:10.1007/s12311-024-01703-z. [PMID: 38760634 DOI: 10.1007/s12311-024-01703-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/07/2024] [Indexed: 05/19/2024]
Abstract
The hereditary cerebellar ataxias (HCAs) are rare, progressive neurologic disorders caused by variants in many different genes. Inheritance may follow autosomal dominant, autosomal recessive, X-linked or mitochondrial patterns. The list of genes associated with adult-onset cerebellar ataxia is continuously growing, with several new genes discovered in the last few years. This includes short-tandem repeat (STR) expansions in RFC1, causing cerebellar ataxia, neuropathy, vestibular areflexia syndrome (CANVAS), FGF14-GAA causing spinocerebellar ataxia type 27B (SCA27B), and THAP11. In addition, the genetic basis for SCA4, has recently been identified as a STR expansion in ZFHX3. Given the large and growing number of genes, and different gene variant types, the approach to diagnostic testing for adult-onset HCA can be complex. Testing methods include targeted evaluation of STR expansions (e.g. SCAs, Friedreich ataxia, fragile X-associated tremor/ataxia syndrome, dentatorubral-pallidoluysian atrophy), next generation sequencing for conventional variants, which may include targeted gene panels, whole exome, or whole genome sequencing, followed by various potential additional tests. This review proposes a diagnostic approach for clinical testing, highlights the challenges with current testing technologies, and discusses future advances which may overcome these limitations. Implementing long-read sequencing has the potential to transform the diagnostic approach in HCA, with the overall aim to improve the diagnostic yield.
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Affiliation(s)
- Laura Ivete Rudaks
- Molecular Medicine Laboratory and Neurology Department, Concord Repatriation General Hospital, Sydney, Australia.
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
- Genomics and Inherited Disease Program, The Garvan Institute of Medical Research, Sydney, Australia.
- Clinical Genetics Unit, Royal North Shore Hospital, Sydney, Australia.
| | - Dennis Yeow
- Molecular Medicine Laboratory and Neurology Department, Concord Repatriation General Hospital, Sydney, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Genomics and Inherited Disease Program, The Garvan Institute of Medical Research, Sydney, Australia
- Neurodegenerative Service, Prince of Wales Hospital, Sydney, Australia
- Neuroscience Research Australia, Sydney, Australia
| | - Karl Ng
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Neurology Department, Royal North Shore Hospital, Sydney, Australia
| | - Ira W Deveson
- Genomics and Inherited Disease Program, The Garvan Institute of Medical Research, Sydney, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Marina L Kennerson
- Molecular Medicine Laboratory and Neurology Department, Concord Repatriation General Hospital, Sydney, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- The Northcott Neuroscience Laboratory, ANZAC Research Institute, Sydney Local Health District, Sydney, Australia
| | - Kishore Raj Kumar
- Molecular Medicine Laboratory and Neurology Department, Concord Repatriation General Hospital, Sydney, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Genomics and Inherited Disease Program, The Garvan Institute of Medical Research, Sydney, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- Faculty of Medicine, St Vincent's Healthcare Campus, UNSW Sydney, Sydney, Australia
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10
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Potashman M, Rudell K, Pavisic I, Suminski N, Doma R, Heinrich M, Abetz-Webb L, Beiner MW, Kuo SH, Rosenthal LS, Zesiwicz T, Fife TD, van de Warrenburg BP, Ristori G, Synofzik M, Perlman S, Schmahmann JD, L'Italien G. Content Validity of the Modified Functional Scale for the Assessment and Rating of Ataxia (f-SARA) Instrument in Spinocerebellar Ataxia. CEREBELLUM (LONDON, ENGLAND) 2024:10.1007/s12311-024-01700-2. [PMID: 38713312 DOI: 10.1007/s12311-024-01700-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/29/2024] [Indexed: 05/08/2024]
Abstract
The functional Scale for the Assessment and Rating of Ataxia (f-SARA) assesses Gait, Stance, Sitting, and Speech. It was developed as a potentially clinically meaningful measure of spinocerebellar ataxia (SCA) progression for clinical trial use. Here, we evaluated content validity of the f-SARA. Qualitative interviews were conducted among individuals with SCA1 (n = 1) and SCA3 (n = 6) and healthcare professionals (HCPs) with SCA expertise (USA, n = 5; Europe, n = 3). Interviews evaluated symptoms and signs of SCA and relevance of f-SARA concepts for SCA. HCP cognitive debriefing was conducted. Interviews were recorded, transcribed, coded, and analyzed by ATLAS.TI software. Individuals with SCA1 and 3 reported 85 symptoms, signs, and impacts of SCA. All indicated difficulties with walking, stance, balance, speech, fatigue, emotions, and work. All individuals with SCA1 and 3 considered Gait, Stance, and Speech relevant f-SARA concepts; 3 considered Sitting relevant (42.9%). All HCPs considered Gait and Speech relevant; 5 (62.5%) indicated Stance was relevant. Sitting was considered a late-stage disease indicator. Most HCPs suggested inclusion of appendicular items would enhance clinical relevance. Cognitive debriefing supported clarity and comprehension of f-SARA. Maintaining current abilities on f-SARA items for 1 year was considered meaningful for most individuals with SCA1 and 3. All HCPs considered meaningful changes as stability in f-SARA score over 1-2 years, 1-2-point change in total f-SARA score, and deviation from natural history. These results support content validity of f-SARA for assessing SCA disease progression in clinical trials.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Sheng-Han Kuo
- Department of Neurology, Columbia University, New York, NY, USA
| | - Liana S Rosenthal
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Theresa Zesiwicz
- Department of Neurology, Ataxia Research Center, University of South Florida, Tampa, FL, USA
| | - Terry D Fife
- Department of Neurology, Barrow Neurological Institute, University of Arizona College of Medicine, Phoenix, AZ, USA
| | | | - Giovanni Ristori
- Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy
| | - Matthis Synofzik
- Division of Translational Genomics of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research and Center of Neurology, University of Tübingen, Tübingen, Germany
| | - Susan Perlman
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jeremy D Schmahmann
- Ataxia Center, Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
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11
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Clément G, Puisieux S, Pellerin D, Brais B, Bonnet C, Renaud M. Spinocerebellar ataxia 27B (SCA27B), a frequent late-onset cerebellar ataxia. Rev Neurol (Paris) 2024; 180:410-416. [PMID: 38609751 DOI: 10.1016/j.neurol.2024.03.007] [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: 01/24/2024] [Revised: 03/18/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024]
Abstract
Genetic cerebellar ataxias are still a diagnostic challenge, and yet not all of them have been identified. Very recently, in early 2023, a new cause of late-onset cerebellar ataxia (LOCA) was identified, spinocerebellar ataxia 27B (SCA27B). This is an autosomal dominant ataxia due to a GAA expansion in intron 1 of the FGF14 gene. Thanks to the many studies carried out since its discovery, it is now possible to define the clinical phenotype, its particularities, and the progression of SCA27B. It has also been established that it is one of the most frequent causes of LOCA. The core phenotype of the disease consists of slowly progressive late-onset ataxia with cerebellar syndrome, oculomotor disorders including downbeat nystagmus, and episodic symptoms such as diplopia. Therapeutic approaches have been proposed, including acetazolamide, and 4-aminopyridine, the latter with a better benefit/tolerance profile.
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Affiliation(s)
- G Clément
- Service de neurologie, centre hospitalier régional universitaire de Nancy, hôpital Central, Nancy, France; Inserm-U1256 NGERE, université de Lorraine, Nancy, France.
| | - S Puisieux
- Service de neurologie, centre hospitalier régional universitaire de Nancy, hôpital Central, Nancy, France; Inserm-U1256 NGERE, université de Lorraine, Nancy, France.
| | - D Pellerin
- Department of Neurology and Neurosurgery, Montreal Neurological Hospital and Institute, McGill University, Montreal, QC, Canada; Dr. John T. Macdonald Foundation Department of Human Genetics and John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, USA.
| | - B Brais
- Department of Neurology and Neurosurgery, Montreal Neurological Hospital and Institute, McGill University, Montreal, QC, Canada.
| | - C Bonnet
- Inserm-U1256 NGERE, université de Lorraine, Nancy, France; Laboratoire de génétique, centre hospitalier régional universitaire de Nancy, hôpitaux de Brabois, Vandœuvre-lès-Nancy, France.
| | - M Renaud
- Service de neurologie, centre hospitalier régional universitaire de Nancy, hôpital Central, Nancy, France; Inserm-U1256 NGERE, université de Lorraine, Nancy, France; Service de génétique clinique, centre hospitalier régional universitaire de Nancy, hôpital d'Enfants, Vandœuvre-Lès-Nancy, France.
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12
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Pellerin D, Heindl F, Traschütz A, Rujescu D, Hartmann AM, Brais B, Houlden H, Dufke C, Riess O, Haack T, Strupp M, Synofzik M. RFC1 repeat expansions in downbeat nystagmus syndromes: frequency and phenotypic profile. J Neurol 2024; 271:2886-2892. [PMID: 38381176 PMCID: PMC11055689 DOI: 10.1007/s00415-024-12229-z] [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: 12/30/2023] [Revised: 01/26/2024] [Accepted: 01/27/2024] [Indexed: 02/22/2024]
Abstract
OBJECTIVES The cause of downbeat nystagmus (DBN) remains unknown in a substantial number of patients ("idiopathic"), although intronic GAA expansions in FGF14 have recently been shown to account for almost 50% of yet idiopathic cases. Here, we hypothesized that biallelic RFC1 expansions may also represent a recurrent cause of DBN syndrome. METHODS We genotyped the RFC1 repeat and performed in-depth phenotyping in 203 patients with DBN, including 65 patients with idiopathic DBN, 102 patients carrying an FGF14 GAA expansion, and 36 patients with presumed secondary DBN. RESULTS Biallelic RFC1 AAGGG expansions were identified in 15/65 patients with idiopathic DBN (23%). None of the 102 GAA-FGF14-positive patients, but 2/36 (6%) of patients with presumed secondary DBN carried biallelic RFC1 expansions. The DBN syndrome in RFC1-positive patients was characterized by additional cerebellar impairment in 100% (15/15), bilateral vestibulopathy (BVP) in 100% (15/15), and polyneuropathy in 80% (12/15) of cases. Compared to GAA-FGF14-positive and genetically unexplained patients, RFC1-positive patients had significantly more frequent neuropathic features on examination and BVP. Furthermore, vestibular function, as measured by the video head impulse test, was significantly more impaired in RFC1-positive patients. DISCUSSION Biallelic RFC1 expansions are a common monogenic cause of DBN syndrome.
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Affiliation(s)
- David Pellerin
- Department of Neurology and Neurosurgery, Montreal Neurological Hospital and Institute, McGill University, Montreal, QC, Canada
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, University College London, London, UK
| | - Felix Heindl
- Department of Neurology and German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians University, Munich, Germany
| | - Andreas Traschütz
- Division Translational Genomics of Neurodegenerative Diseases, Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Dan Rujescu
- Department of Psychiatry and Psychotherapy, Comprehensive Center for Clinical Neurosciences and Mental Health (C3NMH), Medical University of Vienna, Vienna, Austria
| | - Annette M Hartmann
- Department of Psychiatry and Psychotherapy, Comprehensive Center for Clinical Neurosciences and Mental Health (C3NMH), Medical University of Vienna, Vienna, Austria
| | - Bernard Brais
- Department of Neurology and Neurosurgery, Montreal Neurological Hospital and Institute, McGill University, Montreal, QC, Canada
- Department of Human Genetics, McGill University, Montreal, QC, Canada
- Centre de Réadaptation Lucie-Bruneau, Montreal, QC, Canada
| | - Henry Houlden
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, University College London, London, UK
| | - Claudia Dufke
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
| | - Olaf Riess
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
| | - Tobias Haack
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
| | - Michael Strupp
- Department of Neurology and German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians University, Munich, Germany
| | - Matthis Synofzik
- Division Translational Genomics of Neurodegenerative Diseases, Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen, Tübingen, Germany.
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany.
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13
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Shambetova C, Klein C. Genetic testing for non-parkinsonian movement disorders: Navigating the diagnostic maze. Parkinsonism Relat Disord 2024; 121:106033. [PMID: 38429185 DOI: 10.1016/j.parkreldis.2024.106033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/01/2024] [Accepted: 02/09/2024] [Indexed: 03/03/2024]
Abstract
Genetic testing has become a valuable diagnostic tool for movement disorders due to substantial advancements in understanding their genetic basis. However, the heterogeneity of movement disorders poses a significant challenge, with many genes implicated in different subtypes. This paper aims to provide a neurologist's perspective on approaching patients with hereditary hyperkinetic disorders with a focus on select forms of dystonia, paroxysmal dyskinesia, chorea, and ataxia. Age at onset, initial symptoms, and their severity, as well as the presence of any concurrent neurological and non-neurological features, contribute to the individual clinical profiles of hereditary non-parkinsonian movement disorders, aiding in the selection of appropriate genetic testing strategies. There are also more specific diagnostic clues that may facilitate the decision-making process and may be highly specific for certain conditions, such as diurnal fluctuations and l-dopa response in dopa-responsive dystonia, and triggering factors, duration and frequency of attacks in paroxysmal dyskinesia. While the genetic and mutational spectrum across non-parkinsonian movement disorders is broad, certain groups of diseases tend to be associated with specific types of pathogenic variants, such as repeat expansions in many of the ataxias. Some of these pathogenic variants cannot be detected by standard methods, such as panel or exome sequencing, but require the investigation of intronic regions for repeat expansions, such as Friedreich's or FGF14-linked ataxia. With our advancing knowledge of the genetic underpinnings of movement disorders, the incorporation of precise and personalized diagnostic strategies can enhance patient care, prognosis, and the application and development of targeted therapeutic interventions.
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Affiliation(s)
- Cholpon Shambetova
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany; Center for Continuing and Distance Learning, I. K. Akhunbaev Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan
| | - Christine Klein
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany.
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14
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Pellerin D, Heindl F, Wilke C, Danzi MC, Traschütz A, Ashton C, Dicaire MJ, Cuillerier A, Del Gobbo G, Boycott KM, Claassen J, Rujescu D, Hartmann AM, Zuchner S, Brais B, Strupp M, Synofzik M. GAA-FGF14 disease: defining its frequency, molecular basis, and 4-aminopyridine response in a large downbeat nystagmus cohort. EBioMedicine 2024; 102:105076. [PMID: 38507876 PMCID: PMC10960126 DOI: 10.1016/j.ebiom.2024.105076] [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: 12/29/2023] [Revised: 03/06/2024] [Accepted: 03/06/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND GAA-FGF14 disease/spinocerebellar ataxia 27B is a recently described neurodegenerative disease caused by (GAA)≥250 expansions in the fibroblast growth factor 14 (FGF14) gene, but its phenotypic spectrum, pathogenic threshold, and evidence-based treatability remain to be established. We report on the frequency of FGF14 (GAA)≥250 and (GAA)200-249 expansions in a large cohort of patients with idiopathic downbeat nystagmus (DBN) and their response to 4-aminopyridine. METHODS Retrospective cohort study of 170 patients with idiopathic DBN, comprising in-depth phenotyping and assessment of 4-aminopyridine treatment response, including re-analysis of placebo-controlled video-oculography treatment response data from a previous randomised double-blind 4-aminopyridine trial. FINDINGS Frequency of FGF14 (GAA)≥250 expansions was 48% (82/170) in patients with idiopathic DBN. Additional cerebellar ocular motor signs were observed in 100% (82/82) and cerebellar ataxia in 43% (35/82) of patients carrying an FGF14 (GAA)≥250 expansion. FGF14 (GAA)200-249 alleles were enriched in patients with DBN (12%; 20/170) compared to controls (0.87%; 19/2191; OR, 15.20; 95% CI, 7.52-30.80; p < 0.0001). The phenotype of patients carrying a (GAA)200-249 allele closely mirrored that of patients carrying a (GAA)≥250 allele. Patients carrying a (GAA)≥250 or a (GAA)200-249 allele had a significantly greater clinician-reported (80%, 33/41 vs 31%, 5/16; RR, 2.58; 95% CI, 1.23-5.41; Fisher's exact test, p = 0.0011) and self-reported (59%, 32/54 vs 11%, 2/19; RR, 5.63; 95% CI, 1.49-21.27; Fisher's exact test, p = 0.00033) response to 4-aminopyridine treatment compared to patients carrying a (GAA)<200 allele. Placebo-controlled video-oculography data, available for four patients carrying an FGF14 (GAA)≥250 expansion, showed a significant decrease in slow phase velocity of DBN with 4-aminopyridine, but not placebo. INTERPRETATION This study confirms that FGF14 GAA expansions are a frequent cause of DBN syndromes. It provides preliminary evidence that (GAA)200-249 alleles might be pathogenic. Finally, it provides large real-world and preliminary piloting placebo-controlled evidence for the efficacy of 4-aminopyridine in GAA-FGF14 disease. FUNDING This work was supported by the Clinician Scientist program "PRECISE.net" funded by the Else Kröner-Fresenius-Stiftung (to CW, AT, and MSy), the grant 779257 "Solve-RD" from the European's Union Horizon 2020 research and innovation program (to MSy), and the grant 01EO 1401 by the German Federal Ministry of Education and Research (BMBF) (to MSt). This work was also supported by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) N° 441409627, as part of the PROSPAX consortium under the frame of EJP RD, the European Joint Programme on Rare Diseases, under the EJP RD COFUND-EJP N° 825575 (to MSy, BB and-as associated partner-SZ), the NIH National Institute of Neurological Disorders and Stroke (grant 2R01NS072248-11A1 to SZ), the Fondation Groupe Monaco (to BB), and the Montreal General Hospital Foundation (grant PT79418 to BB). The Care4Rare Canada Consortium is funded in part by Genome Canada and the Ontario Genomics Institute (OGI-147 to KMB), the Canadian Institutes of Health Research (CIHR GP1-155867 to KMB), Ontario Research Foundation, Genome Quebec, and the Children's Hospital of Eastern Ontario Foundation. The funders had no role in the conduct of this study.
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Affiliation(s)
- David Pellerin
- Department of Neurology and Neurosurgery, Montreal Neurological Hospital and Institute, McGill University, Montreal, QC, Canada; Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery, University College London, London, United Kingdom
| | - Felix Heindl
- Department of Neurology and German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians University, Munich, Germany
| | - Carlo Wilke
- Division Translational Genomics of Neurodegenerative Diseases, Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen, Tübingen, Germany; German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Matt C Danzi
- Dr. John T. Macdonald Foundation Department of Human Genetics and John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Andreas Traschütz
- Division Translational Genomics of Neurodegenerative Diseases, Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen, Tübingen, Germany; German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Catherine Ashton
- Department of Neurology and Neurosurgery, Montreal Neurological Hospital and Institute, McGill University, Montreal, QC, Canada; Department of Neurology, Royal Perth Hospital, Perth, WA, Australia
| | - Marie-Josée Dicaire
- Department of Neurology and Neurosurgery, Montreal Neurological Hospital and Institute, McGill University, Montreal, QC, Canada
| | - Alexanne Cuillerier
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Giulia Del Gobbo
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Kym M Boycott
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Jens Claassen
- Department of Neurology, University Hospital Essen, University Duisburg-Essen, Essen, Germany; MediClin Klinik Reichshof, Reichshof-Eckenhagen, Germany
| | - Dan Rujescu
- Department of Psychiatry and Psychotherapy, Comprehensive Center for Clinical Neurosciences and Mental Health (C3NMH), Medical University of Vienna, Vienna, Austria
| | - Annette M Hartmann
- Department of Psychiatry and Psychotherapy, Comprehensive Center for Clinical Neurosciences and Mental Health (C3NMH), Medical University of Vienna, Vienna, Austria
| | - Stephan Zuchner
- Dr. John T. Macdonald Foundation Department of Human Genetics and John P. 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; Department of Human Genetics, McGill University, Montreal, QC, Canada; Centre de Réadaptation Lucie-Bruneau, Montreal, QC, Canada
| | - Michael Strupp
- Department of Neurology and German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians University, Munich, Germany
| | - Matthis Synofzik
- Division Translational Genomics of Neurodegenerative Diseases, Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen, Tübingen, Germany; German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany.
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Kartanou C, Mitrousias A, Pellerin D, Kontogeorgiou Z, Iruzubieta P, Dicaire MJ, Danzi MC, Koniari C, Athanassopoulos K, Panas M, Stefanis L, Zuchner S, Brais B, Houlden H, Karadima G, Koutsis G. The FGF14 GAA repeat expansion in Greek patients with late-onset cerebellar ataxia and an overview of the SCA27B phenotype across populations. Clin Genet 2024; 105:446-452. [PMID: 38221848 DOI: 10.1111/cge.14482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/30/2023] [Accepted: 01/03/2024] [Indexed: 01/16/2024]
Abstract
A pathogenic GAA repeat expansion in the first intron of the fibroblast growth factor 14 gene (FGF14) has been recently identified as the cause of spinocerebellar ataxia 27B (SCA27B). We herein screened 160 Greek index cases with late-onset cerebellar ataxia (LOCA) for FGF14 repeat expansions using a combination of long-range PCR and bidirectional repeat-primed PCRs. We identified 19 index cases (12%) carrying a pathogenic FGF14 GAA expansion, a diagnostic yield higher than that of previously screened repeat-expansion ataxias in Greek LOCA patients. The age at onset of SCA27B patients was 60.5 ± 12.3 years (range, 34-80). Episodic onset (37%), downbeat nystagmus (32%) and vertigo (26%) were significantly more frequent in FGF14 expansion-positive cases compared to expansion-negative cases. Beyond typical cerebellar signs, SCA27B patients often displayed hyperreflexia (47%) and reduced vibration sense in the lower extremities (42%). The frequency and phenotypic profile of SCA27B in Greek patients was similar to most other previously studied populations. We conclude that FGF14 GAA repeat expansions are the commonest known genetic cause of LOCA in the Greek population and recommend prioritizing testing for FGF14 expansions in the diagnostic algorithm of patients with LOCA.
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Affiliation(s)
- Chrisoula Kartanou
- Neurogenetics Unit, 1st Department of Neurology, National and Kapodistrian University of Athens, Eginitio Hospital, Athens, Greece
| | - Alexandros Mitrousias
- Neurogenetics Unit, 1st Department of Neurology, National and Kapodistrian University of Athens, Eginitio Hospital, Athens, Greece
| | - David Pellerin
- Department of Neurology and Neurosurgery, Montreal Neurological Hospital and Institute, McGill University, Montreal, Québec, Canada
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology London and The National Hospital for Neurology and Neurosurgery, University College London, London, UK
| | - Zoi Kontogeorgiou
- Neurogenetics Unit, 1st Department of Neurology, National and Kapodistrian University of Athens, Eginitio Hospital, Athens, Greece
| | - Pablo Iruzubieta
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology London and The National Hospital for Neurology and Neurosurgery, University College London, London, UK
- Department of Neurology, Donostia University Hospital, Biogipuzkoa Health Research Institute, Donostia-San Sebastián, Spain
- CIBERNED Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas-Instituto de Salud Carlos III (CIBER-CIBERNED-ISCIII), Madrid, Spain
| | - Marie-Josée Dicaire
- Department of Neurology and Neurosurgery, Montreal Neurological Hospital and Institute, McGill University, Montreal, Québec, Canada
| | - Matt C Danzi
- Dr. John T. Macdonald Foundation Department of Human Genetics and John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Chrysoula Koniari
- Neurogenetics Unit, 1st Department of Neurology, National and Kapodistrian University of Athens, Eginitio Hospital, Athens, Greece
| | - Konstantinos Athanassopoulos
- Neurogenetics Unit, 1st Department of Neurology, National and Kapodistrian University of Athens, Eginitio Hospital, Athens, Greece
| | - Marios Panas
- Neurogenetics Unit, 1st Department of Neurology, National and Kapodistrian University of Athens, Eginitio Hospital, Athens, Greece
| | - Leonidas Stefanis
- 1st Department of Neurology, National and Kapodistrian University of Athens, Eginitio Hospital, Athens, Greece
| | - Stephan Zuchner
- Dr. John T. Macdonald Foundation Department of Human Genetics and John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Bernard Brais
- Department of Neurology and Neurosurgery, Montreal Neurological Hospital and Institute, McGill University, Montreal, Québec, Canada
- Department of Human Genetics, McGill University, Montreal, Québec, Canada
| | - Henry Houlden
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology London and The National Hospital for Neurology and Neurosurgery, University College London, London, UK
| | - Georgia Karadima
- Neurogenetics Unit, 1st Department of Neurology, National and Kapodistrian University of Athens, Eginitio Hospital, Athens, Greece
| | - Georgios Koutsis
- Neurogenetics Unit, 1st Department of Neurology, National and Kapodistrian University of Athens, Eginitio Hospital, Athens, Greece
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Sanchez-Flores M, Corral-Juan M, Gasch-Navalón E, Cirillo D, Sanchez I, Matilla-Dueñas A. Novel genotype-phenotype correlations, differential cerebellar allele-specific methylation, and a common origin of the (ATTTC) n insertion in spinocerebellar ataxia type 37. Hum Genet 2024; 143:211-232. [PMID: 38396267 PMCID: PMC11043136 DOI: 10.1007/s00439-024-02644-7] [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: 08/26/2023] [Accepted: 01/17/2024] [Indexed: 02/25/2024]
Abstract
Spinocerebellar ataxia subtype 37 (SCA37) is a rare disease originally identified in ataxia patients from the Iberian Peninsula with a pure cerebellar syndrome. SCA37 patients carry a pathogenic intronic (ATTTC)n repeat insertion flanked by two polymorphic (ATTTT)n repeats in the Disabled-1 (DAB1) gene leading to cerebellar dysregulation. Herein, we determine the precise configuration of the pathogenic 5'(ATTTT)n-(ATTTC)n-3'(ATTTT)n SCA37 alleles by CRISPR-Cas9 and long-read nanopore sequencing, reveal their epigenomic signatures in SCA37 lymphocytes, fibroblasts, and cerebellar samples, and establish new molecular and clinical correlations. The 5'(ATTTT)n-(ATTTC)n-3'(ATTTT)n pathogenic allele configurations revealed repeat instability and differential methylation signatures. Disease age of onset negatively correlated with the (ATTTC)n, and positively correlated with the 3'(ATTTT)n. Geographic origin and gender significantly correlated with age of onset. Furthermore, significant predictive regression models were obtained by machine learning for age of onset and disease evolution by considering gender, the (ATTTC)n, the 3'(ATTTT)n, and seven CpG positions differentially methylated in SCA37 cerebellum. A common 964-kb genomic region spanning the (ATTTC)n insertion was identified in all SCA37 patients analysed from Portugal and Spain, evidencing a common origin of the SCA37 mutation in the Iberian Peninsula originating 859 years ago (95% CI 647-1378). In conclusion, we demonstrate an accurate determination of the size and configuration of the regulatory 5'(ATTTT)n-(ATTTC)n-3'(ATTTT)n repeat tract, avoiding PCR bias amplification using CRISPR/Cas9-enrichment and nanopore long-read sequencing, resulting relevant for accurate genetic diagnosis of SCA37. Moreover, we determine novel significant genotype-phenotype correlations in SCA37 and identify differential cerebellar allele-specific methylation signatures that may underlie DAB1 pathogenic dysregulation.
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Affiliation(s)
- Marina Sanchez-Flores
- Neurogenetics Unit, Department of Neuroscience, Germans Trias i Pujol Research Institute (IGTP), Universitat Autònoma de Barcelona-Can Ruti Campus, Carretera de Can Ruti, Camí de les Escoles s/n, 08916, Badalona, Spain
| | - Marc Corral-Juan
- Neurogenetics Unit, Department of Neuroscience, Germans Trias i Pujol Research Institute (IGTP), Universitat Autònoma de Barcelona-Can Ruti Campus, Carretera de Can Ruti, Camí de les Escoles s/n, 08916, Badalona, Spain
| | - Esther Gasch-Navalón
- Neurogenetics Unit, Department of Neuroscience, Germans Trias i Pujol Research Institute (IGTP), Universitat Autònoma de Barcelona-Can Ruti Campus, Carretera de Can Ruti, Camí de les Escoles s/n, 08916, Badalona, Spain
| | | | - Ivelisse Sanchez
- Neurogenetics Unit, Department of Neuroscience, Germans Trias i Pujol Research Institute (IGTP), Universitat Autònoma de Barcelona-Can Ruti Campus, Carretera de Can Ruti, Camí de les Escoles s/n, 08916, Badalona, Spain
| | - Antoni Matilla-Dueñas
- Neurogenetics Unit, Department of Neuroscience, Germans Trias i Pujol Research Institute (IGTP), Universitat Autònoma de Barcelona-Can Ruti Campus, Carretera de Can Ruti, Camí de les Escoles s/n, 08916, Badalona, Spain.
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Jiménez-Huete A, Patiño-García A, Guillén EF, Porta JM, Martin-Bastida A, Suárez-Vega V, Pérez N. Brain 18F-FDG PET findings and sequential vestibular testing in SCA27B: a case report. J Neurol 2024; 271:1015-1018. [PMID: 37831126 DOI: 10.1007/s00415-023-12032-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/26/2023] [Accepted: 09/28/2023] [Indexed: 10/14/2023]
Affiliation(s)
- Adolfo Jiménez-Huete
- Department of Neurology, Clínica Universidad de Navarra, C/ Marquesado de Sta. Marta, 1, 28027, Madrid, Spain.
| | - Ana Patiño-García
- Department of Pediatrics and Medical Genetics Unit, Clínica Universidad de Navarra, Pamplona, Madrid, Spain
| | | | | | - Antonio Martin-Bastida
- Department of Neurology, Clínica Universidad de Navarra, C/ Marquesado de Sta. Marta, 1, 28027, Madrid, Spain
| | - Víctor Suárez-Vega
- Department of Radiology, Clínica Universidad de Navarra, Pamplona, Madrid, Spain
| | - Nicolás Pérez
- Department of Otolaryngology, Clínica Universidad de Navarra, Pamplona, Madrid, Spain
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18
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Foucard C, Belley M, Sangare A, Bonnet C, Renaud M, Roze E. Paroxysmal Ataxia: A Characteristic Feature of FGF14 Repeat Expansion (SCA27B). Neurol Genet 2024; 10:e200118. [PMID: 38170134 PMCID: PMC10759144 DOI: 10.1212/nxg.0000000000200118] [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: 07/18/2023] [Accepted: 10/23/2023] [Indexed: 01/05/2024]
Abstract
Objectives Paroxysmal ataxia is typically characterized by early-onset attacks of cerebellar ataxia. Late-onset cerebellar ataxia (LOCA) comprises a group of neurodegenerative disorders mainly characterized by adult-onset progressive cerebellar ataxia. A deep intronic expansion of a GAA triplet in the FGF14 gene encoding fibroblast growth factor 14 has recently been identified as a frequent cause of LOCA. Methods We describe a patient with paroxysmal ataxia/dysarthria due to a FGF14 repeat expansion and 3 affected family members. Results The 4 patients had paroxysmal ataxia/dysarthria occurring between 45 and 50 years as the initial manifestation of a FGF14 repeat expansion. The index case was investigated in detail. We have provided a video showing one of her paroxysmal episodes that could be triggered by alcohol, coffee, exertion, emotion, or cigarette smoking. Brain MRI revealed mild cerebellar atrophy, and oculography showed a subclinical downbeat nystagmus. Treatment with acetazolamide resulted in remarkable improvement. Discussion Paroxysmal dysarthria/ataxia should prompt the clinician to test for FGF14 repeat expansion/SCA27B, especially when the paroxysmal attacks are associated with late-onset cerebellar ataxia and/or a family history consistent with a dominant disorder.
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Affiliation(s)
- Cendrine Foucard
- From the Assistance Publique-Hôpitaux de Paris (C.F., M.B., A.S., E.R.), DMU Neurosciences, Hôpital Pitié-Salpêtrière; Sorbonne Université (C.F., A.S., E.R.); Inserm U1127 (A.S., E.R.), CNRS UMR 7225, UM 75, Institut du Cerveau, Paris; Laboratoire de Génétique Médicale (C.B.), Hôpitaux de Brabois - CHRU de Nancy; INSERM-U1256 NGERE (C.B., M.R.), Université de Lorraine; Service de Neurologie (M.R.), CHRU de Nancy; and Service de Génétique Clinique (M.R.), CHRU Nancy, France
| | - Marie Belley
- From the Assistance Publique-Hôpitaux de Paris (C.F., M.B., A.S., E.R.), DMU Neurosciences, Hôpital Pitié-Salpêtrière; Sorbonne Université (C.F., A.S., E.R.); Inserm U1127 (A.S., E.R.), CNRS UMR 7225, UM 75, Institut du Cerveau, Paris; Laboratoire de Génétique Médicale (C.B.), Hôpitaux de Brabois - CHRU de Nancy; INSERM-U1256 NGERE (C.B., M.R.), Université de Lorraine; Service de Neurologie (M.R.), CHRU de Nancy; and Service de Génétique Clinique (M.R.), CHRU Nancy, France
| | - Aude Sangare
- From the Assistance Publique-Hôpitaux de Paris (C.F., M.B., A.S., E.R.), DMU Neurosciences, Hôpital Pitié-Salpêtrière; Sorbonne Université (C.F., A.S., E.R.); Inserm U1127 (A.S., E.R.), CNRS UMR 7225, UM 75, Institut du Cerveau, Paris; Laboratoire de Génétique Médicale (C.B.), Hôpitaux de Brabois - CHRU de Nancy; INSERM-U1256 NGERE (C.B., M.R.), Université de Lorraine; Service de Neurologie (M.R.), CHRU de Nancy; and Service de Génétique Clinique (M.R.), CHRU Nancy, France
| | - Céline Bonnet
- From the Assistance Publique-Hôpitaux de Paris (C.F., M.B., A.S., E.R.), DMU Neurosciences, Hôpital Pitié-Salpêtrière; Sorbonne Université (C.F., A.S., E.R.); Inserm U1127 (A.S., E.R.), CNRS UMR 7225, UM 75, Institut du Cerveau, Paris; Laboratoire de Génétique Médicale (C.B.), Hôpitaux de Brabois - CHRU de Nancy; INSERM-U1256 NGERE (C.B., M.R.), Université de Lorraine; Service de Neurologie (M.R.), CHRU de Nancy; and Service de Génétique Clinique (M.R.), CHRU Nancy, France
| | - Mathilde Renaud
- From the Assistance Publique-Hôpitaux de Paris (C.F., M.B., A.S., E.R.), DMU Neurosciences, Hôpital Pitié-Salpêtrière; Sorbonne Université (C.F., A.S., E.R.); Inserm U1127 (A.S., E.R.), CNRS UMR 7225, UM 75, Institut du Cerveau, Paris; Laboratoire de Génétique Médicale (C.B.), Hôpitaux de Brabois - CHRU de Nancy; INSERM-U1256 NGERE (C.B., M.R.), Université de Lorraine; Service de Neurologie (M.R.), CHRU de Nancy; and Service de Génétique Clinique (M.R.), CHRU Nancy, France
| | - Emmanuel Roze
- From the Assistance Publique-Hôpitaux de Paris (C.F., M.B., A.S., E.R.), DMU Neurosciences, Hôpital Pitié-Salpêtrière; Sorbonne Université (C.F., A.S., E.R.); Inserm U1127 (A.S., E.R.), CNRS UMR 7225, UM 75, Institut du Cerveau, Paris; Laboratoire de Génétique Médicale (C.B.), Hôpitaux de Brabois - CHRU de Nancy; INSERM-U1256 NGERE (C.B., M.R.), Université de Lorraine; Service de Neurologie (M.R.), CHRU de Nancy; and Service de Génétique Clinique (M.R.), CHRU Nancy, France
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Lopergolo D, Bargagli A, Satolli S, Barghigiani M, Mignarri A, Musumeci O, Maria Santorelli F, Rufa A. Oculomotor features in SCA27B patients. Clin Neurophysiol 2024; 158:56-58. [PMID: 38176158 DOI: 10.1016/j.clinph.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 12/13/2023] [Accepted: 12/15/2023] [Indexed: 01/06/2024]
Affiliation(s)
- Diego Lopergolo
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy; UOC Neurologia e Malattie Neurometaboliche, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Alessia Bargagli
- Evalab-Neurosense, Department of Medicine, Surgery and Neuroscience, University of Siena, Italy
| | - Sara Satolli
- Molecular Medicine for Neurodegenerative and Neuromuscular Diseases Unit, IRCCS Fondazione Stella Maris, Pisa, Italy
| | - Melissa Barghigiani
- Molecular Medicine for Neurodegenerative and Neuromuscular Diseases Unit, IRCCS Fondazione Stella Maris, Pisa, Italy
| | - Andrea Mignarri
- UOC Neurologia e Malattie Neurometaboliche, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Olimpia Musumeci
- Unit of Neurology and Neuromuscular Disorders, Department of Clinical and Experimental Medicine, University of Messina, Italy
| | - Filippo Maria Santorelli
- Molecular Medicine for Neurodegenerative and Neuromuscular Diseases Unit, IRCCS Fondazione Stella Maris, Pisa, Italy
| | - Alessandra Rufa
- Department of Medicine, Surgery, and Neurosciences, University of Siena, Siena, Italy; UOC Neurologia e Malattie Neurometaboliche, Azienda Ospedaliero-Universitaria Senese, Siena, Italy; Evalab-Neurosense, Department of Medicine, Surgery and Neuroscience, University of Siena, Italy.
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20
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Pellerin D, Wilke C, Traschütz A, Nagy S, Currò R, Dicaire MJ, Garcia-Moreno H, Anheim M, Wirth T, Faber J, Timmann D, Depienne C, Rujescu D, Gazulla J, Reilly MM, Giunti P, Brais B, Houlden H, Schöls L, Strupp M, Cortese A, Synofzik M. Intronic FGF14 GAA repeat expansions are a common cause of ataxia syndromes with neuropathy and bilateral vestibulopathy. J Neurol Neurosurg Psychiatry 2024; 95:175-179. [PMID: 37399286 PMCID: PMC10850669 DOI: 10.1136/jnnp-2023-331490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/25/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Intronic GAA repeat expansions in the fibroblast growth factor 14 gene (FGF14) have recently been identified as a common cause of ataxia with potential phenotypic overlap with RFC1-related cerebellar ataxia, neuropathy and vestibular areflexia syndrome (CANVAS). Our objective was to report on the frequency of intronic FGF14 GAA repeat expansions in patients with an unexplained CANVAS-like phenotype. METHODS We recruited 45 patients negative for biallelic RFC1 repeat expansions with a combination of cerebellar ataxia plus peripheral neuropathy and/or bilateral vestibulopathy (BVP), and genotyped the FGF14 repeat locus. Phenotypic features of GAA-FGF14-positive versus GAA-FGF14-negative patients were compared. RESULTS Frequency of FGF14 GAA repeat expansions was 38% (17/45) in the entire cohort, 38% (5/13) in the subgroup with cerebellar ataxia plus polyneuropathy, 43% (9/21) in the subgroup with cerebellar ataxia plus BVP and 27% (3/11) in patients with all three features. BVP was observed in 75% (12/16) of GAA-FGF14-positive patients. Polyneuropathy was at most mild and of mixed sensorimotor type in six of eight GAA-FGF14-positive patients. Family history of ataxia (59% vs 15%; p=0.007) was significantly more frequent and permanent cerebellar dysarthria (12% vs 54%; p=0.009) significantly less frequent in GAA-FGF14-positive than in GAA-FGF14-negative patients. Age at onset was inversely correlated to the size of the repeat expansion (Pearson's r, -0.67; R2=0.45; p=0.0031). CONCLUSIONS GAA-FGF14-related disease is a common cause of cerebellar ataxia with polyneuropathy and/or BVP, and should be included in the differential diagnosis of RFC1 CANVAS and disease spectrum.
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Affiliation(s)
- David Pellerin
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, University College London, London, UK
- Department of Neurology and Neurosurgery, Montreal Neurological Hospital and Institute, McGill University, Montreal, QC, Canada
| | - Carlo Wilke
- Research Division Translational Genomics of Neurodegenerative Diseases, Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Andreas Traschütz
- Research Division Translational Genomics of Neurodegenerative Diseases, Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Sara Nagy
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, University College London, London, UK
- Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Riccardo Currò
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, University College London, London, UK
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Marie-Josée Dicaire
- Department of Neurology and Neurosurgery, Montreal Neurological Hospital and Institute, McGill University, Montreal, QC, Canada
| | - Hector Garcia-Moreno
- Ataxia Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
- National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Mathieu Anheim
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Strasbourg, France
- Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
| | - Thomas Wirth
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Strasbourg, France
- Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
| | - Jennifer Faber
- Department of Neurology, University Hospital Bonn, Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Dagmar Timmann
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), Essen University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Christel Depienne
- Institute of Human Genetics, Essen University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Dan Rujescu
- Department of Psychiatry and Psychotherapy, Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - José Gazulla
- Department of Neurology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Mary M Reilly
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, University College London, London, UK
| | - Paola Giunti
- Ataxia Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
- National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Bernard Brais
- Department of Neurology and Neurosurgery, Montreal Neurological Hospital and Institute, McGill University, Montreal, QC, Canada
- Department of Human Genetics, McGill University, Montreal, QC, Canada
- Centre de Réadaptation Lucie-Bruneau, Montreal, QC, Canada
| | - Henry Houlden
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, University College London, London, UK
| | - Ludger Schöls
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
- Department of Neurodegenerative Diseases, Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen, Tübingen, Germany
| | - Michael Strupp
- Department of Neurology and German Center for Vertigo and Balance Disorders, LMU University Hospital, LMU Munich, Munich, Germany
| | - Andrea Cortese
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, University College London, London, UK
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Matthis Synofzik
- Research Division Translational Genomics of Neurodegenerative Diseases, Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
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21
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Yeow D, Rudaks LI, Siow SF, Davis RL, Kumar KR. Genetic Testing of Movements Disorders: A Review of Clinical Utility. Tremor Other Hyperkinet Mov (N Y) 2024; 14:2. [PMID: 38222898 PMCID: PMC10785957 DOI: 10.5334/tohm.835] [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: 10/29/2023] [Accepted: 12/04/2023] [Indexed: 01/16/2024] Open
Abstract
Currently, pathogenic variants in more than 500 different genes are known to cause various movement disorders. The increasing accessibility and reducing cost of genetic testing has resulted in increasing clinical use of genetic testing for the diagnosis of movement disorders. However, the optimal use case(s) for genetic testing at a patient level remain ill-defined. Here, we review the utility of genetic testing in patients with movement disorders and also highlight current challenges and limitations that need to be considered when making decisions about genetic testing in clinical practice. Highlights The utility of genetic testing extends across multiple clinical and non-clinical domains. Here we review different aspects of the utility of genetic testing for movement disorders and the numerous associated challenges and limitations. These factors should be weighed on a case-by-case basis when requesting genetic tests in clinical practice.
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Affiliation(s)
- Dennis Yeow
- Translational Neurogenomics Group, Neurology Department & Molecular Medicine Laboratory, Concord Repatriation General Hospital, Concord, NSW, Australia
- Concord Clinical School, Sydney Medical School, Faculty of Health & Medicine, University of Sydney, Concord, NSW, Australia
- Rare Disease Program, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
- Department of Neurology, Prince of Wales Hospital, Randwick, NSW, Australia
- Neuroscience Research Australia, Randwick, NSW, Australia
| | - Laura I. Rudaks
- Translational Neurogenomics Group, Neurology Department & Molecular Medicine Laboratory, Concord Repatriation General Hospital, Concord, NSW, Australia
- Concord Clinical School, Sydney Medical School, Faculty of Health & Medicine, University of Sydney, Concord, NSW, Australia
- Rare Disease Program, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
| | - Sue-Faye Siow
- Department of Clinical Genetics, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Ryan L. Davis
- Rare Disease Program, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
- Neurogenetics Research Group, Kolling Institute, School of Medical Sciences, Faculty of Medicine and Health, University of Sydney and Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Kishore R. Kumar
- Translational Neurogenomics Group, Neurology Department & Molecular Medicine Laboratory, Concord Repatriation General Hospital, Concord, NSW, Australia
- Concord Clinical School, Sydney Medical School, Faculty of Health & Medicine, University of Sydney, Concord, NSW, Australia
- Rare Disease Program, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
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Ando M, Higuchi Y, Yuan J, Yoshimura A, Kojima F, Yamanishi Y, Aso Y, Izumi K, Imada M, Maki Y, Nakagawa H, Hobara T, Noguchi Y, Takei J, Hiramatsu Y, Nozuma S, Sakiyama Y, Hashiguchi A, Matsuura E, Okamoto Y, Takashima H. Clinical variability associated with intronic FGF14 GAA repeat expansion in Japan. Ann Clin Transl Neurol 2024; 11:96-104. [PMID: 37916889 PMCID: PMC10791012 DOI: 10.1002/acn3.51936] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/18/2023] [Accepted: 10/19/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The GAA repeat expansion within the fibroblast growth factor 14 (FGF14) gene has been found to be associated with late-onset cerebellar ataxia. This study aimed to investigate the genetic causes of cerebellar ataxia in patients in Japan. METHODS We collected a case series of 940 index patients who presented with chronic cerebellar ataxia and remained genetically undiagnosed after our preliminary genetic screening. To investigate the FGF14 repeat locus, we employed an integrated diagnostic strategy that involved fluorescence amplicon length analysis polymerase chain reaction (PCR), repeat-primed PCR, and long-read sequencing. RESULTS Pathogenic FGF14 GAA repeat expansions were detected in 12 patients from 11 unrelated families. The median size of the pathogenic GAA repeat was 309 repeats (range: 270-316 repeats). In these patients, the mean age of onset was 66.9 ± 9.6 years, with episodic symptoms observed in 56% of patients and parkinsonism in 30% of patients. We also detected FGF14 repeat expansions in a patient with a phenotype of multiple system atrophy, including cerebellar ataxia, parkinsonism, autonomic ataxia, and bilateral vocal cord paralysis. Brain magnetic resonance imaging (MRI) showed normal to mild cerebellar atrophy, and a follow-up study conducted after a mean period of 6 years did not reveal any significant progression. DISCUSSION This study highlights the importance of FGF14 GAA repeat analysis in patients with late-onset cerebellar ataxia, particularly when they exhibit episodic symptoms, or their brain MRI shows no apparent cerebellar atrophy. Our findings contribute to a better understanding of the clinical variability of GAA-FGF14-related diseases.
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Affiliation(s)
- Masahiro Ando
- Department of Neurology and GeriatricsKagoshima University Graduate School of Medical and Dental SciencesKagoshimaJapan
| | - Yujiro Higuchi
- Department of Neurology and GeriatricsKagoshima University Graduate School of Medical and Dental SciencesKagoshimaJapan
| | - Junhui Yuan
- Department of Neurology and GeriatricsKagoshima University Graduate School of Medical and Dental SciencesKagoshimaJapan
| | - Akiko Yoshimura
- Department of Neurology and GeriatricsKagoshima University Graduate School of Medical and Dental SciencesKagoshimaJapan
| | - Fumikazu Kojima
- Department of Neurology and GeriatricsKagoshima University Graduate School of Medical and Dental SciencesKagoshimaJapan
| | - Yuki Yamanishi
- Department of Neurology and Clinical PharmacologyEhime University HospitalToonEhimeJapan
| | - Yasuhiro Aso
- Department of NeurologyOita Prefecture HospitalOitaJapan
| | - Kotaro Izumi
- Department of NeurologyOhashi Go Neurosurgical Neurology ClinicFukuokaJapan
| | - Minako Imada
- Department of NeurologyNational Hospital Organization Minamikyushu HospitalKagoshimaJapan
| | - Yoshimitsu Maki
- Department of NeurologyKagoshima City HospitalKagoshimaJapan
| | - Hiroto Nakagawa
- Department of NeurologyKagoshima Medical Association HospitalKagoshimaJapan
| | - Takahiro Hobara
- Department of Neurology and GeriatricsKagoshima University Graduate School of Medical and Dental SciencesKagoshimaJapan
| | - Yutaka Noguchi
- Department of Neurology and GeriatricsKagoshima University Graduate School of Medical and Dental SciencesKagoshimaJapan
| | - Jun Takei
- Department of Neurology and GeriatricsKagoshima University Graduate School of Medical and Dental SciencesKagoshimaJapan
| | - Yu Hiramatsu
- Department of Neurology and GeriatricsKagoshima University Graduate School of Medical and Dental SciencesKagoshimaJapan
| | - Satoshi Nozuma
- Department of Neurology and GeriatricsKagoshima University Graduate School of Medical and Dental SciencesKagoshimaJapan
| | - Yusuke Sakiyama
- Department of Neurology and GeriatricsKagoshima University Graduate School of Medical and Dental SciencesKagoshimaJapan
| | - Akihiro Hashiguchi
- Department of Neurology and GeriatricsKagoshima University Graduate School of Medical and Dental SciencesKagoshimaJapan
| | - Eiji Matsuura
- Department of Neurology and GeriatricsKagoshima University Graduate School of Medical and Dental SciencesKagoshimaJapan
| | - Yuji Okamoto
- Department of Neurology and GeriatricsKagoshima University Graduate School of Medical and Dental SciencesKagoshimaJapan
- Department of Physical Therapy, Faculty of MedicineSchool of Health Sciences, Kagoshima UniversityKagoshimaJapan
| | - Hiroshi Takashima
- Department of Neurology and GeriatricsKagoshima University Graduate School of Medical and Dental SciencesKagoshimaJapan
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Pellerin D, Danzi MC, Renaud M, Houlden H, Synofzik M, Zuchner S, Brais B. Spinocerebellar ataxia 27B: A novel, frequent and potentially treatable ataxia. Clin Transl Med 2024; 14:e1504. [PMID: 38279833 PMCID: PMC10819088 DOI: 10.1002/ctm2.1504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/19/2023] [Accepted: 11/24/2023] [Indexed: 01/29/2024] Open
Abstract
Hereditary ataxias, especially when presenting sporadically in adulthood, present a particular diagnostic challenge owing to their great clinical and genetic heterogeneity. Currently, up to 75% of such patients remain without a genetic diagnosis. In an era of emerging disease-modifying gene-stratified therapies, the identification of causative alleles has become increasingly important. Over the past few years, the implementation of advanced bioinformatics tools and long-read sequencing has allowed the identification of a number of novel repeat expansion disorders, such as the recently described spinocerebellar ataxia 27B (SCA27B) caused by a (GAA)•(TTC) repeat expansion in intron 1 of the fibroblast growth factor 14 (FGF14) gene. SCA27B is rapidly gaining recognition as one of the most common forms of adult-onset hereditary ataxia, with several studies showing that it accounts for a substantial number (9-61%) of previously undiagnosed cases from different cohorts. First natural history studies and multiple reports have already outlined the progression and core phenotype of this novel disease, which consists of a late-onset slowly progressive pan-cerebellar syndrome that is frequently associated with cerebellar oculomotor signs, such as downbeat nystagmus, and episodic symptoms. Furthermore, preliminary studies in patients with SCA27B have shown promising symptomatic benefits of 4-aminopyridine, an already marketed drug. This review describes the current knowledge of the genetic and molecular basis, epidemiology, clinical features and prospective treatment strategies in SCA27B.
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Affiliation(s)
- David Pellerin
- Department of Neurology and Neurosurgery, Montreal Neurological Hospital and InstituteMcGill UniversityMontrealQuebecCanada
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and NeurosurgeryUniversity College LondonLondonUK
| | - Matt C. Danzi
- Dr. John T. Macdonald Foundation Department of Human Genetics and John P. Hussman Institute for Human GenomicsUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Mathilde Renaud
- INSERM‐U1256 NGEREUniversité de LorraineNancyFrance
- Service de Neurologie, CHRU de NancyNancyFrance
- Service de Génétique Clinique, CHRU de NancyNancyFrance
| | - Henry Houlden
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and NeurosurgeryUniversity College LondonLondonUK
| | - Matthis Synofzik
- Division of Translational Genomics of Neurodegenerative DiseasesHertie‐Institute for Clinical Brain Research and Center of Neurology, University of TübingenTübingenGermany
- German Center for Neurodegenerative Diseases (DZNE)TübingenGermany
| | - Stephan Zuchner
- Dr. John T. Macdonald Foundation Department of Human Genetics and John P. Hussman Institute for Human GenomicsUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Bernard Brais
- Department of Neurology and Neurosurgery, Montreal Neurological Hospital and InstituteMcGill UniversityMontrealQuebecCanada
- Department of Human GeneticsMcGill UniversityMontrealQuebecCanada
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24
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Iruzubieta P, Pellerin D, Bergareche A, Albajar I, Mondragón E, Vinagre A, Fernández-Torrón R, Moreno F, Equiza J, Campo-Caballero D, Poza JJ, Ruibal M, Formica A, Dicaire MJ, Danzi MC, Zuchner S, Croitoru I, Ruiz M, Schlüter A, Casasnovas C, Pujol A, Brais B, Houlden H, López de Munain A, Ruiz-Martínez J. Frequency and phenotypic spectrum of spinocerebellar ataxia 27B and other genetic ataxias in a Spanish cohort of late-onset cerebellar ataxia. Eur J Neurol 2023; 30:3828-3833. [PMID: 37578187 DOI: 10.1111/ene.16039] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 07/30/2023] [Accepted: 08/10/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND AND PURPOSE Dominantly inherited GAA repeat expansions in the fibroblast growth factor 14 (FGF14) gene have recently been shown to cause spinocerebellar ataxia 27B (SCA27B). We aimed to study the frequency and phenotype of SCA27B in a cohort of patients with unsolved late-onset cerebellar ataxia (LOCA). We also assessed the frequency of SCA27B relative to other genetically defined LOCAs. METHODS We recruited a consecutive series of 107 patients with LOCA, of whom 64 remained genetically undiagnosed. We screened these 64 patients for the FGF14 GAA repeat expansion. We next analysed the frequency of SCA27B relative to other genetically defined forms of LOCA in the cohort of 107 patients. RESULTS Eighteen of 64 patients (28%) carried an FGF14 (GAA)≥250 expansion. The median (range) age at onset was 62.5 (39-72) years. The most common clinical features included gait ataxia (100%) and mild cerebellar dysarthria (67%). In addition, episodic symptoms and downbeat nystagmus were present in 39% (7/18) and 37% (6/16) of patients, respectively. SCA27B was the most common cause of LOCA in our cohort (17%, 18/107). Among patients with genetically defined LOCA, SCA27B was the main cause of pure ataxia, RFC1-related disease of ataxia with neuropathy, and SPG7 of ataxia with spasticity. CONCLUSION We showed that SCA27B is the most common cause of LOCA in our cohort. Our results support the use of FGF14 GAA repeat expansion screening as a first-tier genetic test in patients with LOCA.
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Affiliation(s)
- Pablo Iruzubieta
- Department of Neurology, Donostia University Hospital, Biodonostia Health Research Institute, Donostia-San Sebastián, Spain
- CIBERNED Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas-Instituto de Salud Carlos III (CIBER-CIBERNED-ISCIII), Madrid, Spain
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology London and The National Hospital for Neurology and Neurosurgery, University College London, London, UK
| | - David Pellerin
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology London and The National Hospital for Neurology and Neurosurgery, University College London, London, UK
- Department of Neurology and Neurosurgery, Montreal Neurological Hospital and Institute, McGill University, Montreal, Quebec, Canada
| | - Alberto Bergareche
- Department of Neurology, Donostia University Hospital, Biodonostia Health Research Institute, Donostia-San Sebastián, Spain
- CIBERNED Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas-Instituto de Salud Carlos III (CIBER-CIBERNED-ISCIII), Madrid, Spain
| | - Inés Albajar
- Department of Neurology, Donostia University Hospital, Biodonostia Health Research Institute, Donostia-San Sebastián, Spain
| | - Elisabet Mondragón
- Department of Neurology, Donostia University Hospital, Biodonostia Health Research Institute, Donostia-San Sebastián, Spain
- CIBERNED Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas-Instituto de Salud Carlos III (CIBER-CIBERNED-ISCIII), Madrid, Spain
| | - Ana Vinagre
- Department of Neurology, Donostia University Hospital, Biodonostia Health Research Institute, Donostia-San Sebastián, Spain
- CIBERNED Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas-Instituto de Salud Carlos III (CIBER-CIBERNED-ISCIII), Madrid, Spain
| | - Roberto Fernández-Torrón
- Department of Neurology, Donostia University Hospital, Biodonostia Health Research Institute, Donostia-San Sebastián, Spain
- CIBERNED Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas-Instituto de Salud Carlos III (CIBER-CIBERNED-ISCIII), Madrid, Spain
| | - Fermín Moreno
- Department of Neurology, Donostia University Hospital, Biodonostia Health Research Institute, Donostia-San Sebastián, Spain
- CIBERNED Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas-Instituto de Salud Carlos III (CIBER-CIBERNED-ISCIII), Madrid, Spain
| | - Jon Equiza
- Department of Neurology, Donostia University Hospital, Biodonostia Health Research Institute, Donostia-San Sebastián, Spain
| | - David Campo-Caballero
- Department of Neurology, Donostia University Hospital, Biodonostia Health Research Institute, Donostia-San Sebastián, Spain
| | - Juan José Poza
- Department of Neurology, Donostia University Hospital, Biodonostia Health Research Institute, Donostia-San Sebastián, Spain
| | - Marta Ruibal
- Department of Neurology, Donostia University Hospital, Biodonostia Health Research Institute, Donostia-San Sebastián, Spain
| | - Alessandro Formica
- Department of Neurology, Donostia University Hospital, Biodonostia Health Research Institute, Donostia-San Sebastián, Spain
| | - Marie-Josée Dicaire
- Department of Neurology and Neurosurgery, Montreal Neurological Hospital and Institute, McGill University, Montreal, Quebec, Canada
| | - Matt C Danzi
- Dr. John T. Macdonald Foundation Department of Human Genetics and John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Stephan Zuchner
- Dr. John T. Macdonald Foundation Department of Human Genetics and John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ioana Croitoru
- CIBERNED Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas-Instituto de Salud Carlos III (CIBER-CIBERNED-ISCIII), Madrid, Spain
| | - Montserrat Ruiz
- Neurometabolic Diseases Laboratory, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
| | - Agatha Schlüter
- Neurometabolic Diseases Laboratory, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
| | - Carlos Casasnovas
- Neurometabolic Diseases Laboratory, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
- Neuromuscular Unit, Neurology Department, Hospital Universitari de Bellvitge, Universitat de Barcelona, Barcelona, Spain
| | - Aurora Pujol
- Neurometabolic Diseases Laboratory, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
- Catalan Institution of Research and Advanced Studies (ICREA), Barcelona, Spain
| | - Bernard Brais
- Department of Neurology and Neurosurgery, Montreal Neurological Hospital and Institute, McGill University, Montreal, Quebec, Canada
- Department of Human Genetics, McGill University, Montreal, Quebec, Canada
| | - Henry Houlden
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology London and The National Hospital for Neurology and Neurosurgery, University College London, London, UK
| | - Adolfo López de Munain
- Department of Neurology, Donostia University Hospital, Biodonostia Health Research Institute, Donostia-San Sebastián, Spain
- CIBERNED Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas-Instituto de Salud Carlos III (CIBER-CIBERNED-ISCIII), Madrid, Spain
| | - Javier Ruiz-Martínez
- Department of Neurology, Donostia University Hospital, Biodonostia Health Research Institute, Donostia-San Sebastián, Spain
- CIBERNED Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas-Instituto de Salud Carlos III (CIBER-CIBERNED-ISCIII), Madrid, Spain
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25
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Seemann J, Traschütz A, Ilg W, Synofzik M. 4-Aminopyridine improves real-life gait performance in SCA27B on a single-subject level: a prospective n-of-1 treatment experience. J Neurol 2023; 270:5629-5634. [PMID: 37439944 PMCID: PMC10576659 DOI: 10.1007/s00415-023-11868-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 07/14/2023]
Affiliation(s)
- Jens Seemann
- Section Computational Sensomotorics, Hertie Institute for Clinical Brain Research, Otfried-Müller-Straße 25, 72076, Tübingen, Germany
- Centre for Integrative Neuroscience (CIN), Tübingen, Germany
| | - Andreas Traschütz
- Division Translational Genomics of Neurodegenerative Diseases, Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Winfried Ilg
- Section Computational Sensomotorics, Hertie Institute for Clinical Brain Research, Otfried-Müller-Straße 25, 72076, Tübingen, Germany.
- Centre for Integrative Neuroscience (CIN), Tübingen, Germany.
| | - Matthis Synofzik
- Division Translational Genomics of Neurodegenerative Diseases, Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
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26
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Novis LE, Frezatti RS, Pellerin D, Tomaselli PJ, Alavi S, Della Coleta MV, Spitz M, Dicaire MJ, Iruzubieta P, Pedroso JL, Barsottini O, Cortese A, Danzi MC, França MC, Brais B, Zuchner S, Houlden H, Raskin S, Marques W, Teive HA. Frequency of GAA- FGF14 Ataxia in a Large Cohort of Brazilian Patients With Unsolved Adult-Onset Cerebellar Ataxia. Neurol Genet 2023; 9:e200094. [PMID: 37646005 PMCID: PMC10461713 DOI: 10.1212/nxg.0000000000200094] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 07/28/2023] [Indexed: 09/01/2023]
Abstract
Objectives Intronic FGF14 GAA repeat expansions have recently been found to be a common cause of hereditary ataxia (GAA-FGF14 ataxia; SCA27B). The global epidemiology and regional prevalence of this newly reported disorder remain to be established. In this study, we investigated the frequency of GAA-FGF14 ataxia in a large cohort of Brazilian patients with unsolved adult-onset ataxia. Methods We recruited 93 index patients with genetically unsolved adult-onset ataxia despite extensive genetic investigation and genotyped the FGF14 repeat locus. Patients were recruited across 4 different regions of Brazil. Results Of the 93 index patients, 8 (9%) carried an FGF14 (GAA)≥250 expansion. The expansion was also identified in 1 affected relative. Seven patients were of European descent, 1 was of African descent, and 1was of admixed American ancestry. One patient carrying a (GAA)376 expansion developed ataxia at age 28 years, confirming that GAA-FGF14 ataxia can occur before the age of 30 years. One patient displayed episodic symptoms, while none had downbeat nystagmus. Cerebellar atrophy was observed on brain MRI in 7 of 8 patients (87%). Discussion Our results suggest that GAA-FGF14 ataxia is a common cause of adult-onset ataxia in the Brazilian population, although larger studies are needed to fully define its epidemiology.
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Affiliation(s)
- Luiz Eduardo Novis
- From the Pós-graduação Em Medicina Interna e Ciências da Saúde (L.E.N., H.A.T.), Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil; Department of Neuromuscular Diseases (L.E.N., D.P., S.A., P.I., A.C., H.H.), UCL Queen Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, UK; Department of Neurology (R.S.F., P.J.T., W.M.), School of Medicine at Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil; Departments of Neurology and Neurosurgery (D.P., M.-J.D., B.B.), Montreal Neurological Hospital and Institute, McGill University, Canada; Departamento de Neurologia (M.V.D.C.), Universidade do Estado do Amazonas, Manaus; Departamento de Especialidades Médicas (M.S.), Serviço de Neurologia, Universidade Estadual do Rio de Janeiro, Brazil; Department of Neurology (P.I.), Donostia University Hospital; Neuroscience Area (P.I.), Biodonostia Health Research Institute, San Sebastian; Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED) (P.I.), Spain; Department of Neurology (J.L.P., O.B.), Ataxia Unit, Universidade Federal de São Paulo, SP, Brazil; Department of Brain and Behavioral Sciences (A.C.), University of Pavia, Italy; Dr. John T. Macdonald Foundation Department of Human Genetics and John P. Hussman Institute for Human Genomics (M.C.D., S.Z.), University of Miami Miller School of Medicine; Department of Neurology (M.C.F.), School of Medical Sciences-University of Campinas (UNICAMP), São Paulo, Brazil; Department of Human Genetics (B.B.), McGill University, Montreal, Canada; and Laboratório Genetika (S.R.), Curitiba, PR, Brazil
| | - Rodrigo S Frezatti
- From the Pós-graduação Em Medicina Interna e Ciências da Saúde (L.E.N., H.A.T.), Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil; Department of Neuromuscular Diseases (L.E.N., D.P., S.A., P.I., A.C., H.H.), UCL Queen Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, UK; Department of Neurology (R.S.F., P.J.T., W.M.), School of Medicine at Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil; Departments of Neurology and Neurosurgery (D.P., M.-J.D., B.B.), Montreal Neurological Hospital and Institute, McGill University, Canada; Departamento de Neurologia (M.V.D.C.), Universidade do Estado do Amazonas, Manaus; Departamento de Especialidades Médicas (M.S.), Serviço de Neurologia, Universidade Estadual do Rio de Janeiro, Brazil; Department of Neurology (P.I.), Donostia University Hospital; Neuroscience Area (P.I.), Biodonostia Health Research Institute, San Sebastian; Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED) (P.I.), Spain; Department of Neurology (J.L.P., O.B.), Ataxia Unit, Universidade Federal de São Paulo, SP, Brazil; Department of Brain and Behavioral Sciences (A.C.), University of Pavia, Italy; Dr. John T. Macdonald Foundation Department of Human Genetics and John P. Hussman Institute for Human Genomics (M.C.D., S.Z.), University of Miami Miller School of Medicine; Department of Neurology (M.C.F.), School of Medical Sciences-University of Campinas (UNICAMP), São Paulo, Brazil; Department of Human Genetics (B.B.), McGill University, Montreal, Canada; and Laboratório Genetika (S.R.), Curitiba, PR, Brazil
| | - David Pellerin
- From the Pós-graduação Em Medicina Interna e Ciências da Saúde (L.E.N., H.A.T.), Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil; Department of Neuromuscular Diseases (L.E.N., D.P., S.A., P.I., A.C., H.H.), UCL Queen Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, UK; Department of Neurology (R.S.F., P.J.T., W.M.), School of Medicine at Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil; Departments of Neurology and Neurosurgery (D.P., M.-J.D., B.B.), Montreal Neurological Hospital and Institute, McGill University, Canada; Departamento de Neurologia (M.V.D.C.), Universidade do Estado do Amazonas, Manaus; Departamento de Especialidades Médicas (M.S.), Serviço de Neurologia, Universidade Estadual do Rio de Janeiro, Brazil; Department of Neurology (P.I.), Donostia University Hospital; Neuroscience Area (P.I.), Biodonostia Health Research Institute, San Sebastian; Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED) (P.I.), Spain; Department of Neurology (J.L.P., O.B.), Ataxia Unit, Universidade Federal de São Paulo, SP, Brazil; Department of Brain and Behavioral Sciences (A.C.), University of Pavia, Italy; Dr. John T. Macdonald Foundation Department of Human Genetics and John P. Hussman Institute for Human Genomics (M.C.D., S.Z.), University of Miami Miller School of Medicine; Department of Neurology (M.C.F.), School of Medical Sciences-University of Campinas (UNICAMP), São Paulo, Brazil; Department of Human Genetics (B.B.), McGill University, Montreal, Canada; and Laboratório Genetika (S.R.), Curitiba, PR, Brazil
| | - Pedro J Tomaselli
- From the Pós-graduação Em Medicina Interna e Ciências da Saúde (L.E.N., H.A.T.), Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil; Department of Neuromuscular Diseases (L.E.N., D.P., S.A., P.I., A.C., H.H.), UCL Queen Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, UK; Department of Neurology (R.S.F., P.J.T., W.M.), School of Medicine at Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil; Departments of Neurology and Neurosurgery (D.P., M.-J.D., B.B.), Montreal Neurological Hospital and Institute, McGill University, Canada; Departamento de Neurologia (M.V.D.C.), Universidade do Estado do Amazonas, Manaus; Departamento de Especialidades Médicas (M.S.), Serviço de Neurologia, Universidade Estadual do Rio de Janeiro, Brazil; Department of Neurology (P.I.), Donostia University Hospital; Neuroscience Area (P.I.), Biodonostia Health Research Institute, San Sebastian; Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED) (P.I.), Spain; Department of Neurology (J.L.P., O.B.), Ataxia Unit, Universidade Federal de São Paulo, SP, Brazil; Department of Brain and Behavioral Sciences (A.C.), University of Pavia, Italy; Dr. John T. Macdonald Foundation Department of Human Genetics and John P. Hussman Institute for Human Genomics (M.C.D., S.Z.), University of Miami Miller School of Medicine; Department of Neurology (M.C.F.), School of Medical Sciences-University of Campinas (UNICAMP), São Paulo, Brazil; Department of Human Genetics (B.B.), McGill University, Montreal, Canada; and Laboratório Genetika (S.R.), Curitiba, PR, Brazil
| | - Shahryar Alavi
- From the Pós-graduação Em Medicina Interna e Ciências da Saúde (L.E.N., H.A.T.), Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil; Department of Neuromuscular Diseases (L.E.N., D.P., S.A., P.I., A.C., H.H.), UCL Queen Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, UK; Department of Neurology (R.S.F., P.J.T., W.M.), School of Medicine at Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil; Departments of Neurology and Neurosurgery (D.P., M.-J.D., B.B.), Montreal Neurological Hospital and Institute, McGill University, Canada; Departamento de Neurologia (M.V.D.C.), Universidade do Estado do Amazonas, Manaus; Departamento de Especialidades Médicas (M.S.), Serviço de Neurologia, Universidade Estadual do Rio de Janeiro, Brazil; Department of Neurology (P.I.), Donostia University Hospital; Neuroscience Area (P.I.), Biodonostia Health Research Institute, San Sebastian; Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED) (P.I.), Spain; Department of Neurology (J.L.P., O.B.), Ataxia Unit, Universidade Federal de São Paulo, SP, Brazil; Department of Brain and Behavioral Sciences (A.C.), University of Pavia, Italy; Dr. John T. Macdonald Foundation Department of Human Genetics and John P. Hussman Institute for Human Genomics (M.C.D., S.Z.), University of Miami Miller School of Medicine; Department of Neurology (M.C.F.), School of Medical Sciences-University of Campinas (UNICAMP), São Paulo, Brazil; Department of Human Genetics (B.B.), McGill University, Montreal, Canada; and Laboratório Genetika (S.R.), Curitiba, PR, Brazil
| | - Marcus Vinícius Della Coleta
- From the Pós-graduação Em Medicina Interna e Ciências da Saúde (L.E.N., H.A.T.), Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil; Department of Neuromuscular Diseases (L.E.N., D.P., S.A., P.I., A.C., H.H.), UCL Queen Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, UK; Department of Neurology (R.S.F., P.J.T., W.M.), School of Medicine at Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil; Departments of Neurology and Neurosurgery (D.P., M.-J.D., B.B.), Montreal Neurological Hospital and Institute, McGill University, Canada; Departamento de Neurologia (M.V.D.C.), Universidade do Estado do Amazonas, Manaus; Departamento de Especialidades Médicas (M.S.), Serviço de Neurologia, Universidade Estadual do Rio de Janeiro, Brazil; Department of Neurology (P.I.), Donostia University Hospital; Neuroscience Area (P.I.), Biodonostia Health Research Institute, San Sebastian; Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED) (P.I.), Spain; Department of Neurology (J.L.P., O.B.), Ataxia Unit, Universidade Federal de São Paulo, SP, Brazil; Department of Brain and Behavioral Sciences (A.C.), University of Pavia, Italy; Dr. John T. Macdonald Foundation Department of Human Genetics and John P. Hussman Institute for Human Genomics (M.C.D., S.Z.), University of Miami Miller School of Medicine; Department of Neurology (M.C.F.), School of Medical Sciences-University of Campinas (UNICAMP), São Paulo, Brazil; Department of Human Genetics (B.B.), McGill University, Montreal, Canada; and Laboratório Genetika (S.R.), Curitiba, PR, Brazil
| | - Mariana Spitz
- From the Pós-graduação Em Medicina Interna e Ciências da Saúde (L.E.N., H.A.T.), Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil; Department of Neuromuscular Diseases (L.E.N., D.P., S.A., P.I., A.C., H.H.), UCL Queen Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, UK; Department of Neurology (R.S.F., P.J.T., W.M.), School of Medicine at Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil; Departments of Neurology and Neurosurgery (D.P., M.-J.D., B.B.), Montreal Neurological Hospital and Institute, McGill University, Canada; Departamento de Neurologia (M.V.D.C.), Universidade do Estado do Amazonas, Manaus; Departamento de Especialidades Médicas (M.S.), Serviço de Neurologia, Universidade Estadual do Rio de Janeiro, Brazil; Department of Neurology (P.I.), Donostia University Hospital; Neuroscience Area (P.I.), Biodonostia Health Research Institute, San Sebastian; Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED) (P.I.), Spain; Department of Neurology (J.L.P., O.B.), Ataxia Unit, Universidade Federal de São Paulo, SP, Brazil; Department of Brain and Behavioral Sciences (A.C.), University of Pavia, Italy; Dr. John T. Macdonald Foundation Department of Human Genetics and John P. Hussman Institute for Human Genomics (M.C.D., S.Z.), University of Miami Miller School of Medicine; Department of Neurology (M.C.F.), School of Medical Sciences-University of Campinas (UNICAMP), São Paulo, Brazil; Department of Human Genetics (B.B.), McGill University, Montreal, Canada; and Laboratório Genetika (S.R.), Curitiba, PR, Brazil
| | - Marie-Josée Dicaire
- From the Pós-graduação Em Medicina Interna e Ciências da Saúde (L.E.N., H.A.T.), Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil; Department of Neuromuscular Diseases (L.E.N., D.P., S.A., P.I., A.C., H.H.), UCL Queen Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, UK; Department of Neurology (R.S.F., P.J.T., W.M.), School of Medicine at Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil; Departments of Neurology and Neurosurgery (D.P., M.-J.D., B.B.), Montreal Neurological Hospital and Institute, McGill University, Canada; Departamento de Neurologia (M.V.D.C.), Universidade do Estado do Amazonas, Manaus; Departamento de Especialidades Médicas (M.S.), Serviço de Neurologia, Universidade Estadual do Rio de Janeiro, Brazil; Department of Neurology (P.I.), Donostia University Hospital; Neuroscience Area (P.I.), Biodonostia Health Research Institute, San Sebastian; Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED) (P.I.), Spain; Department of Neurology (J.L.P., O.B.), Ataxia Unit, Universidade Federal de São Paulo, SP, Brazil; Department of Brain and Behavioral Sciences (A.C.), University of Pavia, Italy; Dr. John T. Macdonald Foundation Department of Human Genetics and John P. Hussman Institute for Human Genomics (M.C.D., S.Z.), University of Miami Miller School of Medicine; Department of Neurology (M.C.F.), School of Medical Sciences-University of Campinas (UNICAMP), São Paulo, Brazil; Department of Human Genetics (B.B.), McGill University, Montreal, Canada; and Laboratório Genetika (S.R.), Curitiba, PR, Brazil
| | - Pablo Iruzubieta
- From the Pós-graduação Em Medicina Interna e Ciências da Saúde (L.E.N., H.A.T.), Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil; Department of Neuromuscular Diseases (L.E.N., D.P., S.A., P.I., A.C., H.H.), UCL Queen Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, UK; Department of Neurology (R.S.F., P.J.T., W.M.), School of Medicine at Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil; Departments of Neurology and Neurosurgery (D.P., M.-J.D., B.B.), Montreal Neurological Hospital and Institute, McGill University, Canada; Departamento de Neurologia (M.V.D.C.), Universidade do Estado do Amazonas, Manaus; Departamento de Especialidades Médicas (M.S.), Serviço de Neurologia, Universidade Estadual do Rio de Janeiro, Brazil; Department of Neurology (P.I.), Donostia University Hospital; Neuroscience Area (P.I.), Biodonostia Health Research Institute, San Sebastian; Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED) (P.I.), Spain; Department of Neurology (J.L.P., O.B.), Ataxia Unit, Universidade Federal de São Paulo, SP, Brazil; Department of Brain and Behavioral Sciences (A.C.), University of Pavia, Italy; Dr. John T. Macdonald Foundation Department of Human Genetics and John P. Hussman Institute for Human Genomics (M.C.D., S.Z.), University of Miami Miller School of Medicine; Department of Neurology (M.C.F.), School of Medical Sciences-University of Campinas (UNICAMP), São Paulo, Brazil; Department of Human Genetics (B.B.), McGill University, Montreal, Canada; and Laboratório Genetika (S.R.), Curitiba, PR, Brazil
| | - José Luiz Pedroso
- From the Pós-graduação Em Medicina Interna e Ciências da Saúde (L.E.N., H.A.T.), Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil; Department of Neuromuscular Diseases (L.E.N., D.P., S.A., P.I., A.C., H.H.), UCL Queen Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, UK; Department of Neurology (R.S.F., P.J.T., W.M.), School of Medicine at Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil; Departments of Neurology and Neurosurgery (D.P., M.-J.D., B.B.), Montreal Neurological Hospital and Institute, McGill University, Canada; Departamento de Neurologia (M.V.D.C.), Universidade do Estado do Amazonas, Manaus; Departamento de Especialidades Médicas (M.S.), Serviço de Neurologia, Universidade Estadual do Rio de Janeiro, Brazil; Department of Neurology (P.I.), Donostia University Hospital; Neuroscience Area (P.I.), Biodonostia Health Research Institute, San Sebastian; Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED) (P.I.), Spain; Department of Neurology (J.L.P., O.B.), Ataxia Unit, Universidade Federal de São Paulo, SP, Brazil; Department of Brain and Behavioral Sciences (A.C.), University of Pavia, Italy; Dr. John T. Macdonald Foundation Department of Human Genetics and John P. Hussman Institute for Human Genomics (M.C.D., S.Z.), University of Miami Miller School of Medicine; Department of Neurology (M.C.F.), School of Medical Sciences-University of Campinas (UNICAMP), São Paulo, Brazil; Department of Human Genetics (B.B.), McGill University, Montreal, Canada; and Laboratório Genetika (S.R.), Curitiba, PR, Brazil
| | - Orlando Barsottini
- From the Pós-graduação Em Medicina Interna e Ciências da Saúde (L.E.N., H.A.T.), Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil; Department of Neuromuscular Diseases (L.E.N., D.P., S.A., P.I., A.C., H.H.), UCL Queen Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, UK; Department of Neurology (R.S.F., P.J.T., W.M.), School of Medicine at Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil; Departments of Neurology and Neurosurgery (D.P., M.-J.D., B.B.), Montreal Neurological Hospital and Institute, McGill University, Canada; Departamento de Neurologia (M.V.D.C.), Universidade do Estado do Amazonas, Manaus; Departamento de Especialidades Médicas (M.S.), Serviço de Neurologia, Universidade Estadual do Rio de Janeiro, Brazil; Department of Neurology (P.I.), Donostia University Hospital; Neuroscience Area (P.I.), Biodonostia Health Research Institute, San Sebastian; Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED) (P.I.), Spain; Department of Neurology (J.L.P., O.B.), Ataxia Unit, Universidade Federal de São Paulo, SP, Brazil; Department of Brain and Behavioral Sciences (A.C.), University of Pavia, Italy; Dr. John T. Macdonald Foundation Department of Human Genetics and John P. Hussman Institute for Human Genomics (M.C.D., S.Z.), University of Miami Miller School of Medicine; Department of Neurology (M.C.F.), School of Medical Sciences-University of Campinas (UNICAMP), São Paulo, Brazil; Department of Human Genetics (B.B.), McGill University, Montreal, Canada; and Laboratório Genetika (S.R.), Curitiba, PR, Brazil
| | - Andrea Cortese
- From the Pós-graduação Em Medicina Interna e Ciências da Saúde (L.E.N., H.A.T.), Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil; Department of Neuromuscular Diseases (L.E.N., D.P., S.A., P.I., A.C., H.H.), UCL Queen Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, UK; Department of Neurology (R.S.F., P.J.T., W.M.), School of Medicine at Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil; Departments of Neurology and Neurosurgery (D.P., M.-J.D., B.B.), Montreal Neurological Hospital and Institute, McGill University, Canada; Departamento de Neurologia (M.V.D.C.), Universidade do Estado do Amazonas, Manaus; Departamento de Especialidades Médicas (M.S.), Serviço de Neurologia, Universidade Estadual do Rio de Janeiro, Brazil; Department of Neurology (P.I.), Donostia University Hospital; Neuroscience Area (P.I.), Biodonostia Health Research Institute, San Sebastian; Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED) (P.I.), Spain; Department of Neurology (J.L.P., O.B.), Ataxia Unit, Universidade Federal de São Paulo, SP, Brazil; Department of Brain and Behavioral Sciences (A.C.), University of Pavia, Italy; Dr. John T. Macdonald Foundation Department of Human Genetics and John P. Hussman Institute for Human Genomics (M.C.D., S.Z.), University of Miami Miller School of Medicine; Department of Neurology (M.C.F.), School of Medical Sciences-University of Campinas (UNICAMP), São Paulo, Brazil; Department of Human Genetics (B.B.), McGill University, Montreal, Canada; and Laboratório Genetika (S.R.), Curitiba, PR, Brazil
| | - Matt C Danzi
- From the Pós-graduação Em Medicina Interna e Ciências da Saúde (L.E.N., H.A.T.), Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil; Department of Neuromuscular Diseases (L.E.N., D.P., S.A., P.I., A.C., H.H.), UCL Queen Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, UK; Department of Neurology (R.S.F., P.J.T., W.M.), School of Medicine at Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil; Departments of Neurology and Neurosurgery (D.P., M.-J.D., B.B.), Montreal Neurological Hospital and Institute, McGill University, Canada; Departamento de Neurologia (M.V.D.C.), Universidade do Estado do Amazonas, Manaus; Departamento de Especialidades Médicas (M.S.), Serviço de Neurologia, Universidade Estadual do Rio de Janeiro, Brazil; Department of Neurology (P.I.), Donostia University Hospital; Neuroscience Area (P.I.), Biodonostia Health Research Institute, San Sebastian; Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED) (P.I.), Spain; Department of Neurology (J.L.P., O.B.), Ataxia Unit, Universidade Federal de São Paulo, SP, Brazil; Department of Brain and Behavioral Sciences (A.C.), University of Pavia, Italy; Dr. John T. Macdonald Foundation Department of Human Genetics and John P. Hussman Institute for Human Genomics (M.C.D., S.Z.), University of Miami Miller School of Medicine; Department of Neurology (M.C.F.), School of Medical Sciences-University of Campinas (UNICAMP), São Paulo, Brazil; Department of Human Genetics (B.B.), McGill University, Montreal, Canada; and Laboratório Genetika (S.R.), Curitiba, PR, Brazil
| | - Marcondes C França
- From the Pós-graduação Em Medicina Interna e Ciências da Saúde (L.E.N., H.A.T.), Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil; Department of Neuromuscular Diseases (L.E.N., D.P., S.A., P.I., A.C., H.H.), UCL Queen Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, UK; Department of Neurology (R.S.F., P.J.T., W.M.), School of Medicine at Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil; Departments of Neurology and Neurosurgery (D.P., M.-J.D., B.B.), Montreal Neurological Hospital and Institute, McGill University, Canada; Departamento de Neurologia (M.V.D.C.), Universidade do Estado do Amazonas, Manaus; Departamento de Especialidades Médicas (M.S.), Serviço de Neurologia, Universidade Estadual do Rio de Janeiro, Brazil; Department of Neurology (P.I.), Donostia University Hospital; Neuroscience Area (P.I.), Biodonostia Health Research Institute, San Sebastian; Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED) (P.I.), Spain; Department of Neurology (J.L.P., O.B.), Ataxia Unit, Universidade Federal de São Paulo, SP, Brazil; Department of Brain and Behavioral Sciences (A.C.), University of Pavia, Italy; Dr. John T. Macdonald Foundation Department of Human Genetics and John P. Hussman Institute for Human Genomics (M.C.D., S.Z.), University of Miami Miller School of Medicine; Department of Neurology (M.C.F.), School of Medical Sciences-University of Campinas (UNICAMP), São Paulo, Brazil; Department of Human Genetics (B.B.), McGill University, Montreal, Canada; and Laboratório Genetika (S.R.), Curitiba, PR, Brazil
| | - Bernard Brais
- From the Pós-graduação Em Medicina Interna e Ciências da Saúde (L.E.N., H.A.T.), Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil; Department of Neuromuscular Diseases (L.E.N., D.P., S.A., P.I., A.C., H.H.), UCL Queen Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, UK; Department of Neurology (R.S.F., P.J.T., W.M.), School of Medicine at Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil; Departments of Neurology and Neurosurgery (D.P., M.-J.D., B.B.), Montreal Neurological Hospital and Institute, McGill University, Canada; Departamento de Neurologia (M.V.D.C.), Universidade do Estado do Amazonas, Manaus; Departamento de Especialidades Médicas (M.S.), Serviço de Neurologia, Universidade Estadual do Rio de Janeiro, Brazil; Department of Neurology (P.I.), Donostia University Hospital; Neuroscience Area (P.I.), Biodonostia Health Research Institute, San Sebastian; Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED) (P.I.), Spain; Department of Neurology (J.L.P., O.B.), Ataxia Unit, Universidade Federal de São Paulo, SP, Brazil; Department of Brain and Behavioral Sciences (A.C.), University of Pavia, Italy; Dr. John T. Macdonald Foundation Department of Human Genetics and John P. Hussman Institute for Human Genomics (M.C.D., S.Z.), University of Miami Miller School of Medicine; Department of Neurology (M.C.F.), School of Medical Sciences-University of Campinas (UNICAMP), São Paulo, Brazil; Department of Human Genetics (B.B.), McGill University, Montreal, Canada; and Laboratório Genetika (S.R.), Curitiba, PR, Brazil
| | - Stephan Zuchner
- From the Pós-graduação Em Medicina Interna e Ciências da Saúde (L.E.N., H.A.T.), Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil; Department of Neuromuscular Diseases (L.E.N., D.P., S.A., P.I., A.C., H.H.), UCL Queen Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, UK; Department of Neurology (R.S.F., P.J.T., W.M.), School of Medicine at Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil; Departments of Neurology and Neurosurgery (D.P., M.-J.D., B.B.), Montreal Neurological Hospital and Institute, McGill University, Canada; Departamento de Neurologia (M.V.D.C.), Universidade do Estado do Amazonas, Manaus; Departamento de Especialidades Médicas (M.S.), Serviço de Neurologia, Universidade Estadual do Rio de Janeiro, Brazil; Department of Neurology (P.I.), Donostia University Hospital; Neuroscience Area (P.I.), Biodonostia Health Research Institute, San Sebastian; Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED) (P.I.), Spain; Department of Neurology (J.L.P., O.B.), Ataxia Unit, Universidade Federal de São Paulo, SP, Brazil; Department of Brain and Behavioral Sciences (A.C.), University of Pavia, Italy; Dr. John T. Macdonald Foundation Department of Human Genetics and John P. Hussman Institute for Human Genomics (M.C.D., S.Z.), University of Miami Miller School of Medicine; Department of Neurology (M.C.F.), School of Medical Sciences-University of Campinas (UNICAMP), São Paulo, Brazil; Department of Human Genetics (B.B.), McGill University, Montreal, Canada; and Laboratório Genetika (S.R.), Curitiba, PR, Brazil
| | - Henry Houlden
- From the Pós-graduação Em Medicina Interna e Ciências da Saúde (L.E.N., H.A.T.), Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil; Department of Neuromuscular Diseases (L.E.N., D.P., S.A., P.I., A.C., H.H.), UCL Queen Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, UK; Department of Neurology (R.S.F., P.J.T., W.M.), School of Medicine at Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil; Departments of Neurology and Neurosurgery (D.P., M.-J.D., B.B.), Montreal Neurological Hospital and Institute, McGill University, Canada; Departamento de Neurologia (M.V.D.C.), Universidade do Estado do Amazonas, Manaus; Departamento de Especialidades Médicas (M.S.), Serviço de Neurologia, Universidade Estadual do Rio de Janeiro, Brazil; Department of Neurology (P.I.), Donostia University Hospital; Neuroscience Area (P.I.), Biodonostia Health Research Institute, San Sebastian; Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED) (P.I.), Spain; Department of Neurology (J.L.P., O.B.), Ataxia Unit, Universidade Federal de São Paulo, SP, Brazil; Department of Brain and Behavioral Sciences (A.C.), University of Pavia, Italy; Dr. John T. Macdonald Foundation Department of Human Genetics and John P. Hussman Institute for Human Genomics (M.C.D., S.Z.), University of Miami Miller School of Medicine; Department of Neurology (M.C.F.), School of Medical Sciences-University of Campinas (UNICAMP), São Paulo, Brazil; Department of Human Genetics (B.B.), McGill University, Montreal, Canada; and Laboratório Genetika (S.R.), Curitiba, PR, Brazil
| | - Salmo Raskin
- From the Pós-graduação Em Medicina Interna e Ciências da Saúde (L.E.N., H.A.T.), Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil; Department of Neuromuscular Diseases (L.E.N., D.P., S.A., P.I., A.C., H.H.), UCL Queen Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, UK; Department of Neurology (R.S.F., P.J.T., W.M.), School of Medicine at Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil; Departments of Neurology and Neurosurgery (D.P., M.-J.D., B.B.), Montreal Neurological Hospital and Institute, McGill University, Canada; Departamento de Neurologia (M.V.D.C.), Universidade do Estado do Amazonas, Manaus; Departamento de Especialidades Médicas (M.S.), Serviço de Neurologia, Universidade Estadual do Rio de Janeiro, Brazil; Department of Neurology (P.I.), Donostia University Hospital; Neuroscience Area (P.I.), Biodonostia Health Research Institute, San Sebastian; Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED) (P.I.), Spain; Department of Neurology (J.L.P., O.B.), Ataxia Unit, Universidade Federal de São Paulo, SP, Brazil; Department of Brain and Behavioral Sciences (A.C.), University of Pavia, Italy; Dr. John T. Macdonald Foundation Department of Human Genetics and John P. Hussman Institute for Human Genomics (M.C.D., S.Z.), University of Miami Miller School of Medicine; Department of Neurology (M.C.F.), School of Medical Sciences-University of Campinas (UNICAMP), São Paulo, Brazil; Department of Human Genetics (B.B.), McGill University, Montreal, Canada; and Laboratório Genetika (S.R.), Curitiba, PR, Brazil
| | - Wilson Marques
- From the Pós-graduação Em Medicina Interna e Ciências da Saúde (L.E.N., H.A.T.), Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil; Department of Neuromuscular Diseases (L.E.N., D.P., S.A., P.I., A.C., H.H.), UCL Queen Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, UK; Department of Neurology (R.S.F., P.J.T., W.M.), School of Medicine at Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil; Departments of Neurology and Neurosurgery (D.P., M.-J.D., B.B.), Montreal Neurological Hospital and Institute, McGill University, Canada; Departamento de Neurologia (M.V.D.C.), Universidade do Estado do Amazonas, Manaus; Departamento de Especialidades Médicas (M.S.), Serviço de Neurologia, Universidade Estadual do Rio de Janeiro, Brazil; Department of Neurology (P.I.), Donostia University Hospital; Neuroscience Area (P.I.), Biodonostia Health Research Institute, San Sebastian; Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED) (P.I.), Spain; Department of Neurology (J.L.P., O.B.), Ataxia Unit, Universidade Federal de São Paulo, SP, Brazil; Department of Brain and Behavioral Sciences (A.C.), University of Pavia, Italy; Dr. John T. Macdonald Foundation Department of Human Genetics and John P. Hussman Institute for Human Genomics (M.C.D., S.Z.), University of Miami Miller School of Medicine; Department of Neurology (M.C.F.), School of Medical Sciences-University of Campinas (UNICAMP), São Paulo, Brazil; Department of Human Genetics (B.B.), McGill University, Montreal, Canada; and Laboratório Genetika (S.R.), Curitiba, PR, Brazil
| | - Helio A Teive
- From the Pós-graduação Em Medicina Interna e Ciências da Saúde (L.E.N., H.A.T.), Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil; Department of Neuromuscular Diseases (L.E.N., D.P., S.A., P.I., A.C., H.H.), UCL Queen Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, UK; Department of Neurology (R.S.F., P.J.T., W.M.), School of Medicine at Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil; Departments of Neurology and Neurosurgery (D.P., M.-J.D., B.B.), Montreal Neurological Hospital and Institute, McGill University, Canada; Departamento de Neurologia (M.V.D.C.), Universidade do Estado do Amazonas, Manaus; Departamento de Especialidades Médicas (M.S.), Serviço de Neurologia, Universidade Estadual do Rio de Janeiro, Brazil; Department of Neurology (P.I.), Donostia University Hospital; Neuroscience Area (P.I.), Biodonostia Health Research Institute, San Sebastian; Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED) (P.I.), Spain; Department of Neurology (J.L.P., O.B.), Ataxia Unit, Universidade Federal de São Paulo, SP, Brazil; Department of Brain and Behavioral Sciences (A.C.), University of Pavia, Italy; Dr. John T. Macdonald Foundation Department of Human Genetics and John P. Hussman Institute for Human Genomics (M.C.D., S.Z.), University of Miami Miller School of Medicine; Department of Neurology (M.C.F.), School of Medical Sciences-University of Campinas (UNICAMP), São Paulo, Brazil; Department of Human Genetics (B.B.), McGill University, Montreal, Canada; and Laboratório Genetika (S.R.), Curitiba, PR, Brazil
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27
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Ashton C, Indelicato E, Pellerin D, Clément G, Danzi MC, Dicaire MJ, Bonnet C, Houlden H, Züchner S, Synofzik M, Lamont PJ, Renaud M, Boesch S, Brais B. Spinocerebellar ataxia 27B: episodic symptoms and acetazolamide response in 34 patients. Brain Commun 2023; 5:fcad239. [PMID: 37705681 PMCID: PMC10495284 DOI: 10.1093/braincomms/fcad239] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/22/2023] [Accepted: 09/08/2023] [Indexed: 09/15/2023] Open
Abstract
Ashton C et al report a retrospective multi-centre cohort of 34 patients from Canada, France, Austria and Australia with spinocerebellar ataxia 27B, describing the common feature of episodic ataxia and other episodic features, as well as the inefficacy of acetazolamide in these patients.
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Affiliation(s)
- Catherine Ashton
- Department of Neurology and Neurosurgery, Montreal Neurological Hospital and Institute, McGill University, Montreal, QC H3A 2B4, Canada
- Department of Neurology, Royal Perth Hospital, Perth, WA 6007, Australia
| | - Elisabetta Indelicato
- Center for Rare Movement Disorders Innsbruck, Department of Neurology, Medical University of Innsbruck, Innsbruck 6020, Austria
| | - David Pellerin
- Department of Neurology and Neurosurgery, Montreal Neurological Hospital and Institute, McGill University, Montreal, QC H3A 2B4, Canada
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, University College London, London WC1N 3BG, UK
| | - Guillemette Clément
- INSERM-U1256 NGERE, Université de Lorraine, 54500 Vandoeuvre-les-Nancy, France
- Service de Neurologie, Centre Hospitalier Régional Universitaire de Nancy, 54000 Nancy, France
- Service de Génétique Clinique, Centre Hospitalier Régional Universitaire de Nancy, 54000 Nancy, France
| | - Matt C Danzi
- Dr. John T. Macdonald Foundation Department of Human Genetics and John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL 33176, USA
| | - Marie-Josée Dicaire
- Department of Neurology and Neurosurgery, Montreal Neurological Hospital and Institute, McGill University, Montreal, QC H3A 2B4, Canada
| | - Céline Bonnet
- INSERM-U1256 NGERE, Université de Lorraine, 54500 Vandoeuvre-les-Nancy, France
- Laboratoire de Génétique, Centre Hospitalier Régional Universitaire de Nancy, 54000 Nancy, France
| | - Henry Houlden
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, University College London, London WC1N 3BG, UK
| | - Stephan Züchner
- Dr. John T. Macdonald Foundation Department of Human Genetics and John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL 33176, USA
| | - Matthis Synofzik
- Division of Translational Genomics of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research and Center of Neurology, University of Tübingen, 72076 Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), 72076 Tübingen, Germany
| | - Phillipa J Lamont
- German Center for Neurodegenerative Diseases (DZNE), 72076 Tübingen, Germany
| | - Mathilde Renaud
- INSERM-U1256 NGERE, Université de Lorraine, 54500 Vandoeuvre-les-Nancy, France
- Service de Neurologie, Centre Hospitalier Régional Universitaire de Nancy, 54000 Nancy, France
- Service de Génétique Clinique, Centre Hospitalier Régional Universitaire de Nancy, 54000 Nancy, France
| | - Sylvia Boesch
- Center for Rare Movement Disorders Innsbruck, Department of Neurology, Medical University of Innsbruck, Innsbruck 6020, Austria
| | - Bernard Brais
- Department of Neurology and Neurosurgery, Montreal Neurological Hospital and Institute, McGill University, Montreal, QC H3A 2B4, Canada
- Department of Human Genetics, McGill University, Montreal, QC H3A 0G4, Canada
- Clinique des maladies neuromusculaires. Centre de Réadaptation Lucie-Bruneau, Montreal, QC H2H 2N8, Canada
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28
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Pellerin D, Heindl F, Wilke C, Danzi MC, Traschütz A, Ashton C, Dicaire MJ, Cuillerier A, Del Gobbo G, Boycott KM, Claassen J, Rujescu D, Hartmann AM, Zuchner S, Brais B, Strupp M, Synofzik M. Intronic FGF14 GAA repeat expansions are a common cause of downbeat nystagmus syndromes: frequency, phenotypic profile, and 4-aminopyridine treatment response. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.07.30.23293380. [PMID: 37577458 PMCID: PMC10418564 DOI: 10.1101/2023.07.30.23293380] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
The cause of downbeat nystagmus (DBN) remains unknown in approximately 30% of patients (idiopathic DBN). Here, we hypothesized that: (i) FGF14 (GAA) ≥250 repeat expansions represent a frequent genetic cause of idiopathic DBN syndromes, (ii) are treatable with 4-aminopyridine (4-AP), and (iii) FGF14 (GAA) 200-249 alleles are potentially pathogenic. We conducted a multi-modal cohort study of 170 patients with idiopathic DBN that comprised: in-depth ocular motor, neurological, and disease evolution phenotyping; assessment of 4-AP treatment response, including re-analysis of placebo-controlled video-oculography treatment response data from a previous randomized double-blind 4-AP trial; and genotyping of the FGF14 repeat. Frequency of FGF14 (GAA) ≥250 expansions was 48% (82/170) in the entire idiopathic DBN cohort. Additional cerebellar ocular motor signs were observed in 100% (82/82), cerebellar ataxia in 43% (35/82), and extracerebellar features in 21% (17/82) of (GAA) ≥250 - FGF14 patients. Alleles of 200 to 249 GAA repeats were enriched in patients with DBN (12%; 20/170) compared to controls (0.87%; 19/2,191; OR, 15.20; 95% CI, 7.52-30.80; p =9.876e-14). The phenotype of (GAA) 200-249 - FGF14 patients closely mirrored that of (GAA) ≥250 - FGF14 patients. (GAA) ≥250 - FGF14 and (GAA) 200-249 - FGF14 patients had a significantly greater clinician-reported (80% vs 31%; p =0.0011) and self-reported (59% vs 11%; p =0.0003) response rate to 4-AP treatment compared to (GAA) <200 - FGF14 patients. This included a treatment response with high relevance to everyday living, as exemplified by an improvement of 2 FARS stages in some cases. Placebo-controlled video-oculography data of four (GAA) ≥250 - FGF14 patients previously enrolled in a 4-AP randomized double-blind trial showed a significant decrease in slow phase velocity of DBN with 4-AP, but not placebo. This study shows that FGF14 GAA repeat expansions are a highly frequent genetic cause of DBN syndromes, especially when associated with additional cerebellar features. Moreover, they genetically stratify a subgroup of patients with DBN that appear to be highly responsive to 4-AP, thus paving the way for a "theranostics" approach in DBN syndromes.
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29
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Pellerin D, Iruzubieta P, Tekgül Ş, Danzi MC, Ashton C, Dicaire MJ, Wandzel M, Roth V, Lamont PJ, Bonnet C, Renaud M, Synofzik M, Zuchner S, Brais B, Başak NA, Houlden H. Non-GAA Repeat Expansions in FGF14 Are Likely Not Pathogenic-Reply to: "Shaking Up Ataxia: FGF14 and RFC1 Repeat Expansions in Affected and Unaffected Members of a Chilean Family". Mov Disord 2023; 38:1575-1577. [PMID: 37565404 DOI: 10.1002/mds.29552] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 06/12/2023] [Indexed: 08/12/2023] Open
Affiliation(s)
- David Pellerin
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, University College London, London, United Kingdom
- Department of Neurology and Neurosurgery, Montreal Neurological Hospital and Institute, McGill University, Montreal, Quebec, Canada
| | - Pablo Iruzubieta
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, University College London, London, United Kingdom
- Department of Neurology, Donostia University Hospital, San Sebastian, Spain
- Neuroscience Department, Biodonostia Health Research Institute, San Sebastian, Spain
- Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - Şeyma Tekgül
- Department of Molecular Biology and Genetics, Koç University, School of Medicine, KUTTAM-NDAL, Istanbul, Turkey
| | - Matt C Danzi
- Dr. John T. Macdonald Foundation Department of Human Genetics and John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Catherine Ashton
- Department of Neurology and Neurosurgery, Montreal Neurological Hospital and Institute, McGill University, Montreal, Quebec, Canada
- Department of Neurology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Marie-Josée Dicaire
- Department of Neurology and Neurosurgery, Montreal Neurological Hospital and Institute, McGill University, Montreal, Quebec, Canada
| | - Marion Wandzel
- Laboratoire de Génétique Médicale, Hôpitaux de Brabois - CHRU de Nancy, Nancy, France
| | - Virginie Roth
- Laboratoire de Génétique Médicale, Hôpitaux de Brabois - CHRU de Nancy, Nancy, France
| | - Phillipa J Lamont
- Department of Neurology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Céline Bonnet
- Laboratoire de Génétique Médicale, Hôpitaux de Brabois - CHRU de Nancy, Nancy, France
- INSERM-U1256 NGERE, Université de Lorraine, Nancy, France
| | - Mathilde Renaud
- INSERM-U1256 NGERE, Université de Lorraine, Nancy, France
- Service de Neurologie, CHRU de Nancy, Nancy, France
- Service de Génétique Clinique, Hôpitaux de Brabois - CHRU de Nancy, Nancy, France
| | - Matthis Synofzik
- Department of Neurodegenerative Diseases, Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Stephan Zuchner
- Dr. John T. Macdonald Foundation Department of Human Genetics and John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Bernard Brais
- Department of Neurology and Neurosurgery, Montreal Neurological Hospital and Institute, McGill University, Montreal, Quebec, Canada
- Department of Human Genetics, McGill University, Montreal, Quebec, Canada
- Centre de Réadaptation Lucie-Bruneau, Montreal, Quebec, Canada
| | - Nazlı A Başak
- Department of Molecular Biology and Genetics, Koç University, School of Medicine, KUTTAM-NDAL, Istanbul, Turkey
| | - Henry Houlden
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, University College London, London, United Kingdom
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30
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Linares AJ, Fogel BL. Late-onset hereditary ataxias with dementia. Curr Opin Neurol 2023; 36:324-334. [PMID: 37382141 PMCID: PMC10524827 DOI: 10.1097/wco.0000000000001170] [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] [Indexed: 06/30/2023]
Abstract
PURPOSE OF REVIEW Late-onset genetic cerebellar ataxias are clinically heterogenous with variable phenotypes. Several of these conditions are commonly associated with dementia. Recognition of the relationship between ataxia and dementia can guide clinical genetic evaluation. RECENT FINDINGS Spinocerebellar ataxias often present with variable phenotypes that may include dementia. Genomic studies have begun to identify links between incomplete penetrance and such variable phenotypes in certain hereditary ataxias. Recent studies evaluating the interaction of TBP repeat expansions and STUB1 sequence variants provide a framework to understand how genetic interactions influence disease penetrance and dementia risk in spinocerebellar ataxia types 17 and 48. Further advances in next generation sequencing methods will continue to improve diagnosis and create new insights into the expressivity of existing disorders. SUMMARY The late-onset hereditary ataxias are a clinically heterogenous group of disorders with complex presentations that can include cognitive impairment and/or dementia. Genetic evaluation of late-onset ataxia patients with dementia follows a systemic testing approach that often utilizes repeat expansion testing followed by next-generation sequencing. Advances in bioinformatics and genomics is improving both diagnostic evaluation and establishing a basis for phenotypic variability. Whole genome sequencing will likely replace exome sequencing as a more comprehensive means of routine testing.
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Affiliation(s)
- Anthony J. Linares
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095 USA
| | - Brent L. Fogel
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095 USA
- Department of Human Genetics, David Geffen School of Medicine, University of California Los Angeles, 90095 USA
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