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Salles PA, Terán-Jimenez M, Vidal-Santoro A, Chaná-Cuevas P, Kauffman M, Espay AJ. Recognizing Atypical Dopa-Responsive Dystonia and Its Mimics. Neurol Clin Pract 2022; 11:e876-e884. [PMID: 34992971 DOI: 10.1212/cpj.0000000000001125] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 05/07/2021] [Indexed: 11/15/2022]
Abstract
Purpose of Review Dopa-responsive dystonia (DRD) encompasses a group of phenotypically and genetically heterogeneous neurochemical disorders. Classic GTP cyclohydrolase 1 (GCH-1)-associated DRD consists of early-onset lower limb asymmetrical dystonia, with sleep benefit, diurnal variation, and excellent and sustained response to low l-dopa doses. Recent Findings Unlike the classic phenotype, GCH-1-associated DRD may include features inconsistent with the original phenotype. We describe a GCH-1-associated late-onset DRD case with a family history of parkinsonism and cervical dystonia whose response to levodopa was poor and complicated with dyskinesia, blepharospasm, and severe nonmotor symptoms. We use this case as a springboard to review the spectrum of atypical DRD, DRD-plus, and DRD mimics. Summary GCH-1-related dystonia may exhibit wide intrafamilial phenotypic variability, no diurnal fluctuation, poor response to l-dopa, and such complications as dyskinesia, epilepsy, sleep disorders, autonomic dysfunction, oculogyric crisis, myoclonus, or tics. More recently, rare GCH-1 variants have been found to be associated with Parkinson disease. Clinicians should be aware of atypical DRD, DRD-plus, and DRD mimics.
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Affiliation(s)
- Philippe A Salles
- Center for the Study of Movement Disorders (CETRAM) (PAS, MT-J, PC-C), Santiago de Chile University, Santiago, Chile; Movement Disorders Section (PAS, MT-J), Neuroscience Department, Davila Clinic, Santiago, Chile; Movement Disorders Section (MT-J), Neurology Department, Felix Bulnes Hospital, Mayor University, Santiago, Chile; Neurology Department (AV-S), Fuérza Aérea de Chile Hospital, Mayor University, Santiago, Chile; Neurogenetics Unit (MK), Neurology Division, J.M. Ramos Mejía Hospital, University Center of Neurology "J.M. Ramos Mejia". Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina; Department of Neurology (AJE); and UC Gardner Neuroscience Institute and Gardner Family Center for Parkinson's Disease and Movement Disorders (AZ, AJE), University of Cincinnati, OH
| | - Mérida Terán-Jimenez
- Center for the Study of Movement Disorders (CETRAM) (PAS, MT-J, PC-C), Santiago de Chile University, Santiago, Chile; Movement Disorders Section (PAS, MT-J), Neuroscience Department, Davila Clinic, Santiago, Chile; Movement Disorders Section (MT-J), Neurology Department, Felix Bulnes Hospital, Mayor University, Santiago, Chile; Neurology Department (AV-S), Fuérza Aérea de Chile Hospital, Mayor University, Santiago, Chile; Neurogenetics Unit (MK), Neurology Division, J.M. Ramos Mejía Hospital, University Center of Neurology "J.M. Ramos Mejia". Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina; Department of Neurology (AJE); and UC Gardner Neuroscience Institute and Gardner Family Center for Parkinson's Disease and Movement Disorders (AZ, AJE), University of Cincinnati, OH
| | - Alvaro Vidal-Santoro
- Center for the Study of Movement Disorders (CETRAM) (PAS, MT-J, PC-C), Santiago de Chile University, Santiago, Chile; Movement Disorders Section (PAS, MT-J), Neuroscience Department, Davila Clinic, Santiago, Chile; Movement Disorders Section (MT-J), Neurology Department, Felix Bulnes Hospital, Mayor University, Santiago, Chile; Neurology Department (AV-S), Fuérza Aérea de Chile Hospital, Mayor University, Santiago, Chile; Neurogenetics Unit (MK), Neurology Division, J.M. Ramos Mejía Hospital, University Center of Neurology "J.M. Ramos Mejia". Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina; Department of Neurology (AJE); and UC Gardner Neuroscience Institute and Gardner Family Center for Parkinson's Disease and Movement Disorders (AZ, AJE), University of Cincinnati, OH
| | - Pedro Chaná-Cuevas
- Center for the Study of Movement Disorders (CETRAM) (PAS, MT-J, PC-C), Santiago de Chile University, Santiago, Chile; Movement Disorders Section (PAS, MT-J), Neuroscience Department, Davila Clinic, Santiago, Chile; Movement Disorders Section (MT-J), Neurology Department, Felix Bulnes Hospital, Mayor University, Santiago, Chile; Neurology Department (AV-S), Fuérza Aérea de Chile Hospital, Mayor University, Santiago, Chile; Neurogenetics Unit (MK), Neurology Division, J.M. Ramos Mejía Hospital, University Center of Neurology "J.M. Ramos Mejia". Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina; Department of Neurology (AJE); and UC Gardner Neuroscience Institute and Gardner Family Center for Parkinson's Disease and Movement Disorders (AZ, AJE), University of Cincinnati, OH
| | - Marcelo Kauffman
- Center for the Study of Movement Disorders (CETRAM) (PAS, MT-J, PC-C), Santiago de Chile University, Santiago, Chile; Movement Disorders Section (PAS, MT-J), Neuroscience Department, Davila Clinic, Santiago, Chile; Movement Disorders Section (MT-J), Neurology Department, Felix Bulnes Hospital, Mayor University, Santiago, Chile; Neurology Department (AV-S), Fuérza Aérea de Chile Hospital, Mayor University, Santiago, Chile; Neurogenetics Unit (MK), Neurology Division, J.M. Ramos Mejía Hospital, University Center of Neurology "J.M. Ramos Mejia". Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina; Department of Neurology (AJE); and UC Gardner Neuroscience Institute and Gardner Family Center for Parkinson's Disease and Movement Disorders (AZ, AJE), University of Cincinnati, OH
| | - Alberto J Espay
- Center for the Study of Movement Disorders (CETRAM) (PAS, MT-J, PC-C), Santiago de Chile University, Santiago, Chile; Movement Disorders Section (PAS, MT-J), Neuroscience Department, Davila Clinic, Santiago, Chile; Movement Disorders Section (MT-J), Neurology Department, Felix Bulnes Hospital, Mayor University, Santiago, Chile; Neurology Department (AV-S), Fuérza Aérea de Chile Hospital, Mayor University, Santiago, Chile; Neurogenetics Unit (MK), Neurology Division, J.M. Ramos Mejía Hospital, University Center of Neurology "J.M. Ramos Mejia". Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina; Department of Neurology (AJE); and UC Gardner Neuroscience Institute and Gardner Family Center for Parkinson's Disease and Movement Disorders (AZ, AJE), University of Cincinnati, OH
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Opladen T, López-Laso E, Cortès-Saladelafont E, Pearson TS, Sivri HS, Yildiz Y, Assmann B, Kurian MA, Leuzzi V, Heales S, Pope S, Porta F, García-Cazorla A, Honzík T, Pons R, Regal L, Goez H, Artuch R, Hoffmann GF, Horvath G, Thöny B, Scholl-Bürgi S, Burlina A, Verbeek MM, Mastrangelo M, Friedman J, Wassenberg T, Jeltsch K, Kulhánek J, Kuseyri Hübschmann O. Consensus guideline for the diagnosis and treatment of tetrahydrobiopterin (BH 4) deficiencies. Orphanet J Rare Dis 2020; 15:126. [PMID: 32456656 PMCID: PMC7251883 DOI: 10.1186/s13023-020-01379-8] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 04/07/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Tetrahydrobiopterin (BH4) deficiencies comprise a group of six rare neurometabolic disorders characterized by insufficient synthesis of the monoamine neurotransmitters dopamine and serotonin due to a disturbance of BH4 biosynthesis or recycling. Hyperphenylalaninemia (HPA) is the first diagnostic hallmark for most BH4 deficiencies, apart from autosomal dominant guanosine triphosphate cyclohydrolase I deficiency and sepiapterin reductase deficiency. Early supplementation of neurotransmitter precursors and where appropriate, treatment of HPA results in significant improvement of motor and cognitive function. Management approaches differ across the world and therefore these guidelines have been developed aiming to harmonize and optimize patient care. Representatives of the International Working Group on Neurotransmitter related Disorders (iNTD) developed the guidelines according to the SIGN (Scottish Intercollegiate Guidelines Network) methodology by evaluating all available evidence for the diagnosis and treatment of BH4 deficiencies. CONCLUSION Although the total body of evidence in the literature was mainly rated as low or very low, these consensus guidelines will help to harmonize clinical practice and to standardize and improve care for BH4 deficient patients.
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Affiliation(s)
- Thomas Opladen
- Division of Child Neurology and Metabolic Disorders, University Children's Hospital, Heidelberg, Germany.
| | - Eduardo López-Laso
- Pediatric Neurology Unit, Department of Pediatrics, University Hospital Reina Sofía, IMIBIC and CIBERER, Córdoba, Spain
| | - Elisenda Cortès-Saladelafont
- Inborn errors of metabolism Unit, Institut de Recerca Sant Joan de Déu and CIBERER-ISCIII, Barcelona, Spain
- Unit of Pediatric Neurology and Metabolic Disorders, Department of Pediatrics, Hospital Germans Trias i Pujol, and Faculty of Medicine, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Toni S Pearson
- Department of Neurology, Washington University School of Medicine, St. Louis, USA
| | - H Serap Sivri
- Department of Pediatrics, Section of Metabolism, Hacettepe University, Faculty of Medicine, 06100, Ankara, Turkey
| | - Yilmaz Yildiz
- Department of Pediatrics, Section of Metabolism, Hacettepe University, Faculty of Medicine, 06100, Ankara, Turkey
| | - Birgit Assmann
- Division of Child Neurology and Metabolic Disorders, University Children's Hospital, Heidelberg, Germany
| | - Manju A Kurian
- Developmental Neurosciences, UCL Great Ormond Street-Institute of Child Health, London, UK
- Department of Neurology, Great Ormond Street Hospital, London, UK
| | - Vincenzo Leuzzi
- Unit of Child Neurology and Psychiatry, Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Simon Heales
- Neurometabolic Unit, National Hospital, Queen Square, London, UK
| | - Simon Pope
- Neurometabolic Unit, National Hospital, Queen Square, London, UK
| | - Francesco Porta
- Department of Pediatrics, AOU Città della Salute e della Scienza, Torino, Italy
| | - Angeles García-Cazorla
- Inborn errors of metabolism Unit, Institut de Recerca Sant Joan de Déu and CIBERER-ISCIII, Barcelona, Spain
| | - Tomáš Honzík
- Department of Paediatrics and Adolescent Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Roser Pons
- First Department of Pediatrics of the University of Athens, Aghia Sofia Hospital, Athens, Greece
| | - Luc Regal
- Department of Pediatric, Pediatric Neurology and Metabolism Unit, UZ Brussel, Brussels, Belgium
| | - Helly Goez
- Department of Pediatrics, University of Alberta Glenrose Rehabilitation Hospital, Edmonton, Canada
| | - Rafael Artuch
- Clinical biochemistry department, Institut de Recerca Sant Joan de Déu, CIBERER and MetabERN Hospital Sant Joan de Déu, Barcelona, Spain
| | - Georg F Hoffmann
- Division of Child Neurology and Metabolic Disorders, University Children's Hospital, Heidelberg, Germany
| | - Gabriella Horvath
- Department of Pediatrics, Division of Biochemical Genetics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Beat Thöny
- Division of Metabolism, University Children's Hospital Zurich, Zürich, Switzerland
| | - Sabine Scholl-Bürgi
- Clinic for Pediatrics I, Medical University of Innsbruck, Anichstr 35, Innsbruck, Austria
| | - Alberto Burlina
- U.O.C. Malattie Metaboliche Ereditarie, Dipartimento della Salute della Donna e del Bambino, Azienda Ospedaliera Universitaria di Padova - Campus Biomedico Pietro d'Abano, Padova, Italy
| | - Marcel M Verbeek
- Departments of Neurology and Laboratory Medicine, Alzheimer Centre, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Mario Mastrangelo
- Unit of Child Neurology and Psychiatry, Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Jennifer Friedman
- UCSD Departments of Neuroscience and Pediatrics, Rady Children's Hospital Division of Neurology; Rady Children's Institute for Genomic Medicine, San Diego, USA
| | - Tessa Wassenberg
- Department of Pediatric, Pediatric Neurology and Metabolism Unit, UZ Brussel, Brussels, Belgium
| | - Kathrin Jeltsch
- Division of Child Neurology and Metabolic Disorders, University Children's Hospital, Heidelberg, Germany
| | - Jan Kulhánek
- Department of Paediatrics and Adolescent Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.
| | - Oya Kuseyri Hübschmann
- Division of Child Neurology and Metabolic Disorders, University Children's Hospital, Heidelberg, Germany
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Sánchez CL, Van Swearingen AED, Arrant AE, Biskup CS, Kuhn CM, Zepf FD. Simplified dietary acute tryptophan depletion: effects of a novel amino acid mixture on the neurochemistry of C57BL/6J mice. Food Nutr Res 2015; 59:27424. [PMID: 26278978 PMCID: PMC4538305 DOI: 10.3402/fnr.v59.27424] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 06/24/2015] [Accepted: 06/24/2015] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Diet and nutrition can impact on the biological processes underpinning neuropsychiatric disorders. Amino acid (AA) mixtures lacking a specific neurotransmitter precursor can change the levels of brain serotonin (5-HT) or dopamine (DA) in the central nervous system. The availability of these substances within the brain is determined by the blood-brain barrier (BBB) that restricts the access of peripheral AA into the brain. AA mixtures lacking tryptophan (TRP) compete with endogenous TRP for uptake into the brain across the BBB, which in turn leads to a decrease in central nervous 5-HT synthesis. OBJECTIVE The present study compared the effects of a simplified acute tryptophan depletion (SATD) mixture in mice on blood and brain serotonergic and dopaminergic metabolites to those of a commonly used acute tryptophan depletion mixture (ATD Moja-De) and its TRP-balanced control (BAL). DESIGN The SATD formula is composed of only three large neutral AAs: phenylalanine (PHE), leucine (LEU), and isoleucine (ILE). BAL, ATD Moja-De, or SATD formulas were delivered to adult male C57BL/6J mice by gavage. TRP, monoamines, and their metabolites were quantified in blood and brain regions (hippocampus, frontal cortex, amygdala, caudate putamen, and nucleus accumbens). RESULTS Both ATD Moja-De and SATD significantly decreased levels of serum and brain TRP, as well as brain 5-HIAA and 5-HT compared with BAL. SATD reduced HVA levels in caudate but did not alter total DA levels or DOPAC. SATD decreased TRP and serotonergic metabolites comparably to ATD Moja-De administration. CONCLUSION A simplified and more palatable combination of AAs can manipulate serotonergic function and might be useful to reveal underlying monoamine-related mechanisms contributing to different neuropsychiatric disorders.
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Affiliation(s)
- Cristina L Sánchez
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, JARA Brain, RWTH Aachen University, Aachen, Germany.,Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC, USA
| | | | - Andrew E Arrant
- Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC, USA
| | - Caroline S Biskup
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, JARA Brain, RWTH Aachen University, Aachen, Germany
| | - Cynthia M Kuhn
- Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC, USA
| | - Florian D Zepf
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, JARA Brain, RWTH Aachen University, Aachen, Germany.,Department of Child and Adolescent Psychiatry, School of Paediatrics and Child Health & School of Psychiatry and Clinical Neurosciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Perth, WA, Australia.,Specialised Child and Adolescent Mental Health Services (CAHMS), Department of Health, Perth, WA, Australia;
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4
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Malek N, Fletcher N, Newman E. Diagnosing dopamine-responsive dystonias. Pract Neurol 2015; 15:340-5. [DOI: 10.1136/practneurol-2015-001101] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2015] [Indexed: 11/04/2022]
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De Rosa A, Carducci C, Carducci C, Peluso S, Lieto M, Mazzella A, Saccà F, Brescia Morra V, Pappatà S, Leuzzi V, De Michele G. Screening for dopa-responsive dystonia in patients with Scans Without Evidence of Dopaminergic Deficiency (SWEDD). J Neurol 2014; 261:2204-8. [PMID: 25182701 DOI: 10.1007/s00415-014-7477-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 07/29/2014] [Accepted: 08/19/2014] [Indexed: 11/28/2022]
Abstract
The clinical diagnosis of Parkinson's Disease (PD) is not supported by Single Photon Emission Computed Tomography (SPECT) using dopamine transporter radioligand in 4-15 % of patients. It has been hypothesized that this phenomenon, named "Scans Without Evidence of Dopaminergic Deficiency" (SWEDD), may be an adult-onset dystonia. We investigated the hypothesis that these patients might be affected by Dopa-Responsive Dystonia (DRD). We enrolled eleven unrelated patients (8 F and 3 M) with clinical parkinsonism and normal [(123)I]FP-CIT SPECT. The GTP-cyclohydrolase1 (GCH1) gene was sequenced in all patients; urine biopterin and neopterin analysis was carried out in nine and oral phenylalanine (Phe) loading in seven. Neurological examination showed bradykinesia and resting/postural tremor in all patients, and rigidity in ten, suggesting a clinical diagnosis of PD. We detected mild dystonic signs in eight cases. In particular, five of them presented cranial dyskinesias. No mutation of the GCH1 gene was found. The results of the urine biopterin and neopterin analysis and the oral Phe loading did not reveal biochemical abnormalities suggestive of reduced GCH1 activity. We confirm that some clinical features, namely the presence of focal or segmental dystonia, suggest an adult-onset dystonia in SWEDD cases. However, we exclude DRD caused by GCH1 gene mutations in the present series.
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Affiliation(s)
- Anna De Rosa
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Federico II University, Via Pansini 5, 80131, Naples, Italy,
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6
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Mencacci NE, Isaias IU, Reich MM, Ganos C, Plagnol V, Polke JM, Bras J, Hersheson J, Stamelou M, Pittman AM, Noyce AJ, Mok KY, Opladen T, Kunstmann E, Hodecker S, Münchau A, Volkmann J, Samnick S, Sidle K, Nanji T, Sweeney MG, Houlden H, Batla A, Zecchinelli AL, Pezzoli G, Marotta G, Lees A, Alegria P, Krack P, Cormier-Dequaire F, Lesage S, Brice A, Heutink P, Gasser T, Lubbe SJ, Morris HR, Taba P, Koks S, Majounie E, Raphael Gibbs J, Singleton A, Hardy J, Klebe S, Bhatia KP, Wood NW. Parkinson's disease in GTP cyclohydrolase 1 mutation carriers. Brain 2014; 137:2480-92. [PMID: 24993959 PMCID: PMC4132650 DOI: 10.1093/brain/awu179] [Citation(s) in RCA: 141] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 05/16/2014] [Accepted: 05/23/2014] [Indexed: 11/27/2022] Open
Abstract
GTP cyclohydrolase 1, encoded by the GCH1 gene, is an essential enzyme for dopamine production in nigrostriatal cells. Loss-of-function mutations in GCH1 result in severe reduction of dopamine synthesis in nigrostriatal cells and are the most common cause of DOPA-responsive dystonia, a rare disease that classically presents in childhood with generalized dystonia and a dramatic long-lasting response to levodopa. We describe clinical, genetic and nigrostriatal dopaminergic imaging ([(123)I]N-ω-fluoropropyl-2β-carbomethoxy-3β-(4-iodophenyl) tropane single photon computed tomography) findings of four unrelated pedigrees with DOPA-responsive dystonia in which pathogenic GCH1 variants were identified in family members with adult-onset parkinsonism. Dopamine transporter imaging was abnormal in all parkinsonian patients, indicating Parkinson's disease-like nigrostriatal dopaminergic denervation. We subsequently explored the possibility that pathogenic GCH1 variants could contribute to the risk of developing Parkinson's disease, even in the absence of a family history for DOPA-responsive dystonia. The frequency of GCH1 variants was evaluated in whole-exome sequencing data of 1318 cases with Parkinson's disease and 5935 control subjects. Combining cases and controls, we identified a total of 11 different heterozygous GCH1 variants, all at low frequency. This list includes four pathogenic variants previously associated with DOPA-responsive dystonia (Q110X, V204I, K224R and M230I) and seven of undetermined clinical relevance (Q110E, T112A, A120S, D134G, I154V, R198Q and G217V). The frequency of GCH1 variants was significantly higher (Fisher's exact test P-value 0.0001) in cases (10/1318 = 0.75%) than in controls (6/5935 = 0.1%; odds ratio 7.5; 95% confidence interval 2.4-25.3). Our results show that rare GCH1 variants are associated with an increased risk for Parkinson's disease. These findings expand the clinical and biological relevance of GTP cycloydrolase 1 deficiency, suggesting that it not only leads to biochemical striatal dopamine depletion and DOPA-responsive dystonia, but also predisposes to nigrostriatal cell loss. Further insight into GCH1-associated pathogenetic mechanisms will shed light on the role of dopamine metabolism in nigral degeneration and Parkinson's disease.
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Affiliation(s)
- Niccolò E Mencacci
- 1 Department of Molecular Neuroscience, UCL Institute of Neurology, London WC1N 3BG, UK2 IRCCS Istituto Auxologico Italiano, Department of Neurology and Laboratory of Neuroscience - Department of Pathophysiology and Transplantation, "Dino Ferrari" Centre, Università degli Studi di Milano, 20149 Milan, Italy
| | - Ioannis U Isaias
- 3 Department of Neurology, University Hospital, 97080 Würzburg, Germany4 Parkinson Institute, Istituti Clinici di Perfezionamento, 20126 Milan, Italy
| | - Martin M Reich
- 3 Department of Neurology, University Hospital, 97080 Würzburg, Germany
| | - Christos Ganos
- 5 Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London WC1N 3BG, UK6 Department of Neurology, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany7 Department of Paediatric and Adult Movement Disorders and Neuropsychiatry, Institute of Neurogenetics, University of Lübeck, 23538 Lübeck, Germany
| | | | - James M Polke
- 9 Neurogenetics Unit, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
| | - Jose Bras
- 1 Department of Molecular Neuroscience, UCL Institute of Neurology, London WC1N 3BG, UK
| | - Joshua Hersheson
- 1 Department of Molecular Neuroscience, UCL Institute of Neurology, London WC1N 3BG, UK
| | - Maria Stamelou
- 5 Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London WC1N 3BG, UK10 Neurology Clinic, Attiko Hospital, University of Athens, 126 42 Haidari, Athens, Greece11 Neurology Clinic, Philipps University, 35032 Marburg, Germany
| | - Alan M Pittman
- 1 Department of Molecular Neuroscience, UCL Institute of Neurology, London WC1N 3BG, UK12 Reta Lila Weston Institute of Neurological Studies, UCL Institute of Neurology, London WC1N 3BG, UK
| | - Alastair J Noyce
- 1 Department of Molecular Neuroscience, UCL Institute of Neurology, London WC1N 3BG, UK12 Reta Lila Weston Institute of Neurological Studies, UCL Institute of Neurology, London WC1N 3BG, UK
| | - Kin Y Mok
- 1 Department of Molecular Neuroscience, UCL Institute of Neurology, London WC1N 3BG, UK
| | - Thomas Opladen
- 13 Division of Inborn Errors of Metabolism, University Children's Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Erdmute Kunstmann
- 14 Institut of Human Genetics, Julius-Maximilian-University, 97070 Würzburg, Germany
| | - Sybille Hodecker
- 6 Department of Neurology, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Alexander Münchau
- 7 Department of Paediatric and Adult Movement Disorders and Neuropsychiatry, Institute of Neurogenetics, University of Lübeck, 23538 Lübeck, Germany
| | - Jens Volkmann
- 4 Parkinson Institute, Istituti Clinici di Perfezionamento, 20126 Milan, Italy
| | - Samuel Samnick
- 15 Department of Nuclear Medicine, University Hospital, 97080 Würzburg, Germany
| | - Katie Sidle
- 1 Department of Molecular Neuroscience, UCL Institute of Neurology, London WC1N 3BG, UK
| | - Tina Nanji
- 9 Neurogenetics Unit, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
| | - Mary G Sweeney
- 9 Neurogenetics Unit, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
| | - Henry Houlden
- 1 Department of Molecular Neuroscience, UCL Institute of Neurology, London WC1N 3BG, UK
| | - Amit Batla
- 5 Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London WC1N 3BG, UK
| | - Anna L Zecchinelli
- 4 Parkinson Institute, Istituti Clinici di Perfezionamento, 20126 Milan, Italy
| | - Gianni Pezzoli
- 4 Parkinson Institute, Istituti Clinici di Perfezionamento, 20126 Milan, Italy
| | - Giorgio Marotta
- 16 Department of Nuclear Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy
| | - Andrew Lees
- 12 Reta Lila Weston Institute of Neurological Studies, UCL Institute of Neurology, London WC1N 3BG, UK
| | - Paulo Alegria
- 17 Serviço de Neurologia, Hospital Beatriz Ângelo, 2674-514 Loures, Portugal
| | - Paul Krack
- 18 Movement Disorder Unit, CHU Grenoble, Joseph Fourier University, and INSERM U836, Grenoble Institute Neuroscience, F-38043 Grenoble, France
| | - Florence Cormier-Dequaire
- 19 Université Pierre et Marie Curie-Paris6, Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière, UMR-S975; Inserm, U975, Cnrs, UMR 7225, Paris, France20 Centre d'Investigation Clinique (CIC-9503), Département de Neurologie, Hôpital Pitié-Salpétriêre, AP-HP, Paris, France
| | - Suzanne Lesage
- 19 Université Pierre et Marie Curie-Paris6, Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière, UMR-S975; Inserm, U975, Cnrs, UMR 7225, Paris, France
| | - Alexis Brice
- 19 Université Pierre et Marie Curie-Paris6, Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière, UMR-S975; Inserm, U975, Cnrs, UMR 7225, Paris, France21 Département de Génétique et Cytogénétique, Pitié-Salpêtrière hospital, 75013 Paris, France
| | - Peter Heutink
- 22 DZNE-Deutsches Zentrum für Neurodegenerative Erkrankungen (German Centre for Neurodegenerative Diseases), Hertie Institute for Clinical Brain Research, University of Tübingen, 72076 Tübingen, Germany
| | - Thomas Gasser
- 22 DZNE-Deutsches Zentrum für Neurodegenerative Erkrankungen (German Centre for Neurodegenerative Diseases), Hertie Institute for Clinical Brain Research, University of Tübingen, 72076 Tübingen, Germany
| | - Steven J Lubbe
- 23 Department of Clinical Neuroscience, UCL Institute of Neurology, London WC1N 3BG, UK
| | - Huw R Morris
- 23 Department of Clinical Neuroscience, UCL Institute of Neurology, London WC1N 3BG, UK
| | - Pille Taba
- 24 Department of Neurology and Neurosurgery, University of Tartu, 50090 Tartu, Estonia
| | - Sulev Koks
- 25 Department of Pathophysiology, Centre of Excellence for Translational Medicine, University of Tartu, 50411 Tartu, Estonia
| | - Elisa Majounie
- 26 Laboratory of Neurogenetics, National Institute on Aging, Bethesda, MD 20892, USA
| | - J Raphael Gibbs
- 26 Laboratory of Neurogenetics, National Institute on Aging, Bethesda, MD 20892, USA
| | - Andrew Singleton
- 26 Laboratory of Neurogenetics, National Institute on Aging, Bethesda, MD 20892, USA
| | - John Hardy
- 1 Department of Molecular Neuroscience, UCL Institute of Neurology, London WC1N 3BG, UK12 Reta Lila Weston Institute of Neurological Studies, UCL Institute of Neurology, London WC1N 3BG, UK
| | - Stephan Klebe
- 3 Department of Neurology, University Hospital, 97080 Würzburg, Germany
| | - Kailash P Bhatia
- 5 Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London WC1N 3BG, UK
| | - Nicholas W Wood
- 1 Department of Molecular Neuroscience, UCL Institute of Neurology, London WC1N 3BG, UK
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Abstract
Dystonia is a common movement disorder seen by neurologists in clinic. Genetic forms of the disease are important to recognize clinically and also provide valuable information about possible pathogenic mechanisms within the wider disorder. In the past few years, with the advent of new sequencing technologies, there has been a step change in the pace of discovery in the field of dystonia genetics. In just over a year, four new genes have been shown to cause primary dystonia (CIZ1, ANO3, TUBB4A and GNAL), PRRT2 has been identified as the cause of paroxysmal kinesigenic dystonia and other genes, such as SLC30A10 and ATP1A3, have been linked to more complicated forms of dystonia or new phenotypes. In this review, we provide an overview of the current state of knowledge regarding genetic forms of dystonia—related to both new and well-known genes alike—and incorporating genetic, clinical and molecular information. We discuss the mechanistic insights provided by the study of the genetic causes of dystonia and provide a helpful clinical algorithm to aid clinicians in correctly predicting the genetic basis of various forms of dystonia.
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Affiliation(s)
- Gavin Charlesworth
- Department of Molecular Neuroscience, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
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8
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Abstract
Background. The diagnosis of autosomal dominant GTP-cyclohydrolase deficiency relies on the examination of the GCH1 gene and/or pterins and neurotransmitters in CSF. The aim of the study was to assess the diagnostic value, if any, of pterins in urine and blood phenylalanine (Phe) and tyrosine (Tyr) under oral Phe loading test. Methods. We report on two new pedigrees with four symptomatic and four asymptomatic carriers whose pattern of urinary pterins and blood Phe/Tyr ratio under oral Phe loading pointed to GTP-cyclohydrolase deficiency. The study was then extended to 3 further patients and 90 controls. The diagnostic specificity and sensitivity of these metabolic markers were analysed by backwards logistic analysis. Results. Two genetic alterations segregated alternatively in Family 1 (c.631-632 del AT and c.671A > G), while exon 1 deletion was transmitted along three generations in Family 2. Neopterin and biopterin concentrations in urine clustered differently in controls under and over the age of 15. Therefore patients and controls were sub grouped according to this age. Neopterin was significantly reduced in GCH1 mutated subjects younger than 15, and both neopterin and biopterin in those older than 15. Moreover, the Phe/Tyr ratios at the second and third hour were both significantly higher in patients than in controls. Backwards logistic regression demonstrated the high diagnostic sensitivity and specificity of combined values of neopterin concentration and Phe/Tyr ratio at the second hour. Conclusions. Pterins in urine and Phe loading test are non-invasive and reliable tools for the biochemical diagnosis of GTP-cyclohydrolase deficiency.
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9
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The monoamine neurotransmitter disorders: an expanding range of neurological syndromes. Lancet Neurol 2011; 10:721-33. [DOI: 10.1016/s1474-4422(11)70141-7] [Citation(s) in RCA: 239] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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10
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Distonía hereditaria sensible a L-dopa secundaria a déficit de GTP ciclohidrolasa 1. An Pediatr (Barc) 2011; 75:55-7. [DOI: 10.1016/j.anpedi.2011.01.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2010] [Revised: 01/18/2011] [Accepted: 01/19/2011] [Indexed: 11/18/2022] Open
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11
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Albanese A, Asmus F, Bhatia KP, Elia AE, Elibol B, Filippini G, Gasser T, Krauss JK, Nardocci N, Newton A, Valls-Solé J. EFNS guidelines on diagnosis and treatment of primary dystonias. Eur J Neurol 2011; 18:5-18. [PMID: 20482602 DOI: 10.1111/j.1468-1331.2010.03042.x] [Citation(s) in RCA: 261] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES to provide a revised version of earlier guidelines published in 2006. BACKGROUND primary dystonias are chronic and often disabling conditions with a widespread spectrum mainly in young people. DIAGNOSIS primary dystonias are classified as pure dystonia, dystonia plus or paroxysmal dystonia syndromes. Assessment should be performed using a validated rating scale for dystonia. Genetic testing may be performed after establishing the clinical diagnosis. DYT1 testing is recommended for patients with primary dystonia with limb onset before age 30, and in those with an affected relative with early-onset dystonia. DYT6 testing is recommended in early-onset or familial cases with cranio-cervical dystonia or after exclusion of DYT1. Individuals with early-onset myoclonus should be tested for mutations in the DYT11 gene. If direct sequencing of the DYT11 gene is negative, additional gene dosage is required to improve the proportion of mutations detected. A levodopa trial is warranted in every patient with early-onset primary dystonia without an alternative diagnosis. In patients with idiopathic dystonia, neurophysiological tests can help with describing the pathophysiological mechanisms underlying the disorder. TREATMENT botulinum toxin (BoNT) type A is the first-line treatment for primary cranial (excluding oromandibular) or cervical dystonia; it is also effective on writing dystonia. BoNT/B is not inferior to BoNT/A in cervical dystonia. Pallidal deep brain stimulation (DBS) is considered a good option, particularly for primary generalized or cervical dystonia, after medication or BoNT have failed. DBS is less effective in secondary dystonia. This treatment requires a specialized expertise and a multidisciplinary team.
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Affiliation(s)
- A Albanese
- Istituto Neurologico Carlo Besta, Milan, Italy Università Cattolica del Sacro Cuore, Milan, Italy.
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12
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Opladen T, Okun JG, Burgard P, Blau N, Hoffmann GF. Phenylalanine loading in pediatric patients with dopa-responsive dystonia: revised test protocol and pediatric cutoff values. J Inherit Metab Dis 2010; 33:697-703. [PMID: 20668943 DOI: 10.1007/s10545-010-9164-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2010] [Revised: 06/24/2010] [Accepted: 06/28/2010] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The objectives of this study were to determine the value of phenylalanine (Phe) loading for diagnosing dopa-responsive dystonia (DRD) in children. METHODS We investigated orally administered Phe loading tests (100 mg/kg) in seven patients with confirmed DRD and 17 pediatric patients with clinically suspected but excluded DRD. Results of Phe, tyrosine (Tyr), and biopterin from plasma and dried blood spot (DBS) analyses were correlated, and pediatric cutoff values established. RESULTS The peak Phe concentration following a Phe load in the pediatric DRD population is lower than reported in adults. By using adult cutoff values and either Phe/Try ratios or biopterin concentrations only, false positive and false negative results are frequent. Only the combined analysis of the Phe/Tyr ratio and biopterin concentration is reliable in children. In children with DRD, dried blood Phe/Tyr ratio exceeded 4.6 (plasma Phe/Tyr ratio >5.4) after 2 h and biopterin concentration in dried blood remained below 16.2 nmol/L (plasma biopterin <14 nmol/L) 1 h after Phe challenge. CONCLUSIONS Phe loading is a useful tool for diagnosing DRD in children. Test duration can be reduced to only 2 h, and specific pediatric cutoff values need to be applied. Simultaneous measurements of the Phe/Tyr ratio and biopterin in plasma or DBS are essential in pediatric patients.
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Affiliation(s)
- Thomas Opladen
- Division of Inherited Metabolic Diseases, University Children's Hospital Heidelberg, Heidelberg, Germany.
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13
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Abstract
Dystonia-plus syndromes represent a heterogeneous group of diseases, where dystonia is accompanied by other neurological features and gene mutations can be detected frequently. Symptomatic dystonias and complex neurodegenerative diseases with dystonia as part of the clinical presentation are excluded from this category. At present, the following disorders are categorized as dystonia-plus syndromes: Dopa-responsive dystonia (DRD) is a mostly pediatric-onset, neurometabolic disorder with two different modes of inheritance: in its autosomal-dominant form, heterozygous mutations of GTP-cyclohydrolase I (GCH1, DYT5) cause DRD with reduced penetrance and excellent and lasting response to levodopa. Autosomal-recessive (AR) forms of DRD are caused by homozygous or compound heterozygous mutations of the tyrosine hydroxylase (TH) or the sepiapterin reductase (SPR) gene. In AR-DRD, the phenotype is generally more severe including cognitive deficits and developmental delay. Diagnosis can be confirmed by analysis of CSF pterine metabolites. Alternatively, comprehensive genetic testing yields causative mutations in up to 80% of patients. Myoclonus-dystonia (M-D) is caused by heterozygous mutations of the epsilon-sarcoglycan gene (SGCE). Dystonia is generally only mild to moderate, and 'lightning-like' myoclonic jerks occur rarely at rest and can be triggered by complex motor tasks like writing and drawing. Both features together with an age at onset below 25 years strongly predict SGCE mutation in M-D and differentiate this genetic disease from other 'jerky' dystonias. The combination of dystonia and parkinsonism can only be rarely observed in non-degenerative syndromes. Besides DRD, two additional syndromes have been classified. Rapid-onset dystonia-parkinsonism (RPD, DYT12) is a rare disorder with an abrupt onset of symptoms over minutes to days, prominent bulbar involvement and parkinsonism with a lack of response to levodopa. Patients with this rare phenotype should be screened for mutation in the Na(+)/K(+) ATPase alpha3-subunit (ATP1A3) gene, even if family history is negative. Recently, a novel form of dystonia-parkinsonism (DYT16) has been found to be linked to mutations in the PRKRA gene, whose relation to basal ganglia disorders is yet unknown .
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Affiliation(s)
- F Asmus
- Department of Neurodegenerative Disease, Hertie-Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany.
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14
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Lang AE. PATIENT MANAGEMENT PROBLEM. Continuum (Minneap Minn) 2008. [DOI: 10.1212/01.con.0000275636.61709.8c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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15
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Echenne B, Roubertie A, Assmann B, Lutz T, Penzien JM, Thöny B, Blau N, Hoffmann GF. Sepiapterin reductase deficiency: clinical presentation and evaluation of long-term therapy. Pediatr Neurol 2006; 35:308-13. [PMID: 17074599 DOI: 10.1016/j.pediatrneurol.2006.05.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2006] [Revised: 03/17/2006] [Accepted: 05/10/2006] [Indexed: 10/24/2022]
Abstract
Sepiapterin reductase deficiency has recently been recognized as a treatable, inborn error of pterin metabolism. This investigation is the first long-term clinical study demonstrating impressive positive, long-term effects of treatment in two cases of sepiapterin reductase deficiency after 2 and 5 years of treatment respectively. The two patients were not diagnosed before 7 and 13 years of age. These results highlight the importance of cerebrospinal fluid neurotransmitter investigations in childhood encephalopathy, in cases of unexplained early-onset neurologic handicap. Such a widened approach to the diagnostic efforts in early-onset encephalopathy with motor delay during childhood is important, as we have at our disposal a simple and effective treatment.
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Venna N, Sims KB, Grant PE. Case records of the Massachusetts General Hospital. Case 26-2006. A 19-year-old woman with difficulty walking. N Engl J Med 2006; 355:831-9. [PMID: 16928999 DOI: 10.1056/nejmcpc069015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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17
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Albanese A, Barnes MP, Bhatia KP, Fernandez-Alvarez E, Filippini G, Gasser T, Krauss JK, Newton A, Rektor I, Savoiardo M, Valls-Solè J. A systematic review on the diagnosis and treatment of primary (idiopathic) dystonia and dystonia plus syndromes: report of an EFNS/MDS-ES Task Force. Eur J Neurol 2006; 13:433-44. [PMID: 16722965 DOI: 10.1111/j.1468-1331.2006.01537.x] [Citation(s) in RCA: 168] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
To review the literature on primary dystonia and dystonia plus and to provide evidence-based recommendations. Primary dystonia and dystonia plus are chronic and often disabling conditions with a widespread spectrum mainly in young people. Computerized MEDLINE and EMBASE literature reviews (1966-1967 February 2005) were conducted. The Cochrane Library was searched for relevant citations. Diagnosis and classification of dystonia are highly relevant for providing appropriate management and prognostic information, and genetic counselling. Expert observation is suggested. DYT-1 gene testing in conjunction with genetic counselling is recommended for patients with primary dystonia with onset before age 30 years and in those with an affected relative with early onset. Positive genetic testing for dystonia (e.g. DYT-1) is not sufficient to make diagnosis of dystonia. Individuals with myoclonus should be tested for the epsilon-sarcoglycan gene (DYT-11). A levodopa trial is warranted in every patient with early onset dystonia without an alternative diagnosis. Brain imaging is not routinely required when there is a confident diagnosis of primary dystonia in adult patients, whereas it is necessary in the paediatric population. Botulinum toxin (BoNT) type A (or type B if there is resistance to type A) can be regarded as first line treatment for primary cranial (excluding oromandibular) or cervical dystonia and can be effective in writing dystonia. Actual evidence is lacking on direct comparison of the clinical efficacy and safety of BoNT-A vs. BoNT-B. Pallidal deep brain stimulation (DBS) is considered a good option, particularly for generalized or cervical dystonia, after medication or BoNT have failed to provide adequate improvement. Selective peripheral denervation is a safe procedure that is indicated exclusively in cervical dystonia. Intrathecal baclofen can be indicated in patients where secondary dystonia is combined with spasticity. The absolute and comparative efficacy and tolerability of drugs in dystonia, including anticholinergic and antidopaminergic drugs, is poorly documented and no evidence-based recommendations can be made to guide prescribing.
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Affiliation(s)
- A Albanese
- Istituto Nazionale Neurologico Carlo Besta, Milan, Italy.
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López-Laso E, Ormazabal A, Camino R, Gascón FJ, Ochoa JJ, Mateos ME, Muñoz MJ, Pérez-Navero JL, Lao JI, Vilaseca MA, Artuch R. Oral phenylalanine loading test for the diagnosis of dominant guanosine triphosphate cyclohydrolase 1 deficiency. Clin Biochem 2006; 39:893-7. [PMID: 16624273 DOI: 10.1016/j.clinbiochem.2006.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2006] [Revised: 03/03/2006] [Accepted: 03/09/2006] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To evaluate the usefulness of Phe loading test in patients for the diagnosis of guanosine triphosphate cyclohydrolase 1 deficiency (GTPCH). DESIGN AND METHODS We studied one family composed of 13 members harbouring the Q89X mutation in the GTPCH gene, a non-related pediatric patient with GTPCH deficiency and 8 pediatric controls. 100 mg/kg of L-phenylalanine was orally administered, and blood spot samples were taken at baselines 1, 2, 4 and 6 h post-load. RESULTS Two out of 7 pediatric patients showed a phenylalanine/tyrosine ratio higher than the previously reported cut-off value of 5.25 at 4 h, while 6 of the 7 adult patients showed a higher value. The only adult patient with a phenylalanine/tyrosine ratio below 5.25 at 4 h was asymptomatic. CONCLUSIONS A cut-off value of 5.25 seems reliable for interpreting Phe loading test in adult patients with GTPCH deficiency, although a lower value should be established for pediatric patients.
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Affiliation(s)
- Eduardo López-Laso
- Department of Paediatrics, Hospital Universitario Reina Sofía, Córdoba, Spain
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Schrag A, Schott JM. Epidemiological, clinical, and genetic characteristics of early-onset parkinsonism. Lancet Neurol 2006; 5:355-63. [PMID: 16545752 DOI: 10.1016/s1474-4422(06)70411-2] [Citation(s) in RCA: 255] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In this review we discuss the epidemiological, clinical, and genetic characteristics of early-onset parkinsonism, defined as parkinsonism starting before age 40 (sometimes 50) years. Juvenile parkinsonism is very rare and is the result of various secondary or genetic causes. In patients with onset at or above age 21 years, secondary causes require exclusion but are rare; most cases with a fairly pure parkinsonian syndrome (eg, young-onset Parkinson's disease; YOPD) are due to typical Lewy-body Parkinson's disease or, less commonly, genetic causes. In comparison with patients with late-onset disease, most patients with YOPD progress more slowly in terms of motor features and have a longer disease course with preservation of cognitive function, but typically develop motor fluctuations and dyskinesias earlier. Patients with YOPD generally experience a greater effect in their lives than those with late onset, with poorer social adjustment, higher rates of depression, and lower quality of life. Management of YOPD must therefore aim to maintain occupational, social, and daily functioning, while delaying or ameliorating motor complications of treatment, providing psychological support, and, where possible, preventing psychiatric complications including depression.
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Affiliation(s)
- Anette Schrag
- Royal Free and University College Medical School, University College London, Department of Clinical Neurosciences, London, UK.
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Saunders-Pullman R, Blau N, Hyland K, Zschocke J, Nygaard T, Raymond D, Shanker V, Mohrmann K, Arnold L, Tabbal S, deLeon D, Ford B, Brin M, Chouinard S, Ozelius L, Klein C, Bressman SB. Phenylalanine loading as a diagnostic test for DRD: interpreting the utility of the test. Mol Genet Metab 2004; 83:207-12. [PMID: 15542391 DOI: 10.1016/j.ymgme.2004.07.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2004] [Revised: 07/15/2004] [Accepted: 07/19/2004] [Indexed: 11/28/2022]
Abstract
Phenylalanine loading has been proposed as a diagnostic test for autosomal dominant DRD (dopa-responsive dystonia), and recently, a phenylalanine/tyrosine (phe/tyr) ratio of 7.5 after 4 h was reported as diagnostic of DRD. To test the utility of this test in another sample with DRD, we administered an oral challenge of phenylalanine (100 mg/kg) to 11 individuals with DRD and one non-manifesting gene carrier. Only 6/12 had a 4 h phe/tyr ratio of greater than 7.5, suggesting that additional parameters must be set to avoid missing the diagnosis of DRD, including the need for the plasma phenylalanine to reach a minimum level 600 in order for the test to be valid. We propose that in cases where this minimum plasma phenylalanine level is not reached, plasma tetrahydrobiopterin should be measured or alternatively other symptomatic family members should be screened.
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Abstract
Juvenile parkinsonism (JP) describes patients in whom the clinical features of parkinsonism manifest before 21 years of age. Many reported cases that had a good response to levodopa have proved to have autosomal recessive juvenile parkinsonism (AR-JP) due to mutations in the parkin gene. With the exception of parkin mutations and dopa-responsive dystonia, most causes are associated with the presence of additional neurological signs, resulting from additional lesions outside of the basal ganglia. Lewy body pathology has only been reported in one case, suggesting that a juvenile form of idiopathic Parkinson's disease may be extremely rare.
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Affiliation(s)
- Dominic C Paviour
- National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
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Abstract
Treatment of dopa-responsive dystonia is one of the more satisfying experiences in clinical neurology. The response to treatment with levodopa is usually dramatic and complete with no long-term complications. Carbidopa/levodopa is the mainstay in treating dopa-responsive dystonia. There is some experience using anticholinergic agents, but they are more likely to cause side effects and do not treat the underlying biochemical abnormality. Dopa-responsive dystonia caused by guanosine triphosphate cyclohydrolase I deficiency typically presents with dystonia in the lower extremities in the first decade of life. However, the presenting symptoms can vary. Thus, it is this author's recommendation that any child with dystonia receive a trial of carbidopa/levodopa.
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Affiliation(s)
- Jonathan W. Mink
- Department of Neurology, University of Rochester Medical Center, 601 Elmwood Avenue, Box 631, Rochester, NY 14642, USA. r.edu
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