1
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van der Veen S, Eggink H, Elting JWJ, Sival D, Verschuuren-Bemelmans CC, de Koning TJ, Tijssen MAJ. The natural history of progressive myoclonus ataxia. Neurobiol Dis 2024; 199:106555. [PMID: 38844245 DOI: 10.1016/j.nbd.2024.106555] [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: 03/02/2024] [Revised: 05/22/2024] [Accepted: 06/03/2024] [Indexed: 06/16/2024] Open
Abstract
Progressive myoclonus ataxia (PMA) is a rare clinical syndrome characterized by the presence of progressive myoclonus and ataxia, and can be accompanied by mild cognitive impairment and infrequent epileptic seizures. This is the first study to describe the natural history of PMA and identify clinical, electrophysiological, and genetic features explaining the variability in disease progression. A Dutch cohort of consecutive patients meeting the criteria of the refined definition of PMA was included. The current phenotype was assessed during in-person consultation by movement disorders experts, and retrospective data was collected to describe disease presentation and progression, including brain imaging and therapy efficacy. Extensive genetic and electrophysiological tests were performed. The presence of cortical hyperexcitability was determined, by either the identification of a cortical correlate of myoclonic jerks with simultaneous electromyography-electroencephalography or a giant somatosensory evoked potential. We included 34 patients with PMA with a median disease duration of 15 years and a clear progressive course in most patients (76%). A molecular etiology was identified in 82% patients: ATM, CAMTA1, DHDDS, EBF3, GOSR2, ITPR1, KCNC3, NUS1, POLR1A, PRKCG, SEMA6B, SPTBN2, TPP1, ZMYND11, and a 12p13.32 deletion. The natural history is a rather homogenous onset of ataxia in the first two years of life followed by myoclonus in the first 5 years of life. Main accompanying neurological dysfunctions included cognitive impairment (62%), epilepsy (38%), autism spectrum disorder (27%), and behavioral problems (18%). Disease progression showed large variability ranging from an epilepsy free PMA phenotype (62%) to evolution towards a progressive myoclonus epilepsy (PME) phenotype (18%): the existence of a PMA-PME spectrum. Cortical hyperexcitability could be tested in 17 patients, and was present in 11 patients and supported cortical myoclonus. Interestingly, post-hoc analysis showed that an absence of cortical hyperexcitability, suggesting non-cortical myoclonus, was associated with the PMA-end of the spectrum with no epilepsy and milder myoclonus, independent of disease duration. An association between the underlying genetic defects and progression on the PMA-PME spectrum was observed. By describing the natural history of the largest cohort of published patients with PMA so far, we see a homogeneous onset with variable disease progression, in which phenotypic evolution to PME occurs in the minority. Genetic and electrophysiological features may be of prognostic value, especially the determination of cortical hyperexcitability. Furthermore, the identification of cortical and non-cortical myoclonus in PMA helps us gain insight in the underlying pathophysiology of myoclonus.
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Affiliation(s)
- Sterre van der Veen
- Department of Neurology, University of Groningen, University Medical Centre Groningen, 9700 RB, Groningen, the Netherlands; Expertise Centre Movement Disorders Groningen, University Medical Centre Groningen, 9700 RB, Groningen, the Netherlands
| | - Hendriekje Eggink
- Department of Neurology, University of Groningen, University Medical Centre Groningen, 9700 RB, Groningen, the Netherlands; Expertise Centre Movement Disorders Groningen, University Medical Centre Groningen, 9700 RB, Groningen, the Netherlands
| | - Jan Willem J Elting
- Department of Neurology, University of Groningen, University Medical Centre Groningen, 9700 RB, Groningen, the Netherlands; Expertise Centre Movement Disorders Groningen, University Medical Centre Groningen, 9700 RB, Groningen, the Netherlands
| | - Deborah Sival
- Expertise Centre Movement Disorders Groningen, University Medical Centre Groningen, 9700 RB, Groningen, the Netherlands; Department of Pediatrics, University of Groningen, University Medical Center Groningen, 9700 RB, Groningen, the Netherlands
| | - Corien C Verschuuren-Bemelmans
- Expertise Centre Movement Disorders Groningen, University Medical Centre Groningen, 9700 RB, Groningen, the Netherlands; Department of Genetics, University of Groningen, University Medical Centre Groningen, 9700 RB, Groningen, the Netherlands
| | - Tom J de Koning
- Expertise Centre Movement Disorders Groningen, University Medical Centre Groningen, 9700 RB, Groningen, the Netherlands; Department of Genetics, University of Groningen, University Medical Centre Groningen, 9700 RB, Groningen, the Netherlands; Pediatrics, department of Clinical Sciences, Lund University, 22185 Lund, Sweden
| | - Marina A J Tijssen
- Department of Neurology, University of Groningen, University Medical Centre Groningen, 9700 RB, Groningen, the Netherlands; Expertise Centre Movement Disorders Groningen, University Medical Centre Groningen, 9700 RB, Groningen, the Netherlands.
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2
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Stephen CD. Childhood-onset writer's cramp, with later ataxia: A clue to COQ8A-related disorders. Parkinsonism Relat Disord 2024; 123:106014. [PMID: 38355377 PMCID: PMC11144560 DOI: 10.1016/j.parkreldis.2024.106014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 01/25/2024] [Indexed: 02/16/2024]
Affiliation(s)
- Christopher D Stephen
- Ataxia Center, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Dystonia Center, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
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3
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Petley E, Yule A, Alexander S, Ojha S, Whitehouse WP. The natural history of ataxia-telangiectasia (A-T): A systematic review. PLoS One 2022; 17:e0264177. [PMID: 35290391 PMCID: PMC9049793 DOI: 10.1371/journal.pone.0264177] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 02/06/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Ataxia-telangiectasia is an autosomal recessive, multi-system, and life-shortening disease caused by mutations in the ataxia-telangiectasia mutated gene. Although widely reported, there are no studies that give a comprehensive picture of this intriguing condition. OBJECTIVES Understand the natural history of ataxia-telangiectasia (A-T), as reported in scientific literature. SEARCH METHODS 107 search terms were identified and divided into 17 searches. Each search was performed in PubMed, Ovid SP (MEDLINE) 1946-present, OVID EMBASE 1980 -present, Web of Science core collection, Elsevier Scopus, and Cochrane Library. SELECTION CRITERIA All human studies that report any aspect of A-T. DATA COLLECTION AND ANALYSIS Search results were de-duplicated, data extracted (including author, publication year, country of origin, study design, population, participant characteristics, and clinical features). Quality of case-control and cohort studies was assessed by the Newcastle-Ottawa tool. Findings are reported descriptively and where possible data collated to report median (interquartile range, range) of outcomes of interest. MAIN RESULTS 1314 cases reported 2134 presenting symptoms. The most common presenting symptom was abnormal gait (1160 cases; 188 studies) followed by recurrent infections in classical ataxia-telangiectasia and movement disorders in variant ataxia-telangiectasia. 687 cases reported 752 causes of death among which malignancy was the most frequently reported cause. Median (IQR, range) age of death (n = 294) was 14 years 0 months (10 years 0 months to 23 years 3 months, 1 year 3 months to 76 years 0 months). CONCLUSIONS This review demonstrates the multi-system involvement in A-T, confirms that neurological symptoms are the most frequent presenting features in classical A-T but variants have diverse manifestations. We found that most individuals with A-T have life limited to teenage or early adulthood. Predominance of case reports, and case series demonstrate the lack of robust evidence to determine the natural history of A-T. We recommend population-based studies to fill this evidence gap.
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Affiliation(s)
- Emily Petley
- School of Medicine, University of Nottingham, Nottingham, United
Kingdom
| | - Alexander Yule
- United Lincolnshire Hospitals NHS Trust, Lincoln, United
Kingdom
| | - Shaun Alexander
- School of Medicine, University of Nottingham, Nottingham, United
Kingdom
| | - Shalini Ojha
- School of Medicine, University of Nottingham, Nottingham, United
Kingdom
- Children’s Hospital, University Hospitals of Derby and Burton, NHS
Foundation Trust, Derby, United Kingdom
| | - William P. Whitehouse
- School of Medicine, University of Nottingham, Nottingham, United
Kingdom
- Nottingham Children’s Hospital, Nottingham University Hospital NHS Trust,
Nottingham, United Kingdom
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4
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Moeini Shad T, Yazdani R, Amirifar P, Delavari S, Heidarzadeh Arani M, Mahdaviani SA, Sadeghi-Shabestari M, Aghamohammadi A, Rezaei N, Abolhassani H. Atypical Ataxia Presentation in Variant Ataxia Telangiectasia: Iranian Case-Series and Review of the Literature. Front Immunol 2022; 12:779502. [PMID: 35095854 PMCID: PMC8795590 DOI: 10.3389/fimmu.2021.779502] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 12/23/2021] [Indexed: 11/13/2022] Open
Abstract
Ataxia-telangiectasia (AT) is a rare autosomal recessive neurodegenerative multisystem disorder. A minority of AT patients can present late-onset atypical presentations due to unknown mechanisms. The demographic, clinical, immunological and genetic data were collected by direct interview and examining the Iranian AT patients with late-onset manifestations. We also conducted a systematic literature review for reported atypical AT patients. We identified three Iranian AT patients (3/249, 1.2% of total registry) with later age at ataxia onset and slower neurologic progression despite elevated alpha-fetoprotein levels, history of respiratory infections, and immunological features of the syndrome. Of note, all patients developed autoimmunity in which a decrease of naïve T cells and regulatory T cells were observed. The literature searches also summarized data from 73 variant AT patients with atypical presentation indicating biallelic mild mutations mainly lead to an atypical phenotype with an increased risk of cancer. Variant AT patients present with milder phenotype or atypical form of classical symptoms causing under- or mis- diagnosis. Although missense mutations are more frequent, an atypical presentation can be associated with deleterious mutations due to unknown modifying factors.
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Affiliation(s)
- Tannaz Moeini Shad
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.,Primary Immunodeficiency Diseases Network (PIDNet), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Reza Yazdani
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.,Primary Immunodeficiency Diseases Network (PIDNet), Universal Scientific Education and Research Network (USERN), Tehran, Iran.,Department of Neurology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Parisa Amirifar
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Medical Genetics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Samaneh Delavari
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.,Primary Immunodeficiency Diseases Network (PIDNet), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | | | - Seyed Alireza Mahdaviani
- Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Asghar Aghamohammadi
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Nima Rezaei
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.,Primary Immunodeficiency Diseases Network (PIDNet), Universal Scientific Education and Research Network (USERN), Tehran, Iran.,Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Hassan Abolhassani
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.,Primary Immunodeficiency Diseases Network (PIDNet), Universal Scientific Education and Research Network (USERN), Tehran, Iran.,Division of Clinical Immunology, Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden.,Division of Clinical Immunology, Department of Laboratory Medicine, Karolinska Institute at Karolinska University Hospital Huddinge, Stockholm, Sweden
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5
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Levi H, Bar E, Cohen-Adiv S, Sweitat S, Kanner S, Galron R, Mitiagin Y, Barzilai A. Dysfunction of cerebellar microglia in Ataxia-telangiectasia. Glia 2021; 70:536-557. [PMID: 34854502 DOI: 10.1002/glia.24122] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 11/09/2021] [Accepted: 11/12/2021] [Indexed: 12/13/2022]
Abstract
Ataxia-telangiectasia (A-T) is a multisystem autosomal recessive disease caused by mutations in the ATM gene and characterized by cerebellar atrophy, progressive ataxia, immunodeficiency, male and female sterility, radiosensitivity, cancer predisposition, growth retardation, insulin-resistant diabetes, and premature aging. ATM phosphorylates more than 1500 target proteins, which are involved in cell cycle control, DNA repair, apoptosis, modulation of chromatin structure, and other cytoplasmic as well as mitochondrial processes. In our quest to better understand the mechanisms by which ATM deficiency causes cerebellar degeneration, we hypothesized that specific vulnerabilities of cerebellar microglia underlie the etiology of A-T. Our hypothesis is based on the recent finding that dysfunction of glial cells affect a variety of process leading to impaired neuronal functionality (Song et al., 2019). Whereas astrocytes and neurons descend from the neural tube, microglia originate from the hematopoietic system, invade the brain at early embryonic stage, and become the innate immune cells of the central nervous system and important participants in development of synaptic plasticity. Here we demonstrate that microglia derived from Atm-/- mouse cerebellum display accelerated cell migration and are severely impaired in phagocytosis, secretion of neurotrophic factors, and mitochondrial activity, suggestive of apoptotic processes. Interestingly, no microglial impairment was detected in Atm-deficient cerebral cortex, and Atm deficiency had less impact on astroglia than microglia. Collectively, our findings validate the roles of glial cells in cerebellar attrition in A-T.
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Affiliation(s)
- Hadar Levi
- Department of Neurobiology, George S. Wise, Faculty of Life Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Ela Bar
- Department of Neurobiology, George S. Wise, Faculty of Life Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Stav Cohen-Adiv
- Department of Neurobiology, George S. Wise, Faculty of Life Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Suzan Sweitat
- Department of Neurobiology, George S. Wise, Faculty of Life Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Sivan Kanner
- Department of Neurobiology, George S. Wise, Faculty of Life Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Ronit Galron
- Department of Neurobiology, George S. Wise, Faculty of Life Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Yulia Mitiagin
- Department of Neurobiology, George S. Wise, Faculty of Life Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Ari Barzilai
- Department of Neurobiology, George S. Wise, Faculty of Life Sciences, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
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6
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Ganguly J, Bernaola MT, Goobie S, Prasad A, Jog M. Myoclonus‐Dystonia Presentation of
ATM
Gene Mutation in a Canadian Mennonite. Mov Disord Clin Pract 2021; 9:264-267. [DOI: 10.1002/mdc3.13369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/04/2021] [Accepted: 10/24/2021] [Indexed: 12/26/2022] Open
Affiliation(s)
- Jacky Ganguly
- Movement Disorder Centre, London Health Sciences Centre The University of Western Ontario London Ontario Canada
| | - Mellany Tuesta Bernaola
- Movement Disorder Centre, London Health Sciences Centre The University of Western Ontario London Ontario Canada
| | - Sharan Goobie
- Division of Medical Genetics Dalhousie University Halifax Nova Scotia Canada
| | - Asuri Prasad
- Department of Pediatrics, London Health Sciences Centre The University of Western Ontario London Ontario Canada
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7
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Dragašević-Mišković N, Stanković I, Milovanović A, Kostić VS. Autosomal recessive adult onset ataxia. J Neurol 2021; 269:504-533. [PMID: 34499204 DOI: 10.1007/s00415-021-10763-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 08/16/2021] [Accepted: 08/18/2021] [Indexed: 11/24/2022]
Abstract
Autosomal recessive ataxias (ARCA) represent a complex group of diseases ranging from primary ataxias to rare and complex metabolic disorders in which ataxia is a part of the clinical picture. Small number of ARCA manifest exclusively in adulthood, while majority of typical childhood onset ARCA may also start later with atypical clinical presentation. We have systematically searched the literature for ARCA with adult onset, both in the group of primary ataxias including those that are less frequently described in isolated or in a small number of families, and also in the group of complex and metabolic diseases in which ataxia is only part of the clinical picture. We propose an algorithm that could be used when encountering a patient with adult onset sporadic or recessive ataxia in whom the acquired causes are excluded. ARCA are frequently neglected in the differential diagnosis of adult-onset ataxias. Rising awareness of their clinical significance is important, not only because some of these disorders may be potentially treatable, but also for prognostic implications and inclusion of patients to future clinical trials with disease modifying agents.
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Affiliation(s)
- Nataša Dragašević-Mišković
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Dr Subotića 6, 11000, Belgrade, Serbia.
| | - Iva Stanković
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Dr Subotića 6, 11000, Belgrade, Serbia
| | - Andona Milovanović
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Dr Subotića 6, 11000, Belgrade, Serbia
| | - Vladimir S Kostić
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Dr Subotića 6, 11000, Belgrade, Serbia
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8
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Amirifar P, Ranjouri MR, Pashangzadeh S, Lavin M, Yazdani R, Moeini Shad T, Mehrmohamadi M, Salami F, Delavari S, Moamer S, Aghamohammadi A, Akrami SM, Abolhassani H. The spectrum of ATM gene mutations in Iranian patients with ataxia-telangiectasia. Pediatr Allergy Immunol 2021; 32:1316-1326. [PMID: 33547824 DOI: 10.1111/pai.13461] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/19/2021] [Accepted: 01/26/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Ataxia-telangiectasia (A-T) is a rare genetic disorder characterized by a distinct range of clinical manifestations, including progressive ataxia, immunodeficiency, and radiosensitivity. METHODS Clinical data, laboratory results, and genetic data were collected from forty-three A-T patients. Whole-exome sequencing and Sanger sequencing were done for the patients clinically diagnosed as suffering from A-T. Based on the phenotype severity of the disease, patients were divided into severe and mild subgroups. RESULTS The median (IQR) age of diagnosis in this cohort was 5 (3-7) years, and various types of clinical manifestations, including fever (P =.005), lower respiratory tract infection (P = .033), diarrhea (P = .014), and hepatosplenomegaly (P = .032), were significantly higher among patients diagnosed with the severe phenotype. Our results showed a correlation between phenotype severity and mutation type. The chance of having severe phenotype in patients who have severe mutations, including frameshift and nonsense, was 7.3 times higher than in patients who were categorized in the mild genotype group (odds ratio = 7.3, P = .006). Thirty-four types of mutations including 9 novel mutations were observed in our study. CONCLUSION Molecular analysis provides the opportunity for accurate diagnosis and timely management in A-T patients with chronic progressive disease, especially infections and the risk of malignancies. This study characterizes for the first time the broad spectrum of mutations and phenotypes in Iranian A-T patients, which is required for carrier detection and reducing the burden of disease in the future using the patients' families and for the public healthcare system.
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Affiliation(s)
- Parisa Amirifar
- Department of Medical Genetics, School of Medicine, Tehran University of medical sciences, Tehran, Iran.,Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Science, Tehran, Iran
| | - Mohammad Reza Ranjouri
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Science, Tehran, Iran
| | - Salar Pashangzadeh
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Science, Tehran, Iran
| | - Martin Lavin
- University of Queensland Centre for Clinical Research (UQCCR), University of Queensland, Brisbane, QLD, Australia
| | - Reza Yazdani
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Science, Tehran, Iran
| | - Tannaz Moeini Shad
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Science, Tehran, Iran.,Department of Immunology, Semnan University of Medical Sciences, Semnan, Iran
| | - Mahya Mehrmohamadi
- Department of Biotechnology, College of Science, University of Tehran, Tehran, Iran
| | - Fereshte Salami
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Science, Tehran, Iran
| | - Samaneh Delavari
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Science, Tehran, Iran
| | - Soraya Moamer
- School of Public Health, Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Asghar Aghamohammadi
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Science, Tehran, Iran
| | - Seyed Mohammad Akrami
- Department of Medical Genetics, School of Medicine, Tehran University of medical sciences, Tehran, Iran
| | - Hassan Abolhassani
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Science, Tehran, Iran.,Division of Clinical Immunology, Department of Laboratory Medicine, Karolinska Institute at Karolinska University Hospital Huddinge, Stockholm, Sweden
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9
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Donath H, Woelke S, Schubert R, Kieslich M, Theis M, Auburger G, Duecker RP, Zielen S. Neurofilament Light Chain Is a Biomarker of Neurodegeneration in Ataxia Telangiectasia. THE CEREBELLUM 2021; 21:39-47. [PMID: 33893614 PMCID: PMC8885493 DOI: 10.1007/s12311-021-01257-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/10/2021] [Indexed: 12/12/2022]
Abstract
Ataxia telangiectasia (A-T) is a progressive and life-limiting disease associated with cerebellar ataxia due to progressive cerebellar degeneration. In addition to ataxia, which is described in detail, the presence of chorea, dystonia, oculomotor apraxia, athetosis, parkinsonism, and myoclonia are typical manifestations of the disease. The study aimed to evaluate the specificity and sensitivity of neurofilament light chain (NfL) as a biomarker of neurodegeneration in relation to SARA score. In this prospective trial, one visit of 42 A-T patients aged 1.3–25.6 years (mean 11.6 ± 7.3 years) was performed, in which NfL was determined from serum by ELISA. Additionally, a neurological examination of the patients was performed. Blood was collected from 19 healthy volunteers ≥ 12 years of age. We found significantly increased levels of NfL in patients with A-T compared to healthy controls (21.5 ± 3.6 pg/mL vs. 9.3 ± 0.49 pg/mL, p ≤ 0.01). There was a significant correlation of NfL with age, AFP, and SARA. NfL is a new potential progression biomarker in blood for neurodegeneration in A-T which increases with age.
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Affiliation(s)
- H Donath
- Division of Allergology, Pulmonology and Cystic Fibrosis, Department for Children and Adolescents, Goethe University, Frankfurt, Germany.
| | - S Woelke
- Division of Allergology, Pulmonology and Cystic Fibrosis, Department for Children and Adolescents, Goethe University, Frankfurt, Germany
| | - R Schubert
- Division of Allergology, Pulmonology and Cystic Fibrosis, Department for Children and Adolescents, Goethe University, Frankfurt, Germany
| | - M Kieslich
- Division of Pediatric Neurology, Department for Children and Adolescents, Goethe University, Frankfurt, Germany
| | - M Theis
- Division of Pediatric Neurology, Department for Children and Adolescents, Goethe University, Frankfurt, Germany
| | - G Auburger
- Experimental Neurology, Medical School, Goethe University, Frankfurt, Germany
| | - R P Duecker
- Division of Allergology, Pulmonology and Cystic Fibrosis, Department for Children and Adolescents, Goethe University, Frankfurt, Germany
| | - S Zielen
- Division of Allergology, Pulmonology and Cystic Fibrosis, Department for Children and Adolescents, Goethe University, Frankfurt, Germany
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10
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Pourahmadiyan A, Alipour P, Golchin N, Tabatabaiefar MA. Next-generation sequencing reveals a novel pathogenic variant in the ATM gene. Int J Neurosci 2021; 132:558-562. [PMID: 32962506 DOI: 10.1080/00207454.2020.1826944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Ataxia telangiectasia (A-T) is a rare autosomal recessive, multisystemic disease. Patients with the A-T syndrome present a broad spectrum of disease phenotypes. The ATM (ataxia telangiectasia mutated) gene, the only causative gene for A-T. METHOD A patient of Persian origin presenting with typical A-T was referred to our genetics centre for specialized genetic counselling and testing. Targeted next-generation sequencing (NGS) was applied. Sanger sequencing was used to confirm the candidate variant. Modelling was performed using the SWISS-MODEL server. RESULTS A homozygous stop-gain variant c.829G > T (p.E277*) was found in the ATM gene. This variant was confirmed by Sanger sequencing and modelling of native structure, and truncated structure was performed. CONCLUSION To date, very few pathogenic variants of the ATM gene have been reported from the Iranian population. The finding has implications in molecular diagnostic for A-T in Iran.
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Affiliation(s)
- Azam Pourahmadiyan
- Cellular and Molecular Research Center, Basic Health Sciences Institute, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Paria Alipour
- Cellular and Molecular Research Center, Basic Health Sciences Institute, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Neda Golchin
- Ahvaz Noor Medical Genetics Laboratory, Ahvaz, Iran
| | - Mohammad Amin Tabatabaiefar
- Department of Genetics and Molecular Biology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.,Pediatric Inherited Diseases Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
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11
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Rossi M, van der Veen S, Merello M, Tijssen MAJ, van de Warrenburg B. Myoclonus-Ataxia Syndromes: A Diagnostic Approach. Mov Disord Clin Pract 2020; 8:9-24. [PMID: 33426154 DOI: 10.1002/mdc3.13106] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 09/30/2020] [Accepted: 10/14/2020] [Indexed: 12/30/2022] Open
Abstract
Background A myriad of disorders combine myoclonus and ataxia. Most causes are genetic and an increasing number of genes are being associated with myoclonus-ataxia syndromes (MAS), due to recent advances in genetic techniques. A proper etiologic diagnosis of MAS is clinically relevant, given the consequences for genetic counseling, treatment, and prognosis. Objectives To review the causes of MAS and to propose a diagnostic algorithm. Methods A comprehensive and structured literature search following PRISMA criteria was conducted to identify those disorders that may combine myoclonus with ataxia. Results A total of 135 causes of combined myoclonus and ataxia were identified, of which 30 were charted as the main causes of MAS. These include four acquired entities: opsoclonus-myoclonus-ataxia syndrome, celiac disease, multiple system atrophy, and sporadic prion diseases. The distinction between progressive myoclonus epilepsy and progressive myoclonus ataxia poses one of the main diagnostic dilemmas. Conclusions Diagnostic algorithms for pediatric and adult patients, based on clinical manifestations including epilepsy, are proposed to guide the differential diagnosis and corresponding work-up of the most important and frequent causes of MAS. A list of genes associated with MAS to guide genetic testing strategies is provided. Priority should be given to diagnose or exclude acquired or treatable disorders.
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Affiliation(s)
- Malco Rossi
- Movement Disorders Section Neuroscience Department Buenos Aires Argentina.,Argentine National Scientific and Technological Research Council (CONICET) Buenos Aires Argentina
| | - Sterre van der Veen
- Pontificia Universidad Católica Argentina (UCA) Buenos Aires Argentina.,Department of Neurology University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - Marcelo Merello
- Movement Disorders Section Neuroscience Department Buenos Aires Argentina.,Argentine National Scientific and Technological Research Council (CONICET) Buenos Aires Argentina.,Pontificia Universidad Católica Argentina (UCA) Buenos Aires Argentina
| | - Marina A J Tijssen
- Department of Neurology University of Groningen, University Medical Center Groningen Groningen The Netherlands.,Expertise Center Movement Disorders Groningen University Medical Center Groningen (UMCG) Groningen The Netherlands
| | - Bart van de Warrenburg
- Department of Neurology, Donders Institute for Brain, Cognition & Behaviour Radboud University Medical Center Nijmegen The Netherlands
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12
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Clinical characteristics of ataxia-telangiectasia presenting dystonia as a main manifestation. Clin Neurol Neurosurg 2020; 199:106267. [PMID: 33080427 DOI: 10.1016/j.clineuro.2020.106267] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 08/21/2020] [Accepted: 09/30/2020] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Besides cerebellar ataxia, various other movement disorders, including dystonia, could manifest as main clinical symptoms in ataxia-telangiectasia (A-T). However, the clinical characteristics of dystonic A-T patients are not clearly elucidated. METHODS To investigate the characteristics of dystonic A-T, we screened previous reports with A-T patients presenting dystonia as a main manifestation, and included 38 dystonic A-T patients from 16 previous studies and our 2 cases. We reviewed clinical and demographic data of dystonic A-T patients. Additionally, to figure out clinical meaning of cerebellar involvement in dystonic A-T, we divided them into two groups based on the presence of cerebellar involvement, and compared clinical features between two groups. RESULTS In the patients with dystonic A-T, dystonia tended to appear during childhood or adolescence and became generalized over time. Choreoathetosis and myoclonus accompanied more frequently than the typical clinical features, including cerebellar ataxia or atrophy, telangiectasia, or oculomotor apraxia. Additionally, alpha-fetoprotein level was also elevated in the patients with dystonic A-T. When we compared dystonic A-T with and without cerebellar involvement, the former was related with more chance for telangiectasia and oculomotor apraxia, while the latter with that for choreoathetosis and malignancy. CONCLUSION Even without ataxia, telangiectasia, or oculomotor apraxia, A-T should be considered in undiagnosed dystonia, especially generalized dystonia which started from childhood or adolescence period, and alpha-fetoprotein level can be a useful screening tool. In addition, cerebellar involvement is important considering different phenotype in dystonic A-T patients with and without cerebellar sign.
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13
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Amirifar P, Ranjouri MR, Lavin M, Abolhassani H, Yazdani R, Aghamohammadi A. Ataxia-telangiectasia: epidemiology, pathogenesis, clinical phenotype, diagnosis, prognosis and management. Expert Rev Clin Immunol 2020; 16:859-871. [PMID: 32791865 DOI: 10.1080/1744666x.2020.1810570] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Ataxia-telangiectasia (A-T) is a rare autosomal recessive syndrome characterized by progressive cerebellar ataxia, oculocutaneous telangiectasia, variable immunodeficiency, radiosensitivity, and cancer predisposition. Mutations cause A-T in the ataxia telangiectasia mutated (ATM) gene encoding a serine/threonine-protein kinase. AREAS COVERED The authors reviewed the literature on PubMed, Web of Science, and Scopus databases to collect comprehensive data related to A-T. This review aims to discuss various update aspects of A-T, including epidemiology, pathogenesis, clinical manifestations, diagnosis, prognosis, and management. EXPERT OPINION A-T as a congenital disorder has phenotypic heterogeneity, and the severity of symptoms in different patients depends on the severity of mutations. This review provides a comprehensive overview of A-T, although some relevant questions about pathogenesis remain unanswered, probably owing to the phenotypic heterogeneity of this monogenic disorder. The presence of various clinical and immunologic manifestations in A-T indicates that the identification of the role of defective ATM in phenotype can be helpful in the better management and treatment of patients in the future.
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Affiliation(s)
- Parisa Amirifar
- Medical Genetics Department, School of Medicine, Tehran University of Medical Sciences , Tehran, Iran.,Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Science , Tehran, Iran
| | - Mohammad Reza Ranjouri
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Science , Tehran, Iran.,Molecular Medicine and Genetics Department, School of Medicine, Zanjan University of Medical Sciences , Zanjan, Iran
| | - Martin Lavin
- University of Queensland Centre for Clinical Research (UQCCR), University of Queensland , L, Australia
| | - Hassan Abolhassani
- Research Center for Primary Immunodeficiencies, Iran University of Medical Science , Tehran, Iran.,Division of Clinical Immunology, Department of Laboratory Medicine, Karolinska Institute at Karolinska University Hospital Huddinge , Stockholm, Sweden
| | - Reza Yazdani
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Science , Tehran, Iran
| | - Asghar Aghamohammadi
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Science , Tehran, Iran
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14
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Renaud M, Tranchant C, Koenig M, Anheim M. Autosomal Recessive Cerebellar Ataxias With Elevated Alpha-Fetoprotein: Uncommon Diseases, Common Biomarker. Mov Disord 2020; 35:2139-2149. [PMID: 33044027 DOI: 10.1002/mds.28307] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/23/2020] [Accepted: 08/17/2020] [Indexed: 12/12/2022] Open
Abstract
alpha-Fetoprotein (AFP) is a biomarker of several autosomal recessive cerebellar ataxias (ARCAs), especially ataxia telangiectasia (AT) and ataxia with oculomotor apraxia (AOA) type 2 (AOA2). More recently, slightly elevated AFP has been reported in AOA1 and AOA4. Interestingly, AOA1, AOA2, AOA4, and AT are overlapping ARCAs characterized by oculomotor apraxia, with oculocephalic dissociation, choreo-dystonia, and/or axonal sensorimotor neuropathy, in addition to cerebellar ataxia with cerebellar atrophy. The genetic backgrounds in these disorders play central roles in nuclear maintenance through DNA repair [ATM (AT), APTX (AOA1), or PNKP (AOA4)] or RNA termination [SETX (AOA2)]. Partially discriminating thresholds of AFP have been proposed as a way to distinguish between ARCAs with elevated AFP. In these entities, elevated AFP may be an epiphenomenon as a result of liver transcriptional dysregulation. AFP is a simple and reliable biomarker for the diagnosis of ARCA in performance and interpretation of next-generation sequencing. Here, we evaluated clinical, laboratory, imaging, and molecular data of the group of ARCAs that share elevated AFP serum levels that have been described in the past two decades. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Mathilde Renaud
- Service de Génétique Clinique, CHRU de Nancy, Nancy, France.,INSERM-U1256 NGERE, Université de Lorraine, Nancy, France
| | - Christine Tranchant
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), INSERM-U964/CNRS-UMR7104/Université de Strasbourg, Illkirch, France.,Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
| | - Michel Koenig
- Laboratoire de Génétique de Maladies Rares EA7402, Institut Universitaire de Recherche Clinique, Université de Montpellier, CHU Montpellier, Montpellier, France
| | - Mathieu Anheim
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), INSERM-U964/CNRS-UMR7104/Université de Strasbourg, Illkirch, France.,Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
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15
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Cirillo E, Giardino G, Ricci S, Moschese V, Lougaris V, Conti F, Azzari C, Barzaghi F, Canessa C, Martire B, Badolato R, Dotta L, Soresina A, Cancrini C, Finocchi A, Montin D, Romano R, Amodio D, Ferrua F, Tommasini A, Baselli LA, Dellepiane RM, Polizzi A, Chessa L, Marzollo A, Cicalese MP, Putti MC, Pession A, Aiuti A, Locatelli F, Plebani A, Pignata C. Consensus of the Italian Primary Immunodeficiency Network on transition management from pediatric to adult care in patients affected with childhood-onset inborn errors of immunity. J Allergy Clin Immunol 2020; 146:967-983. [PMID: 32827505 DOI: 10.1016/j.jaci.2020.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/17/2020] [Accepted: 08/04/2020] [Indexed: 02/06/2023]
Abstract
Medical advances have dramatically improved the long-term prognosis of children and adolescents with inborn errors of immunity (IEIs). Transfer of the medical care of individuals with pediatric IEIs to adult facilities is also a complex task because of the large number of distinct disorders, which requires involvement of patients and both pediatric and adult care providers. To date, there is no consensus on the optimal pathway of the transitional care process and no specific data are available in the literature regarding patients with IEIs. We aimed to develop a consensus statement on the transition process to adult health care services for patients with IEIs. Physicians from major Italian Primary Immunodeficiency Network centers formulated and answered questions after examining the currently published literature on the transition from childhood to adulthood. The authors voted on each recommendation. The most frequent IEIs sharing common main clinical problems requiring full attention during the transitional phase were categorized into different groups of clinically related disorders. For each group of clinically related disorders, physicians from major Italian Primary Immunodeficiency Network institutions focused on selected clinical issues representing the clinical hallmark during early adulthood.
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Affiliation(s)
- Emilia Cirillo
- Department of Translational Medical Sciences, Pediatric Section, Federico II University, Naples, Italy
| | - Giuliana Giardino
- Department of Translational Medical Sciences, Pediatric Section, Federico II University, Naples, Italy
| | - Silvia Ricci
- Division of Pediatric Immunology, Department of Health Sciences, University of Florence and Meyer Children's Hospital, Florence, Italy
| | - Viviana Moschese
- Pediatric Immunopathology and Allergology Unit, University of Rome Tor Vergata, Rome, Italy
| | - Vassilios Lougaris
- Department of Clinical and Experimental Sciences, University of Brescia and Department of Pediatrics, ASST-Spedali Civili di Brescia, Brescia, Italy
| | - Francesca Conti
- Unit of Pediatrics, University of Bologna, St. Orsola University Hospital, Bologna, Italy
| | - Chiara Azzari
- Division of Pediatric Immunology, Department of Health Sciences, University of Florence and Meyer Children's Hospital, Florence, Italy
| | - Federica Barzaghi
- San Raffaele Telethon Institute for Gene Therapy and Pediatric Immunohematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Clementina Canessa
- Division of Pediatric Immunology, Department of Health Sciences, University of Florence and Meyer Children's Hospital, Florence, Italy
| | - Baldassarre Martire
- Unit of Pediatric and Neonatology, Maternal-Infant Department, Mons A. R. Dimiccoli Hospital, Barletta, Italy
| | - Raffaele Badolato
- Department of Clinical and Experimental Sciences, University of Brescia and Department of Pediatrics, ASST-Spedali Civili di Brescia, Brescia, Italy
| | - Laura Dotta
- Department of Clinical and Experimental Sciences, University of Brescia and Department of Pediatrics, ASST-Spedali Civili di Brescia, Brescia, Italy
| | - Annarosa Soresina
- Department of Clinical and Experimental Sciences, University of Brescia and Department of Pediatrics, ASST-Spedali Civili di Brescia, Brescia, Italy
| | - Caterina Cancrini
- Unit of Immunology and Infectious Diseases, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, Rome, Italy; Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Andrea Finocchi
- Unit of Immunology and Infectious Diseases, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, Rome, Italy; Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Davide Montin
- Division of Pediatric Immunology and Rheumatology, Department of Public Health and Pediatrics, Regina Margherita Children Hospital, University of Turin, Turin, Italy
| | - Roberta Romano
- Department of Translational Medical Sciences, Pediatric Section, Federico II University, Naples, Italy
| | - Donato Amodio
- Unit of Immunology and Infectious Diseases, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, Rome, Italy; Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Francesca Ferrua
- San Raffaele Telethon Institute for Gene Therapy and Pediatric Immunohematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Tommasini
- Department of Pediatrics, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste and Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Lucia Augusta Baselli
- Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Department of Pediatrics, Milan, Italy
| | - Rosa Maria Dellepiane
- Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Department of Pediatrics, Milan, Italy
| | - Agata Polizzi
- Department of Educational Sciences, University of Catania, Catania, Italy
| | - Luciana Chessa
- Department of Clinical and Molecular Medicine, Sapienza, University of Rome, Rome, Italy
| | - Antonio Marzollo
- Department of Women's and Children's Health, Pediatric Hematology-Oncology Unit, University of Padua, Padua, Italy
| | - Maria Pia Cicalese
- San Raffaele Telethon Institute for Gene Therapy and Pediatric Immunohematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Caterina Putti
- Department of Women's and Children's Health, Pediatric Hematology-Oncology Unit, University of Padua, Padua, Italy
| | - Andrea Pession
- Unit of Pediatrics, University of Bologna, St. Orsola University Hospital, Bologna, Italy
| | - Alessandro Aiuti
- San Raffaele Telethon Institute for Gene Therapy and Pediatric Immunohematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Franco Locatelli
- Department of Pediatric Hematology and Oncology, IRCCS Bambino Gesù Childrens' Hospital, Sapienza, University of Rome, Rome Italy
| | - Alessandro Plebani
- Department of Clinical and Experimental Sciences, University of Brescia and Department of Pediatrics, ASST-Spedali Civili di Brescia, Brescia, Italy
| | - Claudio Pignata
- Department of Translational Medical Sciences, Pediatric Section, Federico II University, Naples, Italy.
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16
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Magrinelli F, Latorre A, Balint B, Mackenzie M, Mulroy E, Stamelou M, Tinazzi M, Bhatia KP. Isolated and combined genetic tremor syndromes: a critical appraisal based on the 2018 MDS criteria. Parkinsonism Relat Disord 2020; 77:121-140. [PMID: 32818815 DOI: 10.1016/j.parkreldis.2020.04.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 04/13/2020] [Accepted: 04/18/2020] [Indexed: 12/12/2022]
Abstract
The 2018 consensus statement on the classification of tremors proposes a two-axis categorization scheme based on clinical features and etiology. It also defines "isolated" and "combined" tremor syndromes depending on whether tremor is the sole clinical manifestation or is associated with other neurological or systemic signs. This syndromic approach provides a guide to investigate the underlying etiology of tremors, either genetic or acquired. Several genetic defects have been proven to cause tremor disorders, including autosomal dominant and recessive, X-linked, and mitochondrial diseases, as well as chromosomal abnormalities. Furthermore, some tremor syndromes are recognized in individuals with a positive family history, but their genetic confirmation is pending. Although most genetic tremor disorders show a combined clinical picture, there are some distinctive conditions in which tremor may precede the appearance of other neurological signs by years or remain the prominent manifestation throughout the disease course, previously leading to misdiagnosis as essential tremor (ET). Advances in the knowledge of genetically determined tremors may have been hampered by the inclusion of heterogeneous entities in previous studies on ET. The recent classification of tremors therefore aims to provide more consistent clinical data for deconstructing the genetic basis of tremor syndromes in the next-generation and long-read sequencing era. This review outlines the wide spectrum of tremor disorders with defined or presumed genetic etiology, both isolated and combined, unraveling diagnostic clues of these conditions and focusing mainly on ET-like phenotypes. Furthermore, we suggest a phenotype-to-genotype algorithm to support clinicians in identifying tremor syndromes and guiding genetic investigations.
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Affiliation(s)
- Francesca Magrinelli
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, United Kingdom; Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
| | - Anna Latorre
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, United Kingdom.
| | - Bettina Balint
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, United Kingdom; Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany.
| | - Melissa Mackenzie
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, United Kingdom.
| | - Eoin Mulroy
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, United Kingdom.
| | - Maria Stamelou
- Department of Neurology, Attikon University Hospital, Athens, Greece.
| | - Michele Tinazzi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
| | - Kailash P Bhatia
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, United Kingdom.
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17
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van de Wardt J, van der Stouwe AMM, Dirkx M, Elting JWJ, Post B, Tijssen MA, Helmich RC. Systematic clinical approach for diagnosing upper limb tremor. J Neurol Neurosurg Psychiatry 2020; 91:822-830. [PMID: 32457087 PMCID: PMC7402459 DOI: 10.1136/jnnp-2019-322676] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/19/2020] [Accepted: 03/22/2020] [Indexed: 12/18/2022]
Abstract
Tremor is the most common movement disorder worldwide, but diagnosis is challenging. In 2018, the task force on tremor of the International Parkinson and Movement Disorder Society published a consensus statement that proposes a tremor classification along two independent axes: a clinical tremor syndrome and its underlying aetiology. In line with this statement, we here propose a stepwise diagnostic approach that leads to the correct clinical and aetiological classification of upper limb tremor. We also describe the typical clinical signs of each clinical tremor syndrome. A key feature of our algorithm is the distinction between isolated and combined tremor syndromes, in which tremor is accompanied by bradykinesia, cerebellar signs, dystonia, peripheral neuropathy or brainstem signs. This distinction subsequently informs the selection of appropriate diagnostic tests, such as neurophysiology, laboratory testing, structural and dopaminergic imaging and genetic testing. We highlight treatable metabolic causes of tremor, as well as drugs and toxins that can provoke tremor. The stepwise approach facilitates appropriate diagnostic testing and avoids unnecessary investigations. We expect that the approach offered in this article will reduce diagnostic uncertainty and increase the diagnostic yield in patients with tremor.
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Affiliation(s)
- Jaron van de Wardt
- Department of Neurology, Canisius Wilhelmina Ziekenhuis, Nijmegen, The Netherlands
| | - A M Madelein van der Stouwe
- Department of Neurology, University Medical Centre Groningen (UMCG), Groningen, The Netherlands .,Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - Michiel Dirkx
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Jan Willem J Elting
- Department of Neurology, University Medical Centre Groningen (UMCG), Groningen, The Netherlands.,Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands.,Department of Clinical Neurophysiology, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - Bart Post
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Marina Aj Tijssen
- Department of Neurology, University Medical Centre Groningen (UMCG), Groningen, The Netherlands.,Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - Rick C Helmich
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
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18
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Gana S, Valente EM. Movement Disorders in Genetic Pediatric Ataxias. Mov Disord Clin Pract 2020; 7:383-393. [PMID: 32373654 DOI: 10.1002/mdc3.12937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/24/2020] [Accepted: 03/08/2020] [Indexed: 11/06/2022] Open
Abstract
Background Genetic pediatric ataxias are heterogeneous rare disorders, mainly inherited as autosomal-recessive traits. Most forms are progressive and lack effective treatment, with relevant socioeconomical impact. Albeit ataxia represents the main clinical feature, the phenotype can be more complex, with additional neurological and nonneurological signs being described in several forms. Methods and Results In this review, we provide an overview of the occurrence and spectrum of movement disorders in the most relevant forms of childhood-onset genetic ataxias. All types of hypokinetic and hyperkinetic movement disorders of variable severity have been reported. Movement disorders occasionally represent the symptom of onset, predating ataxia even of a few years and therefore challenging an early diagnosis. Their pathogenesis still remains poorly defined, as it is not yet clear whether movement disorders may directly relate to the cerebellar pathology or result from an extracerebellar dysfunction, including the basal ganglia. Conclusion Recognition of the complete movement disorder phenotype in genetic pediatric ataxias has important implications for diagnosis, management, and genetic counseling.
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Affiliation(s)
| | - Enza Maria Valente
- IRCCS Mondino Foundation Pavia Italy.,Department of Molecular Medicine University of Pavia Pavia Italy
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19
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Zaki-Dizaji M, Tajdini M, Kiaee F, Shojaaldini H, Badv RS, Abolhassani H, Aghamohammadi A. Dystonia in Ataxia Telangiectasia: A Case Report with Novel Mutations. Oman Med J 2020; 35:e93. [PMID: 32095276 PMCID: PMC7024809 DOI: 10.5001/omj.2020.11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 10/17/2018] [Indexed: 11/04/2022] Open
Abstract
Ataxia telangiectasia (A-T) is a common, genetically inherited cause of early childhood-onset ataxia that is classically characterized by progressive cerebellar malfunction, oculocutaneous telangiectasia, genome instability, and immunodeficiency. There is vast phenotype variation in patients with A-T and recently, dystonia, an extrapyramidal movement disorder. Here, we report the case of a 10-year-old girl who had experienced repeated diarrhea and mild gait ataxia since the age of two years. At age seven, ataxia and ocular telangiectasia were evident and immunoglobulin level assessment showed hyper IgM immune phenotype, thus a diagnosis of A-T was made based on clinical and laboratory findings, and she was started on intravenous immunoglobulin therapy. Generalized dystonia appeared when she was 10-years-old. Molecular analysis revealed two heterozygous mutations, c.6259delG and c.6658C>T, in the ATM gene of which one (c.6259delG) is novel. Dystonia can be part of the clinical picture in the A-T disorder and may even mask ataxia. This should be considered as a major feature mainly in variant A-T, which may occur without general ataxia and may be misdiagnosed in adults with primary dystonia.
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Affiliation(s)
- Majid Zaki-Dizaji
- Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran.,Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Science, Tehran, Iran
| | - Mohammad Tajdini
- Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Kiaee
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Science, Tehran, Iran
| | - Hossein Shojaaldini
- Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Shervin Badv
- Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hassan Abolhassani
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Science, Tehran, Iran.,Division of Clinical Immunology, Department of Laboratory Medicine, Karolinska Institute at Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Asghar Aghamohammadi
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Science, Tehran, Iran
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20
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Pogoda M, Hilke FJ, Lohmann E, Sturm M, Lenz F, Matthes J, Muyas F, Ossowski S, Hoischen A, Faust U, Sepahi I, Casadei N, Poths S, Riess O, Schroeder C, Grundmann K. Single Molecule Molecular Inversion Probes for High Throughput Germline Screenings in Dystonia. Front Neurol 2020; 10:1332. [PMID: 31920950 PMCID: PMC6930228 DOI: 10.3389/fneur.2019.01332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 12/02/2019] [Indexed: 11/26/2022] Open
Abstract
Background: This study's aim was to investigate a large cohort of dystonia patients for pathogenic and rare variants in the ATM gene, making use of a new, cost-efficient enrichment technology for NGS-based screening. Methods: Single molecule Molecular Inversion Probes (smMIPs) were used for targeted enrichment and sequencing of all protein coding exons and exon-intron boundaries of the ATM gene in 373 dystonia patients and six positive controls with known ATM variants. Additionally, a rare-variant association study was performed. Results: One patient (0.3%) was compound heterozygous and 21 others were carriers of variants of unknown significance (VUS) in the ATM gene. Although mutations in sporadic dystonia patients are not common, exclusion of pathogenic variants is crucial to recognize a potential tumor predisposition syndrome. SmMIPs produced similar results as routinely used NGS-based approaches. Conclusion: Our results underline the importance of implementing ATM in the routine genetic testing of dystonia patients and confirm the reliability of smMIPs and their usability for germline screenings in rare neurodegenerative conditions.
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Affiliation(s)
- Michaela Pogoda
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
| | - Franz-Joachim Hilke
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany.,Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ebba Lohmann
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.,Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases, Tübingen, Germany
| | - Marc Sturm
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
| | - Florian Lenz
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
| | - Jakob Matthes
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
| | - Francesc Muyas
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany.,Bioinformatics and Genomics Program, Centre for Genomic Regulation, The Barcelona Institute of Science and Technology, Barcelona, Spain.,Universitat Pompeu Fabra, Barcelona, Spain
| | - Stephan Ossowski
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany.,Bioinformatics and Genomics Program, Centre for Genomic Regulation, The Barcelona Institute of Science and Technology, Barcelona, Spain.,Universitat Pompeu Fabra, Barcelona, Spain
| | - Alexander Hoischen
- Department of Human Genetics, Radboud University Nijmegen Medical Center, Nijmegen, Netherlands.,Radboud Institute of Molecular Life Sciences, Radboud University Nijmegen Medical Center, Nijmegen, Netherlands
| | - Ulrike Faust
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
| | - Ilnaz Sepahi
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
| | - Nicolas Casadei
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany.,DFG NGS Competence Center Tübingen, Tübingen, Germany
| | - Sven Poths
- 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.,DFG NGS Competence Center Tübingen, Tübingen, Germany
| | - Christopher Schroeder
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
| | - Kathrin Grundmann
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
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21
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Coutelier M, Hammer MB, Stevanin G, Monin ML, Davoine CS, Mochel F, Labauge P, Ewenczyk C, Ding J, Gibbs JR, Hannequin D, Melki J, Toutain A, Laugel V, Forlani S, Charles P, Broussolle E, Thobois S, Afenjar A, Anheim M, Calvas P, Castelnovo G, de Broucker T, Vidailhet M, Moulignier A, Ghnassia RT, Tallaksen C, Mignot C, Goizet C, Le Ber I, Ollagnon-Roman E, Pouget J, Brice A, Singleton A, Durr A. Efficacy of Exome-Targeted Capture Sequencing to Detect Mutations in Known Cerebellar Ataxia Genes. JAMA Neurol 2019; 75:591-599. [PMID: 29482223 DOI: 10.1001/jamaneurol.2017.5121] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Importance Molecular diagnosis is difficult to achieve in disease groups with a highly heterogeneous genetic background, such as cerebellar ataxia (CA). In many patients, candidate gene sequencing or focused resequencing arrays do not allow investigators to reach a genetic conclusion. Objectives To assess the efficacy of exome-targeted capture sequencing to detect mutations in genes broadly linked to CA in a large cohort of undiagnosed patients and to investigate their prevalence. Design, Setting, and Participants Three hundred nineteen index patients with CA and without a history of dominant transmission were included in the this cohort study by the Spastic Paraplegia and Ataxia Network. Centralized storage was in the DNA and cell bank of the Brain and Spine Institute, Salpetriere Hospital, Paris, France. Patients were classified into 6 clinical groups, with the largest being those with spastic ataxia (ie, CA with pyramidal signs [n = 100]). Sequencing was performed from January 1, 2014, through December 31, 2016. Detected variants were classified as very probably or definitely causative, possibly causative, or of unknown significance based on genetic evidence and genotype-phenotype considerations. Main Outcomes and Measures Identification of variants in genes broadly linked to CA, classified in pathogenicity groups. Results The 319 included patients had equal sex distribution (160 female [50.2%] and 159 male patients [49.8%]; mean [SD] age at onset, 27.9 [18.6] years). The age at onset was younger than 25 years for 131 of 298 patients (44.0%) with complete clinical information. Consanguinity was present in 101 of 298 (33.9%). Very probable or definite diagnoses were achieved for 72 patients (22.6%), with an additional 19 (6.0%) harboring possibly pathogenic variants. The most frequently mutated genes were SPG7 (n = 14), SACS (n = 8), SETX (n = 7), SYNE1 (n = 6), and CACNA1A (n = 6). The highest diagnostic rate was obtained for patients with an autosomal recessive CA with oculomotor apraxia-like phenotype (6 of 17 [35.3%]) or spastic ataxia (35 of 100 [35.0%]) and patients with onset before 25 years of age (41 of 131 [31.3%]). Peculiar phenotypes were reported for patients carrying KCND3 or ERCC5 variants. Conclusions and Relevance Exome capture followed by targeted analysis allows the molecular diagnosis in patients with highly heterogeneous mendelian disorders, such as CA, without prior assumption of the inheritance mode or causative gene. Being commonly available without specific design need, this procedure allows testing of a broader range of genes, consequently describing less classic phenotype-genotype correlations, and post hoc reanalysis of data as new genes are implicated in the disease.
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Affiliation(s)
- Marie Coutelier
- Institut National de la Santé et de la Recherche Medicale (INSERM) U1127, Paris, France.,Centre National de la Recherche Scientifique, Unité Mixte de Recherche (UMR) 7225, Paris, France.,Unité Mixte de Recherche en Santé 1127, Université Pierre et Marie Curie (Paris 06), Sorbonne Universités, Paris, France.,Institut du Cerveau et de la Moelle Epinière, Paris, France.,Laboratory of Human Molecular Genetics, de Duve Institute, Université Catholique de Louvain, Brussels, Belgium.,Ecole Pratique des Hautes Etudes, Paris Sciences et Lettres Research University, Paris, France
| | - Monia B Hammer
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, Maryland
| | - Giovanni Stevanin
- Institut National de la Santé et de la Recherche Medicale (INSERM) U1127, Paris, France.,Centre National de la Recherche Scientifique, Unité Mixte de Recherche (UMR) 7225, Paris, France.,Unité Mixte de Recherche en Santé 1127, Université Pierre et Marie Curie (Paris 06), Sorbonne Universités, Paris, France.,Institut du Cerveau et de la Moelle Epinière, Paris, France.,Ecole Pratique des Hautes Etudes, Paris Sciences et Lettres Research University, Paris, France.,Centre de Référence de Neurogénétique, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Marie-Lorraine Monin
- Centre de Référence de Neurogénétique, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Claire-Sophie Davoine
- Institut National de la Santé et de la Recherche Medicale (INSERM) U1127, Paris, France.,Centre National de la Recherche Scientifique, Unité Mixte de Recherche (UMR) 7225, Paris, France.,Unité Mixte de Recherche en Santé 1127, Université Pierre et Marie Curie (Paris 06), Sorbonne Universités, Paris, France.,Institut du Cerveau et de la Moelle Epinière, Paris, France.,Ecole Pratique des Hautes Etudes, Paris Sciences et Lettres Research University, Paris, France
| | - Fanny Mochel
- Institut National de la Santé et de la Recherche Medicale (INSERM) U1127, Paris, France.,Centre National de la Recherche Scientifique, Unité Mixte de Recherche (UMR) 7225, Paris, France.,Unité Mixte de Recherche en Santé 1127, Université Pierre et Marie Curie (Paris 06), Sorbonne Universités, Paris, France.,Institut du Cerveau et de la Moelle Epinière, Paris, France.,Centre de Référence de Neurogénétique, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Pierre Labauge
- Service de Neurologie, Hopital Gui de Chauliac, Centre Hospitalier Universitaire (CHU) de Montpellier, Montpellier, France
| | - Claire Ewenczyk
- Centre de Référence de Neurogénétique, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Jinhui Ding
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, Maryland
| | - J Raphael Gibbs
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, Maryland
| | - Didier Hannequin
- Service de Génétique, Service de Neurologie, INSERM U1079, Rouen University Hospital, Rouen, France
| | - Judith Melki
- UMR 1169, INSERM and University Paris Saclay, Le Kremlin Bicêtre, France.,Medical Genetics Unit, Centre Hospitalier Sud-Francilien, Corbeil Essonnes, France
| | - Annick Toutain
- Service de Génétique, Centre Hospitalier Universitaire de Tours, INSERM U930, Faculté de Médecine, Université François Rabelais, Tours, France
| | - Vincent Laugel
- Service de Pédiatrie 1, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Sylvie Forlani
- Institut National de la Santé et de la Recherche Medicale (INSERM) U1127, Paris, France.,Centre National de la Recherche Scientifique, Unité Mixte de Recherche (UMR) 7225, Paris, France.,Unité Mixte de Recherche en Santé 1127, Université Pierre et Marie Curie (Paris 06), Sorbonne Universités, Paris, France.,Institut du Cerveau et de la Moelle Epinière, Paris, France
| | - Perrine Charles
- Centre de Référence de Neurogénétique, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Emmanuel Broussolle
- Service de Neurologie C, Hôpital Neurologique Pierre-Wertheimer, Hospices Civils de Lyon, Bron, France.,Centre de Neurosciences Cognitives, Centre National de la Recherche Scientifique (CNRS)-UMR 5229, Bron, France.,Université de Lyon, Université Claude-Bernard-Lyon I, Villeurbanne, France
| | - Stéphane Thobois
- Service de Neurologie C, Hôpital Neurologique Pierre-Wertheimer, Hospices Civils de Lyon, Bron, France.,Centre de Neurosciences Cognitives, Centre National de la Recherche Scientifique (CNRS)-UMR 5229, Bron, France.,Université de Lyon, Université Claude-Bernard-Lyon I, Villeurbanne, France
| | - Alexandra Afenjar
- Service de Génétique et Centre de Référence Pour les Malformations et les Maladies Congénitales du Cervelet, AP-HP, Paris, France
| | - Mathieu Anheim
- Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, Strasbourg, France.,Département de Neurologie, Hôpital de Hautepierre, CHU de Strasbourg, Strasbourg, France.,Institut de Génétique et de Biologie Moléculaire et Cellulaire, INSERM U964, CNRS-UMR 7104, Université de Strasbourg, Illkirch, France
| | - Patrick Calvas
- Service de Génétique Médicale, CHU de Toulouse, Hôpital Purpan, Toulouse, France
| | | | - Thomas de Broucker
- Service de Neurologie, Centre Hospitalier de Saint-Denis, Saint-Denis, France
| | - Marie Vidailhet
- Institut National de la Santé et de la Recherche Medicale (INSERM) U1127, Paris, France.,Centre National de la Recherche Scientifique, Unité Mixte de Recherche (UMR) 7225, Paris, France.,Unité Mixte de Recherche en Santé 1127, Université Pierre et Marie Curie (Paris 06), Sorbonne Universités, Paris, France.,Institut du Cerveau et de la Moelle Epinière, Paris, France.,Département des Maladies du Système Nerveux, Hôpital de la Pitié-Salpêtrière, AP-HP, Paris, France
| | - Antoine Moulignier
- Service de Neurologie, Fondation Ophtalmologique A. de Rothschild, Paris, France
| | | | - Chantal Tallaksen
- Institut National de la Santé et de la Recherche Medicale (INSERM) U1127, Paris, France.,Centre National de la Recherche Scientifique, Unité Mixte de Recherche (UMR) 7225, Paris, France.,Unité Mixte de Recherche en Santé 1127, Université Pierre et Marie Curie (Paris 06), Sorbonne Universités, Paris, France.,Institut du Cerveau et de la Moelle Epinière, Paris, France.,currently affiliated with Department of Neurology, Oslo University Hospital; and Faculty of Medicine, Oslo University, Oslo, Norway
| | - Cyril Mignot
- Département de Génétique and Centre de Référence Déficiences Intellectuelles de Causes Rares, Groupe Hospitalier Pitié Salpêtrière, AP-HP, Paris, France
| | - Cyril Goizet
- Laboratoire Maladies Rares, Génétique et Métabolisme, Université de Bordeaux, Bordeaux, France.,Service de Génétique Médicale, CHU Pellegrin, Bordeaux, France
| | - Isabelle Le Ber
- Institut National de la Santé et de la Recherche Medicale (INSERM) U1127, Paris, France.,Centre National de la Recherche Scientifique, Unité Mixte de Recherche (UMR) 7225, Paris, France.,Unité Mixte de Recherche en Santé 1127, Université Pierre et Marie Curie (Paris 06), Sorbonne Universités, Paris, France.,Institut du Cerveau et de la Moelle Epinière, Paris, France
| | | | - Jean Pouget
- Centre de Référence des Maladies Neuromusculaires et de la Sclérose Latérale Amyotrophique, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université, Hôpital de La Timone, Marseille, France
| | - Alexis Brice
- Institut National de la Santé et de la Recherche Medicale (INSERM) U1127, Paris, France.,Centre National de la Recherche Scientifique, Unité Mixte de Recherche (UMR) 7225, Paris, France.,Unité Mixte de Recherche en Santé 1127, Université Pierre et Marie Curie (Paris 06), Sorbonne Universités, Paris, France.,Institut du Cerveau et de la Moelle Epinière, Paris, France.,Centre de Référence de Neurogénétique, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Andrew Singleton
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, Maryland
| | - Alexandra Durr
- Institut National de la Santé et de la Recherche Medicale (INSERM) U1127, Paris, France.,Centre National de la Recherche Scientifique, Unité Mixte de Recherche (UMR) 7225, Paris, France.,Unité Mixte de Recherche en Santé 1127, Université Pierre et Marie Curie (Paris 06), Sorbonne Universités, Paris, France.,Institut du Cerveau et de la Moelle Epinière, Paris, France.,Centre de Référence de Neurogénétique, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
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22
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Rudenskaya GE, Shchagina OA, Ampleeva MA, Konovalov FA. [Ataxia-telangiectasia with rare phenotype and unusual pedigree]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:101-106. [PMID: 31407689 DOI: 10.17116/jnevro2019119061101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The authors present an unique familial case of ataxia-telangiectasia (AT) mimicking autosomal dominant inheritance with different phenotypes in a 3-year-old boy (ataxia and moderate dyskinesia since 1.5 years) and his 31-year-old mother (mild dystonia, predominantly torticollis, since 10 years). Exome sequencing of the boy detected two heterozygous ATM mutations c.1564_1565delGA (p.Glu522fs) and c.6154G>A (p.Glu2052Lys) reported earlier. Sanger sequencing found both mutations in the child, the father was heterozygous for c.1564_1565delGA, the mother for 6154G>A earlier reported in the rare A-T phenotype of 'pure' local dystonia. Exome sequencing of the mother, who considered herself healthy, detected the allelic ATM mutation c.7630-2A>C in intron 51.
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Affiliation(s)
| | - O A Shchagina
- Research Centre for Medical Genetics, Moscow, Russia
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23
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Fiévet A, Bellanger D, Rieunier G, Dubois d'Enghien C, Sophie J, Calvas P, Carriere JP, Anheim M, Castrioto A, Flabeau O, Degos B, Ewenczyk C, Mahlaoui N, Touzot F, Suarez F, Hully M, Roubertie A, Aladjidi N, Tison F, Antoine-Poirel H, Dahan K, Doummar D, Nougues MC, Ioos C, Rougeot C, Masurel A, Bourjault C, Ginglinger E, Prieur F, Siri A, Bordigoni P, Nguyen K, Philippe N, Bellesme C, Demeocq F, Altuzarra C, Mathieu-Dramard M, Couderc F, Dörk T, Auger N, Parfait B, Abidallah K, Moncoutier V, Collet A, Stoppa-Lyonnet D, Stern MH. Functional classification of ATM variants in ataxia-telangiectasia patients. Hum Mutat 2019; 40:1713-1730. [PMID: 31050087 DOI: 10.1002/humu.23778] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 04/24/2019] [Accepted: 04/29/2019] [Indexed: 12/11/2022]
Abstract
Ataxia-telangiectasia (A-T) is a recessive disorder caused by biallelic pathogenic variants of ataxia-telangiectasia mutated (ATM). This disease is characterized by progressive ataxia, telangiectasia, immune deficiency, predisposition to malignancies, and radiosensitivity. However, hypomorphic variants may be discovered associated with very atypical phenotypes, raising the importance of evaluating their pathogenic effects. In this study, multiple functional analyses were performed on lymphoblastoid cell lines from 36 patients, comprising 49 ATM variants, 24 being of uncertain significance. Thirteen patients with atypical phenotype and presumably hypomorphic variants were of particular interest to test strength of functional analyses and to highlight discrepancies with typical patients. Western-blot combined with transcript analyses allowed the identification of one missing variant, confirmed suspected splice defects and revealed unsuspected minor transcripts. Subcellular localization analyses confirmed the low level and abnormal cytoplasmic localization of ATM for most A-T cell lines. Interestingly, atypical patients had lower kinase defect and less altered cell-cycle distribution after genotoxic stress than typical patients. In conclusion, this study demonstrated the pathogenic effects of the 49 variants, highlighted the strength of KAP1 phosphorylation test for pathogenicity assessment and allowed the establishment of the Ataxia-TeLangiectasia Atypical Score to predict atypical phenotype. Altogether, we propose strategies for ATM variant detection and classification.
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Affiliation(s)
- Alice Fiévet
- Institut Curie, PSL Research University, INSERM U830, Paris, France.,Institut Curie, Hôpital, Service de Génétique, Paris, France
| | - Dorine Bellanger
- Institut Curie, PSL Research University, INSERM U830, Paris, France
| | | | | | - Julia Sophie
- CHU de Toulouse, Service de Génétique Médicale, Toulouse, France
| | - Patrick Calvas
- CHU de Toulouse, Service de Génétique Médicale, Toulouse, France
| | - Jean-Paul Carriere
- Hopital des enfants de Toulouse, Unité de Neuropédiatrie, Toulouse, France
| | - Mathieu Anheim
- CHU de Strasbourg, Service de Neurologie, Strasbourg, France
| | - Anna Castrioto
- CHU de Grenoble, Pole de Psychiatrie et de Neurologie, Grenoble, France
| | - Olivier Flabeau
- CH de la côte Basque, Service de Neurologie, Bayonne, France
| | - Bertrand Degos
- Département des Maladies du Système Nerveux, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France
| | - Claire Ewenczyk
- Hôpitaux universitaires Pitié Salpêtrière - Charles Foix, Service de Génétique, Paris, France
| | - Nizar Mahlaoui
- Hôpital Necker Enfants Malades, Service d'Immunologie, d'Hématologie et de Rhumatologie Pédiatriques, Paris, France
| | - Fabien Touzot
- Hôpital Necker Enfants Malades, Service d'Immunologie, d'Hématologie et de Rhumatologie Pédiatriques, Paris, France
| | - Felipe Suarez
- Hôpital Necker Enfants Malades, Service d'Hématologie Adulte, Paris, France
| | - Marie Hully
- Hôpital Necker Enfants Malades, Service de Neurologie Pédiatrique, Paris, France
| | - Agathe Roubertie
- CHU de Montpellier, Service de Neuropédiatrie, Montpellier, France
| | | | - François Tison
- CHU de Bordeaux, Département de Neurologie, Bordeaux, France
| | - Hélène Antoine-Poirel
- Centre de Génétique Humaine, Cliniques Universitaires Saint-Luc & Université Catholique de Louvain, Brussels, Belgium
| | - Karine Dahan
- Centre de Génétique Humaine, Cliniques Universitaires Saint-Luc & Université Catholique de Louvain, Brussels, Belgium
| | - Diane Doummar
- Hopital Armand Trousseau, Service de Neurologie Pédiatrique, Paris, France
| | | | - Christine Ioos
- Hôpital Raymond Poincaré, Pôle de Pédiatrie, Garches, France
| | | | - Alice Masurel
- Hopital d'Enfants de Dijon, Service de Génétique, Dijon, France
| | - Caroline Bourjault
- CH de Bretagne sud, Site du Scorff, Service de Pédiatrie, Lorient, France
| | | | - Fabienne Prieur
- CHU de St Etienne, Hôpital Nord, Service de Génétique Médicale, Saint Etienne, France
| | - Aurélie Siri
- CHU de Nancy, Service de Neurologie, Nancy, France
| | - Pierre Bordigoni
- CHU Nancy, Hôpitaux de Brabois, Service de Pédiatrie II, Vandoeuvre, France
| | - Karine Nguyen
- Département de Génétique Médicale, Hopital de la Timone, Marseille, France
| | - Noel Philippe
- Hopital Debrousse, Service d'Hématologie Pédiatrique, Lyon, France
| | - Céline Bellesme
- GH Cochin-saint-Vincent de Paul, Service d'Endocrinologie et de Neurologie Pédiatrique, Paris, France
| | - François Demeocq
- CHU de Clermont-Ferrand, Hôtel Dieu, Service de Pédiatrie B, Clermont-Ferrand, France
| | | | | | - Fanny Couderc
- CH d'Aix en Provence - du Pays d'Aix, Service de Pédiatrie, Aix en Provence, France
| | - Thilo Dörk
- Gynecology Research Unit, Hannover Medical School, Hannover, Germany
| | - Nathalie Auger
- Gustave Roussy, Service Génétique des Tumeurs, Villejuif, France
| | - Béatrice Parfait
- Centre de ressources Biologiques, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | | | - Agnès Collet
- Institut Curie, Hôpital, Service de Génétique, Paris, France
| | - Dominique Stoppa-Lyonnet
- Institut Curie, PSL Research University, INSERM U830, Paris, France.,Institut Curie, Hôpital, Service de Génétique, Paris, France.,University Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Marc-Henri Stern
- Institut Curie, PSL Research University, INSERM U830, Paris, France.,Institut Curie, Hôpital, Service de Génétique, Paris, France
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24
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van Os NJH, Chessa L, Weemaes CMR, van Deuren M, Fiévet A, van Gaalen J, Mahlaoui N, Roeleveld N, Schrader C, Schindler D, Taylor AMR, Van de Warrenburg BPC, Dörk T, Willemsen MAAP. Genotype-phenotype correlations in ataxia telangiectasia patients with ATM c.3576G>A and c.8147T>C mutations. J Med Genet 2019; 56:308-316. [PMID: 30819809 DOI: 10.1136/jmedgenet-2018-105635] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 11/21/2018] [Accepted: 12/19/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND Ataxia telangiectasia (A-T) is a neurodegenerative disorder. While patients with classic A-T generally die in their 20s, some patients with variant A-T, who have residual ataxia-telangiectasia mutated (ATM) kinase activity, have a milder phenotype. We noticed two commonly occurring ATM mutations that appeared to be associated with prolonged survival and decided to study patients carrying one of these mutations. METHODS Data were retrospectively collected from the Dutch, Italian, German and French A-T cohorts. To supplement these data, we searched the literature for patients with identical genotypes. RESULTS This study included 35 patients who were homozygous or compound heterozygous for the ATM c.3576G>A; p.(Ser1135_Lys1192del58) mutation and 24 patients who were compound heterozygous for the ATM c.8147T>C; p.(Val2716Ala) mutation. Compared with 51 patients with classic A-T from the Dutch cohort, patients with ATM c.3576G>A had a longer survival and were less likely to develop cancer, respiratory disease or immunodeficiency. This was also true for patients with ATM c.8147T>C, who additionally became wheelchair users later in life and had fewer telangiectasias. The oldest patient with A-T reported so far was a 78-year-old patient who was compound heterozygous for ATM c.8147T>C. ATM kinase activity was demonstrated in cells from all patients tested with the ATM c.8147T>C mutant protein and only at a low level in some patients with ATM c.3576G>A. CONCLUSION Compared with classic A-T, the presence of ATM c.3576G>A results in a milder classic phenotype. Patients with ATM c.8147T>C have a variant phenotype with prolonged survival, which in exceptional cases may approach a near-normal lifespan.
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Affiliation(s)
- Nienke J H van Os
- Department of Pediatric Neurology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Luciana Chessa
- Department of Clinical and Molecular Medicine, Sapienza Università di Roma, Rome, Italy
| | - Corry M R Weemaes
- Department of Pediatrics, Pediatric Infectious Disease and Immunology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marcel van Deuren
- Department of Internal Medicine, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Alice Fiévet
- INSERM UMR 830, Institut de recherche, Institut Curie, PSL Research University, Paris, France
- Service de Génétique, Institut Curie Hôpital, Paris, France
| | - Judith van Gaalen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Nizar Mahlaoui
- French National Reference Center for Primary Immune Deficiencies (CEREDIH), Pediatric Immuno-Haematology and Rheumatology Unit, Biostatistics Unit, Necker Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM UMR 1163, Imagine Institute, Paris, France
- INSERM UMR 1163, Sorbonne Paris Cité, Imagine Institute, Paris Descartes University, Paris, France
| | - Nel Roeleveld
- Department of Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Detlev Schindler
- Institute of Human Genetics, University of Wurzburg, Wurzburg, Germany
| | | | - Bart P C Van de Warrenburg
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Thilo Dörk
- Gynaecology Research Unit, Hannover Medical School, Hannover, Germany
| | - Michèl A A P Willemsen
- Department of Pediatric Neurology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands
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Pearson TS, Pons R, Ghaoui R, Sue CM. Genetic mimics of cerebral palsy. Mov Disord 2019; 34:625-636. [PMID: 30913345 DOI: 10.1002/mds.27655] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 02/04/2019] [Accepted: 02/10/2019] [Indexed: 12/20/2022] Open
Abstract
The term "cerebral palsy mimic" is used to describe a number of neurogenetic disorders that may present with motor symptoms in early childhood, resulting in a misdiagnosis of cerebral palsy. Cerebral palsy describes a heterogeneous group of neurodevelopmental disorders characterized by onset in infancy or early childhood of motor symptoms (including hypotonia, spasticity, dystonia, and chorea), often accompanied by developmental delay. The primary etiology of a cerebral palsy syndrome should always be identified if possible. This is particularly important in the case of genetic or metabolic disorders that have specific disease-modifying treatment. In this article, we discuss clinical features that should alert the clinician to the possibility of a cerebral palsy mimic, provide a practical framework for selecting and interpreting neuroimaging, biochemical, and genetic investigations, and highlight selected conditions that may present with predominant spasticity, dystonia/chorea, and ataxia. Making a precise diagnosis of a genetic disorder has important implications for treatment, and for advising the family regarding prognosis and genetic counseling. © 2019 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Toni S Pearson
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Roser Pons
- First Department of Pediatrics, National and Kapodistrian University of Athens, Aghia Sofia Hospital, Athens, Greece
| | - Roula Ghaoui
- Department of Neurology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Carolyn M Sue
- Department of Neurogenetics, Kolling Institute, Royal North Shore Hospital and University of Sydney, St Leonards, NSW, Australia
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Martin-Rodriguez S, Calvo-Ferrer A, Ortega-Unanue N, Samaniego-Jimenez L, Sanz-Izquierdo MP, Bernardo-Gonzalez I. Two novel variants in the ATM gene causing ataxia-telangiectasia, including a duplication of 90 kb: Utility of targeted next-generation sequencing in detection of copy number variation. Ann Hum Genet 2019; 83:266-273. [PMID: 30888062 DOI: 10.1111/ahg.12312] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 03/03/2019] [Accepted: 03/04/2019] [Indexed: 12/20/2022]
Abstract
Ataxia-telangiectasia (A-T) is a rare autosomal recessive neurodegenerative disorder characterized by progressive cerebellar ataxia, ocular apraxia, immunodeficiency, telangiectasia, elevated serum α-fetoprotein concentration, radiosensitivity and cancer predisposition. Classical A-T is caused by biallelic variants on ATM (ataxia telangiectasia mutated) gene, leading to a loss of function of the protein kinase ATM, involved in DNA damage repair. Atypical presentations can be found in A-T-like disease or in Nijmegen breakage syndrome, caused by deficiency of mre11 or nibrin proteins, respectively. In this report, we present the genetic characterization of a 4-year-old female with clinical diagnosis of A-T. Next-generation sequencing (NGS) revealed two novel heterozygous mutations in the ATM gene: a single-nucleotide variant (SNV) at exon 47 (NM_000051.3:c.6899G > C; p.Trp2300Ser) and ∼90 kb genomic duplication spanning exons 17-61, NG_009830.1:g.(41245_49339)_(137044_147250)dup. These findings were validated by Sanger sequencing and MLPA (multiplex ligation-dependent probe amplification) analysis respectively. Familial segregation study confirmed that the two variants are inherited, and the infant is a compound heterozygote. Thus, our study expands the spectrum of ATM pathogenic variants and demonstrates the utility of targeted NGS in the detection of copy number variation.
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Schon K, van Os NJ, Oscroft N, Baxendale H, Scoffings D, Ray J, Suri M, Whitehouse WP, Mehta PR, Everett N, Bottolo L, van de Warrenburg BP, Byrd PJ, Weemaes C, Willemsen MA, Tischkowitz M, Taylor AM, Hensiek AE. Genotype, extrapyramidal features, and severity of variant ataxia-telangiectasia. Ann Neurol 2019; 85:170-180. [PMID: 30549301 PMCID: PMC6590299 DOI: 10.1002/ana.25394] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 12/09/2018] [Accepted: 12/10/2018] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Variant ataxia-telangiectasia is caused by mutations that allow some retained ataxia telangiectasia-mutated (ATM) kinase activity. Here, we describe the clinical features of the largest established cohort of individuals with variant ataxia-telangiectasia and explore genotype-phenotype correlations. METHODS Cross-sectional data were collected retrospectively. Patients were classified as variant ataxia-telangiectasia based on retained ATM kinase activity. RESULTS The study includes 57 individuals. Mean age at assessment was 37.5 years. Most had their first symptoms by age 10 (81%). There was a diagnostic delay of more than 10 years in 68% and more than 20 years in one third of probands. Disease severity was mild in one third of patients, and 43% were still ambulant 20 years after disease onset. Only one third had predominant ataxia, and 18% had a pure extrapyramidal presentation. Individuals with extrapyramidal presentations had milder neurological disease severity. There were no significant respiratory or immunological complications, but 25% of individuals had a history of malignancy. Missense mutations were associated with milder neurological disease severity, but with a higher risk of malignancy, compared to leaky splice site mutations. INTERPRETATION Individuals with variant ataxia-telangiectasia require malignancy surveillance and tailored management. However, our data suggest the condition may sometimes be mis- or underdiagnosed because of atypical features, including exclusive extrapyramidal symptoms, normal eye movements, and normal alpha-fetoprotein levels in some individuals. Missense mutations are associated with milder neurological presentations, but a particularly high malignancy risk, and it is important for clinicians to be aware of these phenotypes. ANN NEUROL 2019;85:170-180.
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Affiliation(s)
- Katherine Schon
- East Anglian Medical Genetics ServiceCambridge University Hospitals NHS Foundation TrustCambridgeUnited Kingdom
| | - Nienke J.H. van Os
- Departments of Neurology & Pediatric Neurology, Donders Institute for Brain, Cognition and BehaviourRadboud University Medical CentreNijmegenThe Netherlands
| | - Nicholas Oscroft
- Ataxia Telangiectasia Service, Respiratory Support and Sleep CentrePapworth HospitalCambridgeUnited Kingdom
| | - Helen Baxendale
- Ataxia Telangiectasia Service, Respiratory Support and Sleep CentrePapworth HospitalCambridgeUnited Kingdom
| | - Daniel Scoffings
- Department of RadiologyCambridge University Hospitals NHS Foundation TrustCambridgeUnited Kingdom
| | - Julian Ray
- Department of NeurophysiologyCambridge University Hospitals NHS Foundation TrustCambridgeUnited Kingdom
| | - Mohnish Suri
- Nottingham Clinical Genetics ServiceNational Paediatric Ataxia‐Telangiectasia ClinicNottinghamUnited Kingdom
| | - William P. Whitehouse
- School of MedicineUniversity of Nottingham, Queen's Medical CentreNottinghamUnited Kingdom
- Department of Paediatric NeurologyNottingham Children's Hospital, Nottingham University Hospitals NHS TrustNottinghamUnited Kingdom
| | - Puja R. Mehta
- Ataxia Telangiectasia Service, Respiratory Support and Sleep CentrePapworth HospitalCambridgeUnited Kingdom
| | - Natasha Everett
- Ataxia Telangiectasia Service, Respiratory Support and Sleep CentrePapworth HospitalCambridgeUnited Kingdom
| | - Leonardo Bottolo
- Department of Medical GeneticsCambridge Biomedical CampusCambridgeUnited Kingdom
- The Alan Turing InstituteBritish LibraryLondonUnited Kingdom
- MRC Biostatistics UnitUniversity of Cambridge, Cambridge Biomedical CampusCambridgeUnited Kingdom
| | - Bart P. van de Warrenburg
- Departments of Neurology & Pediatric Neurology, Donders Institute for Brain, Cognition and BehaviourRadboud University Medical CentreNijmegenThe Netherlands
| | - Philip J. Byrd
- Institute of Cancer and Genomic Sciences, College of Medical and Dental SciencesUniversity of BirminghamBirminghamUnited Kingdom
| | - Corry Weemaes
- Department of PediatricsRadboudumc Amalia Children's HospitalNijmegenThe Netherlands
| | - Michel A. Willemsen
- Departments of Neurology & Pediatric Neurology, Donders Institute for Brain, Cognition and BehaviourRadboud University Medical CentreNijmegenThe Netherlands
| | - Marc Tischkowitz
- East Anglian Medical Genetics ServiceCambridge University Hospitals NHS Foundation TrustCambridgeUnited Kingdom
- Department of Medical GeneticsCambridge Biomedical CampusCambridgeUnited Kingdom
| | - A. Malcolm Taylor
- Institute of Cancer and Genomic Sciences, College of Medical and Dental SciencesUniversity of BirminghamBirminghamUnited Kingdom
| | - Anke E. Hensiek
- Ataxia Telangiectasia Service, Respiratory Support and Sleep CentrePapworth HospitalCambridgeUnited Kingdom
- Department of NeurologyCambridge University Hospitals NHS Foundation TrustCambridgeUnited Kingdom
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van Os NJH, Hensiek A, van Gaalen J, Taylor AMR, van Deuren M, Weemaes CMR, Willemsen MAAP, van de Warrenburg BPC. Trajectories of motor abnormalities in milder phenotypes of ataxia telangiectasia. Neurology 2019; 92:e19-e29. [PMID: 30504431 DOI: 10.1212/wnl.0000000000006700] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 08/29/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To describe and classify the neurologic trajectories in patients with mild neurologic forms of ataxia telangiectasia (A-T) from the Dutch A-T cohort, combined with patients reported in the literature. METHODS Clinical, genetic, and laboratory data of 14 patients with mild neurologic phenotypes of A-T from the Dutch cohort were analyzed and combined with corresponding data from the literature. A mild neurologic phenotype was defined by a later onset, nonataxia presenting or dominant feature, or slower progression compared to the classic A-T phenotype. Neurologic trajectories were classified based on age at onset, presenting feature, and follow-up data. RESULTS One hundred five patients were included in the study. Neurologic trajectories were categorized into 6 groups: patients with childhood-onset extrapyramidal (EP) features with cerebellar symptoms developing later (group 1; 18 patients), childhood-onset cerebellar symptoms, with EP features developing later (group 2; 35 patients), childhood- to adolescence-onset dystonia, without cerebellar symptoms (group 3; 23 patients), childhood- to adolescence-onset isolated cerebellar symptoms (group 4; 22 patients), childhood- to adult-onset prominent muscle weakness (group 5; 2 patients), and patients with adult-onset EP features, with anterior horn cell disease arising subsequently (group 6; 5 patients). CONCLUSIONS This systematic study of the different motor abnormalities and their course over time in patients with mild phenotypes of A-T, enabled us to recognize 6 essentially different phenotypic patterns. Awareness of these different trajectories of motor abnormalities in milder forms of A-T will contribute to a reduction of diagnostic delay in this severe multisystem disorder.
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Affiliation(s)
- Nienke J H van Os
- From the Department of Neurology-Pediatric Neurology (N.J.H.v.O., M.A.A.P.W.) and Department of Neurology (N.J.H.v.O., J.v.G., B.P.C.v.d.W.), Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Neurology (A.H.), Addenbrookes Hospital, Cambridge; Institute of Cancer & Genomic Sciences (A.M.R.T.), University of Birmingham, UK; Department of Internal Medicine (M.v.D.), Radboud University Medical Center, Nijmegen; Department of Pediatric Infectious Diseases and Immunology (C.M.R.W.), Amalia Children's Hospital and Radboud Institute for Molecular Life Sciences, and Department of Pediatrics, Radboudumc Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Anke Hensiek
- From the Department of Neurology-Pediatric Neurology (N.J.H.v.O., M.A.A.P.W.) and Department of Neurology (N.J.H.v.O., J.v.G., B.P.C.v.d.W.), Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Neurology (A.H.), Addenbrookes Hospital, Cambridge; Institute of Cancer & Genomic Sciences (A.M.R.T.), University of Birmingham, UK; Department of Internal Medicine (M.v.D.), Radboud University Medical Center, Nijmegen; Department of Pediatric Infectious Diseases and Immunology (C.M.R.W.), Amalia Children's Hospital and Radboud Institute for Molecular Life Sciences, and Department of Pediatrics, Radboudumc Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Judith van Gaalen
- From the Department of Neurology-Pediatric Neurology (N.J.H.v.O., M.A.A.P.W.) and Department of Neurology (N.J.H.v.O., J.v.G., B.P.C.v.d.W.), Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Neurology (A.H.), Addenbrookes Hospital, Cambridge; Institute of Cancer & Genomic Sciences (A.M.R.T.), University of Birmingham, UK; Department of Internal Medicine (M.v.D.), Radboud University Medical Center, Nijmegen; Department of Pediatric Infectious Diseases and Immunology (C.M.R.W.), Amalia Children's Hospital and Radboud Institute for Molecular Life Sciences, and Department of Pediatrics, Radboudumc Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Alexander M R Taylor
- From the Department of Neurology-Pediatric Neurology (N.J.H.v.O., M.A.A.P.W.) and Department of Neurology (N.J.H.v.O., J.v.G., B.P.C.v.d.W.), Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Neurology (A.H.), Addenbrookes Hospital, Cambridge; Institute of Cancer & Genomic Sciences (A.M.R.T.), University of Birmingham, UK; Department of Internal Medicine (M.v.D.), Radboud University Medical Center, Nijmegen; Department of Pediatric Infectious Diseases and Immunology (C.M.R.W.), Amalia Children's Hospital and Radboud Institute for Molecular Life Sciences, and Department of Pediatrics, Radboudumc Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marcel van Deuren
- From the Department of Neurology-Pediatric Neurology (N.J.H.v.O., M.A.A.P.W.) and Department of Neurology (N.J.H.v.O., J.v.G., B.P.C.v.d.W.), Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Neurology (A.H.), Addenbrookes Hospital, Cambridge; Institute of Cancer & Genomic Sciences (A.M.R.T.), University of Birmingham, UK; Department of Internal Medicine (M.v.D.), Radboud University Medical Center, Nijmegen; Department of Pediatric Infectious Diseases and Immunology (C.M.R.W.), Amalia Children's Hospital and Radboud Institute for Molecular Life Sciences, and Department of Pediatrics, Radboudumc Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Corry M R Weemaes
- From the Department of Neurology-Pediatric Neurology (N.J.H.v.O., M.A.A.P.W.) and Department of Neurology (N.J.H.v.O., J.v.G., B.P.C.v.d.W.), Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Neurology (A.H.), Addenbrookes Hospital, Cambridge; Institute of Cancer & Genomic Sciences (A.M.R.T.), University of Birmingham, UK; Department of Internal Medicine (M.v.D.), Radboud University Medical Center, Nijmegen; Department of Pediatric Infectious Diseases and Immunology (C.M.R.W.), Amalia Children's Hospital and Radboud Institute for Molecular Life Sciences, and Department of Pediatrics, Radboudumc Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Michèl A A P Willemsen
- From the Department of Neurology-Pediatric Neurology (N.J.H.v.O., M.A.A.P.W.) and Department of Neurology (N.J.H.v.O., J.v.G., B.P.C.v.d.W.), Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Neurology (A.H.), Addenbrookes Hospital, Cambridge; Institute of Cancer & Genomic Sciences (A.M.R.T.), University of Birmingham, UK; Department of Internal Medicine (M.v.D.), Radboud University Medical Center, Nijmegen; Department of Pediatric Infectious Diseases and Immunology (C.M.R.W.), Amalia Children's Hospital and Radboud Institute for Molecular Life Sciences, and Department of Pediatrics, Radboudumc Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Bart P C van de Warrenburg
- From the Department of Neurology-Pediatric Neurology (N.J.H.v.O., M.A.A.P.W.) and Department of Neurology (N.J.H.v.O., J.v.G., B.P.C.v.d.W.), Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Neurology (A.H.), Addenbrookes Hospital, Cambridge; Institute of Cancer & Genomic Sciences (A.M.R.T.), University of Birmingham, UK; Department of Internal Medicine (M.v.D.), Radboud University Medical Center, Nijmegen; Department of Pediatric Infectious Diseases and Immunology (C.M.R.W.), Amalia Children's Hospital and Radboud Institute for Molecular Life Sciences, and Department of Pediatrics, Radboudumc Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands
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Canet-Pons J, Schubert R, Duecker RP, Schrewe R, Wölke S, Kieslich M, Schnölzer M, Chiocchetti A, Auburger G, Zielen S, Warnken U. Ataxia telangiectasia alters the ApoB and reelin pathway. Neurogenetics 2018; 19:237-255. [DOI: 10.1007/s10048-018-0557-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 10/09/2018] [Indexed: 02/07/2023]
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Abstract
Within the field of movement disorders, the conceptual understanding of dystonia has continued to evolve. Clinical advances have included improvements in recognition of certain features of dystonia, such as tremor, and understanding of phenotypic spectrums in the genetic dystonias and dystonia terminology and classification. Progress has also been made in the understanding of underlying biological processes which characterize dystonia from discoveries using approaches such as neurophysiology, functional imaging, genetics, and animal models. Important advances include the role of the cerebellum in dystonia, the concept of dystonia as an aberrant brain network disorder, additional evidence supporting the concept of dystonia endophenotypes, and new insights into psychogenic dystonia. These discoveries have begun to shape treatment approaches as, in parallel, important new treatment modalities, including magnetic resonance imaging-guided focused ultrasound, have emerged and existing interventions such as deep brain stimulation have been further refined. In this review, these topics are explored and discussed.
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Affiliation(s)
- Stephen Tisch
- Faculty of Medicine, University of New South Wales, Sydney, Australia.,Department of Neurology, St Vincent's Hospital, Sydney, Australia
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Levy A, Lang AE. Ataxia-telangiectasia: A review of movement disorders, clinical features, and genotype correlations. Mov Disord 2018; 33:1238-1247. [PMID: 29436738 DOI: 10.1002/mds.27319] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 01/03/2018] [Accepted: 01/08/2018] [Indexed: 01/10/2023] Open
Abstract
Ataxia-telangiectasia is an autosomal recessive neurodegenerative disorder that was initially thought to present exclusively in childhood. With the discovery of the ATM gene, the phenotypic spectrum of the condition has expanded. This review elaborates the expanded phenomenology, including oculomotor apraxia and immunodeficiency, and estimates the presence of each movement disorder feature from previously reported literature. Initial manifestations of Ataxia-telangiectasia include cerebellar symptoms (67%), dystonia (18%), choreoathetosis (10%), and tremor (4%), with parkinsonism and myoclonus not reported as initial features. The prevalence of movement disorders during the course of the disease includes cerebellar symptoms (96%), dystonia (89%), parkinsonism (41%), choreoathetosis (89%), myoclonus (92%), and tremor (74%). Phenomenology and age of onset is modulated by presence of residual ATM kinase activity, with genotypes heavily truncating the ATM protein associated with the most severe phenotypes. Ataxia-telangiectasia commonly results in a spectrum of movement disorders beyond ataxia and telangiectasias. © 2018 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Ariel Levy
- Edmond J Safra Program in Parkinson's Disease, Toronto Western Hospital, Toronto, Ontario, Canada.,Morton and Gloria Shulman Movement Disorders Clinic, Toronto, Ontario, Canada.,Department of Neuroscience, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Anthony E Lang
- Edmond J Safra Program in Parkinson's Disease, Toronto Western Hospital, Toronto, Ontario, Canada.,Morton and Gloria Shulman Movement Disorders Clinic, Toronto, Ontario, Canada
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Tarnutzer AA, Straumann D, Salman MS. Neuro-ophthalmologic assessment and investigations in children and adults with cerebellar diseases. THE CEREBELLUM: FROM EMBRYOLOGY TO DIAGNOSTIC INVESTIGATIONS 2018; 154:305-327. [DOI: 10.1016/b978-0-444-63956-1.00019-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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More than ataxia – Movement disorders in ataxia-telangiectasia. Parkinsonism Relat Disord 2018; 46:3-8. [DOI: 10.1016/j.parkreldis.2017.12.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 12/05/2017] [Accepted: 12/11/2017] [Indexed: 12/31/2022]
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Boltshauser E, Weber KP. Laboratory investigations. HANDBOOK OF CLINICAL NEUROLOGY 2018; 154:287-298. [PMID: 29903445 DOI: 10.1016/b978-0-444-63956-1.00017-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This chapter deals with chemical and hematologic investigations which are often considered in the diagnostic workup of subacute to chronic cerebellar ataxias. Relevant investigations in blood (serum, plasma), urine, and cerebrospinal fluid are discussed. Particular attention is paid to early diagnosis of treatable metabolic ataxias (such as abetalipoproteinemia, coenzyme Q10 deficiency, cerebrotendinous xanthomatosis, glucose transporter type 1 deficiency, Refsum disease, and vitamin E deficiency), but autoimmune ataxias, other vitamin deficiencies, and endocrine disorders should also be kept in mind. Adequate interpretation of test results has to consider age-specific reference values. The selection of investigations should mainly be driven by the overall clinical context, considering gender, history, age, and mode of presentation, cerebellar and other neurologic as well as extraneurologic findings.
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Affiliation(s)
- Eugen Boltshauser
- Department of Pediatric Neurology, University Children's Hospital, University of Zurich, Zurich, Switzerland; Departments of Neurology and Ophthalmology, University Hospital Zurich, University of Zurich, Switzerland.
| | - Konrad P Weber
- Department of Pediatric Neurology, University Children's Hospital, University of Zurich, Zurich, Switzerland; Departments of Neurology and Ophthalmology, University Hospital Zurich, University of Zurich, Switzerland
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Comparing ataxias with oculomotor apraxia: a multimodal study of AOA1, AOA2 and AT focusing on video-oculography and alpha-fetoprotein. Sci Rep 2017; 7:15284. [PMID: 29127364 PMCID: PMC5681651 DOI: 10.1038/s41598-017-15127-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 10/18/2017] [Indexed: 01/03/2023] Open
Abstract
Whether the recessive ataxias, Ataxia with oculomotor apraxia type 1 (AOA1) and 2 (AOA2) and Ataxia telangiectasia (AT), can be distinguished by video-oculography and alpha-fetoprotein level remains unknown. We compared 40 patients with AOA1, AOA2 and AT, consecutively referred between 2008 and 2015 with 17 healthy subjects. Video-oculography revealed constant impairments in patients such as cerebellar signs, altered fixation, impaired pursuit, hypometric saccades and abnormal antisaccades. Horizontal saccade latencies could be highly increased reflecting oculomotor apraxia in one third of patients. Specific distinctive alpha-fetoprotein thresholds were determined for AOA1 (7–15 µg/L), AOA2 (15–65 µg/L) and AT (>65 µg/L). Early age onset, severe walking disability, movement disorders, sensori-motor neuropathy and cerebellar atrophy were all shared. In conclusion, alpha-fetoprotein level seems to permit a distinction while video-oculography does not and therefore is not mandatory, even if an appropriate oculomotor examination remains crucial. Our findings are that AOA1, AOA2 and AT form a particular group characterized by ataxia with complex oculomotor disturbances and elevated AFP for which the final diagnosis is relying on genetic analysis. These findings could guide genetic analysis, assist reverse-phenotyping and provide background for the interpretation of the numerous variants of unknown significance provided by next-generation sequencing.
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Primary Immune Deficiencies in the Adult: A Previously Underrecognized Common Condition. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 4:1101-1107. [PMID: 27836059 DOI: 10.1016/j.jaip.2016.09.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 09/01/2016] [Accepted: 09/09/2016] [Indexed: 12/21/2022]
Abstract
The large majority of classified primary immune deficiency (PID) diseases present in childhood. Yet, most patients with PID are adults, with a large proportion experiencing onset of symptoms beyond their childhood years. Most of these are diagnosed predominantly with antibody defects, but cellular and other disorders are increasingly being identified in older patients as well. Moreover, advances in clinical immunology are allowing pediatric patients, even those with severe disease, to reach adulthood. Because of differences in the physiology and pathophysiology of children and adults, the presentation, diagnosis, and management of a complex chronic disease could differ significantly between these patient populations and therefore require modifications in approach.
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Jinnah HA, Albanese A, Bhatia KP, Cardoso F, Da Prat G, de Koning TJ, Espay AJ, Fung V, Garcia-Ruiz PJ, Gershanik O, Jankovic J, Kaji R, Kotschet K, Marras C, Miyasaki JM, Morgante F, Munchau A, Pal PK, Rodriguez Oroz MC, Rodríguez-Violante M, Schöls L, Stamelou M, Tijssen M, Uribe Roca C, de la Cerda A, Gatto EM. Treatable inherited rare movement disorders. Mov Disord 2017; 33:21-35. [PMID: 28861905 DOI: 10.1002/mds.27140] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 07/21/2017] [Accepted: 07/23/2017] [Indexed: 12/19/2022] Open
Abstract
There are many rare movement disorders, and new ones are described every year. Because they are not well recognized, they often go undiagnosed for long periods of time. However, early diagnosis is becoming increasingly important. Rapid advances in our understanding of the biological mechanisms responsible for many rare disorders have enabled the development of specific treatments for some of them. Well-known historical examples include Wilson disease and dopa-responsive dystonia, for which specific and highly effective treatments have life-altering effects. In recent years, similarly specific and effective treatments have been developed for more than 30 rare inherited movement disorders. These treatments include specific medications, dietary changes, avoidance or management of certain triggers, enzyme replacement therapy, and others. This list of treatable rare movement disorders is likely to grow during the next few years because a number of additional promising treatments are actively being developed or evaluated in clinical trials. © 2017 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- H A Jinnah
- Departments of Neurology, Human Genetics and Pediatrics, Emory University, Atlanta, Georgia, USA
| | - Alberto Albanese
- Department of Neurology, Humanitas Research Hospital, Rozzano, Italy.,Catholic University, Milan, Italy
| | - Kailash P Bhatia
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London Institute of Neurology, London, United Kingdom
| | - Francisco Cardoso
- Department of Internal Medicine, Movement Disorders Clinic, Neurology Service, UFMG, Belo Horizonte, MG, Brazil
| | - Gustavo Da Prat
- Department of Neurology, Affiliated University of Buenos Aires, Buenos Aires, Argentina.,University DelSalvadore, Buenos Aires, Argentina
| | - Tom J de Koning
- Department of Genetics, Pediatrics and Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Alberto J Espay
- James J. and Joan A. Gardner Center for Parkinson's disease and Movement Disorders, University of Cincinnati, Ohio, USA
| | - Victor Fung
- Movement Disorders Unit, Department of Neurology, Westmead Hospital & Sydney Medical School, University of Sydney, Sydney, Australia
| | | | - Oscar Gershanik
- Institute of Neuroscience, Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | - Joseph Jankovic
- Department of Neurology, Parkinson's Disease Center and Movement Disorders Clinic, Baylor College of Medicine, Houston, Texas, USA
| | - Ryuji Kaji
- Department of Neurology, Tokushima University Graduate School of Medicine, Tokushima, Japan
| | - Katya Kotschet
- Clinical Neurosciences, St. Vincent's Health, Melbourne, Australia
| | - Connie Marras
- The Morton and Gloria Shulman Movement Disorders Centre and the Edmond J Safra Program in Parkinson's Disease, Toronto Western Hospital, University of Toronto, Toronto, Canada
| | | | - Francesca Morgante
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Alexander Munchau
- Department of Pediatric and Adult Movement Disorders and Neuropsychiatry, Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health & Neuroscience, Bangalore, India
| | - Maria C Rodriguez Oroz
- University Hospital Donostia, Madrid, Spain.,BioDonostia Research Institute, Basque Center on Cognition, Brain and Language, San Sebastian, Madrid, Spain.,Ikerbasque, Basque Foundation for Science, Bilbao, Spain.,Network Center for Biomedical Research in Neurodegenerative Diseases, Madrid, Spain
| | | | - Ludger Schöls
- Department of Neurology and Hertie Institute for Clinical Brain Research, University of Tubingen, Tubingen, Germany.,German Center for Neurodegenerative Diseases, Tubingen, Germany
| | - Maria Stamelou
- Neurology Clinic, Philipps University Marburg, Marburg, Germany.,Parkinson's Disease and Other Movement Disorders Department, HYGEIA Hospital, Athens, Greece
| | - Marina Tijssen
- Department of Neurology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Claudia Uribe Roca
- Department of Neurology, British Hospital of Buenos Aires, Buenos Aires, Argentina
| | | | - Emilia M Gatto
- Department of Neurology, Affiliated University of Buenos Aires and University DelSalvadore, Buenos Aires, Argentina
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van Os NJH, Haaxma CA, van der Flier M, Merkus PJFM, van Deuren M, de Groot IJM, Loeffen J, van de Warrenburg BPC, Willemsen MAAP. Ataxia-telangiectasia: recommendations for multidisciplinary treatment. Dev Med Child Neurol 2017; 59:680-689. [PMID: 28318010 DOI: 10.1111/dmcn.13424] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/04/2017] [Indexed: 12/29/2022]
Abstract
Ataxia-telangiectasia is a rare, neurodegenerative, and multisystem disease, characterized by cerebellar ataxia, oculocutaneous telangiectasia, immunodeficiency, progressive respiratory failure, and an increased risk of malignancies. It demands specialized care tailored to the individual patient's needs. Besides the classic ataxia-telangiectasia phenotype, a variant phenotype exists with partly overlapping but some distinctive disease characteristics. This guideline summarizes frequently encountered medical problems in the disease course of patients with classic and variant ataxia-telangiectasia, in the domains of neurology, immunology and infectious diseases, pulmonology, anaesthetic and perioperative risk, oncology, endocrinology, and nutrition. Furthermore, it provides a practical guide with evidence- and expert-based recommendations for the follow-up and treatment of all these different clinical topics.
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Affiliation(s)
- Nienke J H van Os
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Charlotte A Haaxma
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Michiel van der Flier
- Department of Pediatric Infectious Diseases and Immunology, Amalia Children's Hospital and Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Peter J F M Merkus
- Department of Pediatric Pulmonology, Amalia Children's Hospital and Canisius Wilhelmina Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marcel van Deuren
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Imelda J M de Groot
- Department of Rehabilitation Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan Loeffen
- Department of Pediatric Oncology and Hematology, Sophia Children's Hospital, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Bart P C van de Warrenburg
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Michèl A A P Willemsen
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
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ATM Gene Mutation Detection Techniques and Functional Analysis. Methods Mol Biol 2017. [PMID: 28477109 DOI: 10.1007/978-1-4939-6955-5_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
Abstract
Ataxia Telangiectasia (A-T) is caused by biallelic inactivation of the Ataxia Telangiectasia Mutated (ATM) gene, due to nonsense or missense mutations, small insertions/deletions (indels), splicing alterations, and large genomic rearrangements. After establishing A-T clinical diagnosis, a molecular confirmation is needed, based on the detection of one of these loss-of-function mutations in at least one allele. In most cases, the pathogenicity of the detected mutations is sufficient to make a definitive diagnosis. More rarely, mutations of unknown consequences are identified and direct biological analyses are required to establish their pathogenic characters. In such cases, complementary analyses of ATM expression, localization, and activity allow fine characterization of these mutations and facilitate A-T diagnosis. Here, we present genetic and biochemical protocols currently used in the laboratory that have proven to be highly accurate, reproducible, and quantitative. We also provide additional discussion on the critical points of the techniques presented here.
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41
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Deep brain stimulation for dystonia: a novel perspective on the value of genetic testing. J Neural Transm (Vienna) 2017; 124:417-430. [PMID: 28160152 DOI: 10.1007/s00702-016-1656-9] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 11/16/2016] [Indexed: 10/20/2022]
Abstract
The dystonias are a group of disorders characterized by excessive muscle contractions leading to abnormal movements and postures. There are many different clinical manifestations and underlying causes. Deep brain stimulation (DBS) provides an effect treatment, but outcomes can vary considerably among the different subtypes of dystonia. Several variables are thought to contribute to this variation including age of onset and duration of dystonia, specific characteristics of the dystonic movements, location of stimulation and stimulator settings, and others. The potential contributions of genetic factors have received little attention. In this review, we summarize evidence that some of the variation in DBS outcomes for dystonia is due to genetic factors. The evidence suggests that more methodical genetic testing may provide useful information in the assessment of potential surgical candidates, and in advancing our understanding of the biological mechanisms that influence DBS outcomes.
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42
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Shiloh Y, Lederman HM. Ataxia-telangiectasia (A-T): An emerging dimension of premature ageing. Ageing Res Rev 2017; 33:76-88. [PMID: 27181190 DOI: 10.1016/j.arr.2016.05.002] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 05/02/2016] [Accepted: 05/10/2016] [Indexed: 12/28/2022]
Abstract
A-T is a prototype genome instability syndrome and a multifaceted disease. A-T leads to neurodegeneration - primarily cerebellar atrophy, immunodeficiency, oculocutaneous telangiectasia (dilated blood vessels), vestigial thymus and gonads, endocrine abnormalities, cancer predisposition and varying sensitivity to DNA damaging agents, particularly those that induce DNA double-strand breaks. With the recent increase in life expectancy of A-T patients, the premature ageing component of this disease is gaining greater awareness. The complex A-T phenotype reflects the ever growing number of functions assigned to the protein encoded by the responsible gene - the homeostatic protein kinase, ATM. The quest to thoroughly understand the complex A-T phenotype may reveal yet elusive ATM functions.
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43
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Marelli C, Guissart C, Hubsch C, Renaud M, Villemin JP, Larrieu L, Charles P, Ayrignac X, Sacconi S, Collignon P, Cuntz-Shadfar D, Perrin L, Benarrosh A, Degardin A, Lagha-Boukbiza O, Mutez E, Carlander B, Morales RJ, Gonzalez V, Carra-Dalliere C, Azakri S, Mignard C, Ollagnon E, Pageot N, Chretien D, Geny C, Azulay JP, Tranchant C, Claustres M, Labauge P, Anheim M, Goizet C, Calvas P, Koenig M. Mini-Exome Coupled to Read-Depth Based Copy Number Variation Analysis in Patients with Inherited Ataxias. Hum Mutat 2016; 37:1340-1353. [DOI: 10.1002/humu.23063] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 07/22/2016] [Indexed: 01/15/2023]
Affiliation(s)
- Cecilia Marelli
- Department of Neurology; University Hospital Gui de Chauliac; Montpellier France
| | - Claire Guissart
- EA7402 Institut Universitaire de Recherche Clinique, and Laboratoire de Génétique Moléculaire, University Hospital; Montpellier France
| | - Cecile Hubsch
- Department of Neurology; Pitié-Salpêtrière University Hospital; Paris France
| | - Mathilde Renaud
- Department of Neurology; Strasbourg University Hospital; Strasbourg France
| | - Jean-Philippe Villemin
- EA7402 Institut Universitaire de Recherche Clinique, and Laboratoire de Génétique Moléculaire, University Hospital; Montpellier France
| | - Lise Larrieu
- EA7402 Institut Universitaire de Recherche Clinique, and Laboratoire de Génétique Moléculaire, University Hospital; Montpellier France
| | - Perrine Charles
- Department of Genetics; Pitié-Salpêtrière University Hospital; Paris France
| | - Xavier Ayrignac
- Department of Neurology; University Hospital Gui de Chauliac; Montpellier France
| | - Sabrina Sacconi
- Peripheral Nervous System, Muscle and ALS, Neuromuscular & ALS Specialized Center; Nice University Hospital, Pasteur 2; Nice France
| | - Patrick Collignon
- Department of Medical Genetics; Sainte Musse Hospital; Toulon France
| | - Danielle Cuntz-Shadfar
- Department of Neurology; University Hospital Gui de Chauliac; Montpellier France
- Department of Paediatrics; University Hospital Gui de Chauliac; Montpellier France
| | - Laurine Perrin
- Department of Physical Medicine and Rehabilitation and Department of Paediatric Neurology; CHU de Saint Etienne France
| | | | - Adrian Degardin
- Department of Neurology; University Hospital Roger Salengro; Lille France
| | | | - Eugenie Mutez
- CHU Lille, UMR-S 1172 - Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer; University of Lille, Inserm; Lille France
| | - Bertrand Carlander
- Department of Neurology; University Hospital Gui de Chauliac; Montpellier France
| | - Raul Juntas Morales
- Department of Neurology; University Hospital Gui de Chauliac; Montpellier France
| | - Victoria Gonzalez
- Department of Neurology; University Hospital Gui de Chauliac; Montpellier France
| | | | - Souhayla Azakri
- Department of Neurology; University Hospital Gui de Chauliac; Montpellier France
| | - Claude Mignard
- Centre de Référence des Maladies Neuro-musculaires et Neurologiques Rares du CHU de la Réunion; France
| | - Elisabeth Ollagnon
- Department of Medical Genetics and Reference Centre for Neurological and Neuromuscular Diseases; Croix-Rousse Hospital; Lyon France
| | - Nicolas Pageot
- Department of Neurology; University Hospital Gui de Chauliac; Montpellier France
| | - Dominique Chretien
- INSERM UMR 1141 Robert Debré Hospital and Denis Diderot University Paris 7; Paris France
| | - Christian Geny
- Department of Neurology; University Hospital Gui de Chauliac; Montpellier France
| | | | | | - Mireille Claustres
- EA7402 Institut Universitaire de Recherche Clinique, and Laboratoire de Génétique Moléculaire, University Hospital; Montpellier France
| | - Pierre Labauge
- Department of Neurology; University Hospital Gui de Chauliac; Montpellier France
| | - Mathieu Anheim
- Department of Neurology; Strasbourg University Hospital; Strasbourg France
| | - Cyril Goizet
- Department of Medical Genetics, Pellegrin University Hospital, and laboratoire Maladies Rares Génétique et Métabolisme (MRGM), INSERM U1211; Université Bordeaux; Bordeaux France
| | - Patrick Calvas
- Department of Clinical Genetics; Purpan University Hospital; Toulouse France
| | - Michel Koenig
- EA7402 Institut Universitaire de Recherche Clinique, and Laboratoire de Génétique Moléculaire, University Hospital; Montpellier France
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Abstract
PURPOSE OF REVIEW Chorea presenting in childhood and adulthood encompasses several neurological disorders, both degenerative and nonprogressive, often with a genetic basis. In this review, we discuss how modern genomic technologies are expanding our knowledge of monogenic choreic syndromes and advancing our insight into the molecular mechanisms responsible for chorea. RECENT FINDINGS A genome-wide association study in Huntington's disease identified genetic disease modifiers involved in controlling DNA repair mechanisms and stability of the HTT trinucleotide repeat expansion. Chorea is the cardinal feature of newly recognized genetic entities, ADCY5 and PDE10A-related choreas, with onset in infancy and childhood. A phenotypic overlap between chorea, ataxia, epilepsy, and neurodevelopmental disorders is becoming increasingly evident. SUMMARY The differential diagnosis of genetic conditions presenting with chorea has considerably widened, permitting a molecular diagnosis and an improved prognostic definition in an expanding number of cases. The identification of Huntington's disease genetic modifiers and new chorea-causing gene mutations has allowed the initial recognition of converging molecular pathways underlying medium spiny neurons degeneration and dysregulation of normal development and activity of basal ganglia circuits. Signalling downstream of dopamine receptors and control of cAMP levels represent a very promising target for the development of new aetiology-based treatments for chorea and other hyperkinetic disorders.
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Affiliation(s)
- Niccolò E. Mencacci
- Department of Molecular Neuroscience, UCL Institute of Neurology,
WC1N 3BG London, United Kingdom
| | - Miryam Carecchio
- Molecular Neurogenetics Unit, IRCCS Foundation Carlo Besta
Neurological Institute, Via Celoria 11, 20131 Milan, Italy
- Department of Pediatric Neurology, IRCCS Foundation Carlo Besta
Neurological Institute, Via Celoria 11, 20131 Milan, Italy
- Department of Molecular and Translational Medicine, University of
Milan Bicocca, Milan, Italy
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Pearson TS. More Than Ataxia: Hyperkinetic Movement Disorders in Childhood Autosomal Recessive Ataxia Syndromes. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2016; 6:368. [PMID: 27536460 PMCID: PMC4950223 DOI: 10.7916/d8h70fss] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 04/21/2016] [Indexed: 12/12/2022]
Abstract
Background The autosomal recessive ataxias are a heterogeneous group of disorders that are characterized by complex neurological features in addition to progressive ataxia. Hyperkinetic movement disorders occur in a significant proportion of patients, and may sometimes be the presenting motor symptom. Presentations with involuntary movements rather than ataxia are diagnostically challenging, and are likely under-recognized. Methods A PubMed literature search was performed in October 2015 utilizing pairwise combinations of disease-related terms (autosomal recessive ataxia, ataxia–telangiectasia, ataxia with oculomotor apraxia type 1 (AOA1), ataxia with oculomotor apraxia type 2 (AOA2), Friedreich ataxia, ataxia with vitamin E deficiency), and symptom-related terms (movement disorder, dystonia, chorea, choreoathetosis, myoclonus). Results Involuntary movements occur in the majority of patients with ataxia–telangiectasia and AOA1, and less frequently in patients with AOA2, Friedreich ataxia, and ataxia with vitamin E deficiency. Clinical presentations with an isolated hyperkinetic movement disorder in the absence of ataxia include dystonia or dystonia with myoclonus with predominant upper limb and cervical involvement (ataxia–telangiectasia, ataxia with vitamin E deficiency), and generalized chorea (ataxia with oculomotor apraxia type 1, ataxia-telangiectasia). Discussion An awareness of atypical presentations facilitates early and accurate diagnosis in these challenging cases. Recognition of involuntary movements is important not only for diagnosis, but also because of the potential for effective targeted symptomatic treatment.
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Affiliation(s)
- Toni S Pearson
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
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46
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Mallaret M, Renaud M, Redin C, Drouot N, Muller J, Severac F, Mandel JL, Hamza W, Benhassine T, Ali-Pacha L, Tazir M, Durr A, Monin ML, Mignot C, Charles P, Van Maldergem L, Chamard L, Thauvin-Robinet C, Laugel V, Burglen L, Calvas P, Fleury MC, Tranchant C, Anheim M, Koenig M. Validation of a clinical practice-based algorithm for the diagnosis of autosomal recessive cerebellar ataxias based on NGS identified cases. J Neurol 2016; 263:1314-22. [DOI: 10.1007/s00415-016-8112-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 02/26/2016] [Accepted: 03/31/2016] [Indexed: 12/20/2022]
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Abstract
PURPOSE OF REVIEW The dystonias are a family of related disorders with many different clinical manifestations and causes. This review summarizes recent developments regarding these disorders, focusing mainly on advances with direct clinical relevance from the past 2 years. RECENT FINDINGS The dystonias are generally defined by their clinical characteristics, rather than by their underlying genetic or neuropathological defects. The many varied clinical manifestations and causes contribute to the fact that they are one of the most poorly recognized of all movement disorders. A series of recent publications has addressed these issues, offering a revised definition and more logical means for classifying the many subtypes. Our understanding of the genetic and neurobiological mechanisms responsible for different types of dystonias also has grown rapidly, creating new opportunities and challenges for diagnosis, and identifying increasing numbers of rare subtypes for which specific treatments are available. SUMMARY Recent advances in describing the clinical phenotypes and determining associated causes have pointed to the need for new strategies for diagnosis, classification, and treatment of the dystonias.
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Affiliation(s)
- Hyder A Jinnah
- aDepartment of Neurology, Human Genetics & Pediatrics, Emory University, Atlanta, Georgia bDystonia Medical Research Foundation, Chicago, Illinois cNational Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
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48
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Beraldi R, Chan CH, Rogers CS, Kovács AD, Meyerholz DK, Trantzas C, Lambertz AM, Darbro BW, Weber KL, White KAM, Rheeden RV, Kruer MC, Dacken BA, Wang XJ, Davis BT, Rohret JA, Struzynski JT, Rohret FA, Weimer JM, Pearce DA. A novel porcine model of ataxia telangiectasia reproduces neurological features and motor deficits of human disease. Hum Mol Genet 2015; 24:6473-84. [PMID: 26374845 DOI: 10.1093/hmg/ddv356] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 09/01/2015] [Indexed: 11/14/2022] Open
Abstract
Ataxia telangiectasia (AT) is a progressive multisystem disorder caused by mutations in the AT-mutated (ATM) gene. AT is a neurodegenerative disease primarily characterized by cerebellar degeneration in children leading to motor impairment. The disease progresses with other clinical manifestations including oculocutaneous telangiectasia, immune disorders, increased susceptibly to cancer and respiratory infections. Although genetic investigations and physiological models have established the linkage of ATM with AT onset, the mechanisms linking ATM to neurodegeneration remain undetermined, hindering therapeutic development. Several murine models of AT have been successfully generated showing some of the clinical manifestations of the disease, however they do not fully recapitulate the hallmark neurological phenotype, thus highlighting the need for a more suitable animal model. We engineered a novel porcine model of AT to better phenocopy the disease and bridge the gap between human and current animal models. The initial characterization of AT pigs revealed early cerebellar lesions including loss of Purkinje cells (PCs) and altered cytoarchitecture suggesting a developmental etiology for AT and could advocate for early therapies for AT patients. In addition, similar to patients, AT pigs show growth retardation and develop motor deficit phenotypes. By using the porcine system to model human AT, we established the first animal model showing PC loss and motor features of the human disease. The novel AT pig provides new opportunities to unmask functions and roles of ATM in AT disease and in physiological conditions.
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Affiliation(s)
- Rosanna Beraldi
- Children's Health Research Center, Sanford Research, 2301 E. 60 Street North, Sioux Falls, SD 57104, USA
| | - Chun-Hung Chan
- Children's Health Research Center, Sanford Research, 2301 E. 60 Street North, Sioux Falls, SD 57104, USA
| | | | - Attila D Kovács
- Children's Health Research Center, Sanford Research, 2301 E. 60 Street North, Sioux Falls, SD 57104, USA
| | - David K Meyerholz
- Department of Pathology, University of Iowa, Iowa City, IA 52242, USA
| | | | - Allyn M Lambertz
- Department of Pathology, University of Iowa, Iowa City, IA 52242, USA
| | - Benjamin W Darbro
- Department of Cytogenetics/Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA 52241, USA and
| | - Krystal L Weber
- Children's Health Research Center, Sanford Research, 2301 E. 60 Street North, Sioux Falls, SD 57104, USA
| | - Katherine A M White
- Children's Health Research Center, Sanford Research, 2301 E. 60 Street North, Sioux Falls, SD 57104, USA
| | - Richard V Rheeden
- Department of Cytogenetics/Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA 52241, USA and
| | - Michael C Kruer
- Children's Health Research Center, Sanford Research, 2301 E. 60 Street North, Sioux Falls, SD 57104, USA
| | | | | | | | | | | | | | - Jill M Weimer
- Children's Health Research Center, Sanford Research, 2301 E. 60 Street North, Sioux Falls, SD 57104, USA, School of Medicine, University of South Dakota, Sioux Falls, SD 57105, USA
| | - David A Pearce
- Children's Health Research Center, Sanford Research, 2301 E. 60 Street North, Sioux Falls, SD 57104, USA, School of Medicine, University of South Dakota, Sioux Falls, SD 57105, USA
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49
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Abstract
PURPOSE OF REVIEW This article discusses recent advances in the understanding of clinical and genetic aspects of primary ataxias, including congenital, autosomal recessive, autosomal dominant, episodic, X-linked, and mitochondrial ataxias, as well as idiopathic degenerative and secondary ataxias. RECENT FINDINGS Many important observations have been published in recent years in connection with primary ataxias, particularly new loci and genes. The most commonly inherited ataxias may present with typical and atypical phenotypes. In the group of idiopathic degenerative ataxias, genes have been found in patients with multiple system atrophy type C. Secondary ataxias represent an important group of sporadic, cerebellar, and afferent/sensory ataxias. SUMMARY Knowledge of primary ataxias has been growing rapidly in recent years. Here we review different forms of primary ataxia, including inherited forms, which are subdivided into congenital, autosomal recessive cerebellar ataxias, autosomal dominant cerebellar ataxias, episodic ataxias, X-linked ataxias, and mitochondrial ataxias, as well as sporadic ataxias and idiopathic degenerative ataxias. Secondary or acquired ataxias are also reviewed and the most common causes are discussed.
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Affiliation(s)
- Hélio A.G. Teive
- Department of Internal Medicine, Movement Disorders Unit and Neurology Service, Hospital de Clínicas, Federal University of Paraná, Curitiba, Paraná, Brazil and
| | - Tetsuo Ashizawa
- Department of Neurology, University of Florida, Gainesville, Florida, USA
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Ataxia-telangiectasia - A historical review and a proposal for a new designation: ATM syndrome. J Neurol Sci 2015; 355:3-6. [PMID: 26050521 DOI: 10.1016/j.jns.2015.05.022] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 05/15/2015] [Accepted: 05/18/2015] [Indexed: 12/11/2022]
Abstract
The authors review ataxia telangiectasia, emphasizing historical aspects, genetic discoveries, and the clinical presentations of the classical and atypical forms. In fact, ataxia telangiectasia represents a multisystem entity with pleomorphic neurological and systemic manifestations. ATM syndrome is proposed as a more adequate designation for this entity.
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