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Yıldız Y, Kuseyri Hübschmann O, Akgöz Karaosmanoğlu A, Manti F, Karaca M, Schwartz IVD, Pons R, López-Laso E, Palacios NAJ, Porta F, Kavecan I, Balcı MC, Dy-Hollins ME, Wong SN, Oppebøen M, Medeiros LS, de Paula LCP, García-Cazorla A, Hoffmann GF, Jeltsch K, Leuzzi V, Gökçay G, Hübschmann D, Harting I, Özön ZA, Sivri S, Opladen T. Levodopa-refractory hyperprolactinemia and pituitary findings in inherited disorders of biogenic amine metabolism. J Inherit Metab Dis 2024; 47:431-446. [PMID: 37452721 DOI: 10.1002/jimd.12658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/07/2023] [Accepted: 07/12/2023] [Indexed: 07/18/2023]
Abstract
Elevated serum prolactin concentrations occur in inherited disorders of biogenic amine metabolism because dopamine deficiency leads to insufficient inhibition of prolactin secretion. This work from the International Working Group on Neurotransmitter Related Disorders (iNTD) presents the results of the first standardized study on levodopa-refractory hyperprolactinemia (LRHP; >1000 mU/L) and pituitary magnetic resonance imaging (MRI) abnormalities in patients with inherited disorders of biogenic amine metabolism. Twenty-six individuals had LRHP or abnormal pituitary findings on MRI. Tetrahydrobiopterin deficiencies were the most common diagnoses (n = 22). The median age at diagnosis of LRHP was 16 years (range: 2.5-30, 1st-3rd quartiles: 12.25-17 years). Twelve individuals (nine females) had symptoms attributed to hyperprolactinemia: menstruation-related abnormalities (n = 7), pubertal delay or arrest (n = 5), galactorrhea (n = 3), and decreased sexual functions (n = 2). MRI of the pituitary gland was obtained in 21 individuals; six had heterogeneity/hyperplasia of the gland, five had adenoma, and 10 had normal findings. Eleven individuals were treated with the dopamine agonist cabergoline, ameliorating the hyperprolactinemia-related symptoms in all those assessed. Routine monitoring of these symptoms together with prolactin concentrations, especially after the first decade of life, should be taken into consideration during follow-up evaluations. The potential of slow-release levodopa formulations and low-dose dopamine agonists as part of first-line therapy in the prevention and treatment of hyperprolactinemia should be investigated further in animal studies and human trials. This work adds hyperprolactinemia-related findings to the current knowledge of the phenotypic spectrum of inherited disorders of biogenic amine metabolism.
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Affiliation(s)
- Yılmaz Yıldız
- Division of Pediatric Metabolism, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Oya Kuseyri Hübschmann
- Division of Child Neurology and Metabolic Disorders, University Children's Hospital Heidelberg, Heidelberg, Germany
| | | | - Filippo Manti
- Department of Human Neuroscience, Unit of Child Neurology and Psychiatry, Università degli Studi di Roma La Sapienza, Rome, Italy
| | - Meryem Karaca
- Division of Pediatric Nutrition and Metabolism, Department of Pediatrics, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Ida Vanessa D Schwartz
- Department of Medical Genetics, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Roser Pons
- First Department of Pediatrics of the University of Athens, Aghia Sofia Hospital, Athens, Greece
| | - Eduardo López-Laso
- Pediatric Neurology Unit, Department of Pediatrics, University Hospital Reina Sofía, IMIBIC and CIBERER, Córdoba, Spain
| | - Natalia Alexandra Julia Palacios
- Inborn Errors of Metabolism Unit, Department of Neurology, Institut de Recerca Sant Joan de Déu and CIBERER-ISCIII, Barcelona, Spain
| | - Francesco Porta
- Department of Pediatrics, AOU Città della Salute e della Scienza, Torino, Italy
| | - Ivana Kavecan
- Faculty of Medicine, University of Novi Sad, Institute for Children and Youth Health Care of Vojvodina, Novi Sad, Serbia
| | - Mehmet Cihan Balcı
- Division of Pediatric Nutrition and Metabolism, Department of Pediatrics, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Marisela E Dy-Hollins
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Suet-Na Wong
- Department of Pediatrics and Adolescent Medicine, The Hong Kong Children's Hospital, Hong Kong SAR, China
| | - Mari Oppebøen
- Division of Child Neurology, Children's Department, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Leonardo Simão Medeiros
- Department of Medical Genetics, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | | | - Angeles García-Cazorla
- Inborn Errors of Metabolism Unit, Department of Neurology, Institut de Recerca Sant Joan de Déu and CIBERER-ISCIII, Barcelona, Spain
| | - Georg F Hoffmann
- Division of Child Neurology and Metabolic Disorders, University Children's Hospital Heidelberg, Heidelberg, Germany
| | - Kathrin Jeltsch
- Division of Child Neurology and Metabolic Disorders, University Children's Hospital Heidelberg, Heidelberg, Germany
| | - Vincenzo Leuzzi
- Department of Human Neuroscience, Unit of Child Neurology and Psychiatry, Università degli Studi di Roma La Sapienza, Rome, Italy
| | - Gülden Gökçay
- Division of Pediatric Nutrition and Metabolism, Department of Pediatrics, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Daniel Hübschmann
- Computational Oncology Group, Molecular Precision Oncology Program, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Heidelberg Institute for Stem Cell Technology and Experimental Medicine (HI-STEM), Heidelberg, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Inga Harting
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Z Alev Özön
- Division of Pediatric Endocrinology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Serap Sivri
- Division of Pediatric Metabolism, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Thomas Opladen
- Division of Child Neurology and Metabolic Disorders, University Children's Hospital Heidelberg, Heidelberg, Germany
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Brooker SM, Mencacci NE. The expanding genetic landscape of myoclonus-dystonia syndrome: YY1 and ATP1A3 are added to the list. Parkinsonism Relat Disord 2023; 117:105929. [PMID: 37981540 DOI: 10.1016/j.parkreldis.2023.105929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Affiliation(s)
- Sarah M Brooker
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Niccolò E Mencacci
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.
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Chang V, Mingbunjerdsuk D. Dystonia Responding to Levodopa in A Child with Myoclonus-Dystonia. Mov Disord Clin Pract 2023; 10:687-690. [PMID: 37070063 PMCID: PMC10105106 DOI: 10.1002/mdc3.13708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 01/27/2023] [Accepted: 02/08/2023] [Indexed: 03/03/2023] Open
Affiliation(s)
- Victoria Chang
- Department of NeurologyUniversity of WashingtonSeattleWashingtonUSA
| | - Dararat Mingbunjerdsuk
- Department of Neurology, Division of Pediatric Neurology, Seattle Children's HospitalUniversity of WashingtonSeattleWashingtonUSA
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Mastrangelo M, Tolve M, Artiola C, Bove R, Carducci C, Carducci C, Angeloni A, Pisani F, Leuzzi V. Phenotypes and Genotypes of Inherited Disorders of Biogenic Amine Neurotransmitter Metabolism. Genes (Basel) 2023; 14:genes14020263. [PMID: 36833190 PMCID: PMC9957200 DOI: 10.3390/genes14020263] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/11/2023] [Accepted: 01/17/2023] [Indexed: 01/21/2023] Open
Abstract
Inherited disorders of biogenic amine metabolism are genetically determined conditions resulting in dysfunctions or lack of enzymes involved in the synthesis, degradation, or transport of dopamine, serotonin, adrenaline/noradrenaline, and their metabolites or defects of their cofactor or chaperone biosynthesis. They represent a group of treatable diseases presenting with complex patterns of movement disorders (dystonia, oculogyric crises, severe/hypokinetic syndrome, myoclonic jerks, and tremors) associated with a delay in the emergence of postural reactions, global development delay, and autonomic dysregulation. The earlier the disease manifests, the more severe and widespread the impaired motor functions. Diagnosis mainly depends on measuring neurotransmitter metabolites in cerebrospinal fluid that may address the genetic confirmation. Correlations between the severity of phenotypes and genotypes may vary remarkably among the different diseases. Traditional pharmacological strategies are not disease-modifying in most cases. Gene therapy has provided promising results in patients with DYT-DDC and in vitro models of DYT/PARK-SLC6A3. The rarity of these diseases, combined with limited knowledge of their clinical, biochemical, and molecular genetic features, frequently leads to misdiagnosis or significant diagnostic delays. This review provides updates on these aspects with a final outlook on future perspectives.
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Affiliation(s)
- Mario Mastrangelo
- Child Neurology and Psychiatry Unit, Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
- Azienda Ospedaliero Universitaria Policlinico Umberto I, 00161 Rome, Italy
| | - Manuela Tolve
- Azienda Ospedaliero Universitaria Policlinico Umberto I, 00161 Rome, Italy
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Cristiana Artiola
- Azienda Ospedaliero Universitaria Policlinico Umberto I, 00161 Rome, Italy
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Rossella Bove
- Child Neurology and Psychiatry Unit, Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Claudia Carducci
- Azienda Ospedaliero Universitaria Policlinico Umberto I, 00161 Rome, Italy
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Carla Carducci
- Azienda Ospedaliero Universitaria Policlinico Umberto I, 00161 Rome, Italy
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Antonio Angeloni
- Azienda Ospedaliero Universitaria Policlinico Umberto I, 00161 Rome, Italy
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Francesco Pisani
- Child Neurology and Psychiatry Unit, Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
- Azienda Ospedaliero Universitaria Policlinico Umberto I, 00161 Rome, Italy
- Correspondence: ; Tel.: +39-649972930; Fax: +39-64440232
| | - Vincenzo Leuzzi
- Child Neurology and Psychiatry Unit, Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
- Azienda Ospedaliero Universitaria Policlinico Umberto I, 00161 Rome, Italy
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Sharma P, Holla VV, Gurram S, Kamble N, Yadav R, Pal PK. Myoclonus-Dystonic Presentation of Childhood Onset DYT-GCH1: A Report From India. J Mov Disord 2023; 16:101-103. [PMID: 36628429 PMCID: PMC9978263 DOI: 10.14802/jmd.22106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 10/29/2022] [Indexed: 01/12/2023] Open
Affiliation(s)
- Praveen Sharma
- Department of Neurology, National Institute of Mental Health & Neurosciences, Karnataka, India
| | - Vikram V Holla
- Department of Neurology, National Institute of Mental Health & Neurosciences, Karnataka, India
| | - Sandeep Gurram
- Department of Neurology, National Institute of Mental Health & Neurosciences, Karnataka, India
| | - Nitish Kamble
- Department of Neurology, National Institute of Mental Health & Neurosciences, Karnataka, India
| | - Ravi Yadav
- Department of Neurology, National Institute of Mental Health & Neurosciences, Karnataka, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health & Neurosciences, Karnataka, India,Corresponding author: Pramod Kumar Pal, MD, DNB, DM, FRCP Department of Neurology, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore, Karnataka 560029, India / Tel: +91-80-26995147 / Fax: +91-80-26564830 / E-mail:
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Pérez‐Dueñas B, Gorman K, Marcé‐Grau A, Ortigoza‐Escobar JD, Macaya A, Danti FR, Barwick K, Papandreou A, Ng J, Meyer E, Mohammad SS, Smith M, Muntoni F, Munot P, Uusimaa J, Vieira P, Sheridan E, Guerrini R, Cobben J, Yilmaz S, De Grandis E, Dale RC, Pons R, Peall KJ, Leuzzi V, Kurian MA. The Genetic Landscape of Complex Childhood-Onset Hyperkinetic Movement Disorders. Mov Disord 2022; 37:2197-2209. [PMID: 36054588 PMCID: PMC9804670 DOI: 10.1002/mds.29182] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/19/2022] [Accepted: 06/29/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND AND OBJECTIVE The objective of this study was to better delineate the genetic landscape and key clinical characteristics of complex, early-onset, monogenic hyperkinetic movement disorders. METHODS Patients were recruited from 14 international centers. Participating clinicians completed standardized proformas capturing demographic, clinical, and genetic data. Two pediatric movement disorder experts reviewed available video footage, classifying hyperkinetic movements according to published criteria. RESULTS One hundred forty patients with pathogenic variants in 17 different genes (ADCY5, ATP1A3, DDC, DHPR, FOXG1, GCH1, GNAO1, KMT2B, MICU1, NKX2.1, PDE10A, PTPS, SGCE, SLC2A1, SLC6A3, SPR, and TH) were identified. In the majority, hyperkinetic movements were generalized (77%), with most patients (69%) manifesting combined motor semiologies. Parkinsonism-dystonia was characteristic of primary neurotransmitter disorders (DDC, DHPR, PTPS, SLC6A3, SPR, TH); chorea predominated in ADCY5-, ATP1A3-, FOXG1-, NKX2.1-, SLC2A1-, GNAO1-, and PDE10A-related disorders; and stereotypies were a prominent feature in FOXG1- and GNAO1-related disease. Those with generalized hyperkinetic movements had an earlier disease onset than those with focal/segmental distribution (2.5 ± 0.3 vs. 4.7 ± 0.7 years; P = 0.007). Patients with developmental delay also presented with hyperkinetic movements earlier than those with normal neurodevelopment (1.5 ± 2.9 vs. 4.7 ± 3.8 years; P < 0.001). Effective disease-specific therapies included dopaminergic agents for neurotransmitters disorders, ketogenic diet for glucose transporter deficiency, and deep brain stimulation for SGCE-, KMT2B-, and GNAO1-related hyperkinesia. CONCLUSIONS This study highlights the complex phenotypes observed in children with genetic hyperkinetic movement disorders that can lead to diagnostic difficulty. We provide a comprehensive analysis of motor semiology to guide physicians in the genetic investigation of these patients, to facilitate early diagnosis, precision medicine treatments, and genetic counseling. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Belén Pérez‐Dueñas
- Department of Pediatric NeurologyVall d'Hebron Hospital Universitary and Vall d'Hebrón Research Institute (VHIR).BarcelonaSpain,Department of Pediatrics, Obstetrics, Gynecology, Preventative Medicine and Public HealthUniversitat Autònoma de BarcelonaBarcelonaSpain,Center for Biomedical Network Research on Rare Diseases (CIBERER) CB06/07/0063BarcelonaSpain
| | - Kathleen Gorman
- Developmental Neurosciences ProgrammeGreat Ormond Street–Institute of Child Health, University College LondonLondonUnited Kingdom,Dubowitz neuromuscular CenterGreat Ormond Street Hospital for ChildrenLondonUnited Kingdom
| | - Anna Marcé‐Grau
- Department of Pediatric NeurologyVall d'Hebron Hospital Universitary and Vall d'Hebrón Research Institute (VHIR).BarcelonaSpain
| | | | - Alfons Macaya
- Department of Pediatric NeurologyVall d'Hebron Hospital Universitary and Vall d'Hebrón Research Institute (VHIR).BarcelonaSpain,Department of Pediatrics, Obstetrics, Gynecology, Preventative Medicine and Public HealthUniversitat Autònoma de BarcelonaBarcelonaSpain,Center for Biomedical Network Research on Rare Diseases (CIBERER) CB06/07/0063BarcelonaSpain
| | - Federica R. Danti
- Unit of Child Neurology and Psychiatry, Department of Human NeuroscienceSapienza University of RomeRomeItaly
| | - Katy Barwick
- Developmental Neurosciences ProgrammeGreat Ormond Street–Institute of Child Health, University College LondonLondonUnited Kingdom
| | - Apostolos Papandreou
- Developmental Neurosciences ProgrammeGreat Ormond Street–Institute of Child Health, University College LondonLondonUnited Kingdom,Dubowitz neuromuscular CenterGreat Ormond Street Hospital for ChildrenLondonUnited Kingdom
| | - Joanne Ng
- Gene Transfer Technology GroupInstitute for Women's Health, University College LondonLondonUnited Kingdom
| | - Esther Meyer
- Developmental Neurosciences ProgrammeGreat Ormond Street–Institute of Child Health, University College LondonLondonUnited Kingdom
| | - Shekeeb S. Mohammad
- Kids Neuroscience Centre and Brain and Mind Centre, Faculty of Medicine and HealthUniversity of SydneyWestmeadNew South WalesAustralia
| | - Martin Smith
- Department of Pediatric NeurologyJohn Radcliffe HospitalOxfordUnited Kingdom
| | - Francesco Muntoni
- Developmental Neurosciences ProgrammeGreat Ormond Street–Institute of Child Health, University College LondonLondonUnited Kingdom,Dubowitz neuromuscular CenterGreat Ormond Street Hospital for ChildrenLondonUnited Kingdom
| | - Pinki Munot
- Dubowitz neuromuscular CenterGreat Ormond Street Hospital for ChildrenLondonUnited Kingdom
| | - Johanna Uusimaa
- PEDEGO Research Unit, Department of Children and Adolescents, Medical Research Center OuluOulu University Hospital, University of OuluOuluFinland
| | - Päivi Vieira
- PEDEGO Research Unit, Department of Children and Adolescents, Medical Research Center OuluOulu University Hospital, University of OuluOuluFinland
| | - Eammon Sheridan
- School of MedicineSt James's University Hospital, University of LeedsLeedsUnited Kingdom
| | - Renzo Guerrini
- Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, Neuroscience DepartmentA. Meyer Children's Hospital, University of FlorenceFlorenceItaly
| | - Jan Cobben
- North West Thames Regional Genetic ServiceNorthwick Park HospitalLondonUnited Kingdom
| | - Sanem Yilmaz
- Department of Pediatrics, Division of Child NeurologyEge University Medical FacultyİzmirTurkey
| | - Elisa De Grandis
- Child Neuropsychiatry Unit, Istituto Giannina Gaslini, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Children's SciencesUniversity of GenoaGenoaItaly
| | - Russell C. Dale
- Institute for Neuroscience and Muscle ResearchChildren's Hospital at Westmead, University of SydneySydneyNew South WalesAustralia
| | - Roser Pons
- First Department of PediatricsAgia Sofia Children's Hospital, National and Kapodistrian University of AthensAthensGreece
| | - Kathryn J. Peall
- Neuroscience and Mental Health Research InstituteInstitute of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff UniversityCardiffUnited Kingdom
| | - Vincenzo Leuzzi
- Unit of Child Neurology and Psychiatry, Department of Human NeuroscienceSapienza University of RomeRomeItaly
| | - Manju A. Kurian
- Developmental Neurosciences ProgrammeGreat Ormond Street–Institute of Child Health, University College LondonLondonUnited Kingdom,Dubowitz neuromuscular CenterGreat Ormond Street Hospital for ChildrenLondonUnited Kingdom
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Kim W, Cho JS, Shim YK, Ko YJ, Choi SA, Kim SY, Kim H, Lim BC, Hwang H, Choi J, Kim KJ, Kim MJ, Seong MW, Chae JH. Early-onset autosomal dominant GTP-cyclohydrolase I deficiency: Diagnostic delay and residual motor signs. Brain Dev 2021; 43:759-767. [PMID: 33875303 DOI: 10.1016/j.braindev.2021.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 02/23/2021] [Accepted: 02/28/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Autosomal dominant (AD) guanosine triphosphate cyclohydrolase 1 (GCH1) deficiency is the most common cause of dopa-responsive dystonia (DRD). Patients with GCH1 deficiency are likely to experience diagnostic delay, but its consequences have not been described thoroughly in patients with early-onset disease. We describe the diagnostic delay and residual motor signs (RMS) observed in patients with early-onset (before 15 years of age) disease. METHODS Twelve patients with early-onset AD GCH1 deficiency from a single center were included in the case series analysis. For the meta-analysis, the PubMed database was searched for articles on early-onset AD GCH1 deficiency published from 1995 to 2019. RESULTS In the case series, the mean duration of diagnostic delay was 5.6 years. Two patients exhibited RMS, and four patients underwent orthopedic surgery. The literature search yielded 137 AD GCH1 deficiency cases for review; gait disturbance was reported in 92.7% of patients, diurnal fluctuation of symptoms in 91.9%, and RMS in 39%. The mean duration of diagnostic delay was 14.6 years overall: 12.0 years in RMS-negative patients and 21.2 years in RMS-positive patients. CONCLUSIONS Diagnostic delay in early-onset AD GCH1 deficiency is more closely associated with later RMS. Early clinical suspicion, timely diagnosis, and levodopa treatment may reduce the occurrence of RMS in patients with early-onset AD GCH1 deficiency.
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Affiliation(s)
- WooJoong Kim
- Department of Pediatrics, Seoul National University College of Medicine, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Jae So Cho
- Department of Pediatrics, Seoul National University College of Medicine, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Young Kyu Shim
- Department of Pediatrics, Seoul National University College of Medicine, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Young Jun Ko
- Department of Pediatrics, Seoul National University College of Medicine, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Sun Ah Choi
- Department of Pediatrics, Seoul National University College of Medicine, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Soo Yeon Kim
- Department of Pediatrics, Seoul National University College of Medicine, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul, Republic of Korea; Rare Disease Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hunmin Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul, Republic of Korea
| | - Byung Chan Lim
- Department of Pediatrics, Seoul National University College of Medicine, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Hee Hwang
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul, Republic of Korea
| | - Jieun Choi
- Department of Pediatrics, SMG-SNU Boramae Hospital, Seoul, Republic of Korea
| | - Ki Joong Kim
- Department of Pediatrics, Seoul National University College of Medicine, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Man Jin Kim
- Rare Disease Center, Seoul National University Hospital, Seoul, Republic of Korea; Department of Laboratory Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Moon-Woo Seong
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jong-Hee Chae
- Department of Pediatrics, Seoul National University College of Medicine, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul, Republic of Korea; Rare Disease Center, Seoul National University Hospital, Seoul, Republic of Korea.
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Fearon C, Peall KJ, Vidailhet M, Fasano A. Medical management of myoclonus-dystonia and implications for underlying pathophysiology. Parkinsonism Relat Disord 2020; 77:48-56. [PMID: 32622300 DOI: 10.1016/j.parkreldis.2020.06.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 05/19/2020] [Accepted: 06/16/2020] [Indexed: 12/14/2022]
Abstract
Myoclonus-dystonia is an early onset genetic disorder characterised by subcortical myoclonus and less prominent dystonia. Its primary causative gene is the epsilon-sarcoglycan gene but the syndrome of "myoclonic dystonia" has been shown to be a heterogeneous group of genetic disorders. The underlying pathophysiology of myoclonus-dystonia is incompletely understood, although it may relate to dysfunction of striatal monoamine neurotransmission or disruption of cerebellothalamic networks (possibly via a GABAergic deficit of Purkinje cells). A broad range of oral medical therapies have been used in the treatment of myoclonus-dystonia with a varying response, and limited data relating to efficacy and tolerability, yet this condition responds dramatically to alcohol. Few well conducted randomized controlled trials have been undertaken leading to an empirical ad hoc approach for many patients. We review the current evidence for pharmacological therapies in myoclonus-dystonia, discuss implications for underlying pathogenesis of the condition and propose a treatment algorithm for these patients.
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Affiliation(s)
- Conor Fearon
- Dublin Neurological Institute at the Mater Misericordiae University Hospital, Dublin, Ireland
| | - Kathryn J Peall
- Neurosciences and Mental Health Research Institute, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, CF24 4HQ, UK
| | - Marie Vidailhet
- AP-HP, Hôpital Salpetriere, Department of Neurology, F-75013, Paris, France; Institut du Cerveau et de la Moelle, ICM, F-75013, Paris, France; INSERM U1127, CNRS UMR 7225, Sorbonne Unversité, F-75013, Paris, France
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital - UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Krembil Research Institute, Toronto, Ontario, Canada; Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, Canada.
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9
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Di Fonzo A, Franco G, Barone P, Erro R. Parkinsonism in diseases predominantly presenting with dystonia. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2019; 149:307-326. [PMID: 31779818 DOI: 10.1016/bs.irn.2019.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
If the presence of dystonia is a well-recognized phenomenon in disorders predominantly presenting with parkinsonism, including sporadic Parkinson Disease, the term dystonia-parkinsonism usually refers to rare conditions, often genetic, in which the severity of dystonia usually equates that of parkinsonism. At variance with parkinsonian syndromes with additional dystonia, the conditions reviewed in this chapter have usually their onset in childhood and their diagnostic work-up is different. In fact, the phenotype is not usually specific of the underlying defect and additional investigations are therefore required. Here, we review the diseases predominantly presenting with dystonia where parkinsonism can develop, according to their main pathophysiological mechanism including disorders of dopamine biosynthesis, neurotransmitter transporter disorders, disorder of metal metabolism (i.e., iron, copper and manganese) and other inherited dystonia-parkinsonism conditions.
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Affiliation(s)
- Alessio Di Fonzo
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neurology Unit, Milan, Italy Dino Ferrari Center, Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Giulia Franco
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neurology Unit, Milan, Italy Dino Ferrari Center, Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Paolo Barone
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, SA, Italy
| | - Roberto Erro
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, SA, Italy
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10
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Menozzi E, Balint B, Latorre A, Valente EM, Rothwell JC, Bhatia KP. Twenty years on: Myoclonus-dystonia and ε-sarcoglycan - neurodevelopment, channel, and signaling dysfunction. Mov Disord 2019; 34:1588-1601. [PMID: 31449710 DOI: 10.1002/mds.27822] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 06/19/2019] [Accepted: 07/14/2019] [Indexed: 12/26/2022] Open
Abstract
Myoclonus-dystonia is a clinical syndrome characterized by a typical childhood onset of myoclonic jerks and dystonia involving the neck, trunk, and upper limbs. Psychiatric symptomatology, namely, alcohol dependence and phobic and obsessive-compulsive disorder, is also part of the clinical picture. Zonisamide has demonstrated effectiveness at reducing both myoclonus and dystonia, and deep brain stimulation seems to be an effective and long-lasting therapeutic option for medication-refractory cases. In a subset of patients, myoclonus-dystonia is associated with pathogenic variants in the epsilon-sarcoglycan gene, located on chromosome 7q21, and up to now, more than 100 different pathogenic variants of the epsilon-sarcoglycan gene have been described. In a few families with a clinical phenotype resembling myoclonus-dystonia associated with distinct clinical features, variants have been identified in genes involved in novel pathways such as calcium channel regulation and neurodevelopment. Because of phenotypic similarities with epsilon-sarcoglycan gene-related myoclonus-dystonia, these conditions can be collectively classified as "myoclonus-dystonia syndromes." In the present article, we present myoclonus-dystonia caused by epsilon-sarcoglycan gene mutations, with a focus on genetics and underlying disease mechanisms. Second, we review those conditions falling within the spectrum of myoclonus-dystonia syndromes, highlighting their genetic background and involved pathways. Finally, we critically discuss the normal and pathological function of the epsilon-sarcoglycan gene and its product, suggesting a role in the stabilization of the dopaminergic membrane via regulation of calcium homeostasis and in the neurodevelopmental process involving the cerebello-thalamo-pallido-cortical network. © 2019 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Elisa Menozzi
- Department of Biomedical, Metabolic and Neural Sciences, University-Hospital of Modena and Reggio Emilia, Modena, Italy.,Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK
| | - Bettina Balint
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK.,Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Anna Latorre
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK.,Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Enza Maria Valente
- Department of Molecular Medicine, University of Pavia, Pavia, Italy.,Neurogenetics Unit, IRCCS Santa Lucia Foundation, Rome, Italy
| | - John C Rothwell
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK
| | - Kailash P Bhatia
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK
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11
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Nedelea F, Veduta A, Duta S, Vayna AM, Panaitescu A, Peltecu G, Duba HC. Prenatal Genetic Testing for Dopa-Responsive Dystonia - Clinical Judgment in the Context of Next Generation Sequencing. J Med Life 2019; 11:343-345. [PMID: 30894892 PMCID: PMC6418328 DOI: 10.25122/jml-2018-0076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We present a family in which the first child was diagnosed with dopa-responsive dystonia based on biochemical findings only. Dopa-responsive dystonia is a severe heterogeneous genetic disease. The possibly involved genes are GCH1 and TH. In their second pregnancy, the parents came for genetic counseling and prenatal diagnosis late, at 12 weeks of gestation. Genetic testing in the affected child was performed, but the results were difficult to interpret. The identified mutations were classified as VOUS – variants of unknown clinical significance. Although possibly causative, a homozygous variant in the TH gene was not reported before in children with dopa-responsive dystonia. Due to limited time, establishing the fetal prognosis was challenging. Our report emphasizes the importance of a multidisciplinary approach in the context of new diagnostic techniques, such as Next Generation Sequencing. We illustrate the fact that behind any laboratory result remains sophisticated clinical judgment. We also describe a previously not reported variant of the TH gene in a child with severe, early-onset dystonia.
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Affiliation(s)
- Florina Nedelea
- Filantropia Clinical Hospital, Bucharest, Romania.,Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Alina Veduta
- Filantropia Clinical Hospital, Bucharest, Romania
| | - Simona Duta
- Filantropia Clinical Hospital, Bucharest, Romania
| | | | - Anca Panaitescu
- Filantropia Clinical Hospital, Bucharest, Romania.,Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Gheorghe Peltecu
- Filantropia Clinical Hospital, Bucharest, Romania.,Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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12
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Rudakou U, Ouled Amar Bencheikh B, Ruskey JA, Krohn L, Laurent SB, Spiegelman D, Liong C, Fahn S, Waters C, Monchi O, Fon EA, Dauvilliers Y, Alcalay RN, Dupré N, Gan-Or Z. Common and rare GCH1 variants are associated with Parkinson's disease. Neurobiol Aging 2018; 73:231.e1-231.e6. [PMID: 30314816 DOI: 10.1016/j.neurobiolaging.2018.09.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 09/07/2018] [Accepted: 09/07/2018] [Indexed: 01/19/2023]
Abstract
GCH1 encodes the enzyme guanosine triphospahte (GTP) cyclohydrolase 1, essential for dopamine synthesis in nigrostriatal cells, and rare mutations in GCH1 may lead to Dopa-responsive dystonia (DRD). While GCH1 is implicated in genomewide association studies in Parkinson's disease (PD), only a few studies examined the role of rare GCH1 variants in PD, with conflicting results. In the present study, GCH1 and its 5' and 3' untranslated regions were sequenced in 1113 patients with PD and 1111 controls. To examine the association of rare GCH1 variants with PD, burden analysis was performed. Three rare GCH1 variants, which were previously reported to be pathogenic in DRD, were found in five patients with PD and not in controls (sequence Kernel association test, p = 0.024). A common haplotype, tagged by rs841, was associated with a reduced risk for PD (OR = 0.71, 95% CI = 0.61-0.83, p = 1.24 × 10-4), and with increased GCH1 expression in brain regions relevant for PD (www.gtexportal.org). Our results support a role for rare, DRD-related variants, and common GCH1 variants in the pathogenesis of PD.
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Affiliation(s)
- Uladzislau Rudakou
- Department of Human Genetics, McGill University, Montréal, Quebec, Canada; Montreal Neurological Institute, McGill University, Montréal, Quebec, Canada
| | - Bouchra Ouled Amar Bencheikh
- Montreal Neurological Institute, McGill University, Montréal, Quebec, Canada; Centre de Recherche, Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada
| | - Jennifer A Ruskey
- Montreal Neurological Institute, McGill University, Montréal, Quebec, Canada; Department of Neurology and Neurosurgery, McGill University, Montréal, Quebec, Canada
| | - Lynne Krohn
- Department of Human Genetics, McGill University, Montréal, Quebec, Canada; Montreal Neurological Institute, McGill University, Montréal, Quebec, Canada
| | - Sandra B Laurent
- Montreal Neurological Institute, McGill University, Montréal, Quebec, Canada; Department of Neurology and Neurosurgery, McGill University, Montréal, Quebec, Canada
| | - Dan Spiegelman
- Montreal Neurological Institute, McGill University, Montréal, Quebec, Canada; Department of Neurology and Neurosurgery, McGill University, Montréal, Quebec, Canada
| | - Christopher Liong
- Department of Neurology, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - Stanley Fahn
- Department of Neurology, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - Cheryl Waters
- Department of Neurology, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - Oury Monchi
- Department of Clinical Neurosciences and Department of Radiology, University of Calgary, Calgary, Alberta, Canada; Cumming School of Medicine, Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Edward A Fon
- Montreal Neurological Institute, McGill University, Montréal, Quebec, Canada; McGill Parkinson Program and Neurodegenerative Diseases Group, Montreal Neurological Institute, McGill University, Montréal, Quebec, Canada
| | - Yves Dauvilliers
- National Reference Center for Narcolepsy, Sleep Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, University of Montpellier, Inserm U1061, Montpellier, France
| | - Roy N Alcalay
- Department of Neurology, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA; Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - Nicolas Dupré
- Division of Neurosciences, CHU de Québec, Université Laval, Québec City, Quebec, Canada; Department of Medicine, Faculty of Medicine, Université Laval, Québec City, Quebec, Canada
| | - Ziv Gan-Or
- Department of Human Genetics, McGill University, Montréal, Quebec, Canada; Montreal Neurological Institute, McGill University, Montréal, Quebec, Canada; Department of Neurology and Neurosurgery, McGill University, Montréal, Quebec, Canada.
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13
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Antelmi E, Stamelou M, Liguori R, Bhatia KP. Nonmotor Symptoms in Dopa-Responsive Dystonia. Mov Disord Clin Pract 2015; 2:347-356. [PMID: 30363518 DOI: 10.1002/mdc3.12211] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Revised: 05/15/2015] [Accepted: 05/15/2015] [Indexed: 02/02/2023] Open
Abstract
Background Dopa-responsive dystonia (DRD) is a rare inherited dystonia, caused by an autosomal dominantly inherited defect in the gene GCH1 that encodes guanosine triphosphate cyclohydrolase 1. It catalyzes the first and rate-limiting enzyme in the biosynthesis of tetrahydrobiopterin, which is the essential co-factor for aromatic amino acid hydroxylases. Mutation results in the typical scenario of a young-onset lower-limb dystonia with diurnal fluctuations, concurrent or subsequent development of parkinsonism and excellent response to levodopa. Given the myriad functions of tetrahydrobiopterin, it is reasonable that other systems, apart from motor, would also be impaired. So far, non-motor symptoms have been overlooked and very few and often contrasting data are currently available on the matter. Methods Here by searching the Medline database for publications between 1971 to March 2015, we render an in-depth analysis of all published data on non-motor symptoms in DRD. Results Depression and subtle sleep quality impairment have been reported among the different cohorts, while current data do not support any alterations of the cardiologic and autonomic systems. However, there is debate about the occurrence of sleep-related movement disorders and cognitive function. Non-motor symptoms are instead frequently reported among the clinical spectrum of other neurotransmitter disorders which may sometimes mimic DRD phenotype, ie, DRD plus diseases. Conclusions Further studies in larger and treatment-naïve cohorts are needed to better elucidate the extend of non-motor symptoms in DRD and also to consider treatment for these.
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Affiliation(s)
- Elena Antelmi
- Department of Biomedical and Neuromotor Sciences Alma Mater Studiorum University of Bologna Bologna Italy.,Sobell Department of Motor Neuroscience and Movement Disorders University College London (UCL) Institute of Neurology London United Kingdom
| | - Maria Stamelou
- Second Department of Neurology University of Athens Athens Greece.,Neurology Clinic Philipps University Marburg Germany
| | - Rocco Liguori
- Department of Biomedical and Neuromotor Sciences Alma Mater Studiorum University of Bologna Bologna Italy.,IRCCS Institute of Neurological Sciences Bologna Italy
| | - Kailash P Bhatia
- Sobell Department of Motor Neuroscience and Movement Disorders University College London (UCL) Institute of Neurology London United Kingdom
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14
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15
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Balint B, Bhatia KP. Isolated and combined dystonia syndromes - an update on new genes and their phenotypes. Eur J Neurol 2015; 22:610-7. [DOI: 10.1111/ene.12650] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 11/12/2014] [Indexed: 11/27/2022]
Affiliation(s)
- B. Balint
- Sobell Department of Motor Neuroscience and Movement Disorders; UCL Institute of Neurology; London UK
- Department of Neurology; University Hospital Heidelberg; Heidelberg Germany
| | - K. P. Bhatia
- Sobell Department of Motor Neuroscience and Movement Disorders; UCL Institute of Neurology; London UK
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16
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Guella I, Sherman HE, Appel-Cresswell S, Rajput A, Rajput AH, Farrer MJ. Parkinsonism in GTP cyclohydrolase 1 mutation carriers. Brain 2014; 138:e349. [PMID: 25497597 DOI: 10.1093/brain/awu341] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ilaria Guella
- 1 Djavad Mowafaghian Centre for Brain Health, Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Holly E Sherman
- 1 Djavad Mowafaghian Centre for Brain Health, Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Silke Appel-Cresswell
- 2 Pacific Parkinson's Research Centre, Department of Medicine (Neurology), University of British Columbia Vancouver, BC, Canada
| | - Alex Rajput
- 3 Division of Neurology, University of Saskatchewan and Saskatoon Health Region, Saskatoon, SK, Canada
| | - Ali H Rajput
- 3 Division of Neurology, University of Saskatchewan and Saskatoon Health Region, Saskatoon, SK, Canada
| | - Matthew J Farrer
- 1 Djavad Mowafaghian Centre for Brain Health, Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
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17
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Grantham HJ, Goldsmith P. Adult-Onset Alcohol Suppressible Cervical Dystonia: A Case Report. Mov Disord Clin Pract 2014; 2:102-103. [PMID: 30363810 DOI: 10.1002/mdc3.12098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 09/08/2014] [Accepted: 09/10/2014] [Indexed: 11/09/2022] Open
Affiliation(s)
| | - Paul Goldsmith
- Department of Neurology Newcastle Hospitals NHS Foundation Trust Newcastle-upon-Tyne United Kingdom
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18
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Mencacci NE, Isaias IU, Reich MM, Ganos C, Plagnol V, Polke JM, Bras J, Hersheson J, Stamelou M, Pittman AM, Noyce AJ, Mok KY, Opladen T, Kunstmann E, Hodecker S, Münchau A, Volkmann J, Samnick S, Sidle K, Nanji T, Sweeney MG, Houlden H, Batla A, Zecchinelli AL, Pezzoli G, Marotta G, Lees A, Alegria P, Krack P, Cormier-Dequaire F, Lesage S, Brice A, Heutink P, Gasser T, Lubbe SJ, Morris HR, Taba P, Koks S, Majounie E, Raphael Gibbs J, Singleton A, Hardy J, Klebe S, Bhatia KP, Wood NW. Parkinson's disease in GTP cyclohydrolase 1 mutation carriers. Brain 2014; 137:2480-92. [PMID: 24993959 PMCID: PMC4132650 DOI: 10.1093/brain/awu179] [Citation(s) in RCA: 141] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 05/16/2014] [Accepted: 05/23/2014] [Indexed: 11/27/2022] Open
Abstract
GTP cyclohydrolase 1, encoded by the GCH1 gene, is an essential enzyme for dopamine production in nigrostriatal cells. Loss-of-function mutations in GCH1 result in severe reduction of dopamine synthesis in nigrostriatal cells and are the most common cause of DOPA-responsive dystonia, a rare disease that classically presents in childhood with generalized dystonia and a dramatic long-lasting response to levodopa. We describe clinical, genetic and nigrostriatal dopaminergic imaging ([(123)I]N-ω-fluoropropyl-2β-carbomethoxy-3β-(4-iodophenyl) tropane single photon computed tomography) findings of four unrelated pedigrees with DOPA-responsive dystonia in which pathogenic GCH1 variants were identified in family members with adult-onset parkinsonism. Dopamine transporter imaging was abnormal in all parkinsonian patients, indicating Parkinson's disease-like nigrostriatal dopaminergic denervation. We subsequently explored the possibility that pathogenic GCH1 variants could contribute to the risk of developing Parkinson's disease, even in the absence of a family history for DOPA-responsive dystonia. The frequency of GCH1 variants was evaluated in whole-exome sequencing data of 1318 cases with Parkinson's disease and 5935 control subjects. Combining cases and controls, we identified a total of 11 different heterozygous GCH1 variants, all at low frequency. This list includes four pathogenic variants previously associated with DOPA-responsive dystonia (Q110X, V204I, K224R and M230I) and seven of undetermined clinical relevance (Q110E, T112A, A120S, D134G, I154V, R198Q and G217V). The frequency of GCH1 variants was significantly higher (Fisher's exact test P-value 0.0001) in cases (10/1318 = 0.75%) than in controls (6/5935 = 0.1%; odds ratio 7.5; 95% confidence interval 2.4-25.3). Our results show that rare GCH1 variants are associated with an increased risk for Parkinson's disease. These findings expand the clinical and biological relevance of GTP cycloydrolase 1 deficiency, suggesting that it not only leads to biochemical striatal dopamine depletion and DOPA-responsive dystonia, but also predisposes to nigrostriatal cell loss. Further insight into GCH1-associated pathogenetic mechanisms will shed light on the role of dopamine metabolism in nigral degeneration and Parkinson's disease.
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Affiliation(s)
- Niccolò E Mencacci
- 1 Department of Molecular Neuroscience, UCL Institute of Neurology, London WC1N 3BG, UK2 IRCCS Istituto Auxologico Italiano, Department of Neurology and Laboratory of Neuroscience - Department of Pathophysiology and Transplantation, "Dino Ferrari" Centre, Università degli Studi di Milano, 20149 Milan, Italy
| | - Ioannis U Isaias
- 3 Department of Neurology, University Hospital, 97080 Würzburg, Germany4 Parkinson Institute, Istituti Clinici di Perfezionamento, 20126 Milan, Italy
| | - Martin M Reich
- 3 Department of Neurology, University Hospital, 97080 Würzburg, Germany
| | - Christos Ganos
- 5 Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London WC1N 3BG, UK6 Department of Neurology, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany7 Department of Paediatric and Adult Movement Disorders and Neuropsychiatry, Institute of Neurogenetics, University of Lübeck, 23538 Lübeck, Germany
| | | | - James M Polke
- 9 Neurogenetics Unit, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
| | - Jose Bras
- 1 Department of Molecular Neuroscience, UCL Institute of Neurology, London WC1N 3BG, UK
| | - Joshua Hersheson
- 1 Department of Molecular Neuroscience, UCL Institute of Neurology, London WC1N 3BG, UK
| | - Maria Stamelou
- 5 Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London WC1N 3BG, UK10 Neurology Clinic, Attiko Hospital, University of Athens, 126 42 Haidari, Athens, Greece11 Neurology Clinic, Philipps University, 35032 Marburg, Germany
| | - Alan M Pittman
- 1 Department of Molecular Neuroscience, UCL Institute of Neurology, London WC1N 3BG, UK12 Reta Lila Weston Institute of Neurological Studies, UCL Institute of Neurology, London WC1N 3BG, UK
| | - Alastair J Noyce
- 1 Department of Molecular Neuroscience, UCL Institute of Neurology, London WC1N 3BG, UK12 Reta Lila Weston Institute of Neurological Studies, UCL Institute of Neurology, London WC1N 3BG, UK
| | - Kin Y Mok
- 1 Department of Molecular Neuroscience, UCL Institute of Neurology, London WC1N 3BG, UK
| | - Thomas Opladen
- 13 Division of Inborn Errors of Metabolism, University Children's Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Erdmute Kunstmann
- 14 Institut of Human Genetics, Julius-Maximilian-University, 97070 Würzburg, Germany
| | - Sybille Hodecker
- 6 Department of Neurology, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Alexander Münchau
- 7 Department of Paediatric and Adult Movement Disorders and Neuropsychiatry, Institute of Neurogenetics, University of Lübeck, 23538 Lübeck, Germany
| | - Jens Volkmann
- 4 Parkinson Institute, Istituti Clinici di Perfezionamento, 20126 Milan, Italy
| | - Samuel Samnick
- 15 Department of Nuclear Medicine, University Hospital, 97080 Würzburg, Germany
| | - Katie Sidle
- 1 Department of Molecular Neuroscience, UCL Institute of Neurology, London WC1N 3BG, UK
| | - Tina Nanji
- 9 Neurogenetics Unit, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
| | - Mary G Sweeney
- 9 Neurogenetics Unit, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
| | - Henry Houlden
- 1 Department of Molecular Neuroscience, UCL Institute of Neurology, London WC1N 3BG, UK
| | - Amit Batla
- 5 Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London WC1N 3BG, UK
| | - Anna L Zecchinelli
- 4 Parkinson Institute, Istituti Clinici di Perfezionamento, 20126 Milan, Italy
| | - Gianni Pezzoli
- 4 Parkinson Institute, Istituti Clinici di Perfezionamento, 20126 Milan, Italy
| | - Giorgio Marotta
- 16 Department of Nuclear Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy
| | - Andrew Lees
- 12 Reta Lila Weston Institute of Neurological Studies, UCL Institute of Neurology, London WC1N 3BG, UK
| | - Paulo Alegria
- 17 Serviço de Neurologia, Hospital Beatriz Ângelo, 2674-514 Loures, Portugal
| | - Paul Krack
- 18 Movement Disorder Unit, CHU Grenoble, Joseph Fourier University, and INSERM U836, Grenoble Institute Neuroscience, F-38043 Grenoble, France
| | - Florence Cormier-Dequaire
- 19 Université Pierre et Marie Curie-Paris6, Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière, UMR-S975; Inserm, U975, Cnrs, UMR 7225, Paris, France20 Centre d'Investigation Clinique (CIC-9503), Département de Neurologie, Hôpital Pitié-Salpétriêre, AP-HP, Paris, France
| | - Suzanne Lesage
- 19 Université Pierre et Marie Curie-Paris6, Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière, UMR-S975; Inserm, U975, Cnrs, UMR 7225, Paris, France
| | - Alexis Brice
- 19 Université Pierre et Marie Curie-Paris6, Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière, UMR-S975; Inserm, U975, Cnrs, UMR 7225, Paris, France21 Département de Génétique et Cytogénétique, Pitié-Salpêtrière hospital, 75013 Paris, France
| | - Peter Heutink
- 22 DZNE-Deutsches Zentrum für Neurodegenerative Erkrankungen (German Centre for Neurodegenerative Diseases), Hertie Institute for Clinical Brain Research, University of Tübingen, 72076 Tübingen, Germany
| | - Thomas Gasser
- 22 DZNE-Deutsches Zentrum für Neurodegenerative Erkrankungen (German Centre for Neurodegenerative Diseases), Hertie Institute for Clinical Brain Research, University of Tübingen, 72076 Tübingen, Germany
| | - Steven J Lubbe
- 23 Department of Clinical Neuroscience, UCL Institute of Neurology, London WC1N 3BG, UK
| | - Huw R Morris
- 23 Department of Clinical Neuroscience, UCL Institute of Neurology, London WC1N 3BG, UK
| | - Pille Taba
- 24 Department of Neurology and Neurosurgery, University of Tartu, 50090 Tartu, Estonia
| | - Sulev Koks
- 25 Department of Pathophysiology, Centre of Excellence for Translational Medicine, University of Tartu, 50411 Tartu, Estonia
| | - Elisa Majounie
- 26 Laboratory of Neurogenetics, National Institute on Aging, Bethesda, MD 20892, USA
| | - J Raphael Gibbs
- 26 Laboratory of Neurogenetics, National Institute on Aging, Bethesda, MD 20892, USA
| | - Andrew Singleton
- 26 Laboratory of Neurogenetics, National Institute on Aging, Bethesda, MD 20892, USA
| | - John Hardy
- 1 Department of Molecular Neuroscience, UCL Institute of Neurology, London WC1N 3BG, UK12 Reta Lila Weston Institute of Neurological Studies, UCL Institute of Neurology, London WC1N 3BG, UK
| | - Stephan Klebe
- 3 Department of Neurology, University Hospital, 97080 Würzburg, Germany
| | - Kailash P Bhatia
- 5 Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London WC1N 3BG, UK
| | - Nicholas W Wood
- 1 Department of Molecular Neuroscience, UCL Institute of Neurology, London WC1N 3BG, UK
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19
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Stamelou M, Mencacci NE, Cordivari C, Batla A, Wood NW, Houlden H, Hardy J, Bhatia KP. Myoclonus-dystonia syndrome due to tyrosine hydroxylase deficiency. Neurology 2012; 79:435-41. [PMID: 22815559 DOI: 10.1212/wnl.0b013e318261714a] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To present a new family with tyrosine hydroxylase deficiency (THD) that presented with a new phenotype of predominant, levodopa-responsive myoclonus with dystonia due to compound heterozygosity of one previously reported mutation in the promoter region and a novel nonsynonymous mutation in the other allele, thus expanding the clinical and genetic spectrum of this disorder. METHODS We performed detailed clinical examination of the family and electrophysiology to characterize the myoclonus. We performed analysis of the TH gene and in silico prediction of the possible effect of nonsynonymous substitutions on protein structure. RESULTS Electrophysiology suggested that the myoclonus was of subcortical origin. Genetic analysis of the TH gene revealed compound heterozygosity of a point mutation in the promoter region (c.1-71 C>T) and a novel nonsynonymous substitution in exon 12 (c.1282G>A, p.Gly428Arg). The latter is a novel variant, predicted to have a deleterious effect on the TH protein function and is the first pathogenic TH mutation in patients of African ancestry. CONCLUSION We presented a THD family with predominant myoclonus-dystonia and a new genotype. It is important to consider THD in the differential diagnosis of myoclonus-dystonia, because early treatment with levodopa is crucial for these patients.
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Affiliation(s)
- Maria Stamelou
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, UK.
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Abstract
Background. The diagnosis of autosomal dominant GTP-cyclohydrolase deficiency relies on the examination of the GCH1 gene and/or pterins and neurotransmitters in CSF. The aim of the study was to assess the diagnostic value, if any, of pterins in urine and blood phenylalanine (Phe) and tyrosine (Tyr) under oral Phe loading test. Methods. We report on two new pedigrees with four symptomatic and four asymptomatic carriers whose pattern of urinary pterins and blood Phe/Tyr ratio under oral Phe loading pointed to GTP-cyclohydrolase deficiency. The study was then extended to 3 further patients and 90 controls. The diagnostic specificity and sensitivity of these metabolic markers were analysed by backwards logistic analysis. Results. Two genetic alterations segregated alternatively in Family 1 (c.631-632 del AT and c.671A > G), while exon 1 deletion was transmitted along three generations in Family 2. Neopterin and biopterin concentrations in urine clustered differently in controls under and over the age of 15. Therefore patients and controls were sub grouped according to this age. Neopterin was significantly reduced in GCH1 mutated subjects younger than 15, and both neopterin and biopterin in those older than 15. Moreover, the Phe/Tyr ratios at the second and third hour were both significantly higher in patients than in controls. Backwards logistic regression demonstrated the high diagnostic sensitivity and specificity of combined values of neopterin concentration and Phe/Tyr ratio at the second hour. Conclusions. Pterins in urine and Phe loading test are non-invasive and reliable tools for the biochemical diagnosis of GTP-cyclohydrolase deficiency.
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Ling H, Polke JM, Sweeney MG, Haworth A, Sandford CA, Heales SJR, Wood NW, Davis MB, Lees AJ. An intragenic duplication in guanosine triphosphate cyclohydrolase-1 gene in a dopa-responsive dystonia family. Mov Disord 2011; 26:905-9. [PMID: 21287604 DOI: 10.1002/mds.23593] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Revised: 11/16/2010] [Accepted: 11/22/2010] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Autosomal dominant dopa-responsive dystonia is commonly caused by mutations in the guanosine triphosphate cyclohydrolase-1 gene. METHODS We report a British family that has been followed for more than 20 years in which no mutations were previously identified. RESULTS Reanalysis of this pedigree detected a duplication of guanosine triphosphate cyclohydrolase-1 exon 2 in affected family members. mRNA analysis showed a mutant transcript with a tandem exon 2 duplication. Four family members developed dopa-responsive dystonia, with onset in their late teens, and subsequently developed restless leg syndrome and migraine. CONCLUSIONS This is the first report of an intragenic guanosine triphosphate cyclohydrolase-1 duplication in a dopa-responsive dystonia family.
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Affiliation(s)
- Helen Ling
- Reta Lila Weston Institute of Neurological Studies, Institute of Neurology, University College London, London, United Kingdom
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22
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Abstract
Myoclonus dystonia syndrome (MDS) refers to a group of heterogeneous nondegenerative clinical conditions characterized by the association of myoclonus and dystonia as the only or prominent symptom. The "core" of MDS is represented by inherited myoclonus-dystonia (M-D), a disorder with autosomal-dominant inheritance and reduced penetrance, beginning in early childhood with a relatively benign course, with myoclonus as the most predominant and disabling symptom. Alcohol responsiveness and psychiatric symptoms are characteristic features. Mutations in the epsilon-sarcoglycan gene (SGCE, DYT11) represent the major genetic cause, but M-D is genetically heterogeneous. In a variable proportion of M-D patients no mutation is found, and at least one other locus (DYT15) has been linked to the disease. Patients with primary dystonia, with or without the DYT1 mutation, may show irregular and arrhythmic jerky movements associated with dystonia. Usually dystonia is the prominent symptom and the myoclonic jerk involves the same body region; this condition, currently defined as "myoclonic dystonia," is included in the spectrum of MDS. Dopa-responsive dystonia due to mutation in the GTP-CH gene and vitamin E deficiency can present with a phenotype of dystonia and myoclonus in combination; both conditions should be considered in the diagnostic approach to patients since they are potentially treatable.
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Affiliation(s)
- Nardo Nardocci
- Department of Child Neurology, Fondazione IRCCS Istituto Neurologico "C. Besta", Milan, Italy.
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23
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Abstract
Clinical characteristics and pahophysiologies of dopa-responsive dystonia are discussed by reviewing autosomal-dominant GTP cyclohydrolase-I deficiency (AD GCHI D), recessive deficiencies of enzymes of pteridine metabolism, and recessive tyrosine hydroxylase (TH). Pteridine and TH metabolism involve TH activities in the terminals of the nigrostriatal dopamine neuron which show high in early childhood and decrease exponentially with age, attaining stational low levels by the early 20s. In these disorders, TH in the terminals follows this course with low levels and develops particular symptoms with functional maturation of the downstream structures of the basal ganglia; postural dystonia through the direct pathway and descending output matured earlier in early childhood and parkinsonism in TH deficiency in teens through the D2 indirect pathway ascending output matured later. In action-type AD GCHI D, deficiency of TH in the terminal on the subthalamic nucleus develops action dystonia through the descending output in childhood, focal and segmental dystonia and parkinsonism in adolescence and adulthood through the ascending pathway maturing later. Dysfunction of dopamine in the terminals does not cause degenerative changes or higher cortical dysfunction. In recessive disorders, hypofunction of serotonin and noradrenaline induces hypofunction of the dopamine in the perikaryon and shows cortical dysfunction.
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Affiliation(s)
- Masaya Segawa
- Segawa Neurological Clinic for Children, Tokyo, Japan.
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24
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Kinugawa K, Vidailhet M, Clot F, Apartis E, Grabli D, Roze E. Myoclonus-dystonia: an update. Mov Disord 2009; 24:479-89. [PMID: 19117361 DOI: 10.1002/mds.22425] [Citation(s) in RCA: 123] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Our knowledge of the clinical, neurophysiological, and genetic aspects of myoclonus-dystonia (M-D) has improved markedly in the recent years. Basic research has provided new insights into the complex dysfunctions involved in the pathogenesis of M-D. On the basis of a comprehensive literature search, this review summarizes current knowledge on M-D, with a focus on recent findings. We also propose modified diagnostic criteria and recommendations for clinical management.
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25
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Luciano MS, Ozelius L, Sims K, Raymond D, Liu L, Saunders-Pullman R. Responsiveness to levodopa in epsilon-sarcoglycan deletions. Mov Disord 2009; 24:425-8. [PMID: 19133653 DOI: 10.1002/mds.22375] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Myoclonus-dystonia (M-D) is characterized by early-onset myoclonus and dystonia, and is often due to mutations in the epsilon-sarcoglycan gene (SCGE) at locus 7q21. The pathogenesis of M-D is poorly understood, and in a murine knockout model, dopaminergic hyperactivity has been postulated as a mechanism. We present two unrelated individuals with M-D due to SCGE deletions who displayed a robust and sustained response to levodopa (L-dopa) treatment. In contrast to using dopamine blocking agents suggested by the hyperdopaminergic knockout model, we propose that a trial of L-dopa may be considered in patients with myoclonus-dystonia.
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Affiliation(s)
- Marta San Luciano
- Department of Neurology, Beth Israel Medical Center, New York, New York 10003, USA
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26
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Ikeda T, Kanmura K, Kodama Y, Sawada K, Nunoi H, Hasegawa K. Segawa disease with a novel heterozygous mutation in exon 5 of the GCH-1 gene (E183K). Brain Dev 2009; 31:173-5. [PMID: 18621497 DOI: 10.1016/j.braindev.2008.05.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2007] [Revised: 05/27/2008] [Accepted: 05/31/2008] [Indexed: 11/19/2022]
Abstract
We report a novel missense mutation in the GCH-1 gene resulting in Segawa disease. The patient, a 6-year-old girl, presented with dystonia. Her CSF biopterin and neopterin levels were reduced, suggesting Segawa disease. L-dopa administration led to clinical improvement. Genetic analysis revealed a missense mutation in exon 5 of the GCH-1 gene (E183K). Although dystonia or other movement disorders were not identified in her family, this may be explained by the low penetrance of Segawa disease.
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Affiliation(s)
- T Ikeda
- Division of Pediatrics, Department of Reproductive and Developmental Medicine, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake-Chou, Miyazaki-Gun, Miyazaki 889-1692, Japan.
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27
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Nardocci N, Zorzi G, Barzaghi C, Zibordi F, Ciano C, Ghezzi D, Garavaglia B. Myoclonus-dystonia syndrome: clinical presentation, disease course, and genetic features in 11 families. Mov Disord 2008; 23:28-34. [PMID: 17853490 DOI: 10.1002/mds.21715] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Myoclonus-dystonia syndrome (MDS) is an inherited movement disorder with clinical and genetic heterogeneity. The epsilon sarcoglycan (SGCE) gene is an important cause of MDS. We report the results of a clinical and genetic study of 20 patients from 11 families. We disclosed six novel and two previously described mutations in nine families. The majority of patients had a phenotype of myoclonus and dystonia in combination, but clinical findings considered atypical, such a very early onset, distal myoclonus, and legs involvement, were detected in a significant proportion of cases. The disease course was variable, from progression to spontaneous remission of the motor symptoms. There were no obvious differences between mutation-positive and -negative cases.
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Affiliation(s)
- Nardo Nardocci
- Department of Child Neurology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, Milano, Italy.
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28
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Camargos ST, Cardoso F, Momeni P, Gianetti JG, Lees A, Hardy J, Singleton A. Novel GCH1 mutation in a Brazilian family with dopa-responsive dystonia. Mov Disord 2008; 23:299-302. [PMID: 18044725 DOI: 10.1002/mds.21842] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Dopa responsive Dystonia (DRD) was first described in 1971 and typically begins at childhood with gait dysfunction caused by foot dystonia progressing to affect other extremities. There is marked diurnal fluctuation and sustained improvement of symptoms with low dose levodopa therapy. Heterozygous mutation of the gene GCH1 has been shown to cause DRD. We studied GCH1 in nine patients with DRD from six families of Federal University of Minas Gerais Movement Disorders Clinic. We identified three mutations; two affected siblings carried a novel T209P mutation and two siblings from another family were compound heterozygous carriers of Met211Val and Lys224Arg mutations. To our knowledge this is the first report of GCH1 mutations underlying DRD in patients from Brazil.
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Affiliation(s)
- Sarah Teixeira Camargos
- Universidade Federal de Minas Gerais, Department of Clinical and Neurological Sciences, Movement Disorders Group, Brazil
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29
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Scola RH, Carducci C, Amaral VG, Lorenzoni PJ, Teive HA, Giovanniello T, Werneck LC. A novel missense mutation pattern of the GCH1 gene in dopa-responsive dystonia. ARQUIVOS DE NEURO-PSIQUIATRIA 2007; 65:1224-7. [DOI: 10.1590/s0004-282x2007000700026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2007] [Accepted: 10/02/2007] [Indexed: 11/22/2022]
Abstract
Dopa-responsive dystonia (DRD) is an inherited metabolic disorder now classified as DYT5 with two different biochemical defects: autosomal dominant GTP cyclohydrolase 1 (GCH1) deficiency or autosomal recessive tyrosine hydroxylase deficiency. We report the case of a 10-years-old girl with progressive generalized dystonia and gait disorder who presented dramatic response to levodopa. The phenylalanine to tyrosine ratio was significantly higher after phenylalanine loading test. This condition had two different heterozygous mutations in the GCH1 gene: the previously reported P23L mutation and a new Q182E mutation. The characteristics of the DRD and the molecular genetic findings are discussed.
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30
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Benoist J, Roze E, Sedel F. Apport de l’analyse du liquide cérébrospinal pour le diagnostic des maladies métaboliques héréditaires. Rev Neurol (Paris) 2007; 163:950-9. [DOI: 10.1016/s0035-3787(07)92639-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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31
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Richardson MA, Read LL, Taylor Clelland CL, Reilly MA, Chao HM, Guynn RW, Suckow RF, Clelland JD. Evidence for a tetrahydrobiopterin deficit in schizophrenia. Neuropsychobiology 2005; 52:190-201. [PMID: 16244500 DOI: 10.1159/000089002] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Tetrahydrobiopterin (BH(4)) is a vital cofactor maintaining availability of the amine neurotransmitters [dopamine (DA), noradrenaline (NA), and serotonin (5-HT)], regulating the synthesis of nitric oxide (NO) by nitric oxide synthase (NOS), and stimulating and modulating the glutamatergic system (directly and indirectly). These BH(4) properties and their potential relevance to schizophrenia led us to investigate the hypothesis of a study group (healthy controls, n=37; schizophrenics, n=154) effect on fasting plasma total biopterin levels (a measure of BH(4)). Study analysis showed a highly significant deficit of total biopterins for the schizophrenic sample after partialling out the effects of potential confounds of gender, age, ethnicity, neuroleptic use history and dose of current use, 24-hour dietary phenylalanine/protein ratio (a dietary variable relevant to BH(4) synthesis), and plasma phenylalanine (which stimulates BH(4) synthesis). A mean decrement of 34% in plasma total biopterins for schizophrenics from control values supports clinical relevance for the finding. In a subsample (21 controls and 23 schizophrenics), sequence analysis was done of the GTP cyclohydrolase I feedback regulatory gene and no mutations were found in the coding region of the gene. A deficiency of BH(4) could lead to hypofunction of the systems of DA, NA, 5-HT, NOS/NO, and glutamate, all of which have been independently implicated in schizophrenia psychopathology. Further, evidence has been accumulating which implicates the critical interdependence of these neurotransmitter systems in schizophrenia; this concept, along with the present study finding of a biopterin deficit, suggests that further study of the BH(4) system in schizophrenia is warranted and desirable.
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Affiliation(s)
- M A Richardson
- The Nathan S. Kline Institute for Psychiatric Research, New York State Office of Mental Health, Orangeburg, NY 10962, USA
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32
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Zorzi G, Marras C, Nardocci N, Franzini A, Chiapparini L, Maccagnano E, Angelini L, Caldiroli D, Broggi G. Stimulation of the globus pallidus internus for childhood-onset dystonia. Mov Disord 2005; 20:1194-200. [PMID: 15895426 DOI: 10.1002/mds.20510] [Citation(s) in RCA: 116] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We report the results of deep brain stimulation (DBS) of the globus pallidus internus (GPi) in 12 patients with childhood-onset generalized dystonia refractory to medication, including 3 patients with status dystonicus. There were 8 patients who had DYT1-negative primary dystonia, 1 had DYT1-positive dystonia, and 3 had symptomatic dystonia. Stimulation was effective in all but 1 patient. Dystonic postures and movements of the axis and limbs responded to DBS to a greater extent than oromandibular dystonia and fixed dystonic postures. These findings provide further evidence that pallidal stimulation is an effective treatment for intractable childhood-onset dystonia, including status dystonicus, and together with previous findings, suggest that it should be considered the treatment of choice for these conditions.
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Affiliation(s)
- Giovanna Zorzi
- Department of Child Neurology, Istituto Nazionale Neurologico Carlo Besta, Milano, Italy
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33
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Garavaglia B, Invernizzi F, Carbone MLA, Viscardi V, Saracino F, Ghezzi D, Zeviani M, Zorzi G, Nardocci N. GTP-cyclohydrolase I gene mutations in patients with autosomal dominant and recessive GTP-CH1 deficiency: identification and functional characterization of four novel mutations. J Inherit Metab Dis 2004; 27:455-63. [PMID: 15303002 DOI: 10.1023/b:boli.0000037349.08483.96] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
GTP-cyclohydrolase I (GTP-CH1, EC 3.5.4.16) is encoded by the GCH1 gene. Mutations in the GCH1 gene cause both dopa-responsive dystonia (McKusick 128230) and recessive GTP-CH1 deficiency (McKusick 600225). The exact molecular mechanism resulting in decreased GTP-CH1 activity in the patients is still obscure. We report the clinical features and molecular and functional study of the GCH1 gene in eight Italian patients affected by dominant and recessive GTP-CH1 deficiency. All the studied patients had mutations in the GCH1 gene. Three missense mutations (V205G, K224R, P199A), a frameshift mutation (Delta G693), and a splice-site mutation (ivs5 + 1g > c) were found. Except for K224R these are all novel mutations. To analyse the defect caused by the novel mutations, an in vivo functional assay in a Saccharomyces cerevisiae strain lacking the endogenous gene encoding GTP-CH1 ( FOL2 ) was performed. Complementation analysis showed that the Delta G693 and V205G mutations abolish the enzymatic function, while the P199A mutation causes a conditional defect. In conclusion, the clinical phenotypes displayed by our patients confirm the wide clinical spectrum of the disease and further support the lack of correlation between a given mutation and a clinical phenotype. Complementation analysis in yeast is a useful tool for confirming the pathogenetic effect of GCH1 mutations.
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Affiliation(s)
- B Garavaglia
- Unità Operativa di Neurogenetica Molecolare, Istituto Nazionale Neurologico-IRCCS Carlo Besta, via L. Temolo 4, 20126 Milano, Italy.
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Roubertie A, Rivier F, Tuffery-Giraud S, Humbertclaude V, Claustres M, Cheminal R, Echenne B. [Movement disorders in childhood: classification and genetic update]. Arch Pediatr 2003; 10:994-1002. [PMID: 14613695 DOI: 10.1016/j.arcped.2003.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abnormal movements are not unusual in childhood. Recent genetic progresses provide a new approach of childhood movement disorders. Several loci have been identified in paroxysmal dyskinesia, or in Gilles de la Tourette syndrome. A gene has been cloned in Hallervorden-Spatz syndrome, and a gene has recently been implicated in benign hereditary chorea. Considerable advances concern the genetic of dystonic syndromes: several chromosomal localizations have been identified, and several genes have been cloned. Genetic advances allow nosographic reclassification of some entities and offer new molecular tools for a more appropriate diagnosis. The increasing wealth of genetic knowledge will provide further insight in the understanding of abnormal movement disorders in childhood.
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Affiliation(s)
- A Roubertie
- Service de neuropédiatrie, hôpital Saint-Eloi, 80, avenue Augustin-Fliche, 34295 cedex 5 Montpellier, France.
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35
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Abstract
Treatment of dopa-responsive dystonia is one of the more satisfying experiences in clinical neurology. The response to treatment with levodopa is usually dramatic and complete with no long-term complications. Carbidopa/levodopa is the mainstay in treating dopa-responsive dystonia. There is some experience using anticholinergic agents, but they are more likely to cause side effects and do not treat the underlying biochemical abnormality. Dopa-responsive dystonia caused by guanosine triphosphate cyclohydrolase I deficiency typically presents with dystonia in the lower extremities in the first decade of life. However, the presenting symptoms can vary. Thus, it is this author's recommendation that any child with dystonia receive a trial of carbidopa/levodopa.
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Affiliation(s)
- Jonathan W. Mink
- Department of Neurology, University of Rochester Medical Center, 601 Elmwood Avenue, Box 631, Rochester, NY 14642, USA. r.edu
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36
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Millichap JG. Myoclonus-Dystonia Syndrome. Pediatr Neurol Briefs 2002. [DOI: 10.15844/pedneurbriefs-16-11-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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