1
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Xu JJ, Li HF, Wu ZY. Paroxysmal Kinesigenic Dyskinesia: Genetics and Pathophysiological Mechanisms. Neurosci Bull 2024; 40:952-962. [PMID: 38091244 PMCID: PMC11250761 DOI: 10.1007/s12264-023-01157-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/03/2023] [Indexed: 07/16/2024] Open
Abstract
Paroxysmal kinesigenic dyskinesia (PKD), the most common type of paroxysmal movement disorder, is characterized by sudden and brief attacks of choreoathetosis or dystonia triggered by sudden voluntary movements. PKD is mainly caused by mutations in the PRRT2 or TMEM151A gene. The exact pathophysiological mechanisms of PKD remain unclear, although the function of PRRT2 protein has been well characterized in the last decade. Based on abnormal ion channels and disturbed synaptic transmission in the absence of PRRT2, PKD may be channelopathy or synaptopathy, or both. In addition, the cerebellum is regarded as the key pathogenic area. Spreading depolarization in the cerebellum is tightly associated with dyskinetic episodes. Whereas, in PKD, other than the cerebellum, the role of the cerebrum including the cortex and thalamus needs to be further investigated.
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Affiliation(s)
- Jiao-Jiao Xu
- Department of Medical Genetics and Center for Rare Diseases, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
- Department of Neurology in the Second Affiliated Hospital, Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Hong-Fu Li
- Department of Medical Genetics and Center for Rare Diseases, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
- Department of Neurology in the Second Affiliated Hospital, Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Zhi-Ying Wu
- Department of Medical Genetics and Center for Rare Diseases, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China.
- Department of Neurology in the Second Affiliated Hospital, Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, 310009, China.
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2
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Yuan Z, Wang Q, Wang C, Liu Y, Fan L, Liu Y, Huang H. Identification of a de novo CACNA1B variant and a start-loss ADRA2B variant in paroxysmal kinesigenic dyskinesia. Heliyon 2024; 10:e28674. [PMID: 38571653 PMCID: PMC10988053 DOI: 10.1016/j.heliyon.2024.e28674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 03/12/2024] [Accepted: 03/21/2024] [Indexed: 04/05/2024] Open
Abstract
Paroxysmal kinesigenic dyskinesia (PKD) represents the most prevalent form of paroxysmal dyskinesia, characterized by recurrent and transient attacks of involuntary movements triggered by a sudden voluntary action. In this study, whole-exome sequencing was conducted on a cohort of Chinese patients to identify causal mutations. In one young female case, a de novo CACNA1B variant (NM_000718.3:exon3:c.479C > T:p.S160F) was identified as the causative lesion. This finding may broaden the phenotypic spectrum of CACNA1B mutations and provide a prospective cause of primary PKD. Additionally, a novel start-loss variant (NM_000682.7:c.3G > A) within ADRA2B further denied its association with benign adult familial myoclonic epilepsy, and a KCNQ2 E515D variant that was reported as a genetic susceptibility factor for seizures had no damaging effect in this family. In sum, this study established a correlation between CACNA1B and primary PKD, and found valid evidence that further negates the pathogenic role of ADRA2B in benign adult familial myoclonic epilepsy.
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Affiliation(s)
- Zhuangzhuang Yuan
- Department of Cell Biology, School of Life Science, Central South University, Changsha, China
| | - Qian Wang
- Department of Cell Biology, School of Life Science, Central South University, Changsha, China
| | - Chenyu Wang
- Department of Cell Biology, School of Life Science, Central South University, Changsha, China
| | - Yuxing Liu
- Department of Cell Biology, School of Life Science, Central South University, Changsha, China
| | - Liangliang Fan
- Department of Cell Biology, School of Life Science, Central South University, Changsha, China
| | - Yihui Liu
- Department of Neurology, Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Hao Huang
- Department of Cell Biology, School of Life Science, Central South University, Changsha, China
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3
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Huang HL, Zhang QX, Huang F, Long XY, Song Z, Xiao B, Li GL, Ma CY, Liu D. TMEM151A variants associated with paroxysmal kinesigenic dyskinesia. Hum Genet 2023; 142:1017-1028. [PMID: 36856871 DOI: 10.1007/s00439-023-02535-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 02/16/2023] [Indexed: 03/02/2023]
Abstract
TMEM151A, located at 11q13.2 and encoding transmembrane protein 151A, was recently reported as causative for autosomal dominant paroxysmal kinesigenic dyskinesia (PKD). Here, through comprehensive analysis of sporadic and familial cases, we expand the clinical and mutation spectrum of PKD. In doing so, we clarify the clinical and genetic features of Chinese PKD patients harboring TMEM151A variants and further explore the relationship between TMEM151A mutations and PKD. Whole exome sequencing was performed on 26 sporadic PKD patients and nine familial PKD pedigrees without PRRT2 variants. Quantitative real-time PCR was used to assess the gene expression of frameshift mutant TMEM151A in a PKD patient. TMEM151A variants reported to date were reviewed. Four TMEM151A variants were detected in four unrelated families with 12 individuals, including a frameshift mutation [c.606_607insA (p.Val203fs)], two missense mutations [c.166G > A (p.Gly56Arg) and c.791T > C (p.Val264Ala)], and a non-pathogenic variant [c.994G > A (p.Gly332Arg)]. The monoallelic frameshift mutation [c.606_607insA (p.Val203fs)] may cause TMEM151A mRNA decay, suggesting a potential pathogenic mechanism of haploinsufficiency. Patients with TMEM151A variants had short-duration attacks and presented with dystonia. Our study provides a detailed clinical description of PKD patients with TMEM151A mutations and reports a new disease-causing mutation, expanding the known phenotypes caused by TMEM151A mutations and providing further detail about the pathoetiology of PKD.
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Affiliation(s)
- Hua Lin Huang
- Department of Neurology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
- Department of Obstetrics and Gynecology, Reproductive Medicine Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qing Xia Zhang
- Department of Neurology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Fei Huang
- Department of Obstetrics and Gynecology, Reproductive Medicine Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiao Yan Long
- Department of Neurology, The Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhi Song
- Department of Neurology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Bo Xiao
- Department of Neurology, The Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Guo Liang Li
- Department of Neurology, The Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Cai Yu Ma
- Department of Neurology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China.
| | - Ding Liu
- Department of Neurology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China.
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4
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Li ZY, Tian WT, Huang XJ, Cao L. The Pathogenesis of Paroxysmal Kinesigenic Dyskinesia: Current Concepts. Mov Disord 2023; 38:537-544. [PMID: 36718795 DOI: 10.1002/mds.29326] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 12/31/2022] [Accepted: 01/06/2023] [Indexed: 02/01/2023] Open
Abstract
Paroxysmal kinesigenic dyskinesia (PKD) is a movement disorder characterized by recurrent and transient episodes of involuntary movements, including dystonia, chorea, ballism, or a combination of these, which are typically triggered by sudden voluntary movement. Disturbance of the basal ganglia-thalamo-cortical circuit has long been considered the cause of involuntary movements. Impairment of the gating function of the basal ganglia can cause an aberrant output toward the thalamus, which in turn leads to excessive activation of the cerebral cortex. Structural and functional abnormalities in the basal ganglia, thalamus, and cortex and abnormal connections between these brain regions have been found in patients with PKD. Recent studies have highlighted the role of the cerebellum in PKD. Insufficient suppression from the cerebellar cortex to the deep cerebellar nuclei could lead to overexcitation of the thalamocortical pathway. Therefore, this literature review aims to provide a comprehensive overview of the current research progress to explore the neural circuits and pathogenesis of PKD and promote further understanding and outlook on the pathophysiological mechanism of movement disorders. © 2023 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Zi-Yi Li
- Department of Neurology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wo-Tu Tian
- Department of Neurology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiao-Jun Huang
- Department of Neurology and Institute of Neurology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Li Cao
- Department of Neurology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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5
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Clinical and genetic analyses of 150 patients with paroxysmal kinesigenic dyskinesia. J Neurol 2022; 269:4717-4728. [DOI: 10.1007/s00415-022-11103-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 03/22/2022] [Accepted: 03/24/2022] [Indexed: 11/25/2022]
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6
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Matthews E, Holmes S, Fialho D. Skeletal muscle channelopathies: a guide to diagnosis and management. Pract Neurol 2021; 21:196-204. [PMID: 33563766 DOI: 10.1136/practneurol-2020-002576] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2020] [Indexed: 12/17/2022]
Abstract
Skeletal muscle channelopathies are a group of rare episodic genetic disorders comprising the periodic paralyses and the non-dystrophic myotonias. They may cause significant morbidity, limit vocational opportunities, be socially embarrassing, and sometimes are associated with sudden cardiac death. The diagnosis is often hampered by symptoms that patients may find difficult to describe, a normal examination in the absence of symptoms, and the need to interpret numerous tests that may be normal or abnormal. However, the symptoms respond very well to holistic management and pharmacological treatment, with great benefit to quality of life. Here, we review when to suspect a muscle channelopathy, how to investigate a possible case and the options for therapy once a diagnosis is made.
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Affiliation(s)
- Emma Matthews
- Atkinson-Morley Neuromuscular Centre, St George's University Hospitals NHS Foundation Trust, London, UK
- Department of Neuromuscular Diseases, UCL, Institute of Neurology, London, UK
| | - Sarah Holmes
- Queen Square Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, London, UK
| | - Doreen Fialho
- Department of Neuromuscular Diseases, UCL, Institute of Neurology, London, UK
- Queen Square Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, London, UK
- Department of Clinical Neurophysiology, King's College Hospital NHS Foundation Trust, London, UK
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7
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Miura S, Shimojo T, Morikawa T, Kamada T, Uchiyama Y, Kurata S, Fujioka R, Shibata H. Familial paroxysmal kinesigenic dyskinesia with a novel missense variant (Arg2866Trp) in NBEA. J Hum Genet 2021; 66:805-811. [PMID: 33692494 DOI: 10.1038/s10038-021-00914-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/17/2021] [Accepted: 02/20/2021] [Indexed: 11/10/2022]
Abstract
Paroxysmal kinesigenic dyskinesia (PKD) is a movement disorder characterized by episodic involuntary movement attacks triggered by sudden movements, acceleration, or intention to move. We ascertained two Japanese familial cases with PKD. The proband is a 22-year-old woman who had noted sudden brief (<30 s) of involuntary movements provoked by kinesigenic trigger such as starting to run, getting on a train, picking up a telephone receiver and so on at the age of 14. Interictal brain single photon emission computed tomography (SPECT) showed hyperperfusion in the left thalamus. A 46-year-old woman, the mother of the proband was also suffering from brief attacks triggered by starting to run in her high school days. On neurological examination, both showed no abnormality. Whole exome sequencing combined with rigorous filtering revealed two heterozygous nonsynonymous variants (NM_001447: c.8976G > C [p.Gln2992His] in FAT2 and NM_015678: c.8596C > T [p.Arg2866Trp] in NBEA). Real time quantitative PCR analysis of Nbea mRNA levels in the developing rat brain revealed peak at postnatal day 28 and decline at postnatal day 56. This result might match the most common clinical course of PKD from the point of view of the most common age at remission. NBEA has been reported to be responsible for neurodevelopmental disease accompanied by epilepsy. We concluded the variant in NBEA most likely to be responsible for our familial cases of PKD.
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Affiliation(s)
- Shiroh Miura
- Department of Neurology and Geriatric Medicine, Ehime University Graduate School of Medicine, Toon, 791-0295, Japan.,Division of Genomics, Medical Institute of Bioregulation, Kyushu University, Fukuoka, 812-8582, Japan
| | - Tomofumi Shimojo
- Division of Genomics, Medical Institute of Bioregulation, Kyushu University, Fukuoka, 812-8582, Japan
| | - Takuya Morikawa
- Division of Genomics, Medical Institute of Bioregulation, Kyushu University, Fukuoka, 812-8582, Japan
| | - Takashi Kamada
- Department of Neurology, Fukuoka Sanno Hospital, Fukuoka, 814-0001, Japan
| | - Yusuke Uchiyama
- Department of Radiology, Kurume University School of Medicine, Kurume, 830-0011, Japan
| | - Seiji Kurata
- Department of Radiology, Kurume University School of Medicine, Kurume, 830-0011, Japan
| | - Ryuta Fujioka
- Department of Food and Nutrition, Beppu University Junior College, Beppu, 874-8501, Japan
| | - Hiroki Shibata
- Division of Genomics, Medical Institute of Bioregulation, Kyushu University, Fukuoka, 812-8582, Japan.
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8
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Recommendations for the diagnosis and treatment of paroxysmal kinesigenic dyskinesia: an expert consensus in China. Transl Neurodegener 2021; 10:7. [PMID: 33588936 PMCID: PMC7885391 DOI: 10.1186/s40035-021-00231-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 01/16/2021] [Indexed: 02/08/2023] Open
Abstract
Paroxysmal dyskinesias are a group of neurological diseases characterized by intermittent episodes of involuntary movements with different causes. Paroxysmal kinesigenic dyskinesia (PKD) is the most common type of paroxysmal dyskinesia and can be divided into primary and secondary types based on the etiology. Clinically, PKD is characterized by recurrent and transient attacks of involuntary movements precipitated by a sudden voluntary action. The major cause of primary PKD is genetic abnormalities, and the inheritance pattern of PKD is mainly autosomal-dominant with incomplete penetrance. The proline-rich transmembrane protein 2 (PRRT2) was the first identified causative gene of PKD, accounting for the majority of PKD cases worldwide. An increasing number of studies has revealed the clinical and genetic characteristics, as well as the underlying mechanisms of PKD. By seeking the views of domestic experts, we propose an expert consensus regarding the diagnosis and treatment of PKD to help establish standardized clinical evaluation and therapies for PKD. In this consensus, we review the clinical manifestations, etiology, clinical diagnostic criteria and therapeutic recommendations for PKD, and results of genetic analyses in PKD patients performed in domestic hospitals.
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9
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Huang XJ, Wang SG, Guo XN, Tian WT, Zhan FX, Zhu ZY, Yin XM, Liu Q, Yin KL, Liu XR, Zhang Y, Liu ZG, Liu XL, Zheng L, Wang T, Wu L, Rong TY, Wang Y, Zhang M, Bi GH, Tang WG, Zhang C, Zhong P, Wang CY, Tang JG, Lu W, Zhang RX, Zhao GH, Li XH, Li H, Chen T, Li HY, Luo XG, Song YY, Tang HD, Luan XH, Zhou HY, Tang BS, Chen SD, Cao L. The Phenotypic and Genetic Spectrum of Paroxysmal Kinesigenic Dyskinesia in China. Mov Disord 2020; 35:1428-1437. [PMID: 32392383 DOI: 10.1002/mds.28061] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 02/23/2020] [Accepted: 02/28/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Paroxysmal kinesigenic dyskinesia is a spectrum of involuntary dyskinetic disorders with high clinical and genetic heterogeneity. Mutations in proline-rich transmembrane protein 2 have been identified as the major pathogenic factor. OBJECTIVES We analyzed 600 paroxysmal kinesigenic dyskinesia patients nationwide who were identified by the China Paroxysmal Dyskinesia Collaborative Group to summarize the clinical phenotypes and genetic features of paroxysmal kinesigenic dyskinesia in China and to provide new thoughts on diagnosis and therapy. METHODS The China Paroxysmal Dyskinesia Collaborative Group was composed of departments of neurology from 22 hospitals. Clinical manifestations and proline-rich transmembrane protein 2 screening results were recorded using unified paroxysmal kinesigenic dyskinesia registration forms. Genotype-phenotype correlation analyses were conducted in patients with and without proline-rich transmembrane protein 2 mutations. High-knee exercises were applied in partial patients as a new diagnostic test to induce attacks. RESULTS Kinesigenic triggers, male predilection, dystonic attacks, aura, complicated forms of paroxysmal kinesigenic dyskinesia, clustering in patients with family history, and dramatic responses to antiepileptic treatment were the prominent features in this multicenter study. Clinical analysis showed that proline-rich transmembrane protein 2 mutation carriers were prone to present at a younger age and have longer attack duration, bilateral limb involvement, choreic attacks, a complicated form of paroxysmal kinesigenic dyskinesia, family history, and more forms of dyskinesia. The new high-knee-exercise test efficiently induced attacks and could assist in diagnosis. CONCLUSIONS We propose recommendations regarding diagnostic criteria for paroxysmal kinesigenic dyskinesia based on this large clinical study of paroxysmal kinesigenic dyskinesia. The findings offered some new insights into the diagnosis and treatment of paroxysmal kinesigenic dyskinesia and might help in building standardized paroxysmal kinesigenic dyskinesia clinical evaluations and therapies. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Xiao-Jun Huang
- Department of Neurology, Rui Jin Hospital and Rui Jin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,China Paroxysmal Dyskinesia Collaborative Group (CPDCG), Shanghai, China
| | - Shi-Ge Wang
- Department of Neurology, Rui Jin Hospital and Rui Jin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,China Paroxysmal Dyskinesia Collaborative Group (CPDCG), Shanghai, China
| | - Xia-Nan Guo
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC), Beijing, China.,McKusick-Zhang Center for Genetic Medicine, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College (PUMC), Beijing, China.,Department of Nephrology, the First Affiliated Hospital of Dalian Medical University, Dalian Medical University, Dalian, China.,China Paroxysmal Dyskinesia Collaborative Group (CPDCG), Shanghai, China
| | - Wo-Tu Tian
- Department of Neurology, Rui Jin Hospital and Rui Jin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,China Paroxysmal Dyskinesia Collaborative Group (CPDCG), Shanghai, China
| | - Fei-Xia Zhan
- Department of Neurology, Rui Jin Hospital and Rui Jin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,China Paroxysmal Dyskinesia Collaborative Group (CPDCG), Shanghai, China
| | - Ze-Yu Zhu
- Department of Neurology, Rui Jin Hospital and Rui Jin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,China Paroxysmal Dyskinesia Collaborative Group (CPDCG), Shanghai, China
| | - Xiao-Meng Yin
- Department of Neurology, Xiangya Hospital, Central South University, State Key Laboratory of Medical Genetics, Changsha, China.,China Paroxysmal Dyskinesia Collaborative Group (CPDCG), Shanghai, China
| | - Qing Liu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC), Beijing, China.,China Paroxysmal Dyskinesia Collaborative Group (CPDCG), Shanghai, China
| | - Kai-Li Yin
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC), Beijing, China.,McKusick-Zhang Center for Genetic Medicine, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College (PUMC), Beijing, China.,China Paroxysmal Dyskinesia Collaborative Group (CPDCG), Shanghai, China
| | - Xiao-Rong Liu
- Institute of Neuroscience and The Second Affiliated Hospital of Guangzhou Medical University, Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou, China.,China Paroxysmal Dyskinesia Collaborative Group (CPDCG), Shanghai, China
| | - Yu Zhang
- Department of Neurology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,China Paroxysmal Dyskinesia Collaborative Group (CPDCG), Shanghai, China
| | - Zhen-Guo Liu
- Department of Neurology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,China Paroxysmal Dyskinesia Collaborative Group (CPDCG), Shanghai, China
| | - Xiao-Li Liu
- Department of Neurology, Fengxian District Central Hospital, Shanghai Jiao Tong University Affiliated to Sixth People's Hospital South Campus, Shanghai, China.,China Paroxysmal Dyskinesia Collaborative Group (CPDCG), Shanghai, China
| | - Lan Zheng
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, China.,China Paroxysmal Dyskinesia Collaborative Group (CPDCG), Shanghai, China
| | - Tian Wang
- Department of Neurology, The Central Hospital of Wuhan, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China.,China Paroxysmal Dyskinesia Collaborative Group (CPDCG), Shanghai, China
| | - Li Wu
- Department of Neurology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.,China Paroxysmal Dyskinesia Collaborative Group (CPDCG), Shanghai, China
| | - Tian-Yi Rong
- Department of Neurology, Shidong Hospital of Yangpu District, Shanghai, China.,China Paroxysmal Dyskinesia Collaborative Group (CPDCG), Shanghai, China
| | - Yan Wang
- Department of Neurology, The First Hospital Affiliated to Anhui University of Science and Technology, Huainan, China.,China Paroxysmal Dyskinesia Collaborative Group (CPDCG), Shanghai, China
| | - Mei Zhang
- Department of Neurology, The First Hospital Affiliated to Anhui University of Science and Technology, Huainan, China.,China Paroxysmal Dyskinesia Collaborative Group (CPDCG), Shanghai, China
| | - Guang-Hui Bi
- Department of Neurology, Dongying People's Hospital, Dongying, China.,China Paroxysmal Dyskinesia Collaborative Group (CPDCG), Shanghai, China
| | - Wei-Guo Tang
- Department of Neurology, Zhoushan Hospital, Zhoushan, China.,China Paroxysmal Dyskinesia Collaborative Group (CPDCG), Shanghai, China
| | - Chao Zhang
- Department of Neurology, Suzhou Municipal Hospital, Suzhou, China.,China Paroxysmal Dyskinesia Collaborative Group (CPDCG), Shanghai, China
| | - Ping Zhong
- Department of Neurology, Suzhou Municipal Hospital, Suzhou, China.,China Paroxysmal Dyskinesia Collaborative Group (CPDCG), Shanghai, China
| | - Chun-Yu Wang
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China.,China Paroxysmal Dyskinesia Collaborative Group (CPDCG), Shanghai, China
| | - Jian-Guang Tang
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China.,China Paroxysmal Dyskinesia Collaborative Group (CPDCG), Shanghai, China
| | - Wei Lu
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China.,China Paroxysmal Dyskinesia Collaborative Group (CPDCG), Shanghai, China
| | - Ru-Xu Zhang
- Department of Neurology, The Third Xiangya Hospital, Central South University, Changsha, China.,China Paroxysmal Dyskinesia Collaborative Group (CPDCG), Shanghai, China
| | - Guo-Hua Zhao
- Department of Neurology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China.,China Paroxysmal Dyskinesia Collaborative Group (CPDCG), Shanghai, China
| | - Xun-Hua Li
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,China Paroxysmal Dyskinesia Collaborative Group (CPDCG), Shanghai, China
| | - Hua Li
- Department of Neurology, Guangdong 999 Brain Hospital, Guangzhou, China.,China Paroxysmal Dyskinesia Collaborative Group (CPDCG), Shanghai, China
| | - Tao Chen
- Department of Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, China.,China Paroxysmal Dyskinesia Collaborative Group (CPDCG), Shanghai, China
| | - Hai-Yan Li
- Department of Neurology, Anyang People's Hospital, Anyang, China.,China Paroxysmal Dyskinesia Collaborative Group (CPDCG), Shanghai, China
| | - Xiao-Guang Luo
- Department of Neurology, Shenzhen People's Hospital, Shenzhen, China.,China Paroxysmal Dyskinesia Collaborative Group (CPDCG), Shanghai, China
| | - Yan-Yan Song
- Department of Biostatistics, Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hui-Dong Tang
- Department of Neurology, Rui Jin Hospital and Rui Jin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,China Paroxysmal Dyskinesia Collaborative Group (CPDCG), Shanghai, China
| | - Xing-Hua Luan
- Department of Neurology, Rui Jin Hospital and Rui Jin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,China Paroxysmal Dyskinesia Collaborative Group (CPDCG), Shanghai, China
| | - Hai-Yan Zhou
- Department of Neurology, Rui Jin Hospital and Rui Jin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,China Paroxysmal Dyskinesia Collaborative Group (CPDCG), Shanghai, China
| | - Bei-Sha Tang
- Department of Neurology, Xiangya Hospital, Central South University, State Key Laboratory of Medical Genetics, Changsha, China.,China Paroxysmal Dyskinesia Collaborative Group (CPDCG), Shanghai, China
| | - Sheng-Di Chen
- Department of Neurology, Rui Jin Hospital and Rui Jin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,China Paroxysmal Dyskinesia Collaborative Group (CPDCG), Shanghai, China
| | - Li Cao
- Department of Neurology, Rui Jin Hospital and Rui Jin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,China Paroxysmal Dyskinesia Collaborative Group (CPDCG), Shanghai, China
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10
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De Gusmao CM, Silveira-Moriyama L. Paroxysmal movement disorders - practical update on diagnosis and management. Expert Rev Neurother 2019; 19:807-822. [PMID: 31353980 DOI: 10.1080/14737175.2019.1648211] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Paroxysmal dyskinesias and episodic ataxias are often caused by mutations in genes related to cell membrane and synaptic function. Despite the exponential increase in publications of genetically confirmed cases, management remains largely clinical based on non-systematic evidence. Areas covered: The authors provide a historical and clinical review of the main types of paroxysmal dyskinesias and episodic ataxias, with recommendations for diagnosis and management of patients suffering from these conditions. Expert opinion: After secondary paroxysmal dyskinesias, the most common paroxysmal movement disorders are likely to be PRRT2-associated paroxysmal kinesigenic dyskinesias, which respond well to small doses of carbamazepine, and episodic ataxia type 2, which often responds to acetazolamide. Familial paroxysmal non-kinesigenic dyskinesias are largely caused by mutations in PNKD and have poor response to therapy but improve with age. Exercise-induced dyskinesias are genetically heterogeneous, caused by disorders of glucose transport, mitochondrial function, dopaminergic pathways or neurodegenerative conditions amongst others. GNAO1 and ADCY5 mutations can also cause paroxysmal movement disorders, often in the context of ongoing motor symptoms. Although a therapeutic trial is justified for classic cases and in limited resource settings, genetic testing may help direct initial or rescue therapy. Deep brain stimulation may be an option for severe cases.
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Affiliation(s)
- Claudio M De Gusmao
- Department of Neurology, Harvard Medical School, Boston Children's Hospital , Boston , MA , USA.,Department of Neurology, Universidade Estadual de Campinas (UNICAMP) , São Paulo , Brazil
| | - Laura Silveira-Moriyama
- Department of Neurology, Universidade Estadual de Campinas (UNICAMP) , São Paulo , Brazil.,Education Unit, UCL Institute of Neurology, University College London , London , UK.,Department of Neurology, Hospital Bairral, Fundação Espírita Américo Bairral , Itapira , Brazil
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11
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Abstract
Paroxysmal dyskinesias (PxD) comprise a group of heterogeneous syndromes characterized by recurrent attacks of mainly dystonia and/or chorea, without loss of consciousness. PxD have been classified according to their triggers and duration as paroxysmal kinesigenic dyskinesia, paroxysmal nonkinesigenic dyskinesia and paroxysmal exertion-induced dyskinesia. Of note, the spectrum of genetic and nongenetic conditions underlying PxD is continuously increasing, but not always a phenotype–etiology correlation exists. This creates a challenge in the diagnostic work-up, increased by the fact that most of these episodes are unwitnessed. Furthermore, other paroxysmal disorders, included those of psychogenic origin, should be considered in the differential diagnosis. In this review, some key points for the diagnosis are provided, as well as the appropriate treatment and future approaches discussed.
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Affiliation(s)
- Raquel Manso-Calderón
- Department of Neurology, University Hospital of Salamanca, Salamanca, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
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12
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Zhao SY, Li LX, Chen YL, Chen YJ, Liu GL, Dong HL, Chen DF, Li HF, Wu ZY. Functional study and pathogenicity classification of PRRT2 missense variants in PRRT2-related disorders. CNS Neurosci Ther 2019; 26:39-46. [PMID: 31124310 PMCID: PMC6930815 DOI: 10.1111/cns.13147] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 04/16/2019] [Accepted: 04/18/2019] [Indexed: 12/01/2022] Open
Abstract
AIMS PRRT2 variants are associated with various paroxysmal disorders. To date, more than 90 PRRT2 variants have been reported in PRRT2-related disorders. Lack of functional study in majority of missense variants makes their pathogenicity uncertain. We aim to evaluate the clinical significance of PRRT2 missense variants by performing in vitro experiments. METHODS We systematically reviewed PRRT2-related disorders and summarized reported PRRT2 missense variants. Protein expression and subcellular localization of mutant PRRT2 were investigated in mammal cells. American College of Medical Genetics and Genomics (ACMG) guidelines were used to analyze the pathogenicity of PRRT2 missense variants. RESULTS A total of 29 PRRT2 missense variants were identified in PRRT2-related disorders. Ten variants were observed to affect both subcellular localization and protein level, three variants only affect membrane localization, and two variants only affect protein level. According to ACMG guidelines, 15 variants were finally classified as "likely pathogenic", three as "benign", three as "likely benign", and eight as "uncertain significance" variants. The likely pathogenic variants were concentrated in the C-terminal of PRRT2. CONCLUSIONS The pathogenicity of eight uncertain significance variants needs further investigation. C-terminal of PRRT2 is crucial for its physiological function.
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Affiliation(s)
- Shao-Yun Zhao
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital, and Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Li-Xi Li
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital, and Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Yu-Lan Chen
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital, and Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Yi-Jun Chen
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital, and Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Gong-Lu Liu
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital, and Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Hai-Lin Dong
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital, and Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Dian-Fu Chen
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital, and Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Hong-Fu Li
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital, and Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhi-Ying Wu
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital, and Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
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13
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Li W, Wang Y, Li B, Tang B, Sun H, Lai J, He N, Li B, Meng H, Liao W, Liu X. 16p11.2 deletion in patients with paroxysmal kinesigenic dyskinesia but without intellectual disability. Brain Behav 2018; 8:e01134. [PMID: 30307717 PMCID: PMC6236233 DOI: 10.1002/brb3.1134] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 09/09/2018] [Accepted: 09/12/2018] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Mutations of the PRRT2 gene are the most common cause for paroxysmal kinesigenic dyskinesia. However, patients with negative PRRT2 mutations are not rare. The aim of this study is to determine whether copy number variant of PRRT2 gene is another potential pathogenic mechanism in the patients with paroxysmal kinesigenic dyskinesia with negative PRRT2 point and frameshift mutations. METHODS We screened PRRT2 copy number variants using the AccuCopy™ method in 29 patients with paroxysmal kinesigenic dyskinesia with negative PRRT2 point and frameshift mutations. Next-generation sequencing was used to determine the chromosomal deletion sites in patients with PRRT2 copy number variants, and to exclude mutations in other known causative genes for paroxysmal kinesigenic dyskinesia. RESULTS Two sporadic patients with negative PRRT2 point and frameshift mutations (6.9%) were identified to have de novo PRRT2 copy number deletions (591 and 832 Kb deletions located in 16p11.2). The two patients presented with pure paroxysmal kinesigenic dyskinesia and paroxysmal kinesigenic dyskinesia and benign infantile convulsions, respectively. They had normal intelligence and neuropsychiatric development, in contrast to those previously reported with 16p11.2 deletions complicated with neuropsychiatric disorders. No correlation between the deletion ranges and phenotypic variations was found. CONCLUSION 16p11.2 deletions play causative roles in paroxysmal kinesigenic dyskinesia, especially for sporadic cases. Our findings extend the phenotype of 16p11.2 deletions to pure paroxysmal kinesigenic dyskinesia. Screening for 16p11.2 deletions should thus be included in genetic evaluations for patients with paroxysmal kinesigenic dyskinesia.
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Affiliation(s)
- Wen Li
- Institute of Neuroscience, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province, the Ministry of Education of China, Guangzhou, China
| | - Yifan Wang
- Institute of Neuroscience, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province, the Ministry of Education of China, Guangzhou, China
| | - Bin Li
- Institute of Neuroscience, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province, the Ministry of Education of China, Guangzhou, China
| | - Bin Tang
- Institute of Neuroscience, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province, the Ministry of Education of China, Guangzhou, China
| | - Hui Sun
- Institute of Neuroscience, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province, the Ministry of Education of China, Guangzhou, China
| | - Jinxing Lai
- Institute of Neuroscience, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province, the Ministry of Education of China, Guangzhou, China
| | - Na He
- Institute of Neuroscience, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province, the Ministry of Education of China, Guangzhou, China
| | - Bingmei Li
- Institute of Neuroscience, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province, the Ministry of Education of China, Guangzhou, China
| | - Heng Meng
- Department of Neurology, the First Affiliated Hospital and Clinical Neuroscience Institute, Jinan University, Guangzhou, China
| | - Weiping Liao
- Institute of Neuroscience, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province, the Ministry of Education of China, Guangzhou, China
| | - Xiaorong Liu
- Institute of Neuroscience, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province, the Ministry of Education of China, Guangzhou, China
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14
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Zima L, Ceulemans S, Reiner G, Galosi S, Chen D, Sahagian M, Haas RH, Hyland K, Friedman J. Paroxysmal motor disorders: expanding phenotypes lead to coalescing genotypes. Ann Clin Transl Neurol 2018; 5:996-1010. [PMID: 30128325 PMCID: PMC6093839 DOI: 10.1002/acn3.597] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 05/28/2018] [Accepted: 05/29/2018] [Indexed: 11/07/2022] Open
Abstract
Paroxysmal movement disorders encompass varied motor phenomena. Less recognized features and wide phenotypic and genotypic heterogeneity are impediments to straightforward molecular diagnosis. We describe a family with episodic ataxia type 1, initially mis‐characterized as paroxysmal dystonia to illustrate this diagnostic challenge. We summarize clinical features in affected individuals to highlight underappreciated aspects and provide comprehensive phenotypic description of the rare familial KCNA1 mutation. Delayed diagnosis in this family is emblematic of the broader challenge of diagnosing other paroxysmal motor disorders. We summarize genotypic and phenotypic overlap and provide a suggested diagnostic algorithm for approaching patients with these conditions.
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Affiliation(s)
- Laura Zima
- University of Nebraska Medical Center Omaha Nebraska
| | - Sophia Ceulemans
- Division of Neurology Rady Children's Hospital San Diego California
| | - Gail Reiner
- Division of Neurology Rady Children's Hospital San Diego California.,Department of Neurosciences University of California San Diego San Diego California
| | - Serena Galosi
- Division of Neurology Rady Children's Hospital San Diego California.,Department of Neurosciences University of California San Diego San Diego California.,Department of Human Neuroscience Child Neurology and Psychiatry Sapienza University Rome Italy
| | - Dillon Chen
- Division of Neurology Rady Children's Hospital San Diego California.,Department of Neurosciences University of California San Diego San Diego California
| | - Michelle Sahagian
- Division of Neurology Rady Children's Hospital San Diego California.,Department of Neurosciences University of California San Diego San Diego California
| | - Richard H Haas
- Division of Neurology Rady Children's Hospital San Diego California.,Department of Pediatrics University of California San Diego San Diego California.,Department of Neurosciences University of California San Diego San Diego California
| | - Keith Hyland
- Medical Neurogenetics Laboratories Atlanta Georgia
| | - Jennifer Friedman
- Division of Neurology Rady Children's Hospital San Diego California.,Department of Pediatrics University of California San Diego San Diego California.,Department of Neurosciences University of California San Diego San Diego California.,Rady Children's Institute for Genomic Medicine San Diego California
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15
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Kim SY, Lee JS, Kim WJ, Kim H, Choi SA, Lim BC, Kim KJ, Chae JH. Paroxysmal Dyskinesia in Children: from Genes to the Clinic. J Clin Neurol 2018; 14:492-497. [PMID: 30198221 PMCID: PMC6172489 DOI: 10.3988/jcn.2018.14.4.492] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 04/11/2018] [Accepted: 04/13/2018] [Indexed: 01/01/2023] Open
Abstract
Background and Purpose Paroxysmal dyskinesia is a genetically and clinically heterogeneous movement disorder. Recent studies have shown that it exhibits both phenotype and genotype overlap with other paroxysmal disorders as well as clinical heterogeneity. We investigated the clinical and genetic characteristics of paroxysmal dyskinesia in children. Methods Fifty-five patients (16 from 14 families and 39 sporadic cases) were enrolled. We classified them into three phenotypes: paroxysmal kinesigenic dyskinesia (PKD), paroxysmal nonkinesigenic dyskinesia (PNKD), and paroxysmal exercise-induced dyskinesia (PED). We sequenced PRRT2, SLC2A1, and MR-1 in these patients and reviewed their medical records. Results Forty patients were categorized as PKD, 14 as PNKD, and 1 as PED. Thirty-eight (69.1%) patients were male, and their age at onset was 8.80±4.53 years (mean±SD). Dystonia was the most common symptom (38 patients, 69.1%). Pathogenic variants were identified in 20 patients (36.4%): 18 with PRRT2 and 2 with SLC2A1. All of the patients with PRRT2 mutations presented with PKD alone. The 2 patients carrying SLC2A1 mutations presented as PNKD and PED, and one of them was treated effectively with a ketogenic diet. Six mutations in PRRT2 (including 2 novel variants) were identified in 9 of the 13 tested families (69.2%) and in 8 patients of the 25 tested sporadic cases (32.0%). There were no significant differences in clinical features or drug response between the PRRT2-positive and PRRT2-negative PKD groups. Conclusions This study has summarized the clinical and genetic heterogeneity of paroxysmal dyskinesia in children. We suggest that pediatric paroxysmal dyskinesia should not be diagnosed using clinical features alone, but by combining them with broader genetic testing.
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Affiliation(s)
- Soo Yeon Kim
- Department of Pediatrics, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul, Korea
| | - Jin Sook Lee
- Department of Pediatrics, Genome Medicine and Science, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Woo Joong Kim
- Department of Pediatrics, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul, Korea
| | - Hyuna Kim
- Department of Pediatrics, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul, Korea
| | - Sun Ah Choi
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Byung Chan Lim
- Department of Pediatrics, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul, Korea
| | - Ki Joong Kim
- Department of Pediatrics, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul, Korea
| | - Jong Hee Chae
- Department of Pediatrics, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul, Korea.
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16
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Tian WT, Huang XJ, Liu XL, Shen JY, Liang GL, Zhu CX, Tang WG, Chen SD, Song YY, Cao L. Depression, anxiety, and quality of life in paroxysmal kinesigenic dyskinesia patients. Chin Med J (Engl) 2018; 130:2088-2094. [PMID: 28836553 PMCID: PMC5586178 DOI: 10.4103/0366-6999.213431] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background: Paroxysmal kinesigenic dyskinesia (PKD) is a rare movement disorder characterized by recurrent dystonic or choreoathetoid attacks triggered by sudden voluntary movements. Under the condition of psychological burden, some patients’ attacks may get worsened with longer duration and higher frequency. This study aimed to assess nonmotor symptoms and quality of life of patients with PKD in a large population. Methods: We performed a cross-sectional survey in 165 primary PKD patients from August 2008 to October 2016 in Rui Jin Hospital, using Symptom Check List-90-Revised (SCL-90-R), World Health Organization Quality of Life-100 (WHOQoL-100), Self-Rating Depression Scale, and Self-Rating Anxiety Scale. We evaluated the differences of SCL-90-R and WHOQOL-100 scores in patients and Chinese normative data (taken from literature) by using the unpaired Student's t-test. We applied multivariate linear regression to analyze the relationships between motor manifestations, mental health, and quality of life among PKD patients. Results: Compared with Chinese normative data taken from literature, patients with PKD exhibited significantly higher (worse) scores across all SCL-90-R subscales (somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism; P = 0.000 for all) and significantly lower (worse) scores of five domains in WHOQoL-100 (physical domain, psychological domain, independence domain, social relationship domain, and general quality of life; P = 0.000 for all). Nonremission of dyskinesia episodes (P = 0.011) and higher depression score (P = 0.000) were significantly associated with lower levels of quality of life. The rates of depression and anxiety in patients with PKD were 41.2% (68/165) and 26.7% (44/165), respectively. Conclusions: Depression, anxiety, and low levels of quality of life were prevalent in patients with PKD. Co-occurrence of depression and anxiety was common among these patients. Regular mental health interventions could set depression and anxiety as intervention targets. Considering that the motor episodes could be elicited by voluntary movements and sometimes also by emotional stress, and that symptoms may get worsened with longer duration and higher frequency when patients are stressed out, intervention or treatment of depression and anxiety might improve the motor symptoms and overall quality of life in PKD patients.
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Affiliation(s)
- Wo-Tu Tian
- Department of Neurology and Institute of Neurology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Xiao-Jun Huang
- Department of Neurology and Institute of Neurology, Rui Jin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai 201801, China
| | - Xiao-Li Liu
- Department of Neurology and Institute of Neurology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Jun-Yi Shen
- Department of Neurology and Institute of Neurology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Gui-Ling Liang
- Basic Medical Science College, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Chen-Xi Zhu
- Basic Medical Science College, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Wei-Guo Tang
- Department of Neurology, Zhoushan Hospital, Zhoushan, Zhejiang 316000, China
| | - Sheng-Di Chen
- Department of Neurology and Institute of Neurology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Yan-Yan Song
- Department of Biostatistics, Institute of Medical Sciences, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Li Cao
- Department of Neurology and Institute of Neurology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
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17
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Kim A, Jang M, Kim HJ, Kim Y, Kim DS, Shin JH, Jeon B. Myotonia Congenita Can Be Mistaken as Paroxysmal Kinesigenic Dyskinesia. J Mov Disord 2018; 11:49-51. [PMID: 29381887 PMCID: PMC5790626 DOI: 10.14802/jmd.17056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 10/19/2017] [Accepted: 10/24/2017] [Indexed: 01/31/2023] Open
Affiliation(s)
- Aryun Kim
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Mihee Jang
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Han-Joon Kim
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yoon Kim
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Dae-Seong Kim
- Department of Neurology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jin-Hong Shin
- Department of Neurology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Beomseok Jeon
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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18
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Tang BS. Attention Should be Drawn to Rare Diseases and Interpretation of Sequence Variants. Chin Med J (Engl) 2016; 129:1009-10. [PMID: 27098782 PMCID: PMC4852664 DOI: 10.4103/0366-6999.180531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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