Chorea-acanthocytosis: A Case Report with Review of Oral Manifestations

Case report: Misdiagnosed orolingual dyskinesia as a consequence of seizures in a chorea-acanthocytosis patient with a novel VPS13A variation from a family with consanguineous marriage

Chorea-acanthocytosis (ChAc) is a rare autosomal recessive inherited syndrome with heterogeneous symptoms, which makes it a challenge for early diagnosis. The mutation of VPS13A is considered intimately related to the pathogenesis of ChAc. To date, diverse mutation patterns of VPS13A, consisting of missense, nonsense, and frameshift mutations, have been reported. In this study, we first report a clinical case that was misdiagnosed as epilepsy due to recurrent seizures accompanied by tongue bite for 9 months, which was not rectified until seizures were controlled and involuntary orolingual movements with awareness became prominent and were confirmed to be orolingual dyskinesia. The patient was eventually diagnosed as ChAc based on whole-exome sequencing revealing novel homozygous c.2061dup (frameshift mutation) and c.6796A > T dual mutations in VPS13A. The patient from a family with consanguineous marriage manifested epileptic seizures at onset, including both generalized tonic-clonic seizures and absence but normal long-term electroencephalography, and gradually developed orofacial dyskinesia, including involuntary tongue protrusion, tongue biting and ulcers, involuntary open jaws, occasionally frequent eye blinks, and head swings. The first test of the peripheral blood smear was negative, and repeated checks confirmed an elevated percentage of acanthocytes by 15-21.3%. Structural brain MRI indicated a mildly swollen left hippocampus and parahippocampal gyrus and a progressively decreased volume of the bilateral hippocampus 1 year later, along with atrophy of the head of the caudate nucleus but no progression in 1 year. We deeply analyzed the reasons for long-term misdiagnosis in an effort to achieve a more comprehensive understanding of ChAc, thus facilitating early diagnosis and treatment in future clinical practice.

Movement Disorders and the Gut: A Review

There is a close link between multiple movement disorders and gastrointestinal dysfunction. Gastrointestinal symptoms may precede the development of the neurologic syndrome or may arise following the neurologic presentation. This review will provide an overview of gastrointestinal accompaniments to several well-known as well as lesser known movement disorders. It will also highlight several disorders which may not be considered primary movement disorders but have an overlapping presentation of both gastrointestinal and movement abnormalities.

Biological Function and Clinical Value of VPS13A in Pan-Cancer Based on Bioinformatics Analysis

Purpose

Vacuolar protein sorting-associated protein 13A (VPS13A) has been shown to be associated with rhabdomyosarcoma, gastric cancer and ovarian cancer, but the pan cancer analysis of VPS13A is still lacking, and the bioinformatics function of VPS13A has not been studied yet.

Methods

We used TCGA and GEO databases to investigate the distribution, expression and prognosis of VPS13A in 33 tumors for the first time. We used TIMER2, ULCAN databases to obtain the expression differences of VPS13A in tumor tissues and corresponding normal tissues, and further obtain the gene expression in different pathological stages of tumors from the GEPIA database. Mutation types and survival analysis of VPS13A were obtained from cBioPortal database. The relationship between VPS13A and immune infiltration was explored using TIMER2. We used the String website to obtain VPS13A binding proteins and draw the protein–protein interaction network map. JVENN was used for cross analysis, and Kyoto Encyclopedia of Genes and Genomes (KEGG) and Gene Ontology (GO) were used for gene enrichment analysis.

Results

VPS13A is highly expressed in most tumors, and gene expression is associated with prognosis in patients with tumors. The expression level of VPS13A was correlated with the infiltration depth of CD8+T cells in DLBC, LUAD, SKCM and TGCT, and was correlated with carcinoma-associated fibroblasts in BRCA, CESC, LIHC and THYM. Compared with normal tissue, VPS13A methylation levels were higher in some primary tumors. KEGG gene enrichment indicates that VPS13A is involved in RNA degradation, autophagy, cell senescence, cell cycle, apoptosis and other pathways.

Conclusion

VPS13A is closely related to the occurrence and progression of tumors and can be used as a biomarker for tumor screening and diagnosis. The level of VPS13A expression and the presence of mutations affect the prognosis of patients with certain cancers, which can be determined by early genetic testing.