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Darling A, Irún P, Giraldo P, Armstrong J, Gort L, Díaz-Conradi Á, Yubero D, De Oryazábal Sanz AL, Ormazábal A, Artuch R, García-Cazorla À, O'Callaghan M. Pediatric Gaucher disease with intermediate type 2-3 phenotype associated with parkinsonian features and levodopa responsiveness. Parkinsonism Relat Disord 2021; 91:19-22. [PMID: 34454394 DOI: 10.1016/j.parkreldis.2021.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 08/15/2021] [Accepted: 08/16/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Gaucher disease (GD) is an autosomal recessive lysosomal storage disorder caused by a deficiency of acid β-glucosidase encoded by the GBA gene. In patients with GD, childhood onset parkinsonian features have been rarely described. METHODS Twin siblings with GD are described, including clinical follow-up and treatment response. Bone marrow, enzyme activity studies and genotyping were performed. RESULTS By age 9 months, symptoms at onset were thrombocytopenia and splenomegaly. By age 2, hypokinesia, bradykinesia and oculomotor apraxia were observed. By age 5 a complete rigid hypokinetic syndrome was stablished in both patients, including bradykinesia, tremor and rigidity. Treatment with imiglucerase, miglustat, ambroxol and levodopa were performed. Levodopa showed a good response with improvement in motor and non-motor skills. Foamy cells were found in the bone marrow study. Glucocerebrosidase activity was 28% and 26%. Sanger sequencing analysis identified a missense mutation and a complex allele (NP_000148: p.[(Asp448His)]; [(Leu422Profs*4)]) in compound heterozygosity in GBA gene. CONCLUSIONS Two siblings with neuronopathic GD with an intermediate form between type 2 and 3, with a systemic and neurological phenotype are described. The complex neurological picture included a hypokinetic-rigid and tremor syndrome that improved with levodopa treatment. These conditions together have not been previously described in pediatric GD. We suggest that in children with parkinsonian features, lysosomal storage disorders must be considered, and a levodopa trial must be performed. Moreover, this report give support to the finding that GBA and parkinsonian features share biological pathways and highlight the importance of lysosomal mechanisms in parkinsonism pathogenesis, what might have therapeutic implications.
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Affiliation(s)
- Alejandra Darling
- Pediatric Neurology Department, Metabolic Unit, Hospital Sant Joan de Déu, Barcelona, Spain.
| | - Pilar Irún
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto Carlos III, IIS Aragón, Zaragoza, 50009, Spain
| | - Pilar Giraldo
- CIBER Enfermedades Raras (CIBERER), Translational Research Unit, Miguel Servet University Hospital, Zaragoza, Spain
| | - Judith Armstrong
- Genetic Department, Hospital Sant Joan de Déu, Barcelona, Spain; CIBERER, Instituto de Salud Carlos III, Spain
| | - Laura Gort
- Errors Congènits Del Metabolisme, Servei de Bioquímica I Genètica Molecular, CDB, Hospital Clínic, IDIBAPS, CIBERER, Barcelona, Spain
| | - Álvaro Díaz-Conradi
- Departamento de Hematología Pediátrica, HMNens, HMHospitales, Barcelona, Spain
| | - Delia Yubero
- Genetic Department, Hospital Sant Joan de Déu, Barcelona, Spain; CIBERER, Instituto de Salud Carlos III, Spain
| | | | - Aída Ormazábal
- CIBERER, Instituto de Salud Carlos III, Spain; Biochemistry Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Rafael Artuch
- CIBERER, Instituto de Salud Carlos III, Spain; Biochemistry Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Àngels García-Cazorla
- Pediatric Neurology Department, Metabolic Unit, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Mar O'Callaghan
- Pediatric Neurology Department, Metabolic Unit, Hospital Sant Joan de Déu, Barcelona, Spain
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