title: Autosomal dominant dystonia-plus with cerebral calcifications.
abstract: OBJECTIVE
  To report genealogic, clinical, imaging, neuropathologic, and genetic data from a Canadian kindred with dystonia and brain calcinosis originally described in 1985.
  
  
  METHODS
  The authors performed clinical examinations and CT and PET studies of the head and analyzed blood samples. One autopsy was performed.
  
  
  RESULTS
  The family tree was expanded to 166 individuals. No individuals were newly affected with dystonia, but postural tremor developed in two. The mean age at symptom onset was 19 years. Eight individuals had dystonia: three focal, one segmental, one multifocal, and three generalized. Seven displayed additional signs: chorea, intellectual decline, postural tremor, and dysarthria. CT studies were performed on five affected and 10 at-risk family members. All affected individuals and eight at-risk individuals had brain calcinosis. PET scans in two individuals showed reduced D(1)- and D(2)-receptor binding and reduced uptake of 6-[(18)F]fluoro-l-dopa. Autopsy of one affected individual showed extensive depositions of calcium in the basal ganglia, thalamus, cerebral white matter, and cerebellum. No specific immunohistochemistry abnormalities were seen. Genome search data showed no evidence of linkage to the previously described loci IBGC1, DYT1, and DYT12.
  
  
  CONCLUSIONS
  The phenotype of this family consists of dystonia-plus syndrome. Brain calcium deposits vary in severity and distribution, suggesting that calcifications alone are not entirely responsible for the observed clinical signs. Further studies are needed to elucidate the etiology of this heterogeneous group of disorders.
authors.affiliation: Department of Neurology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA. wszolek.zbigniew@mayo.edu
authors.forename: Z K
authors.initials: ZK
authors.lastname: Wszolek
authors.forename: Y
authors.initials: Y
authors.lastname: Baba
authors.forename: I R
authors.initials: IR
authors.lastname: Mackenzie
authors.forename: R J
authors.initials: RJ
authors.lastname: Uitti
authors.forename: A J
authors.initials: AJ
authors.lastname: Strongosky
authors.forename: D F
authors.initials: DF
authors.lastname: Broderick
authors.forename: M C
authors.initials: MC
authors.lastname: Baker
authors.forename: S
authors.initials: S
authors.lastname: Melquist
authors.forename: M L
authors.initials: ML
authors.lastname: Hutton
authors.forename: Y
authors.initials: Y
authors.lastname: Tsuboi
authors.forename: J E
authors.initials: JE
authors.lastname: Allanson
authors.forename: J
authors.initials: J
authors.lastname: Carr
authors.forename: A
authors.initials: A
authors.lastname: Kumar
authors.forename: S M
authors.initials: SM
authors.lastname: Calne
authors.forename: J
authors.initials: J
authors.lastname: Miklossy
authors.forename: P L
authors.initials: PL
authors.lastname: McGeer
authors.forename: D B
authors.initials: DB
authors.lastname: Calne
authors.forename: A J
authors.initials: AJ
authors.lastname: Stoessl
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001927:Brain Diseases / Q000453:epidemiology* / Q000235:genetics*; D002114:Calcinosis / Q000453:epidemiology* / Q000235:genetics*; D002170:Canada / Q000453:epidemiology; D002648:Child; D025063:Chromosome Disorders / Q000453:epidemiology / Q000235:genetics; D002883:Chromosomes, Human, Pair 14 / Q000235:genetics*; D015897:Comorbidity; D020821:Dystonic Disorders / Q000453:epidemiology* / Q000235:genetics*; D005260:Female; D020022:Genetic Predisposition to Disease / Q000453:epidemiology / Q000235:genetics; D006579:Heterozygote; D006801:Humans; D008297:Male; D008875:Middle Aged; D010375:Pedigree; D015995:Prevalence; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors