Autosomal dominant dopa-responsive parkinsonism in a multigenerational Swiss family.
OBJECTIVE
To describe a large family with autosomal dominant parkinsonism.


BACKGROUND
Seven genes are directly implicated in autosomally inherited parkinsonism. However, there are several multigenerational large families known with no identifiable mutation.


METHODS
Family members were evaluated clinically, by history and chart review. Genetic investigation included SCA2, SCA3, UCHL1, SNCA, LRRK2, PINK1, PRKN, PGRN, FMR1 premutation, and MAPT. The proband underwent brain fluorodopa PET (FD-PET) scan, and one autopsy was available.


RESULTS
Eleven patients had a diagnosis of Parkinson's disease (PD), nine women. Mean age of onset was 52 with tremor-predominant dopa-responsive parkinsonism. Disease progression was slow but severe motor fluctuations occurred. One patient required subthalamic nucleus deep-brain stimulation with a good motor outcome. One patient had mental retardation, schizophrenia and became demented, and another patient was demented. Three patients and also two unaffected subjects had mild learning difficulties. All genetic tests yielded negative results. FD-PET showed marked asymmetric striatal tracer uptake deficiency, consistent with PD. Pathological examination demonstrated no Lewy bodies and immunostaining was negative for alpha-synuclein.


CONCLUSIONS
Apart from a younger age of onset and a female predominance, the phenotype was indistinguishable from sporadic tremor-predominant PD, including FD-PET scan results. As known genetic causes of autosomal dominant PD were excluded, this family harbors a novel genetic defect.
Wider
C
C
Department of Neurology, CHUV, Lausanne, Switzerland.
Skipper
L
L
Solida
A
A
Brown
L
L
Farrer
M
M
Dickson
D
D
Wszolek
Z K
ZK
Vingerhoets
F J G
FJ
D000328:Adult; D000368:Aged; D000978:Antiparkinson Agents / Q000627:therapeutic use*; D001921:Brain / Q000000981:diagnostic imaging; D025063:Chromosome Disorders / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000235:genetics*; D004252:DNA Mutational Analysis; D004295:Dihydroxyphenylalanine / Q000031:analogs & derivatives; D005260:Female; D005799:Genes, Dominant; D006801:Humans; D007980:Levodopa / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009154:Mutation / Q000502:physiology; D010300:Parkinson Disease / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000235:genetics*; D010375:Pedigree; D010641:Phenotype; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals
D000978:Antiparkinson Agents; D019275:Radiopharmaceuticals; C043437:fluorodopa F 18; D007980:Levodopa; D004295:Dihydroxyphenylalanine