title: Marked improvement in Segawa syndrome after L-dopa and selegiline treatment.
abstract: Three brothers, born to parents who were first cousins, were referred for progressive diffuse dystonia. Initial physical examinations revealed minor dysmorphic features, e.g., bifrontal narrowing, downslanting palpebral fissures, low-set ears, upturned nostrils, and microretrognathia, as well as neurodevelopmental delay. Absence of eye contact and head control, diffuse dystonia, hypokinesia, choreoathetosis, tremor, increased deep tendon reflexes, diffuse muscle atrophy, and spasticity were evident during neurologic evaluations. After laboratory investigations, imaging studies, and the exclusion of other causes of childhood dystonia, the children were diagnosed with Segawa syndrome. A molecular analysis of the tyrosine hydroxylase gene revealed a novel P492R (1475 C>G) mutation, further confirming the clinical diagnosis. After 1-month therapy with 2 mg/kg/day l-dopa, no changes in signs were evident. Selegiline was added, which greatly improved the clinical picture. Segawa syndrome in three brothers resulted from a novel mutation in the tyrosine hydroxylase gene. Treatment with a combination of l-dopa and selegiline led to favorable outcomes.
authors.affiliation: Department of Medical Genetics, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey. yosunkayafenerci@hotmail.com
authors.forename: Elif
authors.initials: E
authors.lastname: Yosunkaya
authors.forename: Ender
authors.initials: E
authors.lastname: Karaca
authors.forename: Sarenur
authors.initials: S
authors.lastname: Basaran
authors.forename: Mehmet
authors.initials: M
authors.lastname: Seven
authors.forename: Adnan
authors.initials: A
authors.lastname: Yüksel
mesh_terms: D002675:Child, Preschool; D004200:Diseases in Twins / Q000175:diagnosis* / Q000188:drug therapy* / Q000201:enzymology; D004359:Drug Therapy, Combination; D020821:Dystonic Disorders / Q000175:diagnosis* / Q000188:drug therapy* / Q000201:enzymology; D006801:Humans; D007223:Infant; D007980:Levodopa / Q000008:administration & dosage*; D008297:Male; D010375:Pedigree; D012642:Selegiline / Q000008:administration & dosage*; D013577:Syndrome; D016896:Treatment Outcome; D014446:Tyrosine 3-Monooxygenase / Q000235:genetics
chemical_list: D012642:Selegiline; D007980:Levodopa; D014446:Tyrosine 3-Monooxygenase