Early-onset L-dopa-responsive parkinsonism with pyramidal signs due to ATP13A2, PLA2G6, FBXO7 and spatacsin mutations.
Seven autosomal recessive genes associated with juvenile and young-onset Levodopa-responsive parkinsonism have been identified. Mutations in PRKN, DJ-1, and PINK1 are associated with a rather pure parkinsonian phenotype, and have a more benign course with sustained treatment response and absence of dementia. On the other hand, Kufor-Rakeb syndrome has additional signs, which distinguish it clearly from Parkinson's disease including supranuclear vertical gaze palsy, myoclonic jerks, pyramidal signs, and cognitive impairment. Neurodegeneration with brain iron accumulation type I (Hallervorden-Spatz syndrome) due to mutations in PANK2 gene may share similar features with Kufor-Rakeb syndrome. Mutations in three other genes, PLA2G6 (PARK14), FBXO7 (PARK15), and Spatacsin (SPG11) also produce clinical similar phenotypes in that they presented with rapidly progressive parkinsonism, initially responsive to Levodopa treatment but later, developed additional features including cognitive decline and loss of Levodopa responsiveness. Here, using homozygosity mapping and sequence analysis in families with complex parkinsonisms, we identified genetic defects in the ATP13A2 (1 family), PLA2G6 (1 family) FBXO7 (2 families), and SPG11 (1 family). The genetic heterogeneity was surprising given their initially common clinical features. On careful review, we found the FBXO7 cases to have a phenotype more similar to PRKN gene associated parkinsonism. The ATP13A2 and PLA2G6 cases were more seriously disabled with additional swallowing problems, dystonic features, severe in some, and usually pyramidal involvement including pyramidal weakness. These data suggest that these four genes account for many cases of Levodopa responsive parkinsonism with pyramidal signs cases formerly categorized clinically as pallido-pyramidal syndrome.
Paisán-Ruiz
Coro
C
Department of Molecular Neuroscience, UCL Institute of Neurology, London, United Kingdom.
Guevara
Rocio
R
Federoff
Monica
M
Hanagasi
Hasmet
H
Sina
Fardaz
F
Elahi
Elahe
E
Schneider
Susanne A
SA
Schwingenschuh
Petra
P
Bajaj
Nin
N
Emre
Murat
M
Singleton
Andrew B
AB
Hardy
John
J
Bhatia
Kailash P
KP
Brandner
Sebastian
S
Lees
Andrew J
AJ
Houlden
Henry
H
D000328:Adult; D001921:Brain / Q000473:pathology; D044783:F-Box Proteins / Q000235:genetics*; D005260:Female; D056726:Genetic Association Studies; D005838:Genotype; D054522:Group VI Phospholipases A2 / Q000235:genetics*; D006801:Humans; D007980:Levodopa / Q000627:therapeutic use; D008297:Male; D020734:Parkinsonian Disorders / Q000188:drug therapy / Q000235:genetics* / Q000473:pathology; D010375:Pedigree; D011506:Proteins / Q000235:genetics*; D006180:Proton-Translocating ATPases / Q000235:genetics*
C514983:ATP13A2 protein, human; D044783:F-Box Proteins; C489149:FBXO7 protein, human; D011506:Proteins; C520412:SPG11 protein, human; D007980:Levodopa; D054522:Group VI Phospholipases A2; C516475:PLA2G6 protein, human; D006180:Proton-Translocating ATPases