论文标题
孤立的帕金森氏症是GRN和C9orf72基因突变的非典型表现
Isolated parkinsonism is an atypical presentation of GRN and C9orf72 gene mutations
论文作者
论文摘要
简介:模仿特发性帕金森氏病(IPD)的孤立帕金森氏病的表型是GRN和C9orf72突变的罕见临床表现,这是额颞痴呆(FTD)的主要遗传原因。如果这种关联是偶然的,它仍然存在争议,哪些临床线索可以可靠地暗示IPD患者的遗传FTD病因。这项研究旨在描述具有IPD表型的FTD突变携带者的临床特征,提供了突变因果关系的神经病理学证据,并根据当前的IPD标准特别针对其“危险信号”。方法:本研究中包括七个GRN和C9orf72载体,具有孤立的帕金森氏症,三名文献中包括了三名。为了更好地描述其表型,分析了每种情况下的支持性,排除和“危险信号”特征的存在。结果:在十名患者(5 GRN,5 C9ORF72)中,在所有疾病过程中可能满足了7个可能的IPD标准,而行为/语言或运动神经元功能障碍发生在三个中。疾病的持续时间更长,与GRN载体相比,C9orf72中的DOPA反应性更高。微妙的运动特征,认知/行为变化,痴呆/ALS家族史是遗传诊断的暗示性线索。重要的是,一名患者的神经病理检查表明,典型的TDP-43插入没有α-突触核疾病,因此证明了FTD突变,TDP-43-PARTALOGY与PD表型之间的因果关系。结论:我们表明,总体而言,早发痴呆/ALS的家族史,认知/行为功能障碍和微妙的运动特征的存在是GRN和C9orf72突变的帕金森氏症表现中经常存在的非典型特征。
Introduction: A phenotype of isolated parkinsonism mimicking Idiopathic Parkinson's Disease (IPD) is a rare clinical presentation of GRN and C9orf72 mutations, the major genetic causes of frontotemporal dementia (FTD). It still remains controversial if this association is fortuitous or not, and which clinical clues could reliably suggest a genetic FTD etiology in IPD patients. This study aims to describe the clinical characteristics of FTD mutation carriers presenting with IPD phenotype, provide neuropathological evidence of the mutation's causality, and specifically address their "red flags" according to current IPD criteria. Methods: Seven GRN and C9orf72 carriers with isolated parkinsonism at onset, and three patients from the literature were included in this study. To allow better delineation of their phenotype, the presence of supportive, exclusion and "red flag" features from MDS criteria were analyzed for each case. Results: Amongst the ten patients (5 GRN, 5 C9orf72), seven fulfilled probable IPD criteria during all the disease course, while behavioral/language or motoneuron dysfunctions occurred later in three. Disease duration was longer and dopa-responsiveness was more sustained in C9orf72 than in GRN carriers. Subtle motor features, cognitive/behavioral changes, family history of dementia/ALS were suggestive clues for a genetic diagnosis. Importantly, neuropathological examination in one patient revealed typical TDP-43-inclusions without alpha-synucleinopathy, thus demonstrating the causal link between FTD mutations, TDP-43-pathology and PD phenotype. Conclusion: We showed that, altogether, family history of early-onset dementia/ALS, the presence of cognitive/behavioral dysfunction and subtle motor characteristics are atypical features frequently present in the parkinsonian presentations of GRN and C9orf72 mutations .