Dopa-responsive parkinsonism phenotype of spinocerebellar ataxia type 2
We report on 2 brothers, Patients 1 and 2, who presented with a similar clinical syndrome consisting of resting tumor, bradykinesia, rigidity, and dysarthria at the ages of 40 and 43 years, respectively. An excellent response to levodopa therapy was observed throughout the disease course. No gait or...
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| Published in | Movement disorders Vol. 17; no. 5; pp. 1046 - 1051 |
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| Main Authors | , , , , , |
| Format | Journal Article |
| Language | English |
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01.09.2002
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| ISSN | 0885-3185 1531-8257 |
| DOI | 10.1002/mds.10243 |
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| Abstract | We report on 2 brothers, Patients 1 and 2, who presented with a similar clinical syndrome consisting of resting tumor, bradykinesia, rigidity, and dysarthria at the ages of 40 and 43 years, respectively. An excellent response to levodopa therapy was observed throughout the disease course. No gait or limb ataxia, slow saccades, or decreased tendon reflexes were detected, but unsteadiness of gait with propulsion developed recently in Patient 1 approximately 25 years after disease onset. Magnetic resonance imaging demonstrated mild atrophy of the pons and cerebellum in Patient 1 and cerebellar atrophy in Patient 2. Expanded CAG repeats, numbering 36, in one allele of the ataxin‐2 gene were identified in Patient 1 only; his brother was not available for this investigation. With [99mTc]TRODAT‐1 single photon emission computed tomography of the brain, a significant bilateral and asymmetrical reduction of striatal dopamine transporters was found in Patient 1 compared to healthy controls. This bilateral reduction of striatal dopamine transporters resembled that observed in a set of controls with Parkinson's disease who had asymmetrical impairment. These results suggest that patients with familial parkinsonism who present with typical Parkinson's disease should be screened for the genetic defect of spinocerebellar ataxia type 2. The presynaptic impairment of nigrostriatal function is very likely to be the reason for levodopa responsiveness. © 2002 Movement Disorder Society |
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| AbstractList | We report on 2 brothers, Patients 1 and 2, who presented with a similar clinical syndrome consisting of resting tumor, bradykinesia, rigidity, and dysarthria at the ages of 40 and 43 years, respectively. An excellent response to levodopa therapy was observed throughout the disease course. No gait or limb ataxia, slow saccades, or decreased tendon reflexes were detected, but unsteadiness of gait with propulsion developed recently in Patient 1 approximately 25 years after disease onset. Magnetic resonance imaging demonstrated mild atrophy of the pons and cerebellum in Patient 1 and cerebellar atrophy in Patient 2. Expanded CAG repeats, numbering 36, in one allele of the ataxin‐2 gene were identified in Patient 1 only; his brother was not available for this investigation. With [99mTc]TRODAT‐1 single photon emission computed tomography of the brain, a significant bilateral and asymmetrical reduction of striatal dopamine transporters was found in Patient 1 compared to healthy controls. This bilateral reduction of striatal dopamine transporters resembled that observed in a set of controls with Parkinson's disease who had asymmetrical impairment. These results suggest that patients with familial parkinsonism who present with typical Parkinson's disease should be screened for the genetic defect of spinocerebellar ataxia type 2. The presynaptic impairment of nigrostriatal function is very likely to be the reason for levodopa responsiveness. © 2002 Movement Disorder Society We report on 2 brothers, Patients 1 and 2, who presented with a similar clinical syndrome consisting of resting tumor, bradykinesia, rigidity, and dysarthria at the ages of 40 and 43 years, respectively. An excellent response to levodopa therapy was observed throughout the disease course. No gait or limb ataxia, slow saccades, or decreased tendon reflexes were detected, but unsteadiness of gait with propulsion developed recently in Patient 1 approximately 25 years after disease onset. Magnetic resonance imaging demonstrated mild atrophy of the pons and cerebellum in Patient 1 and cerebellar atrophy in Patient 2. Expanded CAG repeats, numbering 36, in one allele of the ataxin-2 gene were identified in Patient 1 only; his brother was not available for this investigation. With [(99m)Tc]TRODAT-1 single photon emission computed tomography of the brain, a significant bilateral and asymmetrical reduction of striatal dopamine transporters was found in Patient 1 compared to healthy controls. This bilateral reduction of striatal dopamine transporters resembled that observed in a set of controls with Parkinson's disease who had asymmetrical impairment. These results suggest that patients with familial parkinsonism who present with typical Parkinson's disease should be screened for the genetic defect of spinocerebellar ataxia type 2. The presynaptic impairment of nigrostriatal function is very likely to be the reason for levodopa responsiveness.We report on 2 brothers, Patients 1 and 2, who presented with a similar clinical syndrome consisting of resting tumor, bradykinesia, rigidity, and dysarthria at the ages of 40 and 43 years, respectively. An excellent response to levodopa therapy was observed throughout the disease course. No gait or limb ataxia, slow saccades, or decreased tendon reflexes were detected, but unsteadiness of gait with propulsion developed recently in Patient 1 approximately 25 years after disease onset. Magnetic resonance imaging demonstrated mild atrophy of the pons and cerebellum in Patient 1 and cerebellar atrophy in Patient 2. Expanded CAG repeats, numbering 36, in one allele of the ataxin-2 gene were identified in Patient 1 only; his brother was not available for this investigation. With [(99m)Tc]TRODAT-1 single photon emission computed tomography of the brain, a significant bilateral and asymmetrical reduction of striatal dopamine transporters was found in Patient 1 compared to healthy controls. This bilateral reduction of striatal dopamine transporters resembled that observed in a set of controls with Parkinson's disease who had asymmetrical impairment. These results suggest that patients with familial parkinsonism who present with typical Parkinson's disease should be screened for the genetic defect of spinocerebellar ataxia type 2. The presynaptic impairment of nigrostriatal function is very likely to be the reason for levodopa responsiveness. We report on 2 brothers, Patients 1 and 2, who presented with a similar clinical syndrome consisting of resting tumor, bradykinesia, rigidity, and dysarthria at the ages of 40 and 43 years, respectively. An excellent response to levodopa therapy was observed throughout the disease course. No gait or limb ataxia, slow saccades, or decreased tendon reflexes were detected, but unsteadiness of gait with propulsion developed recently in Patient 1 approximately 25 years after disease onset. Magnetic resonance imaging demonstrated mild atrophy of the pons and cerebellum in Patient 1 and cerebellar atrophy in Patient 2. Expanded CAG repeats, numbering 36, in one allele of the ataxin-2 gene were identified in Patient 1 only; his brother was not available for this investigation. With [(99m)Tc]TRODAT-1 single photon emission computed tomography of the brain, a significant bilateral and asymmetrical reduction of striatal dopamine transporters was found in Patient 1 compared to healthy controls. This bilateral reduction of striatal dopamine transporters resembled that observed in a set of controls with Parkinson's disease who had asymmetrical impairment. These results suggest that patients with familial parkinsonism who present with typical Parkinson's disease should be screened for the genetic defect of spinocerebellar ataxia type 2. The presynaptic impairment of nigrostriatal function is very likely to be the reason for levodopa responsiveness. We report on 2 brothers, Patients 1 and 2, who presented with a similar clinical syndrome consisting of resting tumor, bradykinesia, rigidity, and dysarthria at the ages of 40 and 43 years, respectively. An excellent response to levodopa therapy was observed throughout the disease course. No gait or limb ataxia, slow saccades, or decreased tendon reflexes were detected, but unsteadiness of gait with propulsion developed recently in Patient 1 approximately 25 years after disease onset. Magnetic resonance imaging demonstrated mild atrophy of the pons and cerebellum in Patient 1 and cerebellar atrophy in Patient 2. Expanded CAG repeats, numbering 36, in one allele of the ataxin-2 gene were identified in Patient 1 only; his brother was not available for this investigation. With [99mTc]TRODAT-1 single photon emission computed tomography of the brain, a significant bilateral and asymmetrical reduction of striatal dopamine transporters was found in Patient 1 compared to healthy controls. This bilateral reduction of striatal dopamine transporters resembled that observed in a set of controls with Parkinson's disease who had asymmetrical impairment. These results suggest that patients with familial parkinsonism who present with typical Parkinson's disease should be screened for the genetic defect of spinocerebellar ataxia type 2. The presynaptic impairment of nigrostriatal function is very likely to be the reason for levodopa responsiveness. We report on 2 brothers, Patients 1 and 2, who presented with a similar clinical syndrome consisting of resting tumor, bradykinesia, rigidity, and dysarthria at the ages of 40 and 43 years, respectively. An excellent response to levodopa therapy was observed throughout the disease course. No gait or limb ataxia, slow saccades, or decreased tendon reflexes were detected, but unsteadiness of gait with propulsion developed recently in Patient 1 approximately 25 years after disease onset. Magnetic resonance imaging demonstrated mild atrophy of the pons and cerebellum in Patient 1 and cerebellar atrophy in Patient 2. Expanded CAG repeats, numbering 36, in one allele of the ataxin‐2 gene were identified in Patient 1 only; his brother was not available for this investigation. With [ 99m Tc]TRODAT‐1 single photon emission computed tomography of the brain, a significant bilateral and asymmetrical reduction of striatal dopamine transporters was found in Patient 1 compared to healthy controls. This bilateral reduction of striatal dopamine transporters resembled that observed in a set of controls with Parkinson's disease who had asymmetrical impairment. These results suggest that patients with familial parkinsonism who present with typical Parkinson's disease should be screened for the genetic defect of spinocerebellar ataxia type 2. The presynaptic impairment of nigrostriatal function is very likely to be the reason for levodopa responsiveness. © 2002 Movement Disorder Society |
| Author | Lu, Chin-Song Tsai, Chon-Haw Chang, Hsiu-Chen Yen, Tzu-Chen Wu Chou, Yah-Huei Chen, Rou-Shayn |
| Author_xml | – sequence: 1 givenname: Chin-Song surname: Lu fullname: Lu, Chin-Song email: c81214@adm.cgmh.org.tw organization: Department of Neurology, Chang Gung Memorial Hospital and School of Medicine, Chang Gung University, Taiwan – sequence: 2 givenname: Yah-Huei surname: Wu Chou fullname: Wu Chou, Yah-Huei organization: Human Molecular Genetics Laboratory, Chang Gung Memorial Hospital and School of Medicine, Chang Gung University, Taiwan – sequence: 3 givenname: Tzu-Chen surname: Yen fullname: Yen, Tzu-Chen organization: Department of Nuclear Medicine, Chang Gung Memorial Hospital and School of Medicine, Chang Gung University, Taiwan – sequence: 4 givenname: Chon-Haw surname: Tsai fullname: Tsai, Chon-Haw organization: Department of Neurology, Chang Gung Memorial Hospital and School of Medicine, Chang Gung University, Taiwan – sequence: 5 givenname: Rou-Shayn surname: Chen fullname: Chen, Rou-Shayn organization: Department of Neurology, Chang Gung Memorial Hospital and School of Medicine, Chang Gung University, Taiwan – sequence: 6 givenname: Hsiu-Chen surname: Chang fullname: Chang, Hsiu-Chen organization: Department of Neurology, Chang Gung Memorial Hospital and School of Medicine, Chang Gung University, Taiwan |
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| Keywords | Human Nervous system diseases Radiodiagnosis Emission Parkinson disease Exploration Antiparkinson agent Photon Cerebral disorder Genetic disease Case study Spinocerebellar heredodegeneration Phenotype Central nervous system disease Tomography Degenerative disease Levodopa Spinal cord disease Extrapyramidal syndrome |
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| SubjectTerms | [99mTc]TRODAT-1 SPECT Aged ataxin-2 gene Atrophy - pathology Biological and medical sciences Cerebellum - pathology Corpus Striatum - pathology Corpus Striatum - physiopathology Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases Dopamine Agonists - therapeutic use Genotype Humans Levodopa - therapeutic use Magnetic Resonance Imaging Male Medical sciences Middle Aged Neurology Organotechnetium Compounds Parkinsonian Disorders - drug therapy Parkinsonian Disorders - genetics Parkinsonian Disorders - pathology parkinsonism Pedigree Pons - pathology Radiopharmaceuticals spinocerebellar ataxia type 2 Spinocerebellar Ataxias - genetics Spinocerebellar Ataxias - pathology Spinocerebellar Ataxias - physiopathology Substantia Nigra - pathology Substantia Nigra - physiopathology Tomography, Emission-Computed, Single-Photon Tropanes Tropical medicine |
| Title | Dopa-responsive parkinsonism phenotype of spinocerebellar ataxia type 2 |
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