Han-Joon Kim1, Beom S Jeon2, Junghwan Shin1, Woong-Woo Lee1, Hyeyoung Park1, Yu Jin Jung1, Gwanhee Ehm1. 1. From the Department of Neurology and Movement Disorder Center (H.-J.K., B.S.J., J.S., W.-W.L., H.P.), Parkinson Study Group, and Neuroscience Research Institute, College of Medicine, Seoul National University; Department of Neurology (Y.J.J.), Kyung Hee University Hospital at Gangdong, Seoul; and Department of Neurology (G.E.), Myongji Hospital, Goyang-si, Kyongki-do, Korea. 2. From the Department of Neurology and Movement Disorder Center (H.-J.K., B.S.J., J.S., W.-W.L., H.P.), Parkinson Study Group, and Neuroscience Research Institute, College of Medicine, Seoul National University; Department of Neurology (Y.J.J.), Kyung Hee University Hospital at Gangdong, Seoul; and Department of Neurology (G.E.), Myongji Hospital, Goyang-si, Kyongki-do, Korea. brain@snu.ac.kr.
Abstract
OBJECTIVE: To examine the prevalence of mutations in spinocerebellar ataxia (SCA) genes in patients who were clinically diagnosed with multiple system atrophy (MSA). METHODS: Genetic tests for SCA were performed in 302 of 528 patients who met the diagnostic criteria for MSA based on clinical features. Generally, when a patient had cerebellar symptoms or cerebellar atrophy on neuroimaging, genetic tests for SCA types 1, 2, 3, 6, 7, and 17, and dentatorubropallidoluysian atrophy were done, and when a patient had parkinsonism without cerebellar symptoms, genetic tests for SCA types 2, 3, and 17 were done. RESULTS: Mutations in SCA genes were found in 22 of the 302 patients (7.3%) with SCA17 comprising more than half of the mutation-positive cases. The age at disease onset in these 22 patients was not different compared with the 280 patients without mutations (55.9 ± 9.3 vs 59.2 ± 8.9, p = 0.102). All patients had urinary symptoms, and 10 patients also had orthostatic dizziness or orthostatic hypotension. A family history was reported in only 3 patients. Of note, dream enactment behavior suggesting REM sleep behavior disorder was reported in 9 of the 11 patients (81.8%) asked. CONCLUSIONS: The high proportion of patients with SCA mutations in this study indicates that genetic testing for SCA should be included for patients with MSA, especially for patients with cerebellar dysfunctions.
OBJECTIVE: To examine the prevalence of mutations in spinocerebellar ataxia (SCA) genes in patients who were clinically diagnosed with multiple system atrophy (MSA). METHODS: Genetic tests for SCA were performed in 302 of 528 patients who met the diagnostic criteria for MSA based on clinical features. Generally, when a patient had cerebellar symptoms or cerebellar atrophy on neuroimaging, genetic tests for SCA types 1, 2, 3, 6, 7, and 17, and dentatorubropallidoluysian atrophy were done, and when a patient had parkinsonism without cerebellar symptoms, genetic tests for SCA types 2, 3, and 17 were done. RESULTS: Mutations in SCA genes were found in 22 of the 302 patients (7.3%) with SCA17 comprising more than half of the mutation-positive cases. The age at disease onset in these 22 patients was not different compared with the 280 patients without mutations (55.9 ± 9.3 vs 59.2 ± 8.9, p = 0.102). All patients had urinary symptoms, and 10 patients also had orthostatic dizziness or orthostatic hypotension. A family history was reported in only 3 patients. Of note, dream enactment behavior suggesting REM sleep behavior disorder was reported in 9 of the 11 patients (81.8%) asked. CONCLUSIONS: The high proportion of patients with SCA mutations in this study indicates that genetic testing for SCA should be included for patients with MSA, especially for patients with cerebellar dysfunctions.
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