Association of Amyotrophic Lateral Sclerosis and Dopa-responsive dystonia in a Tunisian patient.

Parkinsonism Relat Disord

Clinical Investigation Center (CIC) "Neurosciences and Mental Health", Razi University Hospital, 1 rue des orangers Manouba, 2010, Tunis, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, 15, Rue Djebel Lakhdhar, La Rabta, 1007, Tunis, Tunisia; Neurology Department, LR18SP03, Razi University Hospital, 1 rue des orangers Manouba, 2010, Tunis, Tunisia.

Published: October 2024

AI Article Synopsis

  • - Dopa-responsive dystonia (DRD) is a genetic disorder characterized by symptoms similar to Parkinson's disease and dystonia, caused by changes in the GCH1 gene affecting dopamine production.
  • - This case report is unique as it connects childhood-onset DRD with amyotrophic lateral sclerosis (ALS), indicating a potential link between these two conditions.
  • - The findings suggest that the diverse genetic backgrounds in the North African population might play a role in the occurrence of multiple related disorders.

Article Abstract

Dopa-responsive dystonia (DRD) is an autosomal dominant disease with parkinsonian and dystonic symptoms caused by GCH1 gene pathogenic variants affecting dopamine synthesis. The present case report is the first to link DRD with childhood-onset with ALS, suggesting that complex inheritance patterns in the North African population may contribute to multiple disorders.

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http://dx.doi.org/10.1016/j.parkreldis.2024.107171DOI Listing

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Association of Amyotrophic Lateral Sclerosis and Dopa-responsive dystonia in a Tunisian patient.

Parkinsonism Relat Disord

October 2024

Clinical Investigation Center (CIC) "Neurosciences and Mental Health", Razi University Hospital, 1 rue des orangers Manouba, 2010, Tunis, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, 15, Rue Djebel Lakhdhar, La Rabta, 1007, Tunis, Tunisia; Neurology Department, LR18SP03, Razi University Hospital, 1 rue des orangers Manouba, 2010, Tunis, Tunisia.

Article Synopsis
  • - Dopa-responsive dystonia (DRD) is a genetic disorder characterized by symptoms similar to Parkinson's disease and dystonia, caused by changes in the GCH1 gene affecting dopamine production.
  • - This case report is unique as it connects childhood-onset DRD with amyotrophic lateral sclerosis (ALS), indicating a potential link between these two conditions.
  • - The findings suggest that the diverse genetic backgrounds in the North African population might play a role in the occurrence of multiple related disorders.
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Article Synopsis
  • Striatal dysfunction is linked to various types of dystonia, such as idiopathic and inherited forms, with the striatum housing different types of GABAergic neurons that control movement.
  • Research using a model of DOPA-responsive dystonia (DRD) revealed that dSPNs and iSPNs exhibit distinct molecular changes that contribute to the disorder, highlighting a specific dysregulation in glutamatergic signaling for both neuron types.
  • The differences in how these neurons adapt due to dopamine deficiencies suggest potential biochemical targets for therapies, emphasizing that the impact of dopamine loss on movement disorders varies depending on the timing and the specific neuron type affected.
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  • Recent findings indicate that biallelic WARS2 pathogenic variants lead to a partial aminoacylation defect, linked to late-onset conditions like dopa-responsive dystonia parkinsonism and myoclonus ataxia.
  • * The case study describes a 39-year-old male with a history of childhood-onset progressive dystonia, psychiatric symptoms, and ataxia, where genome sequencing revealed specific variants that confirmed a WARS2-related disease diagnosis.
  • * The identified missense variant (p.(Trp13Gly)) is associated with milder symptoms compared to severe loss-of-function variants, reinforcing the relationship between genotype and phenotype in these disorders.
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Article Synopsis
  • The GCH1 gene produces an enzyme essential for making tetrahydrobiopterin (BH4), crucial for monoamine neurotransmitter production; deficiencies can lead to various forms of dystonia and developmental issues.
  • The study reviewed 45 patients with arGTPCH deficiency, identifying three main phenotypes: early-infantile encephalopathy, dystonia-parkinsonism, and late-onset dopa-responsive dystonia (DRD).
  • Early pharmacological treatment is vital for the first two phenotypes to mitigate serious neurodevelopmental damage, and genotype analysis may help in quicker diagnosis and assessment of clinical severity.
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