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Clinical, neuroradiological and genetic findings in pontocerebellar hypoplasia.

Journal article
Authors Yasmin Namavar
Peter G Barth
Paul R Kasher
Fred van Ruissen
Knut Brockmann
Günther Bernert
Karin Writzl
Karen Ventura
Edith Y Cheng
Donna M Ferriero
Lina Basel-Vanagaite
Veerle R C Eggens
Ingeborg Krägeloh-Mann
Linda De Meirleir
Mary King
John M Graham
Arpad von Moers
Nine Knoers
Laszlo Sztriha
Rudolf Korinthenberg
William B Dobyns
Frank Baas
Bwee Tien Poll-The
Mårten Kyllerman
Published in Brain : a journal of neurology
Volume 134
Issue Pt 1
Pages 143-56
ISSN 1460-2156
Publication year 2011
Published at Institute of Clinical Sciences, Department of Pediatrics
Pages 143-56
Language en
Links dx.doi.org/10.1093/brain/awq287
Keywords Adolescent, Arginine-tRNA Ligase, genetics, Brain, pathology, Chi-Square Distribution, Child, Child, Preschool, Endoribonucleases, genetics, Female, Humans, Image Processing, Computer-Assisted, Infant, Magnetic Resonance Imaging, Male, Mutation, Olivopontocerebellar Atrophies, genetics, pathology
Subject categories Neurology, Pediatrics

Abstract

Pontocerebellar hypoplasia is a group of autosomal recessive neurodegenerative disorders with prenatal onset. The common characteristics are cerebellar hypoplasia with variable atrophy of the cerebellum and the ventral pons. Supratentorial involvement is reflected by variable neocortical atrophy, ventriculomegaly and microcephaly. Mutations in the transfer RNA splicing endonuclease subunit genes (TSEN54, TSEN2, TSEN34) were found to be associated with pontocerebellar hypoplasia types 2 and 4. Mutations in the mitochondrial transfer RNA arginyl synthetase gene (RARS2) were associated with pontocerebellar hypoplasia type 6. We studied a cohort of 169 patients from 141 families for mutations in these genes, of whom 106 patients tested positive for mutations in one of the TSEN genes or the RARS2 gene. In order to delineate the neuroradiological and clinical phenotype of patients with mutations in these genes, we compared this group with 63 patients suspected of pontocerebellar hypoplasia who were negative on mutation analysis. We found a strong correlation (P < 0.0005) between TSEN54 mutations and a dragonfly-like cerebellar pattern on magnetic resonance imaging, in which the cerebellar hemispheres are flat and severely reduced in size and the vermis is relatively spared. Mutations in TSEN54 are clinically associated with dyskinesia and/or dystonia and variable degrees of spasticity, in some cases with pure generalized spasticity. Nonsense or splice site mutations in TSEN54 are associated with a more severe phenotype of more perinatal symptoms, ventilator dependency and early death. In addition, we present ten new mutations in TSEN54, TSEN2 and RARS2. Furthermore, we show that pontocerebellar hypoplasia type 1 together with elevated cerebrospinal fluid lactate may be caused by RARS2 mutations.

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