遗传性痉挛性共济失调一家系4例报告

遗传性痉挛性共济失调又称Marie共济失调，是遗传性共济失调这一大类疾病中常见的显性遗传成年型共济失调，在我国较常见。现将我们见到的一个家系4例遗传性痉挛性共济失调报告如下。     

遗传性痉挛性共济失调一家系5例报告

遗传性痉挛性共济失调又称Ｍａｒｉｅ共济失调,是遗传性共济失调这一大类疾病中常见的显性遗传成年型共济失调,在我国较常见。由于遗传性共济失调有很多类型,各型之间的症状和体征重叠,因而命名混乱,近年已逐渐按基因检测结果命名,本文暂沿用本名称。现将我们见到的一个家系5例     

散发性共济失调的分类及诊断

共济失调是一种表现为肢体、躯干及语言运动不协调的临床症状.引起共济失调的病因很多,但主要可分为遗传性及散发性两大类.遗传性共济失调是指具有明显家族史或遗传突变的共济失调.而散发性共济失调是指散在发病的、没有明确家族史的共济失调.散发性共济失调的病因非常复杂,主要分为:(1)获得性原因,由内源或者外源性的非遗传因素引起;(2)遗传性原因,一些遗传性共济失调的基因变异也可出现在散发患者中;(3)非遗传的退行性共济失调[1].本文所述的散发性共济失调主要指的是成年发病的、没有明确家族史的进展性共济失调.脑血管病或急性颅内感染等也可表现为共济失调,但其多为急性病程,且共济失调只是其诸多症状之一,故不包括在内.儿童起病的共济失调主要是由于先天的、代谢性的或者继发性的原因引起[2],在这里也不做阐述.     

遗传性共济失调症(附五组家族报告)

报告遗传性共济失调五组家族共56例患者,其中E组为脊髓型(Friedrech共济失调),A～D组属小脑型,因有包括眼震的眼球运动障碍,更似遗传性痉挛性共济失调。A组家族同时有精神异常、近视、提示此三种表现可能是紧密相连的致病基因所致。认为以起病年龄及遗传形式作为遗传性共济失调症的临床分类基础较为简单。     

伴头颈部肌张力障碍的遗传性共济失调的临床特征

目的探讨伴头颈部肌张力障碍的遗传性共济失调的临床特征.方法对200余个遗传性共济失调家系进行回顾性分析.结果14个遗传性共济失调家系伴有痉挛性斜颈或头颈部不自主运动,所有家系呈常染色体显性遗传方式,先证者均表现为共济失调、痉挛性斜颈或头部震颤、构音障碍;2例头颈部震颤呈发作性,2例合并四肢震颤,1例合并躯干抖动,1例全身不自主抖动;患者智力大多正常,无感觉障碍;部分患者头部MRI检查示小脑萎缩而脑干和大脑受累不明显.结论伴头颈部肌张力障碍的遗传性共济失调十分罕见,呈常染色体显性遗传,小脑性共济失调和头颈部肌张力障碍是其重要特征.     

遗传性共济失调临床和基因诊断进展

遗传性共济失调是一组以进行性平衡失调和肢体协调运动障碍为特征的疾病 ,由于基因异质性和表型变异错纵复杂 ,仅根据表型作出准确诊断较为困难。本文综述遗传性共济失调的临床表现和基因学研究进展 ,为正确诊断提供思路。诊断遗传性共济失调的一般顺序 :首先确认患者主要特征是共济失调并收集家族史资料 ,其次排除非遗传性病因 ,并检测有无特定的生化异常 ,最后做基因学检测。一、确认共济失调综合征并确定遗传特点典型病例表现进行性步行困难 ,伴笨拙、语言障碍或视觉障碍。眼震、吟诗样语言、辨距不良、震颤和步态共济失调等是主要的小脑…     

遗传性小脑型共济失调

遗传性小脑型共济失调王伯余，孙苏萍我院于１９９１年５月发现一个家族连续４代１６例罹患遗传性小脑型共济失调，调查结果报告如下。临床资料一、一般资料本组从先证者入手调查该家系７代共１５４人，其中连续４代１６例患有遗传性小脑型共济失调，合并精神障碍者５例。...     

遗传性共济失调诊断与治疗专家策略

遗传性共济失调是一大类具有高度临床和遗传异质性、病死率和病残率较高的遗传性神经系统退行性疾病.临床上以小脑共济失调为主要特征,表现为平衡障碍、进行性肢体协调运动障碍、步态不稳、构音障碍、眼球运动障碍等,并可伴有复杂的神经系统损害.本文结合疾病分子分型提出了遗传性共济失调的分子诊断流程.目前此类疾病尚缺乏有效的治疗方法,主要以对症治疗为主.     

脊髓小脑共济失调3型发病机制研究进展

正脊髓小脑共济失调3型(Spinocerebellar ataxia type 3,SCA3)又称为马查德约瑟夫病(Machado-Joseph Disease,MJD),是我国遗传性共济失调(Hereditary Ataxia,HA)中最常见的亚型,约占所有遗传性共济失调的60%,其患病率为3~5/10万,仅我国就有4万余名患者[1-2]。该病以进展性小脑型共济失调为主要临床表现,主要包括步态不稳、肢体摇晃、动作     

成人发病的散发性共济失调症临床诊疗

成人发病的散发性共济失调症是由多种原因所致,临床表现以共济失调为主要的多种疾病。致病原因包括中毒、免疫介导性、维生素缺乏、感染性疾病、变性病以及遗传性疾患等。散发性共济失调临床谱具有明显异质性,临床正确诊断极具挑战性。但相比于遗传性共济失调症,此类疾患多数治疗效果较好,及时、正确诊断尤为重要。现代生化、免疫以及影像学技术有助于此类疾患的认识和诊治。文中综述并讨论可致成人发病的散发性共济失调的不同疾病分类,并着重其临床和神经影像学表现及诊断标准。     

Adult-onset autosomal recessive ataxia with thalamic lesions in a Finnish family

OBJECTIVE: To describe an unusual kindred with adult-onset ataxia and thalamic lesions detected by brain MRI. METHODS: The authors characterized clinical, laboratory, and pathologic features of the disease and sought linkage to previously recognized ataxia loci. RESULTS: Two sisters and a brother developed progressive ataxia, dysarthria, mild cognitive impairment, and sensorimotor neuropathy at age 30, combined with epilepsy in one sibling. MRI showed symmetric thalamic lesions, changes in brainstem gray matter, and white matter changes in the cerebellum. Autopsy in one of the patients revealed neuronal degeneration with a peculiar vacuolar change in thalamus, probably representing transsynaptic degeneration in response to deafferentation. Neuronal and secondary tract degeneration was observed in the spinal cord, cerebellum, and brainstem suggesting a spinocerebellar degeneration. The disorder appears to be transmitted as an autosomal recessive trait. Genetic and sequence analysis of the FRDA gene and comprehensive laboratory examinations excluded Friedreich's ataxia and other similar recessive diseases. CONCLUSION: Adult-onset recessive ataxia with bilateral thalamic lesions in this family may represent a distinct hereditary spinocerebellar ataxia.     

Visual evoked potentials in spinocerebellar degenerations

Pattern reversal visual evoked potentials were studied in 21 patients with spinocerebellar ataxias among whom 6 had Friedreich's ataxia, 10 had hereditary spastic ataxia and 5 had spinocerebellar degeneration with slow eye movements (olivopontocerebellar degeneration). The VHP abnormalities found in 4 cases of Friedreich's ataxia and one with spinocerebellar degeneration with slow eye movements, consisted of, bilaterally absent VEP in 3 patients and bilaterally abnormal responses with asymmetry in two. All the patients with spastic ataxia had normal VEP latencies. The N 70 – P 100 amplitudes, in patients with hereditary ataxias were significantly reduced compared to controls (P < 0.001). The VEP abnormalities correlated best with neuroopthalmic findings, but had no relation to age, sex, inheritance or duration of illness. The VEP findings are probably suggestive of progressive nerve fibre loss in the visual pathways with associated slowing of conduction. The higher incidence of visual pathway involvement in Friedreich's ataxia compared to other hereditary ataxias as reported in recent studies is confirmed.     

An investigation of pyruvate metabolism in patients with cerebellar and spinocerebellar degeneration

This study extends previous observations of pyruvate metabolism in the spino-cerebellar degenerations by screening for abnormalities of pyruvate oxidation using the rise in blood pyruvate after an oral glucose load and examining the activity of the lipoamide dehydrogenase (LAD) moeity of the pyruvate dehydrogenase complex in the serum of 31 patients with Friedreich's ataxia, hereditary spastic ataxia and primary cerebellar degeneration. Serum LAD activity was significantly reduced in 10 Friedreich's ataxia patients when compared to controls and to 10 patients with spastic ataxia, thus confirming previous studies. Two patients with Friedreich's ataxia and 2 with primary cerebellar degeneration had abnormal blood pyruvate curves after oral glucose loading. The findings suggest that abnormal pyruvate oxidation occurs in some cases of Friedreich's ataxia and primary cerebellar degeneration and that the abnormality of pyruvate metabolism is not necessarily reflected in the serum LAD activity of these patients. The relevance of these findings to the heterogeneity of the hereditary ataxias is discussed.     

Ataxia associated with Hashimoto''s disease: progressive non-familial adult onset cerebellar degeneration with autoimmune thyroiditis

Acquired cerebellar ataxia has been described with hypothyroidism, and is typically reversible by thyroid hormone replacement therapy. The cerebellar dysfunction has been attributed to metabolic and physiological effects of the endocrine disorder. In a few patients, however, ataxia has persisted despite thyroid replacement therapy. Other mechanisms may be involved in ataxia associated with thyroid disorders. OBJECTIVE: To document progressive non-familial adult onset cerebellar degeneration (PNACD) occurring in six patients with raised antithyroid antibodies (Hashimoto's/autoimmune thyroiditis), and other autoimmune manifestations, in the absence of hypothyroidism; and to document the independence of the cerebellar disorder from the endocrine dysfunction. METHODS: A case study of six patients with PNACD reviewing the clinical course and relation to endocrine and autoimmune status. RESULTS: All six patients were euthyroid when they developed their symptoms; had raised antithyroid antibodies consistent with Hashimoto's autoimmune thyroiditis; and had strong personal or family histories of organ specific autoimmune diatheses. Brain MRI disclosed atrophy of the cerebellar vermis in four patients and olivopontocerebellar atrophy in two. Other possible causes of cerebellar degeneration were excluded. De novo treatment (two patients) or continued treatment (three patients) with L-thyroxine did not modify the progression of the ataxia. CONCLUSIONS: Cerebellar degeneration in these patients with raised antithyroid antibodies may be immune mediated. The presence of antithyroid antibodies may signal or cause the autoimmune process producing cerebellar degeneration. "Hashimoto's associated ataxia" seems to represent a recognisable and not uncommon condition; a trial of immunomodulating therapy should be considered in these patients.     

A family with pseudodominant Friedreich's ataxia showing marked variation of phenotype between affected siblings

A family with pseudodominant Friedreich's ataxia is described showing marked variation of phenotype between affected siblings. The mother of this family (III-3) developed a spastic ataxic tetraplegia with neuropathy at 34 years of age; her husband, who was unrelated, was clinically normal. Of their nine children, two (IV-2, IV-3), including one with multiple sclerosis (IV-3), developed a mild spinocerebellar degeneration in the third decade. Three in their late 20s had an asymptomatic spinocerebellar degeneration (IV-4, IV-5, IV-6) and one was confined to a wheelchair at 15 years with typical Friedreich's ataxia (IV-9). Three other siblings (IV-1, IV-7, IV-8) were clinically normal. The father proved to be heterozygous for the triplet repeat expansion at the Friedreich's ataxia locus and all clinically affected members were homozygous for alleles in the expanded size range. This family confirms that homozygote-heterozygote mating is the genetic basis for some families with apparent autosomal dominant Friedreich's ataxia.     

Pattern-reversal visual evoked potentials in the hereditary ataxias and spinal degenerations

Pattern-reversal visual evoked potentials (PRVEP) were evaluated in 24 patients from 18 separate families with various forms of hereditary ataxia and spinal degeneration. Abnormally delayed latencies were found in 3 of 5 patients with classic Friedreich's ataxia, 1 patient with dominant spastic paraparesis, and 1 patient with recessive dentatorubrospinal degeneration. Fifteen other patients with several different types of dominant and recessive hereditary ataxias had normal PRVEP latencies, including 1 patient with bilateral optic atrophy. Testing of PRVEP will be useful in the clinical delineation of the genetic ataxias and spinal degenerations, and, when interpreted with caution, should be an additional variable evaluated in the differentiation of these disorders from multiple sclerosis.     

Clinical and genetic analysis of 188 families with spinocerebellar degeneration. Friedreich's disease and P. Marie's hereditary ataxias]

Based on the hereditary ataxias concepts and a large field survey, the authors analyzed 392 cases of spino-cerebellar degeneration belonging to 188 families. Two main clinical groups were identified: 227 cases of Friedreich ataxia and 74 cases of cerebellar hereditary ataxia of P. Marie type. The association in the same patient of peroneal atrophy of Charcot Marie type with Friedreich ataxia (17 cases) or P. Marie cerebellar hereditary ataxia (13 definite cases and 13 probable) was the most striking finding. "Forme fruste", incomplete form or complex form of Friedreich ataxia were present in some families while in some others there was spastic paraplegia or pure Charcot Marie Tooth disease. This clinical heterogeneity in families of spino-cerebellar degeneration is discussed.     

‘Idiopathic’ late onset cerebellar ataxia: A clinical and genetic study of 36 cases

The clinical features of 36 patients with late onset cerebellar ataxia of unknown cause are described. Overall, the age of onset ranged from 30 to 74 years and there was a significant excess of males. The patients were divided into 3 groups on clinical grounds. The first was composed of 12 cases in whom truncal ataxia was more marked than limb ataxia and onset was relatively late (mean 54.75 years); these correspond to the Marie-Foix-Alajouanine type of cerebellar degeneration. The second group contained 6 individuals who had prominent tremor in the upper limbs, both resting and during action. The 18 individuals in the 3rd group were clinically similar to patients previously reported as sporadic examples of olivopontocerebellar atrophy. It was this latter category which contributed the excess of males. None of the patients had similarly affected relatives. Both the 3rd group, and all 36 cases were compared with 36 other patients with dominantly inherited late onset cerebellar ataxia in order to establish which clinical features might indicate the presence of new dominant mutations in the “sporadic” cases. Optic atrophy, ophthalmoplegia and pigmentary retinal degeneration were more frequent in the familial cases.     

Analysis of follow-up survey in spinocerebellar degeneration

Spinocerebellar degeneration (SCD) is associated with other various degeneration of the nervous systems such as the optic tract, pyramidal pathway, extrapyramidal system, nuclei of the brain stem and autonomic nervous system as well as changes of heart. The clinical pattern, also have the great variability. We investigated the mode of progression of clinical symptoms and signs in 214 cases of SCD which were examined 2 times at intervals of about 10 years. 79 of 214 cases were reported to be died at the last examination. 135 alive cases included 3 with the Holmes type, 14 with late cortical cerebellar atrophy (LCCA) 10 with Menzel type, 18 with olive-ponto-cerebellar atrophy (OPCA), 33 with spinocerebellar form (SCF), 6 with Friedreich's ataxia, 18 with hereditary spastic paraparesis (HSP) and 33 with the other type. 79 dead cases included 0 with the Holmes type, 6 with LCCA, 5 with Menzel type, 32 with OPCA, 16 with SCF, 1 with Friedreich's ataxia, 4 with HSP and 15 with the other type. The disability of daily living in SCD revealed slower progression in the advanced stage than in the early stage. Every type of SCD had some different progression of disability each other. In the early stage, Friedreich's ataxia showed the highest progression of disability, but in the advanced stage, Holmes type and the OPCA did. Holmes type showed progression of ataxia without any remarkable change of other systems. LCCA showed increase of abnormality in the eye movements, pyramidal tract and autonomic nervous system in addition to the cerebellar system. OPCA involved multiple systems as ataxia worsening, but Menzel type had no remarkable changes of incidence in eye movement disorder.(ABSTRACT TRUNCATED AT 250 WORDS)     

Hypertrophia musculorum vera in familial ataxia

A kindred with dominantly inherited ataxia demonstrated hypertrophia musculorum vera as a phenotypic feature of the disease. The proband had fasciculations, cramps, absent sensory nerve action potentials, an increased creatine kinase level, dramatic enlargement of calf muscles, and a muscle biopsy specimen showing denervation accompanied by true muscle fiber hypertrophy; ataxia and other clinical signs of spinocerebellar degeneration were also present. Other family members displayed progressive ataxia and calf muscle enlargement to varying degrees. Though peroneal atrophy is a more common feature of the familial ataxias, some kindreds may have muscle enlargement simulating the pseudohypertrophy of muscular dystrophy that is due instead to denervation-induced compensatory individual fiber hypertrophy.