alpha-synuclein and Dystonic-Disorders

Juvenile parkinsonism is arbitrarily defined as parkinsonian symptoms and signs presenting prior to 21 years of age. Levodopa-responsive juvenile parkinsonism that is consistent with diagnostic criteria for Parkinson's disease is most often caused by mutations in the PARK-Parkin, PARK-PINK1, or PARK-DJ1 genes. However, many other genetic and acquired parkinsonian disorders presenting in childhood or young adulthood are being reported, often with atypical features, such as presence of other movement disorders, cognitive decline, and psychiatric symptoms. The genetic landscape of juvenile parkinsonism is rapidly changing with the discovery of new genes. Although the mainstay of treatment remains levodopa, other symptomatic therapies such as botulinum toxin for focal dystonia, supportive medical therapies, and deep brain stimulation in select cases, may also be used to provide the most optimal long-term outcomes. Since the topic has not been reviewed recently, we aim to provide an update on genetics, differential diagnosis, evaluation, and treatment of juvenile parkinsonism.

Topics: Adolescent; alpha-Synuclein; Antiparkinson Agents; Child; Child, Preschool; Deep Brain Stimulation; Diagnosis, Differential; DiGeorge Syndrome; Dystonic Disorders; Genetic Diseases, X-Linked; Hepatolenticular Degeneration; Humans; Huntington Disease; Levodopa; Parkinsonian Disorders; Protein Deglycase DJ-1; Protein Kinases; Spinocerebellar Ataxias; Ubiquitin-Protein Ligases; Young Adult

Linkage of the Huntington's disease gene to chromosome 4 in 1983 marked the birth of modern genetics in movement disorders. The discovery that an expanded trinucleotide DNA repeat was central to the mechanism of this disease has been repeated over and over in a growing list of inherited ataxias. In 1997, a different mutation and genetic mechanism was discovered in a severe type of generalized primary torsion dystonia - Oppenheim's dystonia. Before this, only the genetic cause for rare metabolic dystonias was known, notably dopa-responsive (Segawa's) dystonia. In the same year, from the identification of mutation in the alpha-synuclein gene in rare pedigrees with autosomal dominant parkinsonism, arose the concept that Parkinson's disease may be part of a broader group of 'synucleinopathies', in which there is a fundamental defect in protein processing. In the following year, mutations in autosomal recessive juvenile onset parkinsonism were found in a gene called 'parkin'. Parkin mutations are a more common cause of parkinsonism than the rare alpha-synuclein mutations, particularly in young-onset disease. However, a most important understanding, occurring in the last year, has been the relationship between the parkin gene product, alpha-synuclein and abnormal protein degradation in the cell. A unified theory of neuronal death in Parkinson's disease is emerging, pointing to potential new therapies in the future.

Topics: alpha-Synuclein; Carrier Proteins; Chromosome Mapping; Chromosomes, Human; Dystonic Disorders; Friedreich Ataxia; Genes, Dominant; Genes, Recessive; Humans; Huntingtin Protein; Huntington Disease; Ligases; Minisatellite Repeats; Molecular Chaperones; Movement Disorders; Nerve Tissue Proteins; Nuclear Proteins; Parkinson Disease; Spinocerebellar Ataxias; Synucleins; Ubiquitin-Protein Ligases

Topics: alpha-Synuclein; Brain; Cerebellum; Dystonic Disorders; Female; Humans; Male; Mutation; Neurons; Pedigree; Sarcoglycans

The 2 major types of neurodegeneration with brain iron accumulation (NBIA) are the pantothenate kinase type 2 (PANK2)-associated neurodegeneration (PKAN) and NBIA2 or infantile neuroaxonal dystrophy (INAD) due to mutations in the phospholipase A2, group VI (PLA2G6) gene. We have recently demonstrated clinical heterogeneity in patients with mutations in the PLA2G6 gene by identifying a poorly defined subgroup of patients who present late with dystonia and parkinsonism. We report the clinical and genetic features of 7 cases with PLA2G6 mutations. Brain was available in 5 cases with an age of death ranging from 8 to 36 years and showed widespread alpha-synuclein-positive Lewy pathology, which was particularly severe in the neocortex, indicating that the Lewy pathology spread corresponded to Braak stage 6 and was that of the "diffuse neocortical type". In 3 cases there was hyperphosphorylated tau accumulation in both cellular processes as threads and neuronal perikarya as pretangles and neurofibrillary tangles. Later onset cases tended to have less tau involvement but still severe alpha-synuclein pathology. The clinical and neuropathological features clearly represent a link between PLA2G6 and parkinsonian disorders.

Topics: Adolescent; Adult; alpha-Synuclein; Brain; Child; DNA Mutational Analysis; Dystonic Disorders; Female; Group VI Phospholipases A2; Humans; Lewy Bodies; Male; Mutation; Parkinsonian Disorders; Phenotype; tau Proteins