Rapidly progressive multiple system atrophy in a patient carrying LRRK2 G2019S mutation

© 2023. Fondazione Società Italiana di Neurologia..

BACKGROUND: Multiple system atrophy (MSA) is considered a primarily sporadic neurodegenerative disease, but the role of genetic is poorly understood.

CASE: We present a female patient of Moroccan origin who developed a rapidly progressive non-levodopa responsive parkinsonism, gait and balance problems, and dysautonomia including severe bulbar symptoms. She was diagnosed with MSA Parkinsonian-type (MSA-P) and suddenly died at night at 58 years of age. Reduced striatal DAT-SPECT, putaminal hyperintensity on T2-MRI, and hypometabolism with FDG-PET were present. Genetic testing documented a G2019S mutation in the LRRK2 gene. A skin biopsy was obtained and used to perform alpha-synuclein RT-QuIC, which was negative, and immunohistochemical analysis, which demonstrated abnormal alpha-synuclein deposits in cutaneous nerves. Elevated blood neurofilament light chain levels were also documented.

CONCLUSIONS: LRRK2 mutations are the most common cause of monogenic Parkinson's disease (PD) and G2019S is the most frequent variant. Our patient presented with biological, clinical, and radiological features of MSA, but genetic testing revealed a G2019S LRRK2 mutation, which has been previously reported only in one other case of pathologically proven MSA but with mild progression. In our patient, post-mortem confirmation could not be performed, but RT-QuIC and immunohistochemical findings on skin biopsy support the diagnosis of MSA. G2019S LRRK2 may be linked to an increased risk of MSA. Cases of atypical parkinsonism with rapid disease course should be screened for PD-related genes especially in populations with a high prevalence of mutations in known genes.

Medienart:

E-Artikel

Erscheinungsjahr:

2024

Erschienen:

2024

Enthalten in:

Zur Gesamtaufnahme - volume:45

Enthalten in:

Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology - 45(2024), 1 vom: 02. Jan., Seite 309-313

Sprache:

Englisch

Beteiligte Personen:

Carrer, Tommaso [VerfasserIn]
Bonato, Giulia [VerfasserIn]
Sandre, Michele [VerfasserIn]
Emmi, Aron [VerfasserIn]
Campagnolo, Marta [VerfasserIn]
Musso, Giulia [VerfasserIn]
Carecchio, Miryam [VerfasserIn]
Parchi, Piero [VerfasserIn]
Antonini, Angelo [VerfasserIn]

Links:

Volltext

Themen:

Alpha-Synuclein
EC 2.7.11.1
G2019S
Journal Article
LRRK2
LRRK2 protein, human
Leucine-Rich Repeat Serine-Threonine Protein Kinase-2
MSA
RT-QuIC

Anmerkungen:

Date Completed 03.01.2024

Date Revised 03.01.2024

published: Print-Electronic

Citation Status MEDLINE

doi:

10.1007/s10072-023-07056-5

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

NLM362486573