The phenotypic spectrum of rapid-onset dystonia-parkinsonism (RDP) and mutations in the ATP1A3 gene

Allison Brashear, William B. Dobyns, Patricia De Carvalho Aguiar, Michel Borg, C. J.M. Frijns, Seema Gollamudi, Andrew Green, João Guimaraes, Bret C. Haake, Christine Klein, Gurutz Linazasoro, Alexander Münchau, Deborah Raymond, David Riley, Rachel Saunders-Pullman, Marina A.J. Tijssen, David Webb, Jacek Zaremba, Susan B. Bressman, Laurie J. Ozelius

Research output: Contribution to journalArticle

177 Scopus citations

Abstract

Rapid-onset dystonia-parkinsonism (RDP) (also known as DYT12) is characterized by the abrupt onset of dystonia and parkinsonism and is caused by mutations in the ATP1A3 gene. We obtained clinical data and sequenced the ATP1A3 gene in 49 subjects from 21 families referred with 'possible' RDP, and performed a genotype-phenotype analysis. Of the new families referred for study only 3 of 14 families (21%) demonstrated a mutation in the ATP1A3 gene, but no new mutations were identified beyond our earlier report of 6. Adding these to previously reported families, we found mutations in 36 individuals from 10 families including 4 de novo mutations and excluded mutations in 13 individuals from 11 families. The phenotype in mutation positive patients included abrupt onset of dystonia with features of parkinsonism, a rostrocaudal gradient, and prominent bulbar findings. Other features found in some mutation carriers included common reports of triggers, minimal or no tremor at onset, occasional mild limb dystonia before the primary onset, lack of response to dopaminergic medications, rare abrupt worsening of symptoms later in life, stabilization of symptoms within a month and minimal improvement overall. In comparing ATP1A3 mutation positive and negative patients, we found that tremor at onset of symptoms, a reversed rostrocaudal gradient, and significant limb pain exclude a diagnosis of RDP. A positive family history is not required. Genetic testing for the ATP1A3 gene is recommended when abrupt onset, rostrocaudal gradient and prominent bulbar findings are present.

Original languageEnglish (US)
Pages (from-to)828-835
Number of pages8
JournalBrain
Volume130
Issue number3
DOIs
StatePublished - Mar 1 2007
Externally publishedYes

Keywords

  • ATP1A3
  • Dystonia
  • Na/K-ATPase
  • Parkinsonism
  • Rapid-onset dystonia-parkinsonism
  • RDP

ASJC Scopus subject areas

  • Clinical Neurology

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  • Cite this

    Brashear, A., Dobyns, W. B., De Carvalho Aguiar, P., Borg, M., Frijns, C. J. M., Gollamudi, S., Green, A., Guimaraes, J., Haake, B. C., Klein, C., Linazasoro, G., Münchau, A., Raymond, D., Riley, D., Saunders-Pullman, R., Tijssen, M. A. J., Webb, D., Zaremba, J., Bressman, S. B., & Ozelius, L. J. (2007). The phenotypic spectrum of rapid-onset dystonia-parkinsonism (RDP) and mutations in the ATP1A3 gene. Brain, 130(3), 828-835. https://doi.org/10.1093/brain/awl340