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Progressive myoclonic epilepsy as an adult-onset manifestation of Leigh syndrome due to m.14487T>C
  1. B Dermaut1,2,
  2. S Seneca3,
  3. L Dom4,
  4. K Smets5,6,
  5. L Ceulemans7,
  6. J Smet8,
  7. B De Paepe1,
  8. S Tousseyn9,
  9. S Weckhuysen9,
  10. M Gewillig10,
  11. P Pals5,
  12. P Parizel11,
  13. J L De Bleecker1,
  14. P Boon1,
  15. L De Meirleir12,
  16. P De Jonghe5,6,
  17. R Van Coster8,
  18. W Van Paesschen9,
  19. P Santens1
  1. 1
    Department of Neurology, University Hospital Ghent, Ghent University, Ghent Belgium
  2. 2
    Laboratory of Developmental Genetics, VIB, Leuven, Belgium
  3. 3
    Center for Medical Genetics, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
  4. 4
    Koningin Paola Kinderziekenhuis, Antwerp, Belgium
  5. 5
    Department of Neurology, University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
  6. 6
    Department of Molecular Genetics, Neurogenetics Research Group, VIB, University of Antwerp, Antwerp, Belgium
  7. 7
    Sint-Jozefkliniek, Bornem, Belgium
  8. 8
    Department of Pediatrics, Division of Neurology and Metabolism, University Hospital Ghent, Ghent University, Ghent, Belgium
  9. 9
    Department of Neurology, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium
  10. 10
    Department of Pediatric Cardiology, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium
  11. 11
    Department of Radiology, University Hospital Antwerp, Antwerp, Belgium
  12. 12
    Department of Pediatric Neurology and Metabolism, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
  1. Correspondence to Professor P Santens, Department of Neurology, University Hospital Ghent, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium; patrick.santens{at}ugent.be

Abstract

Background: m.14487T>C, a missense mutation (p.M63V) affecting the ND6 subunit of complex I of the mitochondrial respiratory chain, has been reported in isolated childhood cases with Leigh syndrome (LS) and progressive dystonia. Adult-onset phenotypes have not been reported.

Objectives: To determine the clinical–neurological spectrum and associated mutation loads in an extended m.14487T>C family.

Methods: A genotype–phenotype correlation study of a Belgian five-generation family with 12 affected family members segregating m.14487T>C was carried out. Clinical and mutation load data were available for nine family members. Biochemical analysis of the respiratory chain was performed in three muscle biopsies.

Results: Heteroplasmic m.14487T>C levels (36–52% in leucocytes, 97–99% in muscle) were found in patients with progressive myoclonic epilepsy (PME) and dystonia or progressive hypokinetic-rigid syndrome. Patients with infantile LS were homoplasmic (99–100% in leucocytes, 100% in muscle). We found lower mutation loads (between 8 and 35% in blood) in adult patients with clinical features including migraine with aura, Leber hereditary optic neuropathy, sensorineural hearing loss and diabetes mellitus type 2. Despite homoplasmic mutation loads, complex I catalytic activity was only moderately decreased in muscle tissue.

Interpretation: m.14487T>C resulted in a broad spectrum of phenotypes in our family. Depending on the mutation load, it caused severe encephalopathies ranging from infantile LS to adult-onset PME with dystonia. This is the first report of PME as an important neurological manifestation of an isolated mitochondrial complex I defect.

https://doi.org/10.1136/jnnp.2008.157354

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    Footnotes

    • Funding This work was supported by grants of the Research Council of the Vrije Universiteit Brussel (OZR1216-OZR1145), the University of Antwerp and FWO grants G.0666.06 and G.0399.08. BD is a postdoctoral researcher of the Fund for Scientific Research (FWO).

    • Competing interests None.

    • Patient consent Obtained.

    • Provenance and Peer review Not commissioned; externally peer reviewed.