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Autosomal dominant pure spastic paraplegia: a clinical, paraclinical, and genetic study
  1. J E Nielsena,b,
  2. K Krabbec,
  3. P Jennumd,
  4. P Koefoeda,
  5. L Neerup Jensene,
  6. K Fengera,
  7. H Eiberga,
  8. L Hasholta,
  9. L Werdelinf,
  10. S A Sørensena
  1. aInstitute of Medical Biochemistry and Genetics, Laboratory of Medical Genetics, Section of Neurogenetics, University of Copenhagen, Denmark, bUniversity Clinic of Neurology, Hvidovre Hospital, Copenhagen, Denmark, cDanish Research Center of Magnetic Resonance, Hvidovre Hospital, Denmark, dDepartment of Clinical Neurophysiology, Hvidovre Hospital, Copenhagen, Denmark, eUniversity Clinic of Urology, Herlev Hospital, Denmark, fUniversity Clinic of Neurology, Frederiksberg Hospital, Denmark
  1. Dr J E Nielsen, Institute of Medical Biochemistry and Genetics, Laboratory of Medical Genetics, Section of Neurogenetics, The Panum Institute, Building 24.4, Blegdamsvej 3, DK-2200 Copenhagen. N Denmark. Telephone 0045 3532 7816; fax 0045 3139 3373; email: jnielsen{at}


OBJECTIVES At least three clinically indistinguishable but genetically different types of autosomal dominant pure spastic paraplegia (ADPSP) have been described. In this study the clinical, genetic, neurophysiological, and MRI characteristics of ADPSP were investigated.

METHODS Sixty three at risk members from five families were clinically evaluated. A diagnostic index was constructed for the study. Microsatellite genotypes were determined for chromosomes 2p, 14q, and 15q markers and multipoint linkage analyses were performed. Central motor conduction time studies (CMCT), somatosensory evoked potential (SSEP) measurement, and MRI of the brain and the total spinal cord were carried out in 16 patients from four families.

RESULTS The clinical core features of ADPSP were homogeneously expressed in all patients but some features were only found in some families and not in all the patients within the family. In two families non-progressive “congenital” ADPSP was seen in some affected members whereas adult onset progressive ADPSP was present in other affected family members. As a late symptom not previously described low backache was reported by 47%. Age at onset varied widely and there was a tendency for it to decline in successive generations in the families, suggesting anticipation. Genetic linkage analysis confined the ADPSP locus to chromosome 2p21-p24 in the five families. The lod scores obtained by multipoint linkage analysis were positive with a combined maximum lod score of Z=8.60. The neurophysiological studies only showed minor and insignificant prolongation of the central motor conduction time and further that peripheral conduction and integrity of the dorsal columns were mostly normal. Brain and the total spinal cord MRI did not disclose any significant abnormalities compared with controls.

CONCLUSIONS ADPSP linked to chromosome 2p21-p24 is a phenotypic heterogeneous disorder characterised by both interfamilial and intrafamilial variation. In some families the disease may be “pure” but the existence of “pure plus” families is suggested in others. The neurophysiological and neuroimaging investigations did not show any major abnormalities.

  • autosomal dominant pure spastic paraplegia linked to chromosome 2p
  • clinical features
  • neurophysiology
  • magnetic resonance imaging

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