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Patients with horizontal gaze palsy and progressive scoliosis due to ROBO3 E319K mutation have both uncrossed and crossed central nervous system pathways and perform normally on neuropsychological testing
  1. G Amoiridis1,
  2. M Tzagournissakis1,
  3. P Christodoulou2,
  4. S Karampekios3,
  5. H Latsoudis1,
  6. T Panou4,
  7. P Simos4,
  8. A Plaitakis1
  1. 1Department of Neurology, University Hospital of Crete, Crete, Greece
  2. 2Department of Otorhinolaryngology, University Hospital of Crete
  3. 3Department of Radiology, University Hospital of Crete
  4. 4Department of Psychology, University of Crete, Heraklion, Greece
  1. Correspondence to:
 G Amoiridis
 Department of Neurology, University of Crete, PO Box 2208, 71003 Heraklion, Greece;amoirid{at}


Background: Horizontal gaze palsy and progressive scoliosis (HGPPS) is caused by mutations of the ROBO3 gene, which encodes a receptor associated with axonal guidance during development. Although there is evidence for uncrossed cuneatal and corticospinal tracts in HGPPS, it is unclear whether other central nervous system pathways are involved.

Objective: To study two patients with HGPPS homozygotic for the ROBO3 E319K mutation using a variety of neurophysiological and neuropsychological tests.

Methods: A battery of neuropsychological tests was applied to assess various cognitive and perceptual functions. The corticospinal, somatosensory and auditory pathways were evaluated using appropriate neurophysiological tests. To access motor pathways to the neck muscles, electromyographic recordings were obtained from the sternocleidomastoideus and splenius capitis muscle during active head rotation.

Results: Both patients performed normally on manual dexterity, complex sensory and visuospatial functions, reading and general intelligence tests. Motor evoked potentials in both patients showed uncrossed corticospinal tracts for the extremities, although in one patient, electromyography indicated pyramidal tract crossing for the neck muscles. Although somatosensory evoked potentials showed uncrossed somatosensory fibres subserving proprioception and light touch, right median nerve somatosensory evoked potential in one patient indicated a partial lemniscal crossing. Sympathetic skin response and blink reflex showed a midline crossing of the spinothalamic and quintothalamic tracts. Brain stem auditory evoked potentials indicated a lack of crossing in the level of the trapezoid body.

Conclusions: Our patients with the ROBO3 E319Κ mutation show normal perceptual and cognitive functions and have both crossed and uncrossed motor, sensory and auditory pathways.

  • BAEP, brain stem auditory evoked potential
  • EMG, electromyography
  • FDI, first dorsal interosseus
  • HGPPS, horizontal gaze palsy and progressive scoliosis
  • SSR, sympathetic skin response

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  • Published Online First 13 June 2006

  • Competing interests: None declared.