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Hereditary spastic paraplegia due to SPAST mutations in 151 Dutch patients: new clinical aspects and 27 novel mutations
  1. S T de Bot1,
  2. R T M van den Elzen1,
  3. A R Mensenkamp2,
  4. H J Schelhaas1,
  5. M A A P Willemsen3,
  6. N V A M Knoers2,
  7. H P H Kremer4,
  8. B P C van de Warrenburg1,
  9. H Scheffer2
  1. 1Department of Neurology, Radboud University Nijmegen Medical Centre, Donders Centre for Brain Cognition and Behaviour, Nijmegen, The Netherlands
  2. 2Department of Human Genetics, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
  3. 3Department of Pediatric Neurology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
  4. 4University Medical Centre Groningen, Department of Neurology, Groningen, The Netherlands
  1. Correspondence to Mrs S T de Bot, Radboud University Nijmegen Medical Centre, Department of Neurology, PO Box 9101, Nijmegen 6500 HB, The Netherlands;{at}


Background In the clinically and genetically heterogeneous group of the hereditary spastic paraplegias (HSPs), mutations in the SPAST gene are most frequently found and cause a pure autosomal dominant form.

Objective To provide the clinical and genetic characteristics of Dutch patients with HSP due to a SPAST mutation (SPG4).

Methods SPAST mutation carriers were identified through a comprehensive national database search. Available medical records were reviewed.

Results 151 mutation carriers carried 60 different changes in the SPAST gene, of which one was a known polymorphism, and 27 were novel. Missense mutations were most frequently found (39%). Clinical information was available from 72 mutation carriers. Age at onset ranged from 1 to 63 years with a bimodal peak distribution in the first decade and above age 30. The predominantly pure spastic paraplegia was accompanied by deep sensory disturbances and sphincter problems in almost 50%. An additional hand tremor was found in 10%. Patients with missense mutations and exon deletions did not reveal a distinctive phenotype.

Conclusions Dutch SPAST mutation carriers show a broad mutation spectrum, with 27 novel mutations in the present series. A bimodal peak distribution in age at onset was found and an accompanying tremor as peculiar feature of SPG4. The pathogenicity of S44L, the first exon 4 mutation, and a possible autosomal recessive mode of inheritance are discussed.

  • novel mutations
  • tremor
  • exon 4
  • S44L
  • genetics
  • heredit spastic paraplegia
  • tremor

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  • Scheffer H & van de Warrenburg BPC contributed equally to this study.

  • Competing interests None.

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