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A wide spectrum of clinical, neurophysiological and neuroradiological abnormalities in a family with a novel CACNA1A mutation
  1. Romina Romaniello1,
  2. Claudio Zucca2,
  3. Alessandra Tonelli3,
  4. Sara Bonato1,
  5. Cinzia Baschirotto3,
  6. Nicoletta Zanotta2,
  7. Roberta Epifanio2,
  8. Andrea Righini4,
  9. Nereo Bresolin3,5,
  10. Maria T Bassi3,
  11. Renato Borgatti1
  1. 1Department of Child Neuropsychiatry and Neurorehabilitation IRCCS, E Medea Scientific Institute, Bosisio Parini, Lecco, Italy
  2. 2Clinical Neurophysiology Unit IRCCS, E Medea Scientific Institute, Bosisio Parini, Lecco, Italy
  3. 3Laboratory of Molecular Biology IRCCS, E Medea Scientific Institute, Bosisio Parini, Lecco, Italy
  4. 4Radiology and Neuroradiology Department, Children's Hospital V Buzzi of Milano, Italy
  5. 5Scientific Institute Ospedale Maggiore Policlinico, Department of Neurology, University of Milano, Italy
  1. Correspondence to Dr R Borgatti, Department of Neurorehabilitation 1, Scientific Institute ‘E Medea’, Via Don Luigi Monza 20, Bosisio Parini 23842 (LC), Italy; renato.borgatti{at}


Background Mutations in the calcium channel voltage dependent P/Q-type α-1A subunit (CACNA1A) can cause different neurological disorders which share a wide range of symptoms, including episodic ataxia type 2 (EA2), familial hemiplegic migraine (FHM1) and progressive spinocerebellar ataxia (SCA6).

Objective To describe a three generations family in which a spectrum of different phenotypes, ranging from SCA6 (proband), to EA2 (proband's mother) to FHM1 (proband's mother and proband's aunt) was found. All of the family members carried a novel CACNA1A missense mutation.

Patients and methods A clinical, molecular, neuroradiological and neurophysiological study was carried out in all subjects.

Results A single heterozygous base change in exon 9, c1213G→A, leading to the amino acid substitution pAla405Thr was found to segregate within the family. Brain MRI showed cerebellar and cerebral atrophy signs in all but one mutation carriers. Neurophysiological findings (electroencephalography and evoked potentials) confirmed possible cerebral cortex and white matter involvement regardless of the clinical symptoms displayed.

Conclusions This novel CACNA1A mutation adds to the number of mutations associated with a heterogeneous clinical picture in family members. This mutation might affect the interaction between the intracellular loops and the β subunit, leading to a relatively rapid cell death. In order to explain the wide phenotypic variability observed in this family, it is hypothesised that additional genetic and environmental (hormonal) factors play a role in the pathophysiology of the disease.

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  • Funding This study was supported by the Italian National Institute of Health research funding (Ministero della Sanità) grant RC/2006 and RC/2007, and by the Istituto Superiore di Sanità (Italy–USA program No 526/D/10).

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Ethics Committee approval was obtained from the Eugenio Medea Institute's ethics committee.

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