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When does ALS start? A novel SOD-1 p.Gly142Arg mutation causing motor neurone disease with prominent premorbid cramps and spasms
  1. Z A Ioannides1,2,
  2. R D Henderson2,
  3. T Robertson3,
  4. M Davis4,
  5. P A McCombe1,2
  1. 1 Centre for Clinical Research, The University of Queensland Centre for Clinical Research, Brisbane, Queensland, Australia
  2. 2 Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
  3. 3 Anatomical Pathology, Queensland Pathology, Brisbane, Queensland, Australia
  4. 4 Department of Diagnostic Genomics, PathWest Laboratory Medicine WA, QEII Medical Centre, Perth, Western Australia, Australia
  1. Correspondence to Dr P A McCombe, Centre for Clinical Research, The University of Queensland Centre for Clinical Research, Brisbane, Queensland 4000, Australia; pamela.mccombe{at}

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Amyotrophic lateral sclerosis (ALS) is characterised by progressive muscle weakness and degeneration of upper and lower motor neurones. The risk of developing ALS is partly genetic and partly environmental. Approximately 10% of cases of ALS are familial and a number of causative genes have been identified.1 Many of the causative genes encode proteins that accumulate in cells in ALS. Mutations of the copper-zinc (Cu, Zn) superoxide dismutase type 1 (SOD1) gene account for approximately 20% of familial and 3% of sporadic ALS cases.

Over 150 mutations in the coding region of SOD1 have been found in patients with ALS worldwide, with variation of the frequency of SOD1 mutations in different populations. However, not all SOD1 mutations are pathogenic and there is a variety of clinical presentations of patients with pathogenic mutations. Furthermore, the different mutations have diverse effects on the structure of the SOD1 protein, and some cause no abnormality other than decreasing the net charge of the protein.

We now describe two sisters, from a family of Caucasian genetic background, with a novel SOD1 mutation, and unusual clinical features before the onset of weakness. The proband developed painful leg and hand cramps and leg stiffening in her sixth decade. After about 10 years, she …

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  • Contributors ZAI collected the data and helped to write the paper. RDH performed the neurophysiology and contributed to writing the paper. TR reported the muscle biopsies and reviewed the paper. MD performed the genetic studies and helped to write the paper. PMM designed the study and wrote the paper.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval This is a case report—we have written consent from the living subject and the husband of the deceased subject.

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