西孟加拉邦孟加拉族的原发性退行性小脑共济失调:一些观察结果。

Primary degenerative cerebellar ataxias in ethnic Bengalees in West Bengal: some observations.

作者信息

Chakravarty A, Mukherjee S C

机构信息

Department of Neurology, Vivekananda Institute of Medical Sciences, Medical College, Kolkata 700-006, India.

出版信息

Neurol India. 2003 Jun;51(2):227-34.

DOI:
Abstract

Seventy cases of primary degenerative cerebellar ataxias in ethnic Bengalees from southern West Bengal, India, were studied by the authors. Of these, 50 cases were of the familial type (hereditary ataxias) encountered in 23 families and the remaining 20 were of sporadic onset. 18 cases (from 11 families) were of "probable" autosomal recessive (AR) inheritance, 12 cases (8 families) had Friedreich's type ataxia (FA), 4 cases (2 families) had FA type ataxia with retained reflexes and in 2 cases (1 family) the exact phenotypic characterization could not be made. AR inheritance in these cases seemed most likely in view of the occurrence in a single generation with unaffected parents and history of consanguinity in many of the families studied. Genotypic confirmation of FA type ataxia and its variants could not be done in any case due to the non-availability of technology for studying the FA locus but some common dominant ataxia genotypes could be excluded. Thirty-two cases (from 12 families) with autosomal dominant ataxias (ADCA) were studied. Genotype analysis revealed 4 families with SCA2 genotype, 5 families with SCA3 and 3 families where genotypic characterization could not be made (phenotypically 2 were of ADCA I and 1 of ADCA II). No clear preponderance of one particular genotype of SCA over another could be demonstrated in our ethnic Bengalee patients. We also noted significant intra and inter-family variations in phenotypes within the same genotypic form as well as overlapping of clinical signs between different genotypes. Slow saccades and peripheral neuropathy were not seen consistently in our ethnic Bengalee subjects with SCA2 genotype. Similarly, extrapyramidal features, ophthalmoplegias and distal amyotrophy were seen in some but not all families with the SCA3 genotype. Phenotypic expression appeared to be an inconsistent marker of the SCA genotype in our patients. Of the 20 sporadic cases with cerebellar ataxia, genotype analysis revealed 2 cases with SCA1 and 1 with SCA2. Some of the sporadic ataxia cases had extracerebellar involvement and may warrant classification as Multiple System Atrophy. In all the 3 subjects with genotype characterization, phenotype correlation was lacking. The clinical pattern of hereditary ataxias in ethnic Bengalees seems to be somewhat different from that seen in Western India. The need for clinical and genetic studies of ataxias in different specific ethnic populations of India has been stressed.

摘要

作者对来自印度西孟加拉邦南部的70例孟加拉族原发性退行性小脑共济失调患者进行了研究。其中,50例为家族性类型(遗传性共济失调),分布于23个家族,其余20例为散发性发病。18例(来自11个家族)为“可能的”常染色体隐性(AR)遗传,12例(8个家族)患有弗里德赖希型共济失调(FA),4例(2个家族)患有保留反射的FA型共济失调,2例(1个家族)无法进行确切的表型特征描述。鉴于这些病例在单代中出现且父母未受影响,以及在所研究的许多家族中有近亲结婚史,AR遗传似乎最有可能。由于缺乏研究FA基因座的技术,在任何情况下都无法对FA型共济失调及其变异型进行基因型确认,但可以排除一些常见的显性共济失调基因型。对32例(来自12个家族)常染色体显性共济失调(ADCA)患者进行了研究。基因型分析显示,4个家族为SCA2基因型,5个家族为SCA3基因型,3个家族无法进行基因型特征描述(表型上2例为ADCA I型,1例为ADCA II型)。在我们的孟加拉族患者中,无法证明一种特定的SCA基因型比另一种更占优势。我们还注意到,在相同基因型形式内,家族内和家族间的表型存在显著差异,不同基因型之间的临床体征也有重叠。在我们具有SCA2基因型的孟加拉族受试者中,并非始终能观察到缓慢扫视和周围神经病变。同样,在一些但并非所有具有SCA3基因型的家族中,可见锥体外系特征、眼肌麻痹和远端肌萎缩。在我们的患者中,表型表达似乎不是SCA基因型的一致标志物。在20例散发性小脑共济失调病例中,基因型分析显示2例为SCA1基因型,1例为SCA2基因型。一些散发性共济失调病例有小脑外受累,可能需要归类为多系统萎缩。在所有3例有基因型特征描述的受试者中,均缺乏表型相关性。孟加拉族遗传性共济失调的临床模式似乎与印度西部所见有所不同。强调了对印度不同特定种族人群的共济失调进行临床和遗传学研究的必要性。

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