Fonderico Mattia, Laudisi Michele, Andreasi Nico Golfrè, Bigoni Stefania, Lamperti Costanza, Panteghini Celeste, Garavaglia Barbara, Carecchio Miryam, Emanuele Elia Antonio, Forni Gian L, Granieri Enrico
Department of Biomedical and Specialistic Surgical Sciences, Section of Neurological, Psychiatric and Psychological Sciences, Ferrara University, Ferrara, Italy.
Department of Medical Sciences, Section of Medical Genetics, Ferrara University, Ferrara, Italy.
Front Neurol. 2017 Aug 21;8:385. doi: 10.3389/fneur.2017.00385. eCollection 2017.
Here, we report the case of a 36-year-old patient with a diagnosis of mutation of the WDR45 gene, responsible for beta-propeller protein-associated neurodegeneration, a phenotypically distinct, X-linked dominant form of Neurodegeneration with Brain Iron Accumulation. The clinical history is characterized by a relatively stable intellectual disability and a hypo-bradykinetic and hypertonic syndrome with juvenile onset. Genetic investigations and T1 and T2-weighted MR images align with what is described in literature. The patient was also subjected to PET with 18-FDG investigation and DaT-Scan study. In reporting relevant clinical data, we want to emphasize the fact that the patient received a chelation therapy with deferiprone (treatment already used in other forms of NBIA with encouraging results), which, however, had to be interrupted because the parkinsonian symptoms worsened. Conversely, the patient has benefited from non-drug therapies and, in particular, from an adapted motor activity with assisted pedaling (method in the process of validation in treatments of parkinsonian syndromes), which started before the treatment with deferiprone and still continues.
在此,我们报告一例36岁患者,其被诊断为WDR45基因突变,该基因与β-螺旋桨蛋白相关神经变性有关,这是一种表型独特的、X连锁显性形式的脑铁沉积神经变性。临床病史的特征为相对稳定的智力残疾以及青少年期起病的运动徐缓-少动和张力亢进综合征。基因检测以及T1加权和T2加权磁共振图像与文献描述相符。该患者还接受了18氟脱氧葡萄糖正电子发射断层显像(PET)检查和多巴胺转运体(DaT)扫描研究。在报告相关临床数据时,我们想强调的是,该患者接受了去铁酮螯合治疗(这种治疗已用于其他形式的脑铁沉积神经变性且取得了令人鼓舞的结果),然而,由于帕金森症状加重,该治疗不得不中断。相反,该患者从非药物治疗中获益,尤其是从适应性运动活动及辅助踏板运动中获益(该方法正在帕金森综合征治疗中进行验证),这种运动活动在使用去铁酮治疗之前就已开始且仍在继续。