Estrada-Rodriguez Humberto, Meza-Martinez Daniel A, Muñuzuri-Camacho Marco Antonio, Garcia-Romero David, Reyes-Melo Isael
Neurology and Psychiatry Department, National Institute of Medical Sciences and Nutrition, Mexico City, MEX.
Cirugía General, Instituto Mexicano del Seguro Social, Hospital General de Zona No. 33, Monterrey, MEX.
Cureus. 2023 Aug 23;15(8):e43954. doi: 10.7759/cureus.43954. eCollection 2023 Aug.
Frontotemporal dementia (FTD) is a heterogeneous condition characterized by changes in behavior, personality, and language resulting from degeneration of the frontal and/or temporal lobes. A wide spectrum of clinical syndromes and an overlap with different motor disorders make this entity challenging for clinicians, both in achieving a correct diagnosis and providing proper treatment. Despite the majority of cases being sporadic, FTD has a hereditary component, and more than 10 disease-causing genes have been identified. We present the case of a Mexican patient with a positive family history of neurocognitive disorders who developed early-onset behavioral symptoms, cognitive alterations, and motor disturbances. After a comprehensive study and multiple assessments by various medical services, a molecular diagnosis was achieved by documenting a loss-of-function mutation in the TANK-binding kinase 1 (TBK1) gene, an extremely rare cause of FTD. Genetic diagnosis is crucial in these situations, as this mutation has been associated with rapid disease progression and the potential development of motor syndromes during its course. Our case underscores the challenges involved in reaching an accurate diagnosis, highlighting the importance of molecular testing. A thorough family history, past medical records, and a detailed description of symptom onset and progression are imperative, as they can significantly influence both treatment approaches and prognosis. Diagnostic errors, combined with their subsequent inappropriate treatment, can further deteriorate patients' quality of life.
额颞叶痴呆(FTD)是一种异质性疾病,其特征是额叶和/或颞叶变性导致行为、人格和语言发生改变。广泛的临床综合征以及与不同运动障碍的重叠,使得该疾病对临床医生来说具有挑战性,无论是在做出正确诊断还是提供适当治疗方面。尽管大多数病例为散发性,但FTD具有遗传成分,并且已经鉴定出10多种致病基因。我们报告一例有神经认知障碍家族史阳性的墨西哥患者,该患者出现了早发性行为症状、认知改变和运动障碍。经过综合研究以及多个医疗服务部门的多次评估,通过记录TANK结合激酶1(TBK1)基因的功能丧失突变实现了分子诊断,这是FTD极为罕见的病因。在这些情况下,基因诊断至关重要,因为这种突变与疾病快速进展以及病程中运动综合征的潜在发展有关。我们的病例强调了准确诊断所面临的挑战,突出了分子检测的重要性。详尽的家族史、既往病历以及症状发作和进展的详细描述必不可少,因为它们会对治疗方法和预后产生重大影响。诊断错误及其随后的不恰当治疗会进一步恶化患者的生活质量。