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丘脑腹中间核深部脑刺激治疗Polr3a相关震颤共济失调综合征的震颤:两例报告

"Deep Brain Stimulation of the Ventral Intermediate Nucleus of the Thalamus for Tremor in Polr3a-Related Tremor-ataxia Syndrome: A Two-case Report".

作者信息

Sánchez-Román Edgar Javier, Villa-Villegas Leonel, Leal-Ortega Roberto, Lira-Jaime Luz Gabriela, Rivas-Ruvalcaba Francisco, Díaz-Ramírez Karely, Piña-Avilés Carlos Eduardo, Mercado-Pimentel Rodrigo, Zúñiga-Ramírez Carlos

机构信息

Movement Disorders and Neurodegenerative Diseases Unit, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara, Mexico.

Department of Neurology, Hospital Faro del Mayab, Mérida Yucatán, México.

出版信息

Tremor Other Hyperkinet Mov (N Y). 2025 Sep 5;15:42. doi: 10.5334/tohm.1000. eCollection 2025.

DOI:10.5334/tohm.1000
PMID:40917817
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12412673/
Abstract

CLINICAL VIGNETTE

RNA polymerase III subunit A (POLR3A) related disorders are a group of heterogeneous diseases with a recessive autosomic inheritance. These disorders manifest with distinct clinical features like ataxia, spasticity, hypodontia, hypogonadism, mental retardation and progressive motor decline.

CLINICAL DILEMMA

POLR3A gene mutation can manifest with parkinsonism, dystonia, ataxia and tremor. Deep brain stimulation (DBS) might be effective for motor symptoms. Choosing the best DBS target is essential for successful treatment.

CASE REPORTS AND CLINICAL SOLUTION

Two subjects with a predominant tremorous syndrome due to POLR3A gene mutation with no response to pharmacological treatment underwent DBS at ventral intermediate nuclei (Vim DBS) of thalamus, with significant improvement in tremor.

GAP IN KNOWLEDGE

Tremor in POLR3A gene mutation could respond to Vim DBS.

摘要

临床病例

RNA聚合酶III亚基A(POLR3A)相关疾病是一组具有隐性常染色体遗传的异质性疾病。这些疾病表现出不同的临床特征,如共济失调、痉挛、牙齿发育不全、性腺功能减退、智力迟钝和进行性运动功能衰退。

临床困境

POLR3A基因突变可表现为帕金森综合征、肌张力障碍、共济失调和震颤。深部脑刺激(DBS)可能对运动症状有效。选择最佳的DBS靶点对成功治疗至关重要。

病例报告及临床解决方案

两名因POLR3A基因突变导致以震颤综合征为主且对药物治疗无反应的患者在丘脑腹中间核接受了DBS(丘脑腹中间核DBS),震颤得到显著改善。

知识空白

POLR3A基因突变引起的震颤可能对丘脑腹中间核DBS有反应。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5171/12412673/838b976afdf4/tohm-15-1-1000-g2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5171/12412673/2965904a91e2/tohm-15-1-1000-g1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5171/12412673/838b976afdf4/tohm-15-1-1000-g2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5171/12412673/2965904a91e2/tohm-15-1-1000-g1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5171/12412673/838b976afdf4/tohm-15-1-1000-g2.jpg

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本文引用的文献

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Clinical phenotype and genetic function analysis of a family with hypomyelinating leukodystrophy-7 caused by POLR3A mutation.临床表型及 POLR3A 突变致脱髓鞘白质营养不良-7 家系的遗传学功能分析
Sci Rep. 2024 Apr 1;14(1):7638. doi: 10.1038/s41598-024-58452-6.
2
POLR3-related leukodystrophy caused by biallelic and pathogenic variants: a single-center experience.由双等位基因和致病性变异引起的POLR3相关脑白质营养不良:单中心经验
Front Neurol. 2024 Mar 14;15:1355484. doi: 10.3389/fneur.2024.1355484. eCollection 2024.
3
A Chinese patient with -related leukodystrophy: a case report and literature review.
一名患有-相关脑白质营养不良的中国患者:病例报告及文献综述。
Front Neurol. 2023 Oct 27;14:1269237. doi: 10.3389/fneur.2023.1269237. eCollection 2023.
4
Craniofacial features of POLR3-related leukodystrophy caused by biallelic variants in , and .POLR3 相关脑白质营养不良的颅面特征由 、 和 中的双等位基因突变引起。
J Med Genet. 2023 Oct;60(10):1026-1034. doi: 10.1136/jmg-2023-109223. Epub 2023 May 16.
5
A novel variant of the POLR3A gene in a Chinese patient with POLR3-related leukodystrophy.中国一位 POLR3 相关性脑白质营养不良患者的 POLR3A 基因新型变异。
Neurol Sci. 2023 Sep;44(9):3363-3368. doi: 10.1007/s10072-023-06767-z. Epub 2023 Mar 29.
6
DBS in tremor with dystonia: VIM, GPi or both? A review of the literature and considerations from a single-center experience.DBS 治疗震颤合并肌张力障碍:选择 VIM、GPi 还是两者都选?文献综述及单中心经验的考虑。
J Neurol. 2023 Apr;270(4):2217-2229. doi: 10.1007/s00415-023-11569-6. Epub 2023 Jan 21.
7
Developmental regression and movement disorder as a phenotypic variant of POLR3A Mutation-Case report.发育倒退和运动障碍作为POLR3A突变的一种表型变异——病例报告
Clin Case Rep. 2022 Nov 15;10(11):e6556. doi: 10.1002/ccr3.6556. eCollection 2022 Nov.
8
Identification of a Novel Missense Mutation of Gene in a Cohort of Sicilian Patients with Leukodystrophy.西西里岛白质营养不良患者队列中一个基因新错义突变的鉴定。
Biomedicines. 2022 Sep 14;10(9):2276. doi: 10.3390/biomedicines10092276.
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RNA Polymerase III Subunit Mutations in Genetic Diseases.遗传性疾病中的RNA聚合酶III亚基突变
Front Mol Biosci. 2021 Jul 30;8:696438. doi: 10.3389/fmolb.2021.696438. eCollection 2021.
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Neurol Sci. 2022 Feb;43(2):1071-1077. doi: 10.1007/s10072-021-05462-1. Epub 2021 Jul 23.