Genetic, Clinical, and Radiographic Delineation of Hallervorden-Spatz Syndrome

Susan Hayflick, Shawn Westaway, Barbara Levinson, Bing Zhou, Monique A. Johnson, Katherine H L Ching, Jane Gitschier

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: Hallervorden-Spatz syndrome is an autosomal recessive disorder characterized by dystonia, parkinsonism, and iron accumulation in the brain. Many patients with this disease have mutations in the gene encoding pantothenate kinase 2 (PANK2); these patients are said to have pantothenate kinase-associated neurodegeneration. In this study, we compared the clinical and radiographic features of patients with Hallervorden-Spatz syndrome with and without mutations in PANK2. METHODS: One hundred twenty-three patients from 98 families with a diagnosis of Hallervorden-Spatz syndrome were classified on the basis of clinical assessment as having classic disease (characterized by early onset with rapid progression) or atypical disease (later onset with slow progression). Their genomic DNA was sequenced for PANK2 mutations. RESULTS: All patients with classic Hallervorden-Spatz syndrome and one third of those with atypical disease had PANK2 mutations. Whereas almost all mutations in patients with atypical disease led to amino acid changes, those in patients with classic disease more often resulted in predicted protein truncation. Patients with atypical disease who had PANK2 mutations were more likely to have prominent speech-related and psychiatric symptoms than patients with classic disease or mutation-negative patients with atypical disease. In all patients with pantothenate kinase-associated neurodegeneration, whether classic or atypical, T2-weighted magnetic resonance imaging (MRI) of the brain showed a specific pattern of hyperintensity within the hypointense medial globus pallidus. This pattern was not seen in any patients without mutations. CONCLUSIONS: PANK2 mutations are associated with all cases of classic Hallervorden-Spatz syndrome and one third of cases of atypical disease. A specific MRI pattern distinguishes patients with PANK2 mutations. Predicted levels ofpantothenate kinase 2 protein correlate with the severity of disease.

Original languageEnglish (US)
Pages (from-to)33-40
Number of pages8
JournalNew England Journal of Medicine
Volume348
Issue number1
DOIs
StatePublished - Jan 2 2003

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Pantothenate Kinase-Associated Neurodegeneration
Mutation
Magnetic Resonance Imaging
Dystonic Disorders
Globus Pallidus
Brain
Parkinsonian Disorders

ASJC Scopus subject areas

  • Medicine(all)

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Genetic, Clinical, and Radiographic Delineation of Hallervorden-Spatz Syndrome. / Hayflick, Susan; Westaway, Shawn; Levinson, Barbara; Zhou, Bing; Johnson, Monique A.; Ching, Katherine H L; Gitschier, Jane.

In: New England Journal of Medicine, Vol. 348, No. 1, 02.01.2003, p. 33-40.

Research output: Contribution to journalArticle

Hayflick, Susan ; Westaway, Shawn ; Levinson, Barbara ; Zhou, Bing ; Johnson, Monique A. ; Ching, Katherine H L ; Gitschier, Jane. / Genetic, Clinical, and Radiographic Delineation of Hallervorden-Spatz Syndrome. In: New England Journal of Medicine. 2003 ; Vol. 348, No. 1. pp. 33-40.
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AB - BACKGROUND: Hallervorden-Spatz syndrome is an autosomal recessive disorder characterized by dystonia, parkinsonism, and iron accumulation in the brain. Many patients with this disease have mutations in the gene encoding pantothenate kinase 2 (PANK2); these patients are said to have pantothenate kinase-associated neurodegeneration. In this study, we compared the clinical and radiographic features of patients with Hallervorden-Spatz syndrome with and without mutations in PANK2. METHODS: One hundred twenty-three patients from 98 families with a diagnosis of Hallervorden-Spatz syndrome were classified on the basis of clinical assessment as having classic disease (characterized by early onset with rapid progression) or atypical disease (later onset with slow progression). Their genomic DNA was sequenced for PANK2 mutations. RESULTS: All patients with classic Hallervorden-Spatz syndrome and one third of those with atypical disease had PANK2 mutations. Whereas almost all mutations in patients with atypical disease led to amino acid changes, those in patients with classic disease more often resulted in predicted protein truncation. Patients with atypical disease who had PANK2 mutations were more likely to have prominent speech-related and psychiatric symptoms than patients with classic disease or mutation-negative patients with atypical disease. In all patients with pantothenate kinase-associated neurodegeneration, whether classic or atypical, T2-weighted magnetic resonance imaging (MRI) of the brain showed a specific pattern of hyperintensity within the hypointense medial globus pallidus. This pattern was not seen in any patients without mutations. CONCLUSIONS: PANK2 mutations are associated with all cases of classic Hallervorden-Spatz syndrome and one third of cases of atypical disease. A specific MRI pattern distinguishes patients with PANK2 mutations. Predicted levels ofpantothenate kinase 2 protein correlate with the severity of disease.

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