Cases reported "friedreich ataxia"

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1/119. Hypertrophic cardiomyopathy in Friedreich's ataxia.

    The cardiac findings in two sibs with Friedreich's ataxia are described. The clinical signs were suggestive of hypertrophic obstructive cardiomyopathy. During left heart catheterization a systolic pressure gradient across the left ventricular outflow tract could be provoked by an infusion of isoprenaline. Left ventricular angiocardiograms and echocardiograms showed gross thickening of the interventricular septum. In one patient a systolic anterior movement of the anterior leaflet of the mitral valve was seen. The importance of serial echocardiographic examination for patients with Friedreich's ataxia is emphasized. ( info)

2/119. Clinical and molecular studies in five Brazilian cases of friedreich ataxia.

    friedreich ataxia (FRDA), the most common autosomal recessive ataxia, is caused in 94% of cases by homozygous expansions of an unstable GAA repeat localised in intron 1 of the X25 gene. We have investigated this mutation in five Brazilian patients: four with typical FRDA findings and one patient with atypical manifestations, who was considered to have some other form of cerebellar ataxia with retained reflexes. The GAA expansion was detected in all these patients. The confirmation of FRDA diagnosis in the atypical case may be pointing out, as in other reports, that clinical spectrum of Friedreich's ataxia is broader than previously recognised and includes cases with intact tendon reflexes. ( info)

3/119. Fatal liver failure associated with valproate therapy in a patient with Friedreich's disease: review of valproate hepatotoxicity in adults.

    PURPOSE: Valproate (VPA)-associated hepatotoxicity is usually considered a problem of young children with polytherapy, mental retardation, and underlying metabolic defects. methods: An adult patient with fatal liver failure during treatment with VPA is presented, and a review of the literature on other adult patients is given. RESULTS: A 29-year-old female patient with Friedreich's ataxia and partial seizures with acute liver failure during VPA treatment is reported. The first symptoms of liver failure (i.e., apathy during febrile upper airway infection) occurred 2 months after starting VPA therapy. VPA was discontinued 10 days later on hospital admission, when she had hepatic encephalopathy and severe bleeding diathesis. The patient died of severe liver failure and bronchopneumonia after 4 weeks of supportive treatment. CONCLUSIONS: Twenty-six adult patients (>17 years) with VPA-associated fatal hepatotoxicity have been reported in the literature. Of the 26 adult patients, three were receiving VPA monotherapy. The age ranged between 17 and 62 years. The duration of VPA treatment before the first symptom varied between 7 days and 6 years. Twelve of the 26 affected adults had no underlying disease or a clearly nonmetabolic and non-hepatic disease. Therefore VPA-associated severe side effects also must be considered in adult patients without any evidence of a metabolic defect or underlying neurologic disease. ( info)

4/119. citalopram, a selective serotonin reuptake inhibitor, improves symptoms of Friedreich's ataxia.

    Two patients (siblings) with Friedreich's ataxia showed improvement in their clinical symptoms--particularly spasticity and cardiac symptoms--after treatment with the selective serotonin reuptake inhibitor citalopram. ( info)

5/119. An unusual association of a rare variant of Friedreich's ataxia with type-I neurofibromatosis in a Nigerian Fulani family: a 5-year follow-up study.

    A very rare form of heredofamilial spinocerebellar degenerative disorder is reported in a 12-year old boy and his 39-year old Fulani mother. The two cases were compatible with the clinical picture of Harding's variant of spastic ataxia of childhood--a clinical and genetic entity distinct from the more common Friedreich's ataxia. The mode of progression of the disease and the computed tomographic (CT) and electrophysiologic findings in both patients also support the diagnosis. In addition, the mother had the typical clinical picture of type-1 neurofibromatosis combined with the rare heredofamilial ataxic syndrome. The signs of neurofibromatosis could not be detected in her child. The cases were followed up regularly for 5 years with the aim of identifying possible complications. These cases are reported because of the extreme rarity of Harding's variant of heredofamilial ataxia and the rarity of the association of this disorder with type-1 neurofibromatosis. ( info)

6/119. A nonpathogenic GAAGGA repeat in the Friedreich gene: implications for pathogenesis.

    An individual with late-onset ataxia was found to be heterozygous for an unusual (GAAGGA)65 sequence and a normal GAA repeat in the frataxin gene. No frataxin point mutation was present, excluding a form of friedreich ataxia. (GAAGGA)65 did not have the inhibitory effect on gene expression in transfected cells shown by pathogenic GAA repeats of similar length. GAA repeats, but not (GAAGGA)65, adopt a triple helical conformation in vitro. We suggest that such a triplex structure is essential for suppression of gene expression. ( info)

7/119. A case of Friedreich's ataxia confirmed by dna-analysis.

    The first case of dna-confirmed Friedreich's ataxia in bulgaria is presented. The results from the dna studies of the index patient revealed two alleles with an expansion between 500 and 1500 repeats of the GAA trinucleotide in the first intron of the X25 gene. The parents had one normal allele with 7-22 repeats and one allele with a similar expansion to that of the patient in the first intron of the X25 gene. These results confirm the homozygous mode of transmission of the abnormal alleles (with an expansion of the GAA trinucleotide in the first intron of the X25 gene) from the two normal heterozygous parents to their affected offspring. ( info)

8/119. Atypical friedreich ataxia phenotype associated with a novel missense mutation in the X25 gene.

    We describe two sisters with early onset gait ataxia, rapid disease progression, absent or very mild dysarthria and upper limb dysmetria, retained knee jerks in one, slight to moderate peripheral nerve involvement, and diabetes. Molecular analysis showed that they are compound heterozygotes for GAA expansion and a novel exon 5a missense mutation (R165P). This mutation appears to be associated with an atypical but not milder friedreich ataxia phenotype. ( info)

9/119. Very late-onset friedreich ataxia despite large GAA triplet repeat expansions.

    BACKGROUND: Most patients with friedreich ataxia (FRDA) have abnormal GAA triplet repeat expansions in both X25 genes. The size of the GAA expansion in the shorter of the 2 expanded alleles correlates significantly with parameters of clinical severity and is inversely related to the age at onset. OBJECTIVES: To describe the clinical and molecular genetic findings in a patient with very late-onset FRDA and to review the literature. PATIENT AND methods: A 58-year-old white woman with mild progressive gait disturbance of 15 years' duration whose examination revealed mild incoordination was analyzed for mutations in the X25 gene. A combination of long-range polymerase chain reaction and genomic Southern blot analyses were used to identify GAA expansions in intron 1 of the X25 gene. To uncover evidence of somatic variability in triplet repeat length, dna isolated from several tissue samples was similarly analyzed. Single-strand conformational polymorphism analysis was used to screen for mutations spanning the entire coding sequence of frataxin and all intron-exon junctions of the X25 gene. RESULTS: dna isolated from blood leukocytes revealed GAA triplet repeat expansions in both X25 genes, which were estimated to contain 835 and 1200 repeats. Similar expansions were detected in dna isolated from lymphoblasts, fibroblasts, buccal cells, and sural nerve, with estimated mean ( /- SD) lengths of the shorter and longer expansions being 854 ( /-69) and 1283 ( /-72) triplets, respectively. A review of reported cases of late-onset friedreich ataxia (25-39 years) and very late-onset friedreich ataxia (> or =40 years) demonstrated that this is the first instance of a patient presenting with very late-onset FRDA despite carrying more than 800 GAA repeats in both expanded X25 alleles. CONCLUSIONS: This unique case of very late-onset FRDA highlights a limitation in our ability to accurately predict the phenotype in FRDA based solely on the size of the GAA expansion. Other genetic or environmental factors may significantly modify disease severity in FRDA. ( info)

10/119. The correlation of clinical phenotype in friedreich ataxia with the site of point mutations in the FRDA gene.

    Most cases of friedreich ataxia (FRDA) are due to expansions of a GAA trinucleotide repeat sequence in the FRDA gene coding for frataxin, a protein of poorly understood function which may regulate mitochondrial iron transport. However, between 1% and 5% of mutations are single base changes in the sequence of the FRDA gene, causing missense, nonsense, or splicing mutations. We describe three new mutations, IVS4nt2 (T to G), R165C, and L182F, which occur in patients in association with GAA expansions. These cases, and a further five reported cases of point mutations causing FRDA, demonstrate that splicing, nonsense, or initiation codon mutations (which cause a complete absence of functional frataxin) are associated with a severe phenotype. Missense mutations, even in highly evolutionally conserved amino acids, may cause a mild or severe phenotype. ( info)
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