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      Cortical myoclonus and epilepsy in a family with a new SLC20A2 mutation

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          Abstract

          Idiopathic basal ganglia calcification (IBGC) or primary familial brain calcification is a rare genetic condition characterized by an autosomal dominant inheritance pattern and the presence of bilateral calcifications in the basal ganglia, thalami, cerebellum and cerebral subcortical white matter. The syndrome is genetically and phenotypically heterogeneous. Causal mutations have been identified in four genes: SLC20A2, PDGFRB, PDGFB and XPR1. A variety of progressive neurological and psychiatric symptoms have been described, including cognitive impairment, movement disorders, bipolar disorder, chronic headaches and migraine, and epilepsy. Here we describe a family with a novel SLC20A2 mutation mainly presenting with neurological symptoms including cortical myoclonus and epilepsy. While epilepsy, although rare, has been reported in patients with IBGC associated with SLC20A2 mutations, cortical myoclonus seems to be a new manifestation.

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          Most cited references28

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          Expansions of intronic TTTCA and TTTTA repeats in benign adult familial myoclonic epilepsy

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            Mutations in XPR1 cause primary familial brain calcification associated with altered phosphate export

            Primary familial brain calcification (PFBC) is a neurological disease characterized by calcium phosphate deposits in the basal ganglia and other brain regions, thus far associated with SLC20A2, PDGFB, or PDGFRB mutations. We identified in multiple PFBC families mutations in XPR1, a gene encoding a retroviral receptor with phosphate export function. These mutations alter phosphate export, providing a direct evidence of an impact of XPR1 and phosphate homeostasis in PFBC.
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              Unstable TTTTA/TTTCA expansions in MARCH6 are associated with Familial Adult Myoclonic Epilepsy type 3

              Familial Adult Myoclonic Epilepsy (FAME) is a genetically heterogeneous disorder characterized by cortical tremor and seizures. Intronic TTTTA/TTTCA repeat expansions in SAMD12 (FAME1) are the main cause of FAME in Asia. Using genome sequencing and repeat-primed PCR, we identify another site of this repeat expansion, in MARCH6 (FAME3) in four European families. Analysis of single DNA molecules with nanopore sequencing and molecular combing show that expansions range from 3.3 to 14 kb on average. However, we observe considerable variability in expansion length and structure, supporting the existence of multiple expansion configurations in blood cells and fibroblasts of the same individual. Moreover, the largest expansions are associated with micro-rearrangements occurring near the expansion in 20% of cells. This study provides further evidence that FAME is caused by intronic TTTTA/TTTCA expansions in distinct genes and reveals that expansions exhibit an unexpectedly high somatic instability that can ultimately result in genomic rearrangements.
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                Author and article information

                Contributors
                s.sisodiya@ucl.ac.uk
                Journal
                J Neurol
                J. Neurol
                Journal of Neurology
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                0340-5354
                1432-1459
                9 April 2020
                9 April 2020
                2020
                : 267
                : 8
                : 2221-2227
                Affiliations
                [1 ]GRID grid.4691.a, ISNI 0000 0001 0790 385X, Epilepsy Centre, Department of Neuroscience, Reproductive and Odontostomatological Sciences, , Federico II University, ; Naples, Italy
                [2 ]GRID grid.83440.3b, ISNI 0000000121901201, Department of Clinical and Experimental Epilepsy, , UCL Queen Square Institute of Neurology, ; Queen Square, London, WC1N 3BG UK
                [3 ]The Chalfont Centre for Epilepsy, Chalfont-St-Peter, Bucks, UK
                [4 ]GRID grid.270474.2, ISNI 0000 0000 8610 0379, East Kent Hospitals University Foundation Trust, ; Ethelbert Road, Canterbury, Kent UK
                [5 ]GRID grid.83440.3b, ISNI 0000000121901201, Department of Clinical Neurophysiology, , UCL Queen Square Institute of Neurology, ; London, UK
                Article
                9821
                10.1007/s00415-020-09821-4
                7359151
                32274582
                5300b482-726b-4034-8b60-752b29cd4e6d
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 6 January 2020
                : 31 March 2020
                : 2 April 2020
                Funding
                Funded by: muir maxwell trust
                Funded by: Department of Health’s NIHR Biomedical Research Centres
                Funded by: Epilepsy Society
                Categories
                Original Communication
                Custom metadata
                © Springer-Verlag GmbH Germany, part of Springer Nature 2020

                Neurology
                slc20a2,brain calcifications,epilepsy,cortical myoclonus,exome sequencing
                Neurology
                slc20a2, brain calcifications, epilepsy, cortical myoclonus, exome sequencing

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