ABSTRACT
OBJECTIVE: Myoclonus is characterized by sudden, brief involuntary movements, and its presence is debilitating. We identified a family suffering from adult onset, cortical myoclonus without associated seizures. We performed clinical, electrophysiological, and genetic studies to define this phenotype. METHODS: A large, 4-generation family with a history of myoclonus underwent careful questioning, examination, and electrophysiological testing. Thirty-five family members donated blood samples for genetic analysis, which included single nucleotide polymorphism mapping, microsatellite linkage, targeted massively parallel sequencing, and Sanger sequencing. In silico and in vitro experiments were performed to investigate functional significance of the mutation. RESULTS: We identified 11 members of a Canadian Mennonite family suffering from adult onset, slowly progressive, disabling, multifocal myoclonus. Somatosensory evoked potentials indicated a cortical origin of the myoclonus. There were no associated seizures. Some severely affected individuals developed signs of progressive cerebellar ataxia of variable severity late in the course of their illness. The phenotype was inherited in an autosomal dominant fashion. We demonstrated linkage to chromosome 16q21-22.1. We then sequenced all coding sequence in the critical region, identifying only a single cosegregating, novel, nonsynonymous mutation, which resides in the gene NOL3. Furthermore, this mutation was found to alter post-translational modification of NOL3 protein in vitro. INTERPRETATION: We propose that familial cortical myoclonus is a novel movement disorder that may be caused by mutation in NOL3. Further investigation of the role of NOL3 in neuronal physiology may shed light on neuronal membrane hyperexcitability and pathophysiology of myoclonus and related disorders.
Subject(s)
Apoptosis Regulatory Proteins/genetics , Family Health , Genetic Predisposition to Disease/genetics , Muscle Proteins/genetics , Mutation/genetics , Myoclonus/genetics , Adolescent , Adult , Age of Onset , Animals , Canada , Cell Line, Transformed , Chromosome Mapping , Chromosomes, Human, Pair 16 , Electroencephalography , Female , Glutamic Acid/genetics , Humans , Male , Mice , Middle Aged , Myoclonus/diagnosis , Phenotype , Proline/genetics , TransfectionSubject(s)
Adenocarcinoma/secondary , Carcinoma, Small Cell/pathology , Lung Neoplasms/pathology , Nystagmus, Pathologic/diagnosis , Paraneoplastic Syndromes/diagnosis , Adenocarcinoma/drug therapy , Adenocarcinoma/immunology , Antigens/immunology , Antigens, Neoplasm/immunology , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Autoantibodies/blood , Carcinoma, Small Cell/immunology , Carcinoma, Small Cell/radiotherapy , ELAV Proteins/immunology , Fatal Outcome , Female , Humans , Lung Neoplasms/drug therapy , Lung Neoplasms/immunology , Lung Neoplasms/radiotherapy , Lymphatic Metastasis , Middle Aged , Nerve Tissue Proteins/immunology , Tomography, X-Ray ComputedABSTRACT
Individuals with a germ-line mutation in one of the DNA mismatch repair (MMR) genes are at significant risk for colorectal cancer and other tumors. Three families have previously been reported with individuals homozygous for mutations in the MMR gene MLH1 that are predicted to compromise MMR. These individuals develop hematological malignancies and/or neurofibromatosis type 1 at an early age. Here, in an individual, we demonstrate that a homozygous novel mutation in the MMR gene MSH2 is associated with leukemia and multiple café-au-lait spots, a feature of neurofibromatosis type 1. Because the hematological malignancies observed in the individuals homozygous for the loss of MMR are reflective of the lymphomas seen in mice lacking MMR, the mice may provide a useful model for human neoplasia.