The fragile X tremor ataxia syndrome in the differential diagnosis of multiple system atrophy

Data from the EMSA Study Group

C. Kamm, D. G. Healy, N. P. Quinn, U. Wüllner, J. C. Moller, L. Schols, F. Geser, K. Burk, A. D. Børglum, M. T. Pellecchia, E. Tolosa, F. Del Sorbo, C. Nilsson, O. Bandmann, M. Sharma, P. Mayer, M. Gasteiger, A. Haworth, T. Ozawa, A. J. Lees & 8 others J. Short, P. Giunti, E. Holinski-Feder, T. Illig, H. E. Wichmann, G. K. Wenning, N. W. Wood, T. Gasser

Research output: Contribution to journalArticle

69 Citations (Scopus)

Abstract

The recent identification of fragile X-associated tremor ataxia syndrome (FXTAS) associated with premutations in the FMRI gene and the possibility of clinical overlap with multiple system atrophy (MSA) has raised important questions, such as whether genetic testing for FXTAS should be performed routinely in MSA and whether positive cases might affect the specificity of current MSA diagnostic criteria. We genotyped 507 patients with clinically diagnosed or pathologically proven MSA for FMRI repeat length. Among the 426 clinically diagnosed cases, we identified four patients carrying FMRI premutations (0.94%). Within the subgroup of patients with probable MSA-C, three of 76 patients (3.95%) carried premutations. We identified no premutation carriers among 81 patients with pathologically proven MSA and only one carrier among 622 controls (0.16%). Our results suggest that, with proper application of current diagnostic criteria, FXTAS is very unlikely to be confused with MSA. However, slowly progressive disease or predominant tremor are useful red flags and should prompt the consideration of FXTAS. On the basis of our data, the EMSA Study Group does not recommend routine FMRI genotyping in typical MSA patients.

Original languageEnglish
Pages (from-to)1855-1860
Number of pages6
JournalBrain
Volume128
Issue number8
DOIs
Publication statusPublished - Aug 2005

Fingerprint

Multiple System Atrophy
Differential Diagnosis
Fragile X Tremor Ataxia Syndrome
Genetic Testing
Tremor

Keywords

  • FMRI
  • Fragile X
  • FXTAS
  • Multiple system atrophy
  • Premutation

ASJC Scopus subject areas

  • Neuroscience(all)

Cite this

Kamm, C., Healy, D. G., Quinn, N. P., Wüllner, U., Moller, J. C., Schols, L., ... Gasser, T. (2005). The fragile X tremor ataxia syndrome in the differential diagnosis of multiple system atrophy: Data from the EMSA Study Group. Brain, 128(8), 1855-1860. https://doi.org/10.1093/brain/awh535

The fragile X tremor ataxia syndrome in the differential diagnosis of multiple system atrophy : Data from the EMSA Study Group. / Kamm, C.; Healy, D. G.; Quinn, N. P.; Wüllner, U.; Moller, J. C.; Schols, L.; Geser, F.; Burk, K.; Børglum, A. D.; Pellecchia, M. T.; Tolosa, E.; Del Sorbo, F.; Nilsson, C.; Bandmann, O.; Sharma, M.; Mayer, P.; Gasteiger, M.; Haworth, A.; Ozawa, T.; Lees, A. J.; Short, J.; Giunti, P.; Holinski-Feder, E.; Illig, T.; Wichmann, H. E.; Wenning, G. K.; Wood, N. W.; Gasser, T.

In: Brain, Vol. 128, No. 8, 08.2005, p. 1855-1860.

Research output: Contribution to journalArticle

Kamm, C, Healy, DG, Quinn, NP, Wüllner, U, Moller, JC, Schols, L, Geser, F, Burk, K, Børglum, AD, Pellecchia, MT, Tolosa, E, Del Sorbo, F, Nilsson, C, Bandmann, O, Sharma, M, Mayer, P, Gasteiger, M, Haworth, A, Ozawa, T, Lees, AJ, Short, J, Giunti, P, Holinski-Feder, E, Illig, T, Wichmann, HE, Wenning, GK, Wood, NW & Gasser, T 2005, 'The fragile X tremor ataxia syndrome in the differential diagnosis of multiple system atrophy: Data from the EMSA Study Group', Brain, vol. 128, no. 8, pp. 1855-1860. https://doi.org/10.1093/brain/awh535
Kamm, C. ; Healy, D. G. ; Quinn, N. P. ; Wüllner, U. ; Moller, J. C. ; Schols, L. ; Geser, F. ; Burk, K. ; Børglum, A. D. ; Pellecchia, M. T. ; Tolosa, E. ; Del Sorbo, F. ; Nilsson, C. ; Bandmann, O. ; Sharma, M. ; Mayer, P. ; Gasteiger, M. ; Haworth, A. ; Ozawa, T. ; Lees, A. J. ; Short, J. ; Giunti, P. ; Holinski-Feder, E. ; Illig, T. ; Wichmann, H. E. ; Wenning, G. K. ; Wood, N. W. ; Gasser, T. / The fragile X tremor ataxia syndrome in the differential diagnosis of multiple system atrophy : Data from the EMSA Study Group. In: Brain. 2005 ; Vol. 128, No. 8. pp. 1855-1860.
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AU - Schols, L.

AU - Geser, F.

AU - Burk, K.

AU - Børglum, A. D.

AU - Pellecchia, M. T.

AU - Tolosa, E.

AU - Del Sorbo, F.

AU - Nilsson, C.

AU - Bandmann, O.

AU - Sharma, M.

AU - Mayer, P.

AU - Gasteiger, M.

AU - Haworth, A.

AU - Ozawa, T.

AU - Lees, A. J.

AU - Short, J.

AU - Giunti, P.

AU - Holinski-Feder, E.

AU - Illig, T.

AU - Wichmann, H. E.

AU - Wenning, G. K.

AU - Wood, N. W.

AU - Gasser, T.

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N2 - The recent identification of fragile X-associated tremor ataxia syndrome (FXTAS) associated with premutations in the FMRI gene and the possibility of clinical overlap with multiple system atrophy (MSA) has raised important questions, such as whether genetic testing for FXTAS should be performed routinely in MSA and whether positive cases might affect the specificity of current MSA diagnostic criteria. We genotyped 507 patients with clinically diagnosed or pathologically proven MSA for FMRI repeat length. Among the 426 clinically diagnosed cases, we identified four patients carrying FMRI premutations (0.94%). Within the subgroup of patients with probable MSA-C, three of 76 patients (3.95%) carried premutations. We identified no premutation carriers among 81 patients with pathologically proven MSA and only one carrier among 622 controls (0.16%). Our results suggest that, with proper application of current diagnostic criteria, FXTAS is very unlikely to be confused with MSA. However, slowly progressive disease or predominant tremor are useful red flags and should prompt the consideration of FXTAS. On the basis of our data, the EMSA Study Group does not recommend routine FMRI genotyping in typical MSA patients.

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