Simplifying the clinical classification of polymerase gamma (POLG) disease based on age of onset; studies using a cohort of 155 cases

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http://hdl.handle.net/10138/319145

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Hikmat , O , Naess , K , Engvall , M , Klingenberg , C , Rasmussen , M , Tallaksen , C M E , Brodtkorb , E , Ostergaard , E , de Coo , I F M , Pias-Peleteiro , L , Isohanni , P , Uusimaa , J , Darin , N , Rahman , S & Bindoff , L A 2020 , ' Simplifying the clinical classification of polymerase gamma (POLG) disease based on age of onset; studies using a cohort of 155 cases ' , Journal of Inherited Metabolic Disease , vol. 43 , no. 4 , pp. 726-736 . https://doi.org/10.1002/jimd.12211

Title: Simplifying the clinical classification of polymerase gamma (POLG) disease based on age of onset; studies using a cohort of 155 cases
Author: Hikmat, Omar; Naess, Karin; Engvall, Martin; Klingenberg, Claus; Rasmussen, Magnhild; Tallaksen, Chantal M. E.; Brodtkorb, Eylert; Ostergaard, Elsebet; de Coo, I. F. M.; Pias-Peleteiro, Leticia; Isohanni, Pirjo; Uusimaa, Johanna; Darin, Niklas; Rahman, Shamima; Bindoff, Laurence A.
Contributor: University of Helsinki, HUS Children and Adolescents
Date: 2020-07
Language: eng
Number of pages: 11
Belongs to series: Journal of Inherited Metabolic Disease
ISSN: 0141-8955
URI: http://hdl.handle.net/10138/319145
Abstract: Background Variants inPOLGare one of the most common causes of inherited mitochondrial disease. Phenotypic classification of POLG disease has evolved haphazardly making it complicated and difficult to implement in everyday clinical practise. The aim of our study was to simplify the classification and facilitate better clinical recognition. Methods A multinational, retrospective study using data from 155 patients withPOLGvariants recruited from seven European countries. Results We describe the spectrum of clinical features associated withPOLGvariants in the largest known cohort of patients. While clinical features clearly form a continuum, stratifying patients simply according to age of onset-onset prior to age 12 years; onset between 12 and 40 years and onset after the age of 40 years, permitted us to identify clear phenotypic and prognostic differences. Prior to 12 years of age, liver involvement (87%), seizures (84%), and feeding difficulties (84%) were the major features. For those with onset between 12 and 40 years, ataxia (90%), peripheral neuropathy (84%), and seizures (71%) predominated, while for those with onset over 40 years, ptosis (95%), progressive external ophthalmoplegia (89%), and ataxia (58%) were the major clinical features. The earlier the onset the worse the prognosis. Patients with epilepsy and those with compound heterozygous variants carried significantly worse prognosis. Conclusion Based on our data, we propose a simplified POLG disease classification, which can be used to guide diagnostic investigations and predict disease course.
Subject: Alpers syndrome
epilepsy
mitochondrial disease
POLG
stroke-like episodes
MUTATIONS
SPECTRUM
PARKINSONISM
3112 Neurosciences
1184 Genetics, developmental biology, physiology
3121 General medicine, internal medicine and other clinical medicine
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