Adult-onset leukodystrophies from respiratory chain disorders: do they exist?

TitleAdult-onset leukodystrophies from respiratory chain disorders: do they exist?
Publication TypeJournal Article
Year of Publication2013
AuthorsSalsano, E, Farina, L, Lamperti, C, Piscosquito, G, Salerno, F, Morandi, L, Carrara, F, Lamantea, E, Zeviani, M, Uziel, G, Savoiardo, M, Pareyson, D
JournalJ Neurol
Volume260
Issue6
Pagination1617-23
Date Published2013 Jun
ISSN1432-1459
KeywordsAdult, Age of Onset, Brain, Diagnosis, Differential, Female, Humans, Leukodystrophy, Metachromatic, Magnetic Resonance Imaging, Mitochondrial Diseases
Abstract

Respiratory chain disorders (RCDs) have been included in the differential diagnosis of adult-onset leukodystrophies. Here, we first report a 32-year-old female with an atypical, adult-onset, non-syndromic RCD due to a mitochondrial DNA deletion and manifesting as complicated ataxia. A 'leukodystrophic' pattern was found on brain MRI, but it was neither isolated nor predominant because of the presence of overt basal ganglia and infratentorial lesions, which led us to the proper diagnosis. Subsequently, we evaluated our series of patients with RCDs in order to verify whether a 'leukodystrophic' pattern with little or no involvement of deep grey structures and brainstem may be found in adult-onset RCDs, as reported in children. Among 52 patients with adult-onset RCDs, no case with a 'leukodystrophic' pattern was found, apart from three cases with a classical phenotype of mitochondrial neurogastrointestinal encephalopathy. In addition, no case of RCDs was found among six cases of adult-onset leukodystrophy of unknown origin and at least one feature suggestive of mitochondrial disease. The review of the literature was in agreement with these findings. Thus, we provide evidence that, unlike in children, RCDs should not be included in the differential diagnosis of adult-onset leukodystrophies, except when there are additional MRI findings or clinical features which unequivocally point towards a mitochondrial disorder.

DOI10.1007/s00415-013-6844-z
Alternate JournalJ. Neurol.
Citation Key10.1007/s00415-013-6844-z
PubMed ID23358625
Grant ListMC_UP_1002/1 / / Medical Research Council / United Kingdom