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Original Contribution |

Characterization of a Family With c9FTD/ALS Associated With the GGGGCC Repeat Expansion in C9ORF72

Rodolfo Savica, MD, MSc; Anahita Adeli, MD; Prashanthi Vemuri, PhD; David S. Knopman, MD; Mariely DeJesus-Hernandez, BS; Rosa Rademakers, PhD; Julie A. Fields, PhD; Jennifer Whitwell, PhD; Clifford R. Jack, MD; Val Lowe, MD; Ronald C. Petersen, PhD, MD; Bradley F. Boeve, MD
Arch Neurol. 2012;69(9):1164-1169. doi:10.1001/archneurol.2012.772.
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Background  The hexanucleotide repeat in the chromosome 9 open reading frame 72 (C9ORF72) gene was recently discovered as the underlying genetic cause of many families with frontotemporal dementia (FTD) and/or amyotrophic lateral sclerosis (ALS) linked to chromosome 9 (c9FTD/ALS). We report the clinical, neuropsychologic, and neuroimaging findings of a family with the C9ORF72 mutation and clinical diagnoses bridging the FTD, parkinsonism, and ALS spectrum.

Objective  To characterize the antemortem characteristics of a family with c9FTD/ALS associated with the GGGGCC repeat expansion in C9ORF72.

Design  Clinical series.

Setting  Tertiary care academic medical center.

Patients  The members of a family affected by the mutation with features of FTD and/or ALS.

Main Outcome Measures  Clinical, neuropsychologic, and neuroimaging assessments.

Results  All 3 examined subjects had the hexanucleotide expansion detected in C9ORF72. All had personality/behavioral changes early in the course of the disease. One case had levodopa-unresponsive parkinsonism, and 1 had ALS. Magnetic resonance imaging showed symmetric bilateral frontal, temporal, insular, and cingulate atrophy.

Conclusions  This report highlights the clinical and neuroimaging characteristics of a family with c9FTD/ALS. Further studies are needed to better understand the phenotypical variability and the cliniconeuroimaging-neuropathologic correlations.

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Figures

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Grahic Jump Location

Figure 1. Pedigree of the kindred with frontotemporal dementia (FTD) and/or amyotrophic lateral sclerosis (ALS) linked to chromosome 9 associated with the GGGGCC hexanucleotide repeat expansion in C9ORF72. Diamonds represent individuals; symbols, syndromes as shown in the key; and shapes with diagonal lines through them, deceased individuals. The proband is indicated by an arrow. Individuals with a confirmed hexanucleotide repeat expansion are indicated by the dots. Diamonds with 2 sets of numbers represent the age at onset (top number) and age at death (bottom number); those with only 1 number reflect living subjects. NOS indicates not otherwise specified.

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Grahic Jump Location

Figure 2. Fluorodeoxyglucose F 18 positron-emission tomographic scan of case III.3, with representative images in the axial (A) and coronal (B) planes. Note that the degree of hypometabolism is quite mild and primarily involves the frontotemporal regions, which is slightly more apparent in the left cerebral hemisphere. The parietal, occipital, and posterior cingulate cortices were normal. L indicates left; R, right.

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Grahic Jump Location

Figure 3. Atrophy patterns in individual subjects. Magnetic resonance image scans of individual subjects overlaid with regions of severe atrophy in yellow using magnetic resonance Structural Abnormality due to NeuroDegeneration maps (z score < −2.5 relative to normal subjects was used as a threshold). The brightness of the overlaid color indicates the degree of atrophy. Two sets of scans are shown for case III.3 and 3 sets for case IV.1, all showing relatively symmetric atrophy involving the frontal, insular, and temporal cortices more so than the parietal and occipital cortices. The posterior cingulate is affected more than the anterior cingulate in both cases. The posterior mesial cerebellum is also atrophic. Most findings progress as shown by the topography and brightness of the overlaid yellow across serial scans in the same individual. L indicates left; R, right.

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