Brain, Vol. 118, No. 5, 1095-1103, 1995
© 1995 Guarantors of Brain
research-article |
Familial progressive supranuclear palsy
Description of a pedigree and review of the literature
1Departamento de Neurología, Universidad Autónoma de Madrid Spain 2Banco de Tejidos para Investigaciones Neurológicas, Universidad Autónoma de Madrid Spain 3Patología, Fundación Jiménez Díaz, Facultad de Medicina, Universidad Autónoma de Madrid Spain 4Parkinson's Disease Society Brain Tissue Bank of the UK and Department of Neuropathology, Institute of Neurology, National Hospital for Neurology and Neurosurgery London, UK 5Department of Clinical Neurology, National Hospital for Neurology and Neurosurgery London, UK
Correspondence to:
Justo García de Yébenes, Servicio de Neurología, Fundación Jiménez Díaz, Avda de Reyes Católicos 2, Madrid 28040, Spain
We describe a family with autosomal dominant progressive supranuclear palsy (PSP) involving five generations which was confirmed in one patient. The proband presented with progressive slowness at age 53 years, followed by ocular palsy, loss of balance, axial dystonia, dysphagia and dysarthria, and died at age 59 years. Neuropathological examination revealed moderate numbers of neurofibrillary tangles without prominent senile plaques in the cortex, and neuronal loss, gliosis and moderate to severe accumulation of tangles in the basal ganglia and brainstem. Other affected relatives, including the proband's sister, father, paternal uncle, and other members of earlier generations presented with non-characteristic akinetic syndromes, which progressed towards more typical PSP only after several years of disease. A review of the literature revealed six other families with neurodegenerative disorders associated with pathological findings compatible with PSP in at least one member. The clinical symptoms varied greatly between individuals in these families. The pattern of inheritance seems compatible with autosomal dominant transmission, although other patterns of transmission could not be excluded. We conclude that there is an autosomal dominant form of PSP and that the number of hereditary cases may be greater than previously thought. The rarity of familial cases of PSP could be attributed to diagnostic problems, including lack of recognition of atypical cases and death of the gene carriers before the age of appearance of the clinical symptoms. Large families with hereditary PSP could provide an adequate point of departure for investigation of the gene defect responsible for this disease.
progressive supranuclear palsy; Steele-Richardson-Olszewski syndrome; hereditary autosomal dominant neurological disorders
Received April 26, 1995. Revised June 5, 1995. Accepted June 9, 1995.
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