Recessively inherited parkinsonism: Effect of ATP13A2 mutations on the clinical and neuroimaging phenotype

Norbert Brüggemann, Johann Hagenah, Kathrin Reetz, Alexander Schmidt, Meike Kasten, Inga Buchmann, Susanne Eckerle, Manfred Bähre, Alexander Münchau, Ana Djarmati, Joyce Van Der Vegt, Hartwig Siebner, Ferdinand Binkofski, Alfredo Ramirez, Maria I. Behrens, Christine Klein*

*Corresponding author for this work
48 Citations (Scopus)


Objective: To determine clinical features and to identify changes in brain structure and function in compound heterozygous and heterozygous ATP13A2 mutation carriers. Design: Prospective multimodal clinical and neuroimaging study. Setting: University of Lübeck, Lübeck, Germany. Participants: Eight family members of a large Chilean pedigree with Kufor-Rakeb syndrome (KRS). Interventions: Clinical characterization, dopamine transporter (DAT) imaging, voxel-based morphometry (VBM), and transcranial sonography (TCS). Main Outcome Measures: Frequency of parkinsonian signs, brain structure, and functional alterations. Results: The only available patient with compound heterozygous KRS showed a markedly reduced striatal DAT density bilaterally. Magnetic resonance imaging revealed severe global brain atrophy as well as iron deposition in the basal ganglia. The heterozygous mother had definite parkinsonism with reduced DAT density in both putamina. While all asymptomatic heterozygous siblings displayed subtle extrapyramidal signs, DAT imaging revealed striatal tracer uptake within physiological levels. Voxel-based morphometry revealed an increase in gray matter volume in the right putamen and a decrease in the cerebellum of the heterozygous carriers. In all mutation carriers, the substantia nigra had a normal appearance on TCS. Conclusions: Single ATP13A2 heterozygous mutations may be associated with clinical signs of parkinsonism and contribute to structural and functional brain changes. Lack of hyperechogenicity in the substantia nigra may be a distinctive feature of this form of genetic parkinsonism. This, along with the finding of iron in the basal ganglia in our patient with KRS, implies a different underlying pathophysiology compared with other monogenic forms of parkinsonism and idiopathic PD and may place KRS among the syndromes of neurodegeneration with brain iron accumulation (NBIA).

Original languageEnglish
JournalArchives of Neurology
Issue number11
Pages (from-to)1357-1363
Number of pages7
Publication statusPublished - 01.11.2010


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