Brain (2002), 125, 695±721 INVITED REVIEW The genetics of primary dystonias and related disorders Andrea H. NeÂmeth The Wellcome Trust Centre for Human Genetics, Roosevelt Drive, Headington, Oxford OX3 7BN, UK E-mail:
[email protected] Summary Dystonias are a heterogeneous group of disorders which dystonia (DYT1), focal dystonias (DYT7) and mixed dys- are known to have a strong inherited basis. This review tonias (DYT6 and DYT13), dopa-responsive dystonia, details recent advances in our understanding of the gen- myoclonus dystonia, rapid-onset dystonia parkinsonism, etic basis of dystonias, including the primary dystonias, Fahr disease, Aicardi±Goutieres syndrome, Haller- the `dystonia-plus' syndromes and heredodegenerative vorden±Spatz syndrome, X-linked dystonia parkin- disorders. The review focuses particularly on clinical sonism, deafness±dystonia syndrome, mitochondrial and genetic features and molecular mechanisms. dystonias, neuroacanthocytosis and the paroxysmal dys- Conditions discussed in detail include idiopathic torsion tonias/dyskinesias. Keywords: dystonia; L-dopa; parkinsonism; myoclonus; mitochondria Abbreviations: DRD = dopa-responsive dystonia; ITD = idiopathic torsion dystonia; PDJ = juvenile onset Parkinson's disease; PKC = paroxysmal kinesigenic choreoathetosis; PNKD = paroxysmal non-kinesigenic dyskinesia; TH = tyrosine hydroxylase Introduction Dystonia is a disorder of movement caused by `involuntary, (Fahn et al., 1998). Clinically, this is useful because onset of sustained muscle contractions affecting one or more sites of dystonia in the limbs, particularly the legs, is more likely to the body, frequently causing twisting and repetitive move- be associated with spread to other body parts and has ments, or abnormal postures' (Fahn et al., 1987, 1998). The important implications for treatment, management and prog- genetic contribution to the development of dystonia has been nosis, since generalized dystonia is usually much more recognized for many years, but it is only recently that some of disabling.