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ObjectiveOur study investigated the presence of regional differences in hexanucleotide repeat number in postmortem brain tissues of 2 patients with X-linked dystonia-parkinsonism (XDP), a combined dystonia-parkinsonism syndrome modified by a (CCCTCT)n repeat within the causal SINE-VNTR-Alu retrotransposon insertion in the TAF1 gene.MethodsGenomic DNA was extracted from blood and postmortem brain samples, including the basal ganglia and cortex from both patients and from the cerebellum, midbrain, and pituitary gland from 1 patient. Repeat sizing was performed using fragment analysis, small-pool PCR-based Southern blotting, and Oxford nanopore sequencing.ResultsThe basal ganglia (p < 0.001) and cerebellum (p < 0.001) showed higher median repeat numbers and higher degrees of repeat instability compared with blood.ConclusionsSomatic repeat instability may predominate in brain regions selectively affected in XDP, thereby hinting at its potential role in disease manifestation and modification.

We thank Dr. Oliveira for the thoughtful commentary on our Clinical/Scientific Note.1 Dr. Oliveira raises the issue of the differential diagnosis of F68.1 (factitious disorder, Munchausen syndrome) vs Z76.5 (feigning illness with obvious motivation). Such a differentiation would indeed be relevant for further patient management.