Search

Mutations in the GTP-cyclohydrolase I (GCH) gene have been identified as a cause of two disorders: autosomal dominant hereditary progressive dystonia/dopa-responsive dystonia (HPD/DRD) and autosomal recessive GCH-deficient hyperphenylalaninemia (HPA). Detailed clinical descriptions and genetic analysis of patients with phenotypes intermediate between HPD/DRD (mild) and GCH-deficient HPA (severe) have not been reported. We conducted genomic DNA sequencing of the GCH gene in two patients (Cases 1 and 2) manifesting generalized dystonia responsive to levodopa and severe developmental motor delay. In the pedigree of Patient 1, there were HPD/DRD patients in three generations preceding the index case. Patients 1 and 2 were compound heterozygotes with maternally and paternally transmitted mutations in the coding region of the GCH gene. In both compound heterozygotes, tetrahydrobiopterin (BH4) levels in cerebrospinal fluid were lower than those in HPD/DRD. Administration of BH4, in addition to levodopa, further improved the symptomatology of Patient 1. Our data demonstrate a new phenotype of GCH deficiency associated with compound heterozygosity for GCH gene mutations and suggest the usefulness of combined BH4 and levodopa therapy for this disorder.

Intramuscular injections of HRP were used to map the spinal cord location of motoneurons innervating wing and shoulder girdle muscles in newly hatched chicks. Motor pools are grouped in the lateral motor column in relationship to embryonic origin of the muscles: muscles derived from the ventral muscle mass are innervated by medially lying motor pools, while muscles derived from the dorsal mass are innervated by lateral pools. Motor pool position is also well correlated with nerve supply. Muscles innervated by nerves diverging from common nerve trunks are innervated by neighboring motor pools. The rostro-caudal organization of the motor pools reflects both proximo-distal and antero-posterior axes of the limb with proximal and anterior muscles innervated from rostral motor pools.