Expanding the DARS phenotype: Late-adult onset myelopathy and leukoencephalopathy

Tan, Ai Huey and Ng, Adeline Su Lyn and Mohd Ramli, Norlisah and Lim, Weng Khong and Cheah, Peng Loon and Teo, Jing Xian and Kuan, Jyn Ling and Tan, Yi Jayne and Lim, Jia Lun and Chew, Elaine Guo Yan and Foo, Jia Nee and Goh, Khean Jin and Tan, Eng-King and Lim, Shen-Yang (2023) Expanding the DARS phenotype: Late-adult onset myelopathy and leukoencephalopathy. Neurology Asia, 28 (1). 185+. ISSN 1823-6138, DOI https://doi.org/10.54029/2023vkd.

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Abstract

A significant proportion of adult-onset neurological disorders remain diagnostic odysseys despite extensive evaluation. Hypomyelination with Brainstem and Spinal Cord Involvement and Leg Spasticity (HBSL) is an autosomal recessive disorder caused by mutations in the cytoplasmic aspartyl-tRNA synthetase (DARS) gene involved in mRNA translation. Clinical features of patients with DARS mutations include developmental delay, leg spasticity, cerebellar dysfunction, cognitive impairment and epilepsy. Most reported cases have been infantile-onset with severe neurological disability and neuroimaging abnormalities. To our knowledge, late-or adult-onset cases have never been reported in the literature. Here, we report for the first time, with video documentation and six-year clinical follow-up, an ethnic Malay patient with onset of spasticity and ataxia in late-adulthood, carrying a pathogenic DARS mutation discovered via whole-genome sequencing. His clinical and radiological findings were consistent with HBSL, but this diagnosis was not considered as, up until now, HBSL has only been reported with childhood/adolescent-onset. This case highlights that HBSL/DARS mutations should now be considered in the differential diagnosis of adult-onset spastic paraplegia and/or leukoencephalopathy.

Item Type: Article
Funders: UNSPECIFIED
Uncontrolled Keywords: HBSL; DARS; Spastic paraplegia; Leukoencephalopathy; Ataxia
Subjects: R Medicine
R Medicine > R Medicine (General) > Medical technology
R Medicine > RC Internal medicine
Depositing User: Ms Zaharah Ramly
Date Deposited: 25 Oct 2024 03:54
Last Modified: 25 Oct 2024 03:54
URI: http://eprints.um.edu.my/id/eprint/38500

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