Parkin Mutations and Early-Onset Parkinsonism in a Taiwanese Cohort

Background: Loss of function of the parkin gene (PRKN) is the predominant genetic cause of juvenile and earlyonset parkinsonism in Japan, Europe, and the United States. Objectives: To evaluate the frequency of PRKN mutations in Taiwanese (ethnic Chinese) patients with earlyonset parkinsonism and to explore genotypephenotype correlations. Design: Clinical assessment included medical, neurologic, and psychiatric evaluation. GenomicDNAsequencing and quantitative polymerase chain reaction were performed to identify PRKN mutations. Gene expression was examined in patient lymphoblastoid cell lines, in which PRKN mutations were identified. Patients: Forty-one Taiwanese patients with earlyonset parkinsonism (aged Results: Four of 41 probands had PRKN mutations. One proband had compound heterozygous mutations, with a PRKN exon 2 deletion and an exon 7 G284R substitution. The phenotype resembled typical Parkinson disease. Three patients were mutation carriers. One proband had PRKN exon 2 and exon 3 deletions in the same allele. However, this patient ’s phenotype was that of classic “parkin-proven” autosomal recessive juvenile parkinsonism, characterized by symmetrical foot dystonia at onset , gait disturbance, diurnal change, and very slow progression. The 2 remaining carriers had novel heterozygous exon 11 R396G substitutions. Patients with PRKN mutations were younger at onset than those without mutations ,and they required a lower dose of levodopa despite longer disease duration. Conclusions: Mutations in PRKN are a rare cause of earlyonset parkinsonism in Taiwanese individuals. The overall mutation frequency, adjusted for age at onset, was comparable with that reported for white cohorts; however, the point mutations identified seem to be population specific.