Journal of Neurology

, Volume 256, Issue 10, pp 1696–1704 | Cite as

Brain anomalies in maternally inherited diabetes and deafness syndrome

  • I. Fromont
  • F. Nicoli
  • R. Valéro
  • O. Felician
  • B. Lebail
  • Y. Lefur
  • J. Mancini
  • V. Paquis-Flucklinger
  • P. J. Cozzone
  • Bernard Vialettes
Original Communication

Abstract

Maternally inherited diabetes and deafness (MIDD) and myoencephalopathy, lactic acidosis, stroke-like episodes (MELAS) syndromes are characterized by the same A3243G mutation of mitochondrial DNA (mtDNA). Should there be a link between these two clinical entities, one could expect to observe minor signs of MELAS in MIDD patients. To examine this issue, extensive evaluations of brain function and imaging in patients with mitochondrial diabetes and in age-matched type 1 diabetic patients were conducted and compared. MIDD patients (nine A3243G, two T14709G) and nine age-matched type 1 diabetic patients (T1D) were submitted for evaluation of cognitive functions, brain magnetic resonance (MR) imaging, and 1H-MR spectroscopy. Three MIDD patients exhibited cerebellar ataxia. The MIDD group exhibited poorer performances in sustained attention, verbal memory working, and abstract reasoning procedures, in comparison with the T1D group. MR imaging showed cerebellar atrophy in seven out of ten MIDD patients (versus 3 mild/8 in T1D controls) and basal ganglia calcifications in one MIDD patient. No evidence of (sub)acute stroke was detected. White-matter anomalies were observed in both groups (50%). 1H-MR spectroscopy revealed a significant decrease of N-acetyl aspartate only in vermis in the MIDD group, suggesting functional defect and/or neuronal loss. Lactate was detected in cerebrospinal fluid (CSF) in two MIDD and one T1D patient. Typical manifestations of MELAS are rare in MIDD syndrome, suggesting two different clinical entities. However, cerebellum involvement as assessed by imaging and 1H-MR spectroscopy is shared by both phenotypes.

Keywords

Mitochondrial diabetes MIDD MELAS Brain dysfunction Cerebellar atrophy 1H-MR spectroscopy 

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Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • I. Fromont
    • 1
  • F. Nicoli
    • 2
    • 3
  • R. Valéro
    • 1
  • O. Felician
    • 4
  • B. Lebail
    • 4
  • Y. Lefur
    • 2
  • J. Mancini
    • 5
  • V. Paquis-Flucklinger
    • 6
  • P. J. Cozzone
    • 2
  • Bernard Vialettes
    • 1
    • 7
  1. 1.Départment d’Endocrinologie-Nutrition, Hôpital La TimoneUniversité de la MéditerranéeMarseilleFrance
  2. 2.Faculté de Médecine la Timone, Unité Mixte de Recherche (UMR), Centre de Résonance Magnétique Biologique et MédicaleUniversité de la Méditerranée, CNRS 6612MarseilleFrance
  3. 3.Unité Neurovasculaire, Hôpital La TimoneUniversité de la MéditerranéeMarseilleFrance
  4. 4.Départment de Neurologie et Neuropsychologie, Hôpital La TimoneUniversité de la Méditerranée, UMRS 751MarseilleFrance
  5. 5.Départment d’Information médicale et santé publique, Hôpital La TimoneUniversité de la MéditerranéeMarseilleFrance
  6. 6.Department of Medical Genetics, Hôpital L’Archet 2Université de NiceNiceFrance
  7. 7.Service de NutritionCHU TimoneMarseilleFrance

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