Introduction
Synaptic physiology
Synaptic pathology
Postsynaptic dysfunction in brain diseases
Key features of the dopaminergic postsynaptic medium spiny neuron
Dopaminergic signaling in striatal medium spiny neurons
cAMP signaling pathway in striatal medium spiny neurons
Dysfunction of medium spiny neurons in movement disorders
Gene | Protein | Postulated effect of mutation on protein function | Inheritance | Typical age of onset | Typical clinical features | Distinguishing clinical features | Drugs reported to have some efficacy |
---|---|---|---|---|---|---|---|
ADCY5
| Adenylate cyclase 5 | Gain of function | AD (familial, de novo, and somatic mosaicism) | Infancy to childhood | Generalized chorea, perioral dyskinesia, dystonia and myoclonus, lower limb spasticity, static or mildly progressive | Fluctuation in severity and frequency of MD, sleep-related episodes of hyperkinesia | Clonazepam, clobazam, acetazolamide, DBS |
PDE10A
| Phosphodiesterase 10A | Loss of function | AD (de novo) AR (biallelic, inheriting one disease allele from each parent) | Infancy to childhood | Generalized chorea, orolingual dyskinesia, static or mildly progressive | Abnormal MRI in heterozygous patients with bilateral T2-hyperintense striatal lesions | na |
GNAO1
| Gαo subunit of GPCR | Loss of function (EE phenotype) Gain of function (MD phenotype) | AD (de novo, somatic, and gonadal somaticism) | Infancy to childhood | Spectrum includes EE phenotype: neonatal-/infantile-onset seizures, infantile spasms, dyskinesia MD phenotype: Generalized chorea, facial and orolingual dyskinesia, dystonia, progressive | Severe exacerbations of chorea/ballism with autonomic dysfunction, complex motor stereotypies | Tetrabenazine and neuroleptics, topiramate, DBS especially for hyperkinetic exacerbations |
GNAL1
| Gαolf subunit of GPCR | Loss of function | AD (familial, de novo) AR | Infancy (AR) Adulthood (AD) | Generalized chorea, hypertonia Progressive dystonia | na | na |
GPR88
| G-protein coupled receptor 88 | Loss of function | AR | Childhood | Generalized chorea | na | na |