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Large-scale calcium channel gene rearrangements in Episodic Ataxia and Hemiplegic Migraine: Implications for diagnostic testing
  1. R W Labrum (robyn.labrum{at}
  1. Institute of Neurology, United Kingdom
    1. S Rajakulendran (s.rajakulendran{at}
    1. Institute of Neurology, United Kingdom
      1. T D Graves (t.graves{at}
      1. Institute of Neurology, United Kingdom
        1. L H Eunson (louiseandianbeard{at}
        1. University of Essex, United Kingdom
          1. R Bevan (rosanna.bevan{at}
          1. Institute of Neurology, United Kingdom
            1. M G Sweeney (mary.sweeney{at}
            1. University College Hospitals, United Kingdom
              1. S R Hammans (simon.hammans{at}
              1. Wessex Neurological Centre, Southampton General Hospital, United Kingdom
                1. N Tubridy (n.tubridy{at}
                1. St. Vincent's University Hospital, United Kingdom
                  1. T Britton (thomas.britton{at}
                  1. Kings College Hospital, United Kingdom
                    1. L J Carr (carrl{at}
                    1. Great Ormond Street Hospital, United Kingdom
                      1. J R Ostergaard (johnoest{at}
                      1. University Hospital Aarhus, Denmark
                        1. C R Kennedy (crk1{at}
                        1. University of Southampton, United Kingdom
                          1. A Al-Memar (ali{at}
                          1. St. Georges Hospital, United Kingdom
                            1. D M Kullmann (d.kullmann{at}
                            1. Institute of Neurology, United Kingdom
                              1. S Schorge
                              1. Institute of Neurology, United Kingdom
                                1. K Temple (i.k.temple{at}
                                1. Academic Unit of Genetic Medicine, Princess Anne Hospital, Southampton, United Kingdom
                                  1. M B Davis (mary.davis{at}
                                  1. University College Hospitals, United Kingdom
                                    1. M G Hanna (mhanna{at}
                                    1. Institute of Neurology, United Kingdom


                                      Background: Episodic ataxia type 2 (EA2) and familial hemiplegic migraine type 1 (FHM1) are autosomal dominant disorders characterized by paroxysmal ataxia and migraine respectively. Point mutations in CACNA1A, which encodes the neuronal P/Q-type calcium channel, have been detected in many cases of EA2 and FHM1. The genetic basis of typical cases without CACNA1A point mutations is not fully known. Standard DNA sequencing methods may miss large scale genetic rearrangements such as deletions and duplications. We investigated whether large-scale genetic rearrangements in CACNA1A can cause EA2 and FHM1.

                                      Methods: We used multiplex ligation-dependent probe amplification (MLPA) to screen for intragenic CACNA1A rearrangements.

                                      Results: We identified five previously unreported large scale deletions in CACNA1A in seven families with episodic ataxia and in one case with hemiplegic migraine. One of the deletions (exon 6 of CACNA1A) segregated with episodic ataxia in a four-generation family with eight affected individuals previously mapped to 19p13. In addition, we identified the first pathogenic duplication in CACNA1A in an index case with isolated episodic diplopia without ataxia and in a first degree relative with episodic ataxia.

                                      Conclusions: Large-scale deletions and duplications can cause CACNA1A associated channelopathies. Direct DNA sequencing alone is not sufficient as a diagnostic screening test.

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