NGS-Based Diagnosis of Treatable Neurogenetic Disorders in Adults: Opportunities and Challenges

Abstract

The identification of neurological disorders by next-generation sequencing (NGS)-based gene panels has helped clinicians understand the underlying physiopathology, resulting in personalized treatment for some rare diseases. While the phenotype of distinct neurogenetic disorders is generally well-known in childhood, in adulthood, the phenotype can be unspecific and make the standard diagnostic approach more complex. Here we present three unrelated adults with various neurological manifestations who were successfully diagnosed using NGS, allowing for the initiation of potentially life-changing treatments. A 63-year-old woman with progressive cognitive decline, pyramidal signs, and bilateral cataract was treated by chenodeoxycholic acid following the diagnosis of cerebrotendinous xanthomatosis due to a homozygous variant in CYP27A1. A 32-year-old man with adult-onset spastic paraplegia, in whom a variant in ABCD1 confirmed an X-linked adrenoleukodystrophy, was treated with corticoids for adrenal insufficiency. The third patient, a 28-year-old woman with early-onset developmental delay, epilepsy, and movement disorders was treated with a ketogenic diet following the identification of a variant in SLC2A1, confirming a glucose transporter type 1 deficiency syndrome. This case study illustrates the challenges in the timely diagnosis of medically actionable neurogenetic conditions, but also the considerable potential for improving patient health through modern sequencing technologies.

Keywords: X-linked adrenoleukodystrophy; cerebrotendinous xanthomatosis; glucose transporter type 1 deficiency syndrome; neurogenetic disorders; next-generation sequencing (NGS); treatable diseases.

Figure 1

Family trees and phenotypic data of the three patients: (A,B) proband 1: family pedigree (left panel) and axial views of brain MRI, FLAIR images showing non-confluent bilateral periventricular and semi-oval center white matter hyperintensities (right panel); (C,D) proband 2: family pedigree (left panel) and a picture of the mouth showing gingival hyperpigmentation (right panel); (E,F) proband 3: family pedigree (left panel) and a photograph showing cervical dystonia with right torticollis, as well as microcephaly. CTX, cerebrotendinous xanthomatosis; Glut1 DS, glucose transporter type 1 deficiency syndrome; X-ALD, X-linked adrenoleukodystrophy.