660 | Brain 2010: 133; 655–670 W. G. Leen et al.Missense/nonsensep.Pro485Leu**(Slaughter et al., 2009)p.Lys456Xp.Tyr449Xp.Ala405Asp*p.Gln397Xp.Gly382Asp*p.Arg333Gln*p.Arg333Trp (4)(Takahashi et al., 2008)p.Arg330X (4)*** (Ito et al., 2008)p.Glu329Gln*p.Asn317Thr (Suls et al., 2008)p.Gly314Ser(6) (Weber et al., 2008)p.Thr310Ilep.Val303Leu*p.Thr295Met (3)***p.Gln283X (Zorzi et al., 2008)p.Gln282X*p.Ala275Thr (4) (Weber et al., 2008)p.Lys256Valp.Glu243X*p.Arg223Trp*p.Arg218Hisp.Arg212His (2)**(Roulet-Perez et al., 2008)p.Arg212Cys*p.Gln161X*p.Ala155Val (2)*p.Arg153Leu (2)p.Arg153Cysp.Arg153His*p.Glu146Lysp.Val140Met (Suls et al., 2008)p.Cys133Xp.Gly130Ser (2)***p.Arg126Cys (7)***(Zorzi et al., 2008)p.Arg126His (4)p.Arg126Leup.Met96Val*p.Ser95Ile (22) (Suls et al., 2008)p.Arg93Trp(2)***(Joshi et al., 2008)p.Gly91Asp (3)p.Gly75Trpp.Ser66Phep.Glu54X*(Klepper et al., 2007)p.Trp48X (Zorzi et al., 2008)p.Glu42X*p.Asn34Ilep.Asn34Ser(2)p.Asn34Tyr*p.Tyr28Xp.M1Ile*p.M1Val*Amino-acid4934274263593583253242892882271731729291393861098610751074973972228 680547326795175162761151147 191Nucleotide1279127886418863275Deletions, insertions, frame shift, splice sitec.1383_1384ATCGc.1377dup (Bertsche et al., 2009)c.1348_1361dupTTCAAAGTTCCTGc.1346_1359del*c.1279-1G>C** (Ticus et al., 2008)c.1216_1220delGTTGCc.1198delCc.1185delCc.1100dup**c.980_981delTGc.972+981G>Tc.966_971delinsT*c.970delc.907delc.864-1G>C*c.855_856ins12c.843_854del (4) (Weber et al., 2008)c.798_799insC*c.790del; 792C>Tc.790delc.790dup**c.746del; 746_747ins9*c.745_746insCc.737_741del*c.725delc.715_716insC*c.709_710insGc.683delc.680-1G>Cc.678T>G; 679G>A; 679+1delc.654dup (Suls et al., 2008)c.562_563insCc.507_508dupc.505_507del (3)***c.371_381dupc.354_355insTc.338_352delinsTTGAG*c.337_338insTTGAG; c.338_352del (2)c.337_381dupc.305_308del*c.227_228insGc.189_190ins23c.170dup*c.115-1G>A*c.81_92dupc.87delC; 88A>Tc.32_33del*c.18+1G>A(2)***c.18+1G>C*Figure 1 Distribution of 100 different pathogenic mutations in <strong>the</strong> SLC2A1 gene in 162 patients with GLUT1 <strong>deficiency</strong> <strong>syndrome</strong> thatwere identified by us or have previously been described in literature. Six patients that we identified with a heterozygous multiple exondeletion and five patients that were described previously with haplo-insufficiency of <strong>the</strong> SLC2A1 gene are not represented. The blackvertical line represents <strong>the</strong> GLUT1 gene with boxes indicating <strong>the</strong> exons. The left hand diagram shows missense and nonsense mutations.Amino-acid residues at <strong>the</strong> intron/exon boundaries are shown. The right hand diagram shows frame shift and splice-site mutations.Nucleotides at <strong>the</strong> intron–exon boundaries are indicated. Genbank Accession Number NM_006516 was used as <strong>the</strong> SLC2A1 referencesequence in which <strong>the</strong> A of <strong>the</strong> ATG start-codon is designated position 1. Some mutations have been reported in <strong>the</strong> past with a differentreference sequence (in which <strong>the</strong> A of <strong>the</strong> ATG start-codon is +180); we have adapted <strong>the</strong>se mutations to <strong>the</strong> reference sequence asmentioned above. The number between brackets represents total number of patients identified with <strong>the</strong> mutation. Mutation hot spots arerepresented in bold. Novel mutation identified in our patient group. Novel mutation identified in one of our patients that has previouslybeen reported as a case report. Mutation identified in our patient group that has previously been reported in o<strong>the</strong>r patients. Referencesof mutations that have been described by o<strong>the</strong>rs after 2007 are mentioned. All o<strong>the</strong>r mutations have been described previously by Klepperand Leiendecker (2007).Downloaded from http://brain.oxfordjournals.org at centro sperimentale di medicina e biotecnologie-cnr on August 5, 2010
Clinical and genetic spectrum of GLUT1DS Brain 2010: 133; 655–670 | 661Table 2 Characteristics of 36 novel GLUT1 <strong>deficiency</strong> <strong>syndrome</strong> patients with <strong>the</strong> early-onset classical phenotypePatient characteristics Type ofPatient Sex; age mutationCSF : bloodglucoseratioBiochemical data Clinical data Effect of ketogenic diet onCSFbloodglucoseCSFlactateAge atdiagnosisSeizures;onset/frequencyMicrocephaly MentalretardationHypotonia PyramidalsignsMovement disorderyears mmol/l mmol/l years months Ataxia Dystonia Chorea Seizures MovementdisorderCognition1 F; 1.4 A 0.28 1.3 0.6 0.2 1/W – Mild + – – – – + N/A –2 M; 4 A 0.30 1.7 1.4 0.4 4/M + Sev + + – P – +/– – –3 F; 8 A 0.31 2.0 1.0 7 15/D – Mild – – – – – +/– N/A +4 F; 3 A 50.4 NA NA NA 6/NA NA NA NA NA NA NA NA NA NA NA5 F; 19 A 0.40 2.0 0.9 16 4/W + Mildz – – P P – + +/– –6 M; 21 A 0.41 2.1 1.1 17 3/D – Mod – + C – – – +/– +7 a F; 12 A 0.42 1.9 1.1 9 3/D – Mild – – – – – + N/A +8 F; 19 A 0.43 2.1 1.2 17 15/D NA Mildz NA – – – – NA NA NA9 M; 12 A 0.43 2.4 1.3 9 3/M – Mildz – + C/P P – – +/– +10 a F; 11 A 0.45 2.0 NA 9 12/D – Mild – – – – – +/– N/A +11 F; 34 A NA NA NA 33 6/W NA Mild – – P – – +/–(MA) – –12 M; 4 B 0.19 1.1 0.9 0.4 2/D – Mild + – – – – + N/A +13 M; 7 B 0.25 1.3 0.6 4 3/D – Modz – + P C C + – –14 F; 5 B 0.28 1.3 0.9 0.8 1/W + Mild + – C – – + – +15 M; 16 B 0.29 1.8 1.1 14 23/M + Sevz + – C/P – – 0 0 016 F; 3 B 0.30 1.4 1.0 2 2/D + Modz – – C – – + +/– +17 M; 17 B 0.31 1.3 NA 15 2/M NA Sevz – – C – – 0 0 018 M; 12 B 0.31 2.2 NA 11 13/D + Mod + + – – – 0 0 019 F; 16 B 0.32 1.4 0.7 14 3/D – Mod – + C – – +/– – –20 M; 7 B 0.36 1.6 NA 4 3/W – Mod + – C – – + – –21 M; 7 B 0.36 1.7 1.2 4 9/W – Modz + – C C/P – + +/– +22 a M; 5 B 0.37 1.9 NA 2 4/D + Modz + – P P – + +/– –23 M; 5 B 0.38 1.7 NA 4 3/NA – Mild – – – – – + N/A –24 F; 19 B 0.38 1.8 0.7 14 6/D – Sev NA + C – – +/–; S –; S –; S25 M; 8 B 0.39 2.0 0.7 4 8/S + Mod + + C C – + +/– +26 M; 12 B 0.38 1.8 1.0 7 11/NA + Mod – – + – – +/– – +27 M; 24 B 0.40 2.1 1.5 20 4/D – Mildz + – P – – + +/– –28 M; 14 B NA NA NA NA 6/S + Mod + + C C – 0 0 029 F; 10 B NA 1.5 1.1 8 14/S – Modz + + C C – +/–(MA) +/– –30 F; 13 B NA NA NA 11 2/D + Sev + – C – – – – +31 F; 6 C 0.20 0.9 NA 5 + – Mild – – – C – + – +32 F; 2 C 0.29 1.3 0.9 0.7 3/D – Modz + – – – – + N/A +33 F; 7 C 0.32 1.6 0.9 6 6/S + Mod + + P P – +; S +; S –; S34 M; 3 C 0.35 1.9 1.5 1.7 2/W + Modz + + – C – + +/– +35 F; 9 C 0.37 1.6 1.5 5 12/W – Sev + + C – – + +/– –(continued)Downloaded from http://brain.oxfordjournals.org at centro sperimentale di medicina e biotecnologie-cnr on August 5, 2010