Case Report

A Chinese Patient with Spastic Paraplegia Type 4 with a De Novo Mutation in the SPAST Gene

Table 1

Clinical findings of hereditary spastic paraplegia.

PatientNucleotide changeAmino acid changeSexDuration ageAge of onsetWalking achievementFunctional impairmentSpasticityIncreased reflexesDysarthriaMRI or intelligenceLiterature

1c.1496G>Ap.Arg499HisM12 y14 mNo63Exaggerated muscle stretch reflexes of both the upper and lower limbs9 y, lost ability to speak at 12 yMore pronounced hyperintense bilateral PLICs in FLAIR sequences[26]
2c.1496G>Ap.Arg499HisF36 y<2 yNA63NA<6 yMild hyperintensities in corticospinal tracts (white arrows) in T2-weighted and FLAIR sequences[27]
3c.1496G>Ap.Arg499HisF13 y20 mNo5LL spasticityLower limb hyper-reflexia<11 yIntellectual disability[28]
4c.1496G>Ap.Arg499HisF5 y1 y22 m, hold on to furniture4NAYesEarly expressive language delaysLow-lying conus medullaris with minimal thickening of the filum terminale[28]
5c.1496G>Ap.Arg499HisM11 y1.5 y48 m, walk alone2NANoNA[29]
6c.1496G>Ap.Arg499HisM3 y1 yNANASpasticityLower extremity hyper-reflexia, Babinski signNoNA[30]
7c.1495C>Tp.Arg499CysM2013 yNA31LL increased; UL normal/yesNoNA[31]
8c.1496G>Ap.Arg499HisM>40ChildhoodLimited walking without aid33Not determinedNANA[31]
9c.1495C>Tp.Arg499CysF60ChildhoodNA63Lower limb increased; upper limb normalNANA[31]
10c.1495C>Tp.Arg499CysNA63ChildhoodNeed help for daily life63LL, UL/bilateralNANA[32]
11c.1495C>Tp.Arg499CysNA5551Need help for daily life21LL, UL/bilateralNANA[32]
12c.1495C>Tp.Arg499CysNA53AdolescencePartially need help for daily life53LL, UL/bilateralNACortical and subcortial atrophy, nonspecific WMH[32]
13c.1495C>Tp.Arg499CysNA474Need help for daily life63LL, UL/bilateralNACortical atrophy[32]
14c.1495C>Tp.Arg499CysNA455None53LL, UL/bilateralNANA[32]
15c.1495C>Tp.Arg499CysNA43BirthNeed help for daily life63LL/bilateralNACortical and subcortical atrophy[32]
16c.1495C>Tp.Arg499CysNA39ChildhoodPartially need help for daily life63LL, UL/bilateralNANA[32]
17c.1495C>Tp.Arg499CysNA29BirthPartially need help for daily life33LL, UL/bilateralNANormal[32]
18c.1495C>Tp.Arg499CysNA271Partially need help for daily life32LL/bilateralNANA[32]
19c.1495C>Tp.Arg499CysNA24ChildhoodNeed help for daily life32LL/bilateralNANA[32]
20c.1496G>Ap.Arg499HisF27ChildhoodNo6YesLower limb increased, positive Babinski signSpeech is slow, slurred, and the voice diminishes at 22 yThoracic spinal cord atrophyThis report

LL, lower limb; UL, upper limb. Functional impairment: 0—none, 1—no functional impairment but signs at examination, 2—mild, 3—moderate, 4—walking with one cane, 5—walking with two canes, and 6—wheelchair-bounded. Gait spasticity: 0—none, 1—mild, 2—moderate, and 3—severe.