Neuropathologic Findings in a Patient with Juvenile-Onset Levodopa-Responsive Parkinsonism Due to ATP13A2 Mutation

Hsin Fen Chien*, Roberta Diehl Rodriguez, Vincenzo Bonifati, Ricardo Nitrini, Carlos Augusto Pasqualucci, Ellen Gelpi, Egberto Reis Barbosa

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

10 Citations (Scopus)


Objective To describe the postmortem neuropathologic findings of a patient with Kufor Rakeb syndrome (KRS) due to ATP13A2 mutation. KRS is characterized by juvenile-onset levodopa-responsive parkinsonism associated with pyramidal signs, supranuclear gaze palsy, and cognitive impairment. Methods A detailed neuropathologic analysis of the brain was performed. The patient had a genetically confirmed ATP13A2 homozygous missense mutation and died at age 38 years, which was 26 years after the onset of his symptoms. Results The main brain neuropathologic findings were widespread neuronal and glial lipofuscin accumulation with no Lewy body-type inclusions and absence of α-synuclein-positive, tau-positive, β-amyloid-positive, and TDP-43 protein-positive pathologies. Sparse iron deposits were observed in several brain areas, but no obvious axonal spheroids were identified. Discussion This is to our knowledge the first KRS postmortem neuropathologic description. Iron deposits were found but not associated with increased axonal spheroids, as frequently observed in neurodegeneration with brain iron accumulation. ATP13A2 mutations have been described in patients with neuronal ceroid lipofuscinosis (CLN). Moreover, animal models with these mutations develop neurodegenerative disorders with CLN pathology. Therefore, our findings support that ATP13A2 mutations may be considered a genetic etiology of neuronal lipofuscinosis.

Original languageEnglish
Pages (from-to)763-766
Number of pages4
Issue number16
Early online date2 Sept 2021
Publication statusPublished - 19 Oct 2021

Bibliographical note

Funding Information:
H.F. Chien declares no disclosures relevant to the manuscript. R.D. Rodriguez received support from the São Paulo Research Foundation and Coordination for the Improvement of Higher Education Personnel postdoctoral scholarship (FAPESP/CAPES- 2016/24326-0) and Alzheimer Association (AARF 18-566005). V. Bonifati received support from the Stichting Parkinson Fonds (The Netherlands). R. Nitrini received support for research from the National Council for Scientific and Technological Development (CNPq- 303878/20142). C.A. Pasqualucci, E. Gelpi, and E.R. Barbosa declare no disclosures relevant to the manuscript. Go to for full disclosures.

Publisher Copyright:
© 2021 American Academy of Neurology.


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