Locus-phenotype correlations in autosomal dominant pure hereditary spastic paraplegia. A clinical and molecular genetic study of 28 United Kingdom families.

This study aimed to describe the clinical phenotype of a large collection of families with autosomal dominant pure hereditary spastic paraplegia (ADPHSP), to examine the relative frequency of each of the three known ADPHSP genes within this population, to assess locus-phenotype correlation in ADPHSP and to ascertain whether there are clinical subgroups within genetically defined populations of ADPHSP families. We examined 306 family members, 144 affected, from 28 families with ADPHSP. Linkage analysis at the three known ADPHSP loci allowed us to categorize the families into three groups: (i) those families showing linkage to the chromosome 2 ADPHSP locus (seven families); (ii) those in which linkage to all known loci was excluded (five families); and (iii) those in which linkage results were inconclusive. There was a correlation between linkage group and clinical features, with chromosome 2-linked families having a later age at onset of symptoms (P = 0.001) and later age before commencing walking stick use (P = 0.007) than those families in which linkage to all known ADPHSP loci was excluded. There were no clinical differences between the families showing linkage to the chromosome 2 locus, but there were clinical differences between the families in which linkage to all of the known loci had been excluded (P < 0.0001). We conclude that the chromosome 2 ADPHSP gene is a frequent cause of ADPHSP in UK families, that the responsible gene has not yet been mapped in a significant proportion of families and that certain clinical features of ADPHSP, including age at onset, are at least in part determined by genetic locus.