{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T12:43:33Z","timestamp":1768481013476,"version":"3.49.0"},"reference-count":20,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2022,3,3]],"date-time":"2022-03-03T00:00:00Z","timestamp":1646265600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Euro J of Neurology"],"published-print":{"date-parts":[[2022,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and purpose<\/jats:title><jats:p>Recently, the pathogenic and intermediate GGC repeat expansion in <jats:italic>NOTCH2NLC<\/jats:italic> was detected in Parkinson's disease (PD). However, detailed clinical, neuroimaging, and pathological information of clinically diagnosed PD patients with pathogenic GGC repeat expansion in <jats:italic>NOTCH2NLC<\/jats:italic> remains scarce. Thus, we aimed to elucidate the clinical, neuroimaging, and pathological characteristics of PD patients carrying the pathogenic GGC repeat expansion in <jats:italic>NOTCH2NLC<\/jats:italic>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The <jats:italic>NOTCH2NLC<\/jats:italic> GGC repeat expansion was screened in 941 sporadic PD patients and 244 unrelated probands. Comprehensive assessments were performed in three PD patients with pathogenic GGC repeat expansion in <jats:italic>NOTCH2NLC<\/jats:italic>. The repeat expansion length was estimated using CRISPR\/Cas9\u2010based targeted long\u2010read sequencing.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The three patients (two PD patients from Family 1 and one sporadic PD) carrying the pathogenic <jats:italic>NOTCH2NLC<\/jats:italic> expansion were reconfirmed with a diagnosis of clinically established PD. Although they lacked the typical neuronal intranuclear inclusion disease (NIID) magnetic resonance imaging (MRI) feature, the typical PD pattern of striatal dopamine transporter loss was detected. Notably, all three patients presented with systemic areflexia, and other secondary causes of polyneuropathy were excluded. Skin biopsy showed intranuclear inclusions and an absence of phosphorylated alpha\u2010synuclein deposition in the skin nerve fibers of all three patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Although these clinically diagnosed PD patients with pathogenic GGC repeat expansion in <jats:italic>NOTCH2NLC<\/jats:italic> were hardly distinguishable from idiopathic PD based on clinical course and neuroimaging features, the pathological findings indicated that their phenotype was a PD phenocopy of NIID. Systemic areflexia may be an important and unique clinical clue suggesting further genetic testing and skin biopsy examination to confirm the diagnosis of NIID in patients presenting with a PD phenocopy.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ene.15283","type":"journal-article","created":{"date-parts":[[2022,2,11]],"date-time":"2022-02-11T12:11:04Z","timestamp":1644581464000},"page":"1610-1618","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["The role of <i>NOTCH2NLC<\/i> in Parkinson's disease: A clinical, neuroimaging, and pathological study"],"prefix":"10.1111","volume":"29","author":[{"given":"Peng","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Neurology The Second Affiliated Hospital Zhejiang University School of Medicine  Hangzhou China"},{"name":"Key Laboratory of Cancer Prevention and Intervention China National Ministry of Education The Second Affiliated Hospital Cancer Institute 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