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Original Article LRRK2 G2019S impact on Parkinson disease; clinical phenotype and treatment in Tunisian patients
Guedi ALI BARREH1,3, Ikram SGHAIER1,3, Youssef ABIDA1,2,3, Alya GHARBI1,2,3, Amina NASRI1,2,3, Saloua MRABET1,2,3, Amira SOUISSI1,2,3, Mouna BEN DJEBARA1,2,3, Sameh TRABELSI2,4,5, Imen KACEM1,2,3, Amina GARGOURI-BERRACHI1,2,3, Riadh GOUIDER1,2,3corresp_icon

DOI: https://doi.org/10.14802/jmd.23276 [Accepted]
Published online: April 23, 2024
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1Neurology Department, LR18SP03, Razi University Hospital, 1 rue des OrangersManouba, 2010, Tunis, Tunisia
2Faculty of Medicine of Tunis, University of Tunis El Manar, 15, Rue Djebel Akhdhar, La Rabta, 1007, Tunis, Tunisia
3Clinical Investigation Center (CIC) “Neurosciences and Mental Health”, Razi University Hospital, 1 rue des OrangersManouba, 2010, Tunis, Tunisia
4Clinical Pharmacology Department, National Center of Pharmacovigilance, 1006 Tunis, Tunisia
5Research Laboratory of Clinical and Experimental Pharmacology LR16SP02, 1006 Tunis, Tunisia
Corresponding author:  Riadh GOUIDER, Tel: +216 71 600 339 ; poste 522, Fax: +216 71 601 300, 
Email: riadh.gouider@gnet.tn
Received: 30 December 2023   • Revised: 24 March 2024   • Accepted: 19 April 2024

Background
LRRK2-G2019S is the most frequent mutation in North African Parkinson's disease (PD) patients.Data on its impact on disease progression and treatment response remains elusive.Therefore, we aimed to explore the clinical features,treatments,and complications through the disease course of PD Tunisian patients according to their LRRK2-G2019S profile.
Methods
Longitudinal retrospective study conducted in the department of Neurology,Razi University Hospital.We included clinically diagnosed PD patients according to the MDS criteria and reviewed their medical records for clinical,treatment, and neuropsychological assessments.LRRK2-G2019S mutation was screened among all cases using Sanger sequencing.The correlation of LRRK2-G2019S and the clinical PD features was then evaluated.
Results
We included 393 PD patients with 41.5% of cases were mutated for LRRK2-G2019S. Those with mutation exhibited an earlier age of onset(p=0.017),and female-PD cases had a higher mutation frequency (p=0.008).Mutation carriers displayed distinct clinical features,with a higher frequency of postural instability gait difficulty (PIGD)forms(adjusted-p<0.001).Throughout the disease progression,carriers showed a faster annual progression in UPDRS-III scores (adjusted-p=0.009) and a significantly higher Levodopa Equivalent Dosevalues in later stages(1060.81 vs. 877.83 for 6-8 years).Motor complications such as dyskinesia (adjusted-p<0.001) and motor fluctuations(31.9% vs. 25.7%,adjusted-p<0.001) were more prevalent in carriers,particularly in later stages.LRRK2-G2019S carriers also exhibited a lower prevalence of non-motor symptoms including cognitive disordersfor episodic memory(adjusted-p<0.001),attention(adjusted-p<0.001),and dysexecutive disorders (adjusted-p=0.039),as well asneuropsychiatric symptoms and dysautonomic signs.
Conclusion
This study demonstrated the variability of clinical profile among Tunisian PD cases explained by the incomplete penetrance of LRRK2-G2019S that increases with age.Further studies with biomarker and disease progression data are necessary to improve PD management.

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