Phenotypic variation in 2 Huntington's disease families with linkage to chromosome 4

Variability of expression of the Huntington's disease (HD) gene is illustrated in 2 families with linkage of DNA restriction fragment length polymorphism to the short arm of chromosome 4. In 1 family, affected persons from 3 generations show 50-year variation of onset age. The member with the latest onset age (67) died at 91 with autopsy-confirmed HD. The next generation had hypotonic chorea beginning in the 4th decade with death in the 5th. In the 3rd generation, a rigid patient, inheriting the illness from an affected father, had a much earlier onset at 16, while her siblings had chorea beginning in the 3rd decade. In the 2nd family, several members had cerebellar signs, chorea, and dementia. MRI and CT revealed olivoponto-cerebellar and striatal atrophy. These phenotypes may be the result of different allelic genes at the HD locus or unlinked autosomal modifying loci influencing the expression of the HD gene.