Segregation analysis of chronic childhood spinal muscular atrophy

A formal segregation analysis for the disease 'chronic childhood spinal muscular atrophy' is presented. This disease is also known as 'Kugelberg-Welander disease', 'arrested Werdnig-Hoffmann disease', and 'chronic proximal or generalised spinal muscular atrophy'. There were 124 index cases occurring in 115 families. Ascertainment of index patients was by incomplete multiple selection. Three types of segregation analysis were performed: Weinberg Proband, an improved Weinberg Proband with a variance corrected formula for differences both in family size and ascertainment probability and a backeting technique assuming the extremes of both single and of truncate selection. All three methods gave similar results. The improved Weinberg Proband method with corrections for differences in ascertainment and in family size gave a segregation ratio of 0.18 and a 95% confidence range of 0.11 to 0.25. The mid-point of the bracketing method assuming extremes of truncate and of single selection was 0.19. The segregation ratio of that group of children with clinical onset before 9 months of age was 0.21, which does not differ significantly from the 0.25 predicted on the basis of autosomal recessivity. Evidence is presented to indicate that 25% of index patients may be due to new dominant mutations, or phenocopies, or both, and that these occur particularly among sporadic cases with clinical onset over 2 years of age. Empirical risk figures for use in genetic counselling are presented, and the literature of the subject is reviewed.