Independent coexistence of diseases in neurogenetics: case reports and literature review

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Abstract

Combined hereditary pathology (“double trouble”) in a patient and/or family, previously considered a rarity, is being identified increasingly often due to the development of modern genetic diagnostic methods. We describe 13 patients from 12 families with two hereditary diseases of the nervous system, verified by DNA analysis. The spectrum of diseases includes 23 nosological forms, including a number of rare ones. The cases differ in their diagnostic pathways (clinical diagnoses of two diseases and their laboratory confirmation; an unusual clinical presentation of the first disease followed by a targeted search for the second; unexpected findings during molecular genetic testing) and DNA analysis methods (massive parallel sequencing: panel, whole-exome and whole-genome sequencing; targeted methods: sequencing of individual genes and testing for common pathogenic variants; molecular cytogenetic methods). Among the identified gene variants, 8 have not been previously described. The cases are discussed in comparison with literature data on neurogenetic “double troubles”.

About the authors

Galina E. Rudenskaya

Research Centre for Medical Genetics

Author for correspondence.
Email: rudenskaya@med-gen.ru
ORCID iD: 0000-0002-8244-9367
Russian Federation, 1 Moskvorechye St., Moscow 115522

A. S. Kuchina

Research Centre for Medical Genetics

Email: kuchina@med-gen.ru
ORCID iD: 0000-0002-3153-7041
Russian Federation, 1 Moskvorechye St., Moscow 115522

E. A. Melnik

Research Centre for Medical Genetics

Email: evmel88@gmail.com
ORCID iD: 0000-0001-5436-836X
Russian Federation, 1 Moskvorechye St., Moscow 115522

I. V. Sharkova

Research Centre for Medical Genetics

Email: sharkova.inna@gmail.com
ORCID iD: 0000-0002-5819-4835
Russian Federation, 1 Moskvorechye St., Moscow 115522

T. S. Nagornova

Research Centre for Medical Genetics

Email: t.korotkaya90@gmail.com
ORCID iD: 0000-0003-4527-4518
Russian Federation, 1 Moskvorechye St., Moscow 115522

V. V. Musatova

Research Centre for Medical Genetics

Email: shkarupo@mail.ru
ORCID iD: 0000-0002-4313-2877
Russian Federation, 1 Moskvorechye St., Moscow 115522

P. A. Chausova

Research Centre for Medical Genetics

Email: zay85@mail.ru
ORCID iD: 0000-0002-0431-1477
Russian Federation, 1 Moskvorechye St., Moscow 115522

A. A. Stepanova

Research Centre for Medical Genetics

Email: anna_stepanova@med-gen.ru
ORCID iD: 0000-0003-0416-8137
Russian Federation, 1 Moskvorechye St., Moscow 115522

F. M. Bostanova

Research Centre for Medical Genetics

Email: bostanova@med-gen.ru
ORCID iD: 0000-0002-5337-1775
Russian Federation, 1 Moskvorechye St., Moscow 115522

E. L. Dadali

Research Centre for Medical Genetics

Email: genclinic@yandex.ru
ORCID iD: 0000-0001-5602-2805
Russian Federation, 1 Moskvorechye St., Moscow 115522

L. A. Bessonova

Research Centre for Medical Genetics

Email: bessonovala@yandex.ru
ORCID iD: 0000-0002-5946-4577
Russian Federation, 1 Moskvorechye St., Moscow 115522

D. M. Guseva

Research Centre for Medical Genetics

Email: guseva@med-gen.ru
ORCID iD: 0000-0003-3761-8595
Russian Federation, 1 Moskvorechye St., Moscow 115522

K. G. Zabudskaya

Research Centre for Medical Genetics

Email: zabudskaya@med-gen.ru
ORCID iD: 0000-0003-1290-574X
Russian Federation, 1 Moskvorechye St., Moscow 115522

E. N. Solodovnikova

Research Centre for Medical Genetics

Email: solodovnikova@med-gen.ru
ORCID iD: 0000-0002-2406-9016
Russian Federation, 1 Moskvorechye St., Moscow 115522

O. A. Shchagina

Research Centre for Medical Genetics

Email: schagina@dnalab.ru
ORCID iD: 0000-0003-4905-1303
Russian Federation, 1 Moskvorechye St., Moscow 115522

A. F. Murtazina

Research Centre for Medical Genetics

Email: aysylumurtazina@gmail.com
ORCID iD: 0000-0001-7023-7378
Russian Federation, 1 Moskvorechye St., Moscow 115522

Oksana P. Ryzhkova

Research Centre for Medical Genetics

Email: ryzhkova@dnalab.ru
ORCID iD: 0000-0003-1285-9093
Russian Federation, 1 Moskvorechye St., Moscow 115522

References

  1. Scarlato M., Nuara A., Gerevini S. et al. A new double-trouble phenotype: fascioscapulohumeral muscular dystrophy ameliorates hereditary spastic paraparesis due to spastin mutation. Neurol 2015;62(2):476–8. doi: 10.1007/s00415-014-7606-2
  2. Reuner U., Stremmel W., Weiskirchen R. The interesting case-orphan diseases-double trouble. Ann Transl Med 2019; 7(Suppl 2):S74. doi: 10.21037/atm.2019.04.31
  3. Frączek A., Potulska-Chromik A., Bednarska-Makaruk M. et al. Spinal muscular atrophy with an overlapping syndrome – “double trouble” or a potentially better outcome? Neurol Neurochir Pol 2020;54(5):475–7. doi: 10.5603/PJNNS.a2020.0060
  4. Granger A., Beecher G., Liewluck T. et al. Inherited myopathy plus: double-trouble from rare neuromuscular disorders. Neuromuscul Disord 2023;33(2):153–60. doi: 10.1016/j.nmd.2022.12.009
  5. Puma A., Tammam G., Ezaru A. et al. Double trouble: a comprehensive study into unrelated genetic comorbidities in adult patients with facioscapulohumeral muscular dystrophy type I. Eur J Hum Genet 2025;33(8):1006–14. doi: 10.1038/s41431-024-01770-0
  6. Chelban V., Lynch D., Houlden H., Wood N. Triple trouble: a striking new phenotype or competing genes in a family with hereditary spastic paraplegia. J Neurol 2016;263(6):1232–3. doi: 10.1007/s00415-016-8103-6
  7. Lin X.D., He J.J., Lin F. et al. A “triple trouble” case of facioscapulohumeral muscular dystrophy accompanied by peripheral neuropathy and myoclonic epilepsy. Chin Med J 2018;131(18):2164–71. doi: 10.4103/0366-6999.240797
  8. Pasquetti D., Gazzellone A., Rossi S. et al. Triple genetic diagnosis in a patient with late-onset leukodystrophy and mild intellectual disability. Int J Mol Sci 2023;25(1):495. doi: 10.3390/ijms25010495
  9. Samuels M., Shields K., Hillman P., Farach L. Rapid whole genome sequencing uncovers a triple diagnosis: X-linked chondrodysplasia punctata, MECP2-related disorder, and mosaic Jacobs syndrome. Mol Genet Genomic Med 2025;13(2):e70061. doi: 10.1002/mgg3.70061
  10. Chen Z., Saini M., Jan K., Chai J. Occam’s razor or Hickam’s dictum: a case of myopathy double trouble. Ann Acad Med Singap 2019;48(8):264–7.
  11. Nóbrega P.R., Santana da Costa F.B., Barros Rodrigues P.G. Moyamoya associated with Turner syndrome in a patient with type 2 spinocerebellar ataxia – Occam’s razor or Hickam’s dictum: a case report. BMC Neurol 2022;22(1):381. doi: 10.1186/s12883-022-02912-x
  12. Spedicati B., Morgan A., Pianigiani G. et al. Challenging Occam’s razor: dual molecular diagnoses explain entangled clinical pictures. Genes (Basel) 2022;13(11):2023. doi: 10.3390/genes13112023
  13. Sheikh A.S.F., Lilleker J.B., Chinoy H. Applying Hickam’s dictum: a case of adult-onset LGMD2I muscular dystrophy and long QT syndrome. Rheumatol Adv Pract 2023;7(2):rkad059. doi: 10.1093/rap/rkad059
  14. Руденская Г.Е., Шумарина А.О., Антонец А.В. и др. Случай сочетания двух редких неврологических болезней, выявленных панельным экзомным секвенированием. Медицинская генетика 2017;16(11):38–41. Rudenskaya G.E., Shumarina A.O., Antonets A.V. et al. Coincidence of two rare neurologic diseases detected by panel next-generation sequencing. Meditsinskaya Genetika = Medical Genetics 2017;16(11):38–41. (In Russ.).
  15. Руденская Г.Е., Булах М.В., Миловидова Т.Б., Щагина О.А. Cочетание наследственной моторно-сенсорной нейропатии 1А типа и поясно-конечностной мышечной дистрофии 2А типа. Журнал неврологии и психиатрии им. С.С. Корсакова 2018;118(11):72–6. doi: 10.17116/jnevro201811811143 Rudenskaya G.E., Bulakh M.V., Milovidova T.B., Shchagina O.A. Coincidence of hereditary motor and sensory neuropathy type 1A and limb girdle muscular dystrophy type 2A. Zhurnal nevrologii i psikhiatrii im S.S. Korsakova = S.S. Korsakov Journal of Neurology and Psychiatry 2018;118(11):72–6. (In Russ.). doi: 10.17116/jnevro201811811143
  16. Руденская Г.Е., Кучина А.С., Кадникова В.А., Рыжкова О.П. Случай спастической параплегии с мутациями в генах двух форм: SPG4 и SPG3. Журнал неврологии и психиатрии им. С.С. Корсакова 2023;123(5):171–6. doi: 10.17116/jnevro2023123051171 Rudenskaya G.E., Kuchina A.S., Kadnikova V.A., Ryzhkova O.P. A case of spastic paraplegia with SPG4 and SPG3 associated mutations. Zhurnal nevrologii i psikhiatrii im S.S. Korsakova = S.S. Korsakov Journal of Neurology and Psychiatry 2023;123(5):171–6. (In Russ.). doi: 10.17116/jnevro2023123051171
  17. Шарова М.В., Маркова Т.В., Чухрова А.Л. и др. Расширение фенотипа, или двойной удар по нервной системе: сочетание врожденного нарушения гликозилирования 1i-типа и синдрома Жубер 17-го типа. Нервно-мышечные болезни 2025;15(1):67–72. doi: 10.17650/2222-8721-2025-15-1-67-72 Sharova M.V., Markova T.V., Chukhrova A.L. et al. Phenotype expansion, or double trouble: the combination of congenital disorder of glycosylation type 1i and Joubert syndrome type 17. Nervno-myshechnye bolezni = Neuromuscular Diseases 2025;15(1): 67–72. (In Russ.). doi: 10.17650/2222-8721-2025-15-1-67-72
  18. Vital A., Latour P., Sole G. et al. A French family with Charcot–Marie–Tooth disease related to simultaneous heterozygous MFN2 and GDAP1 mutations. Neuromuscul Disord 2012;22(8):735–41. doi: 10.1016/j.nmd.2012.04.001
  19. Ardissone A., Brugnoni R., Gandioli C. et al. Double-trouble in pediatric neurology: myotonia congenita combined with Сharcot–Marie–Tooth disease type 1A. Muscle Nerve 2014;50(1):145–7. doi: 10.1002/mus.24205
  20. Comella M., Collotta A., Pavone V. et al. Concomitant MPZ and MFN2 gene variants and Charcot–Marie–Tooth disease in a boy: clinical and genetic analysis-literature review. Case Rep Pediatr 2022;2022:3793226. doi: 10.1155/2022/3793226
  21. Nan H., Wu Y., Cui S. et al. Coexistence of Charcot–Marie–Tooth 1A and nondystrophic myotonia due to PMP22 duplication and SCN4A pathogenic variants: a case report. BMC Neurol 2022;22(1):17. doi: 10.1186/s12883-021-02538-5
  22. Filosto M., Lanzi G., Nesti C. et al. A novel mitochondrial tRNA(Ala) gene variant causes chronic progressive external ophthalmoplegia in a patient with Huntington disease. Mol Genet Metab Rep 2016;6:70–3. doi: 10.1016/j.ymgmr.2016.02.001
  23. Lal D., Neubauer B.A. Toliat M. et al. Increased probability of co-occurrence of two rare diseases in consanguineous families and resolution of a complex phenotype by next generation sequencing. PLoS One 2016;11(1):e0146040. doi: 10.1371/journal.pone.0146040
  24. Tadic V., Klein C., Hinrichs F. et al. CAPN1 mutations are associated with a syndrome of combined spasticity and ataxia. J Neurol 2017;264(5):1008–10. doi: 10.1007/s00415-017-8464-5
  25. Shetty A., Gan-Or Z., Ashtiani S. et al. CAPN1: novel mutations expanding the phenotype of hereditary spastic paraparesis. Eur J Med Genet 2019;62(12):103605. doi: 10.1016/j.ejmg.2018.12.010
  26. Sadr Z., Rohani M., Jamal P., A. A case report of concurrent occurrence of two inherited axonopathies within a family: the benefit of whole-exome sequencing. Int J Neurosci 2024;134(11):1282–87. doi: 10.1080/00207454.2023.2260091
  27. Pontrucher A., Barth M., Ziegler A. et al. Case report: diagnosis of ADCY5-related dyskinesia explaining the entire phenotype in a patient with atypical citrullinemia type I. Front Neurol 2023;14:1266686. doi: 10.3389/fneur.2023.1266686
  28. Di Fabio R., Tessa A., Marcotulli C. et al. When atlastin meets spastin. Clin Genet 2014;86(5):504–5. doi: 10.1111/cge.12331
  29. Hodapp J., Carter G., Lipe H. et al. Double trouble in hereditary neuropathy: concomitant mutations in the PMP-22 gene and another gene produce novel phenotypes. Arch Neurol 2006;63(1):112–7. doi: 10.1001/archneur.63.1.112
  30. Rudnik-Schöneborn S., Weis J., Kress W. et al. Becker’s muscular dystrophy aggravating facioscapulohumeral muscular dystrophy – double trouble as an explanation for an atypical phenotype. Neuromuscul Disord 2008;18(11):881–5. doi: 10.1016/j.nmd.2008.06.387
  31. Ricci G., Scionti I., Ali G. et al. Rippling muscle disease and facioscapulohumeral dystrophy-like phenotype in a patient carrying a heterozygous CAV3 T78M mutation and a D4Z4 partial deletion: further evidence for ‘‘double trouble’’ overlapping syndromes. Neuromuscul Disord 2012;22(6):534–40. doi: 10.1016/j.nmd.2011.12.001
  32. Jedrzejowska M., Ryniewicz B., Kabzińska D. et al. A patient with both Charcot–Marie–Tooth disease (CMT1A) and mild spinal muscular atrophy (SMA 3). Neuromuscul Disord 2008;18(4):339–41. doi: 10.1016/j.nmd.2008.02.001
  33. Fierro R.B., Mora P.H., Zenteno J.C., Villarroel Cortés C. Clinical and molecular evidence of possible digenic inheritance for MFN2/GDAP1 genes in Charcot–Marie–Tooth disease. Neuromuscul Disord 2020;30(12):986–90. doi: 10.1016/j.nmd.2020.10.003
  34. Tasende M.S., Pauni M., Armando R., Muntadas J. Late diagnosis of spinal muscular atrophy in a patient with Down syndrome. Arch Argent Pediatr 2022;20:e287–90. doi: 10.5546/aap.2022.e287
  35. Capra A.P., La Rosa M.A., Briguori S. et al. Coexistence of genetic diseases is a new clinical challenge: three unrelated cases of dual diagnosis. Genes (Basel) 2023;14(2):484. doi: 10.3390/genes14020484
  36. Bregvadze K., Abashishvili L., Tatishvili N. et al. Insights into diagnostic difficulties in spinal muscular atrophy: a case report series. Front Genet 2024;15:1502444. doi: 10.3389/fgene.2024.1502444
  37. Gupta B., Mohamed M., Sohal S. et al. A rare genetic intersection: Down syndrome with coexisting spinal muscular atrophy. Cureus 2024;16(8):e67243. doi: 10.7759/cureus.67243
  38. Kuchina A., Murtazina A., Borovikov A. et al. Challenging diagnosis of a patient with two novel variants in the SYNE1 gene. Int J Mol Sci 2024;25(19):10841. doi: 10.3390/ijms251910841
  39. Руденская Г.Е., Гусева Д.М., Шатохина О.Л. и др. Энцефалопатия с нарушением развития и эпилепсией, вызванная мутацией гена ATP1A2. Журнал неврологии и психиатрии им. С.С. Корсакова 2024;124(6):133–8. doi: 10.17116/jnevro2024124061133 Rudenskaya G.E., Guseva D.M., Shatokhina O.L. et al. Developmental and epileptic encephalopathy produced by the ATP1A2 mutation. Zhurnal nevrologii i psikhiatrii im S.S. Korsakova = S.S. Korsakov Journal of Neurology and Psychiatry 2024;124(6):133–8. (In Russ.). doi: 10.17116/jnevro2024124061133

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Copyright (c) 2026 Rudenskaya G.E., Kuchina A.S., Melnik E.A., Sharkova I.V., Nagornova T.S., Musatova V.V., Chausova P.A., Stepanova A.A., Bostanova F.M., Dadali E.L., Bessonova L.A., Guseva D.M., Zabudskaya K.G., Solodovnikova E.N., Shchagina O.A., Murtazina A.F., Ryzhkova O.P.

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