We examined histologically and biochemically the brains of two patients with generalized
childhood-onset dystonia musculorum deformans. We found no important histologic changes in the basal ganglia, cerebral cortex, higher brain-stem nuclei, locus ceruleus, or raphe nuclei. Similarly, the activity of
choline acetyltransferase and the levels of
gamma-aminobutyric acid and
glutamic acid in the cerebral cortex and basal ganglia were within the control range. In contrast, the
norepinephrine concentrations were markedly and consistently decreased in the lateral and posterior hypothalamus, mamillary body, subthalamic nucleus, and locus ceruleus. The
serotonin level was subnormal in the dorsal raphe nucleus, as was the
dopamine level in the nucleus accumbens and, in one of the two cases, in the striatum. Elevated concentrations of
norepinephrine were found in the septum, thalamus, colliculi, red nucleus, and dorsal raphe nucleus; of
serotonin, in the globus pallidus, subthalamic nucleus, and locus ceruleus; and of 5-hydroxyindoleacetic
acid, in the globus pallidus, subthalamic nucleus, and nuclei raphe centralis inferior and obscurus. The level of
homovanillic acid showed little consistent change in the regions examined. We conclude that some of these monoamine changes, especially the pronounced apparent disturbance of noradrenergic brain mechanisms, may represent a basic neurochemical abnormality in
dystonia musculorum deformans and may thus be relevant to the pathoneurophysiology and treatment of this disorder.