To describe the consequences of the identification of the
Huntington's disease (HD) mutation on predictive and prenatal testing.
retrospective study was performed considering the test applicants, procedures, and results before and after the identification
of the mutation. 1032 people at risk for Huntington's disease in The Netherlands
were included, of whom 741 applied for the predictive test in the period 1987 to 1997
in Leiden at the Department of Clinical Genetics, and after 1994, also in the other seven clinical genetics departments in
Uptake, sociodemographic variables, and test results, taken before and after the mutation was identified,
The uptake of the predictive test in the period studied was 24% and for
the prenatal test 2%. No differences were noted in numbers and sociodemographic data between the period before and after the mutation was identified.
After an initial increase in test applicants, a decrease was seen after 1995. After 1993 a significant increase of 25% at risk test applicants and a significant decrease of prenatal
exclusion tests was noticed. Only 7% asked for reassessment by mutation analysis.
New problems arose after the identification of the mutation, such as the option of reassessing the risk obtained by linkage analysis, direct mutation testing of 25% at risk persons with a parent who does not wish to know, new choices regarding reproduction, and new uncertainties for carriers of intermediate and reduced penetrance
alleles and for their offspring and relatives.
Although predictive testing has become reliable and available
for every person at risk
since the mutation has been identified, the uptake of predictive and prenatal tests fell
short of expectation, no change in socio-demographic variables was seen, and a decrease
in number of applicants was noted. Furthermore, new uncertainties, psycho-logical problems,
and questions arose.
J Neurol Neurosurg Psychiatry 2000;69:579-583 ( November )A Maat-Kievita, M Vegter-van
der Vlisa, M Zoeteweija, M Losekoota,
A van Haeringena, R Roosc at Department of Clinical Genetics, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden,
The Netherlands, b Department of Human Genetics, Department of