Only recently have mutations in MECP2 been found to be a cause of Rett Synd
rome (RTT), a neurodevelopmental disorder characterized by mental retardati
on, loss of expressive speech, deceleration of head growth and loss of acqu
ired skills that almost exclusively affects females. We analysed the MECP2
gene in 31 patients diagnosed with RTT. Sequencing of the coding region and
the splice sites revealed mutations in 24 females (77.40%). However, no ab
normalities were detected in any of the parents that were available for inv
estigation. Eleven mutations have not been described previously. Confirming
two earlier studies, we found that most mutations are truncating and only
a few of them are missense mutations. Several females carrying the same mut
ation display different phenotypes indicating that factors other than the t
ype or position of mutations influence the severity of RTT. Four females wi
th RTT variants were included in the study. Three of these presented with p
reserved speech while the fourth patient with congenital RTT lacked the ini
tial period of normal development. Detection of mutations in these cases re
veals that they are indeed variants of RTT. They represent the mild and the
severe extremes of RTT. Conclusions: mutations in MECP2 seem to be the mai
n cause for RTT and can be expected to be found in similar to 77% of patien
ts that fulfil the criteria for RTT. Therefore analysis of MECP2 should be
performed if RTT is suspected. Three mutation hotspots (T158M, R168X and R2
55X) were confirmed and a further one (R270X) newly identified. We recommen
d screening for these mutations before analysing the coding region.