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Harding’s disease: an important MS mimic
  1. Stuti Joshi1 and
  2. Allan G Kermode2,3
  1. 1 Department of Neurology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
  2. 2 The Perron Institute for Neurological and Translational Science, Nedlands, Western Australia, Australia
  3. 3 Murdoch University, Institute for Immunology and Infectious Diseases, Murdoch, Western Australia, Australia
  1. Correspondence to Dr Stuti Joshi, soshi24{at}


Leber’s hereditary optic neuropathy (LHON) is a mitochondrially inherited disorder characterised by bilateral, painless visual loss which leads to severe optic atrophy. It can be associated with other conditions including multiple sclerosis (MS), movement disorders, epilepsy and cardiac arrhythmias. The association of LHON with an MS-like illness is often referred to as Harding’s disease (or Harding’s syndrome). We report two siblings, who both harbour the 11 778 mitochondrial DNA (mtDNA) mutation, but who manifest markedly different clinical phenotypes; a male with classical LHON and a female with an MS-like illness. LHON affects males four to five times more often than females. By contrast, Harding’s disease is seen predominantly in females, in a pattern comparable to that seen in MS. The pathogenic basis behind the variation in penetrance and phenotype between genders and individual family members remains unclear.

  • multiple sclerosis
  • neuro genetics
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  • Contributors Both authors were involved equally in the design and planning of of the paper. SJ was predominantly responsible for drafting of the paper. AGK was responsible for the acquisition of patient data, for revising the draft and providing final approval of the submitted version. Both authors will be equally accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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