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Background  In a Danish family, multiple individuals in five generations present with early‐onset paroxysmal cranial dyskinesia, musculoskeletal abnormalities, and kidney dysfunction.    Objective  To demonstrate linkage and to identify the underlying genetic cause of disease.    Methods  Genome‐wide single‐nucleotide polymorphisms analysis, Sequence‐Tagged‐Site marker analyses, exome sequencing, and Sanger sequencing were performed.    Results  Linkage analyses identified a candidate locus on chromosome 9. Exome sequencing revealed a novel variant in  LMX1B  present in all affected individuals, logarithm of the odds (LOD) score of  z  = 6.54, predicted to be damaging. Nail‐patella syndrome (NPS) is caused by pathogenic variants in  LMX1B  encoding a transcription factor essential to cytoskeletal and kidney growth and dopaminergic and serotonergic network development. NPS is characterized by abnormal musculoskeletal features and kidney dysfunction. Movement disorders have not previously been associated with NPS.    Conclusions  Paroxysmal dyskinesia is a heretofore unrecognized feature of the NPS spectrum. The pathogenic mechanism might relate to aberrant dopaminergic circuits. © 2020 The Authors.  Movement Disorders  published by Wiley Periodicals LLC on behalf of International Parkinson Movement Disorder Society. This article has been contributed to by US Government employees and their work is in the public domain in the USA.

Paroxysmal Cranial Dyskinesia and Nail‐Patella Syndrome Caused by a Novel Variant in the LMX1B Gene