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Mantel T, Dresel C, Altenmüller E, Zimmer C, Noe J, Haslinger B. Activity and topographic changes in the somatosensory system in embouchure dystonia. Mov Disord 2016; 31:1640-1648. [PMID: 27273329 DOI: 10.1002/mds.26664] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Revised: 04/04/2016] [Accepted: 04/07/2016] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Embouchure dystonia is a highly disabling focal task-specific dystonia affecting professional brass players. OBJECTIVE This study was designed to analyze activity changes along with topographic representations in primary and nonprimary centers for somatosensory processing in patients with embouchure dystonia. METHODS We used event-related functional magnetic resonance imaging with automized tactile stimulation of dystonic (upper lip) and nondystonic (forehead and dorsal hand) body regions in 15 professional brass players with and without embouchure dystonia. Statistical analyses included whole-brain between-group comparisons of stimulation-induced activation and region-of-interest-based single patient analyses of topographic activation characteristics. RESULTS Affected musicians revealed increased stimulation-induced activity in contralateral primary and bilateral secondary somatosensory representations of dystonic and nondystonic body regions as well as in the cerebellum ipsilateral to the left dystonic upper lip. Changes of somatotopic organization with altered intracortical distances and between-group differences of the centers of representations were found in the right primary and the bilateral secondary somatosensory cortex and in the left cerebellum. Positional variability of dystonic and nondystonic body regions was reduced with an emphasis on face representations. CONCLUSIONS The present findings are supportive of the concept of an abnormal processing of somatosensory information in embouchure dystonia affecting multiple domains. The underlying neurophysiological mechanisms (eg, changes in inhibition, maladaptive plasticity, changes in baseline activity) remain unclear. The involvement of nondystonic body areas can be viewed in the context of possible compensation or an endophenotypic predisposition. © 2016 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Tobias Mantel
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Christian Dresel
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Eckart Altenmüller
- Institute for Music Physiology and Musicians' Medicine, Hochschule für Musik, Theater und Medien Hannover, Hannover, Germany
| | - Claus Zimmer
- Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Jonas Noe
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Bernhard Haslinger
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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Ren WQ, Yin F, Zhang JN, Lu WS, Liang YK, Adlerberth J, Tian ZM. Neural stem cell transplantation for the treatment of primary torsion dystonia: A case report. Exp Ther Med 2016; 12:661-666. [PMID: 27446258 PMCID: PMC4950735 DOI: 10.3892/etm.2016.3392] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 05/05/2016] [Indexed: 12/18/2022] Open
Abstract
Primary torsion dystonia (PTD) occurs due to a genetic mutation and often advances gradually. Currently, there is no therapy available that is able to inhibit progression. Neural stem cells (NSCs) are being investigated as potential therapies for neurodegenerative diseases, such as stroke and trauma. The present study evaluated the clinical effectiveness of NSC transplantation in an 18-year-old male patient with PTD, to assess the ability of this therapy to inhibit PTD progression. Genetic testing of the patient revealed a mutation in the torsion dystonia-1 (DYT1) gene (907–909 delGAG). NSCs were bilaterally implanted in the globus pallidus of the patient through stereotactic surgery. Prior to surgery, the patient's Burke-Fahn-Marsden dystonia movement score (BFMDMS) was 21, which progressively decreased after surgery to 18, 17, 15 and 13 at 1, 2, 3 and 4 postoperative years, respectively. BFMDMS was improved by 38.1% over the 4 postoperative years. Although computed tomography and magnetic resonance imaging examinations showed no significant changes prior to and following surgery, postoperative brain positron emission tomography scans revealed increased glucose metabolism in the transplanted region. The clinical efficacy of NSC transplantation in this patient suggests its potential for the treatment of DYT1-positive patients with PTD.
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Affiliation(s)
- Wen-Qing Ren
- Institute of Neurosurgery, The PLA Navy General Hospital, Beijing 100048, P.R. China
| | - Feng Yin
- Institute of Neurosurgery, The PLA Navy General Hospital, Beijing 100048, P.R. China
| | - Jian-Ning Zhang
- Institute of Neurosurgery, The PLA Navy General Hospital, Beijing 100048, P.R. China
| | - Wang-Sheng Lu
- Institute of Neurosurgery, The PLA Navy General Hospital, Beijing 100048, P.R. China
| | - Ying-Kui Liang
- PET Center, The PLA Navy General Hospital, Beijing 100048, P.R. China
| | - Josefin Adlerberth
- Department of Pure and Applied Biochemistry, Lund University, Lund, 22100 Scania, Sweden
| | - Zeng-Min Tian
- Institute of Neurosurgery, The PLA Navy General Hospital, Beijing 100048, P.R. China
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Neumann WJ, Kühn AA. Reply: Role of cortico-pallidal connectivity in the pathophysiology of dystonia. Brain 2016; 139:e49. [PMID: 27190018 DOI: 10.1093/brain/aww105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Wolf-Julian Neumann
- Sektion Bewegungsstörungen und Neuromodulation, Klinik für Neurologie, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Andrea A Kühn
- Sektion Bewegungsstörungen und Neuromodulation, Klinik für Neurologie, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin, Berlin, Germany
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Zhang Y, Zhang YC, Sheng YJ, Chen XF, Wang CS, Ma Q, Chen HB, Yu LF, Mao CJ, Xiong KP, Luo WF, Liu CF. Sonographic Alteration of Basal Ganglia in Different Forms of Primary Focal Dystonia: A Cross-sectional Study. Chin Med J (Engl) 2016; 129:942-5. [PMID: 27064039 PMCID: PMC4831529 DOI: 10.4103/0366-6999.179792] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Few studies have addressed whether abnormalities in the lenticular nucleus (LN) are characteristic transcranial sonography (TCS) echo features in patients with primary dystonia. This study aimed to explore alterations in the basal ganglia in different forms of primary focal dystonia. Methods: cross-sectional observational study was performed between December 2013 and December 2014 in 80 patients with different forms of primary focal dystonia and 55 neurologically normal control subjects. TCS was performed in patients and control subjects. Multiple comparisons of multiple rates were used to compare LN hyperechogenicity ratios between control and patient groups. Results: Thirteen individuals were excluded due to poor temporal bone windows, and two subjects were excluded due to disagreement in evaluation by sonologists. Totally, 70 patients (cervical dystonia, n = 30; blepharospasm, n = 30; oromandibular dystonia, n = 10) and 50 normal controls were included in the final analysis. LN hyperechogenicity was observed in 51% (36/70) of patients with primary focal dystonia, compared with 12% (6/50) of controls (P < 0.001). Substantia nigra hyperechogenicity did not differ between the two groups. LN hyperechogenicity was observed in 73% (22/30) of patients with cervical dystonia, a greater prevalence than in patients with blepharospasm (33%, 10/30, P = 0.002) and oromandibular dystonia (40%, 4/10, P = 0.126). LN hyperechogenicity was more frequently observed in patients with cervical dystonia compared with controls (73% vs. 12%, P < 0.001); however, no significant difference was detected in patients with blepharospasm (33% vs. 12%, P = 0.021) or oromandibular dystonia (40% vs. 12%, P = 0.088). Conclusions: LN hyperechogenicity is more frequently observed in patients with primary focal dystonia than in controls. It does not appear to be a characteristic TCS echo feature in patients with blepharospasm or oromandibular dystonia.
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Affiliation(s)
| | - Ying-Chun Zhang
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, China
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105
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Albanese A, Sorbo FD. Dystonia and Tremor: The Clinical Syndromes with Isolated Tremor. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2016; 6:319. [PMID: 27152246 PMCID: PMC4850743 DOI: 10.7916/d8x34xbm] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 02/21/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Dystonia and tremor share many commonalities. Isolated tremor is part of the phenomenological spectrum of isolated dystonia and of essential tremor. The occurrence of subtle features of dystonia may allow one to differentiate dystonic tremor from essential tremor. Diagnostic uncertainty is enhanced when no features of dystonia are found in patients with a tremor syndrome, raising the question whether the observed phenomenology is an incomplete form of dystonia. METHODS Known forms of syndromes with isolated tremor are reviewed. Diagnostic uncertainties between tremor and dystonia are put into perspective. RESULTS The following isolated tremor syndromes are reviewed: essential tremor, head tremor, voice tremor, jaw tremor, and upper-limb tremor. Their varied phenomenology is analyzed and appraised in the light of a possible relationship with dystonia. DISCUSSION Clinicians making a diagnosis of isolated tremor should remain vigilant for the detection of features of dystonia. This is in keeping with the recent view that isolated tremor may be an incomplete phenomenology of dystonia.
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Affiliation(s)
- Alberto Albanese
- Istituto Clinico Humanitas, Rozzano, Italy; Istituto di Neurologia, Università Cattolica del Sacro Cuore, Milan, Italy
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106
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Valls-Sole J, Defazio G. Blepharospasm: Update on Epidemiology, Clinical Aspects, and Pathophysiology. Front Neurol 2016; 7:45. [PMID: 27064462 PMCID: PMC4814756 DOI: 10.3389/fneur.2016.00045] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 03/14/2016] [Indexed: 12/12/2022] Open
Abstract
Blepharospasm (BSP) is a rather distressing form of focal dystonia. Although many aspects of its pathophysiological mechanisms are already known, we lack fundamental evidence on etiology, prevention, and treatment. To advance in our knowledge, we need to review what is already known in various aspects of the disorder and use these bases to find future lines of interest. Some of the signs observed in BSP are cause, while others are consequence of the disorder. Non-motor symptoms and signs may be a cue for understanding better the disease. Various cerebral sites have been shown to be functionally abnormal in BSP, including the basal ganglia, the cortex, and the cerebellum. However, we still do not know if the dysfunction or structural change affecting these brain regions is cause or consequence of BSP. Further advances in neurophysiology and neuroimaging may eventually clarify the pathophysiological mechanisms implicated. In this manuscript, we aim to update what is known regarding epidemiology, clinical aspects, and pathophysiology of the disorder and speculate on the directions of research worth pursuing in the near future.
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Affiliation(s)
- Josep Valls-Sole
- EMG and Motor Control Section, Neurology Department, Hospital Clinic, University of Barcelona , Barcelona , Spain
| | - Giovanni Defazio
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, "Aldo Moro" University of Bari , Bari , Italy
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Kostic VS, Agosta F, Sarro L, Tomić A, Kresojević N, Galantucci S, Svetel M, Valsasina P, Filippi M. Brain structural changes in spasmodic dysphonia: A multimodal magnetic resonance imaging study. Parkinsonism Relat Disord 2016; 25:78-84. [PMID: 26876036 DOI: 10.1016/j.parkreldis.2016.02.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 01/27/2016] [Accepted: 02/01/2016] [Indexed: 01/15/2023]
Abstract
INTRODUCTION The pathophysiology of spasmodic dysphonia is poorly understood. This study evaluated patterns of cortical morphology, basal ganglia, and white matter microstructural alterations in patients with spasmodic dysphonia relative to healthy controls. METHODS T1-weighted and diffusion tensor magnetic resonance imaging (MRI) scans were obtained from 13 spasmodic dysphonia patients and 30 controls. Tract-based spatial statistics was applied to compare diffusion tensor MRI indices (i.e., mean, radial and axial diffusivities, and fractional anisotropy) between groups on a voxel-by-voxel basis. Cortical measures were analyzed using surface-based morphometry. Basal ganglia were segmented on T1-weighted images, and volumes and diffusion tensor MRI metrics of nuclei were measured. RESULTS Relative to controls, patients with spasmodic dysphonia showed increased cortical surface area of the primary somatosensory cortex bilaterally in a region consistent with the buccal sensory representation, as well as right primary motor cortex, left superior temporal, supramarginal and superior frontal gyri. A decreased cortical area was found in the rolandic operculum bilaterally, left superior/inferior parietal and lingual gyri, as well as in the right angular gyrus. Compared to controls, spasmodic dysphonia patients showed increased diffusivities and decreased fractional anisotropy of the corpus callosum and major white matter tracts, in the right hemisphere. Altered diffusion tensor MRI measures were found in the right caudate and putamen nuclei with no volumetric changes. CONCLUSIONS Multi-level alterations in voice-controlling networks, that included regions devoted not only to sensorimotor integration, motor preparation and motor execution, but also processing of auditory and visual information during speech, might have a role in the pathophysiology of spasmodic dysphonia.
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Affiliation(s)
- Vladimir S Kostic
- Clinic of Neurology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Federica Agosta
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Lidia Sarro
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Aleksandra Tomić
- Clinic of Neurology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nikola Kresojević
- Clinic of Neurology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Sebastiano Galantucci
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Marina Svetel
- Clinic of Neurology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Paola Valsasina
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
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108
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Obeso I, Cerasa A, Quattrone A. The Effectiveness of Transcranial Brain Stimulation in Improving Clinical Signs of Hyperkinetic Movement Disorders. Front Neurosci 2016; 9:486. [PMID: 26778947 PMCID: PMC4703824 DOI: 10.3389/fnins.2015.00486] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 12/07/2015] [Indexed: 01/21/2023] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is a safe and painless method for stimulating cortical neurons. In neurological realm, rTMS has prevalently been applied to understand pathophysiological mechanisms underlying movement disorders. However, this tool has also the potential to be translated into a clinically applicable therapeutic use. Several available studies supported this hypothesis, but differences in protocols, clinical enrollment, and variability of rTMS effects across individuals complicate better understanding of efficient clinical protocols. The aim of this present review is to discuss to what extent the evidence provided by the therapeutic use of rTMS may be generalized. In particular, we attempted to define optimal cortical regions and stimulation protocols that have been demonstrated to maximize the effectiveness seen in the actual literature for the three most prevalent hyperkinetic movement disorders: Parkinson's disease (PD) with levodopa-induced dyskinesias (LIDs), essential tremor (ET) and dystonia. A total of 28 rTMS studies met our search criteria. Despite clinical and methodological differences, overall these studies demonstrated that therapeutic applications of rTMS to "normalize" pathologically decreased or increased levels of cortical activity have given moderate progress in patient's quality of life. Moreover, the present literature suggests that altered pathophysiology in hyperkinetic movement disorders establishes motor, premotor or cerebellar structures as candidate regions to reset cortico-subcortical pathways back to normal. Although rTMS has the potential to become a powerful tool for ameliorating the clinical outcome of hyperkinetic neurological patients, until now there is not a clear consensus on optimal protocols for these motor disorders. Well-controlled multicenter randomized clinical trials with high numbers of patients are urgently required.
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Affiliation(s)
- Ignacio Obeso
- Centro Integral en Neurociencias A. C. (CINAC), HM Hospitales – Puerta del Sur. MóstolesMadrid, Spain
- Center for Networked Biomedical Research on Neurodegenerative DiseasesMadrid, Spain
| | - Antonio Cerasa
- Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology - National Research CouncilGermaneto, Italy
| | - Aldo Quattrone
- Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology - National Research CouncilGermaneto, Italy
- Neurology Unit, Institute of Neurology, University “Magna Graecia”Catanzaro, Italy
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109
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Lumsden DE, Ashmore J, Ball G, Charles-Edwards G, Selway R, Ashkan K, Lin JP. Fractional anisotropy in children with dystonia or spasticity correlates with the selection for DBS or ITB movement disorder surgery. Neuroradiology 2016; 58:401-8. [PMID: 26759316 PMCID: PMC4819774 DOI: 10.1007/s00234-015-1639-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 12/01/2015] [Indexed: 12/30/2022]
Abstract
INTRODUCTION There is increasing interest in neurosurgical interventions for hypertonicity in children and young people (CAYP), which often presents with a mixture of dystonia and spasticity. Significant spasticity would usually be considered a contraindication for deep brain stimulation (DBS) and more suitably treated with intrathecal baclofen (ITB). We aimed to explore whether white matter microstructure, as measured by Fractional Anisotropy (FA), differed between CAYP selected for DBS compared to ITB surgery. METHODS We retrospectively analysed Diffusion Tensor Imaging for 31 CAYP selected for DBS surgery (14 primary dystonia, 17 secondary dystonia) and 10 CAYP selected for ITB surgery. A voxel-wise comparison of FA values was performed using tract-based spatial statistics, comparing primary and secondary dystonia groups to the ITB group, and the two dystonia groups. RESULTS Widespread areas of reduced FA were demonstrated in ITB compared to either DBS group and in CAYP with secondary compared to primary dystonia. These changes were not restricted to motor pathways. Region of interest (ROI) analysis from the corticospinal tract (CST) demonstrated groupwise differences but overlapping values at the individual level. CONCLUSIONS DTI measures may contribute to decision making for CAYP selection for movement disorder surgery. Significant differences in CAYP with secondary dystonia selected for DBS surgery compared to CAYP selected for ITB pump implants, suggesting that more extensive white matter injury may be a feature of the spastic motor phenotype. Altered white matter microstructure could potentially explain the reduced responsiveness to interventions such as DBS in secondary compared to primary dystonia.
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Affiliation(s)
- Daniel E. Lumsden
- Complex Motor Disorders Service, Evelina Children’s Hospital, Guy’s & St Thomas’ NHS Foundation Trust, Lambeth Palace Road, London, SE1 7EH UK ,Imaging Sciences and Biomedical Engineering, King’s College London, London, UK
| | - Jonathan Ashmore
- Imaging Sciences and Biomedical Engineering, King’s College London, London, UK
| | - Gareth Ball
- Centre for the Developing Brain, King’s College London, London, UK
| | - Geoffrey Charles-Edwards
- Imaging Sciences and Biomedical Engineering, King’s College London, London, UK ,Medical Physics, St Thomas’ Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Richard Selway
- Functional Neurosurgery, King’s College Hospital, King’s College Hospital NHS Foundation Trust, London, UK
| | - Keyoumars Ashkan
- Functional Neurosurgery, King’s College Hospital, King’s College Hospital NHS Foundation Trust, London, UK ,Clinical Neuroscience, Institute of Psychiatry, London, UK
| | - Jean-Pierre Lin
- Complex Motor Disorders Service, Evelina Children’s Hospital, Guy’s & St Thomas’ NHS Foundation Trust, Lambeth Palace Road, London, SE1 7EH UK
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Liu YB, Tewari A, Salameh J, Arystarkhova E, Hampton TG, Brashear A, Ozelius LJ, Khodakhah K, Sweadner KJ. A dystonia-like movement disorder with brain and spinal neuronal defects is caused by mutation of the mouse laminin β1 subunit, Lamb1. eLife 2015; 4. [PMID: 26705335 PMCID: PMC4749547 DOI: 10.7554/elife.11102] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 12/15/2015] [Indexed: 12/30/2022] Open
Abstract
A new mutant mouse (lamb1t) exhibits intermittent dystonic hindlimb movements and postures when awake, and hyperextension when asleep. Experiments showed co-contraction of opposing muscle groups, and indicated that symptoms depended on the interaction of brain and spinal cord. SNP mapping and exome sequencing identified the dominant causative mutation in the Lamb1 gene. Laminins are extracellular matrix proteins, widely expressed but also known to be important in synapse structure and plasticity. In accordance, awake recording in the cerebellum detected abnormal output from a circuit of two Lamb1-expressing neurons, Purkinje cells and their deep cerebellar nucleus targets, during abnormal postures. We propose that dystonia-like symptoms result from lapses in descending inhibition, exposing excess activity in intrinsic spinal circuits that coordinate muscles. The mouse is a new model for testing how dysfunction in the CNS causes specific abnormal movements and postures.
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Affiliation(s)
- Yi Bessie Liu
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, United States
| | - Ambika Tewari
- Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, New York, United States
| | - Johnny Salameh
- Department of Neurology, University of Massachusetts Medical School, Worcester, United States
| | - Elena Arystarkhova
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, United States
| | - Thomas G Hampton
- Neuroscience Discovery Core, Mouse Specifics Inc., Framingham, United States
| | - Allison Brashear
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, United States
| | - Laurie J Ozelius
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, United States
| | - Kamran Khodakhah
- Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, New York, United States
| | - Kathleen J Sweadner
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, United States
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111
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Tibussek D, Mayatepek E, Klee D, Koy A. Post stroke hemi-dystonia in children: a neglected area of research. Mol Cell Pediatr 2015; 2:14. [PMID: 26660977 PMCID: PMC4676777 DOI: 10.1186/s40348-015-0026-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 12/08/2015] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Childhood arterial ischemic stroke (CAIS) is increasingly recognized as an important cause of significant long-term morbidity in the pediatric population. Post stroke movement disorders, above all hemi-dystonias, are much more common in children after stroke compared to adults. However, research in this field is largely lacking. By highlighting some important knowledge gaps, we aim to encourage future collaborative research projects in this particular field. FINDINGS Post stroke-dystonia seems to be much more common among children than adults. However, no reliable epidemiological data of post-stroke movement disorders in childhood are available, and differentiation between spasticity and dystonia can be challenging. Pharmacotherapy for dystonia is limited by lack of effect, especially in the long-term treatment. The pathophysiology of dystonia is complex and incompletely understood. Recent findings from functional imaging studies suggest that dystonia does not result from a single lesion but rather network dysfunctions and abnormalities in functional connectivity. However, very few patients with post stroke dystonia have been studied, and it is not clear to what extent pathophysiology of primary and post stroke ischemia shares common characteristics on network level. In general, progress in understanding the nature of childhood dystonia lags far behind adult onset CNS diseases. CONCLUSIONS Dystonia after CAIS is a common yet insufficiently understood and poorly studied clinical challenge. Studies to improve our understanding of the underlying pathophysiology and consequently the development of instruments for early prediction as well as targeted treatment of dystonia should become a high priority in collaborative childhood stroke research.
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Affiliation(s)
- Daniel Tibussek
- Department of General Pediatrics, Neonatalogy and Pediatric Cardiology, University Children's Hospital, Heinrich-Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany.
| | - Ertan Mayatepek
- Department of General Pediatrics, Neonatalogy and Pediatric Cardiology, University Children's Hospital, Heinrich-Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany.
| | - Dirk Klee
- Department of Neurology, University of Cologne, Kerpener Strasse 62, 50924, Cologne, Germany.
| | - Anne Koy
- Department of General Pediatrics, Neonatalogy and Pediatric Cardiology, University Children's Hospital, Heinrich-Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany. .,Department of Neurology, University of Cologne, Kerpener Strasse 62, 50924, Cologne, Germany.
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112
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Løkkegaard A, Herz DM, Haagensen BN, Lorentzen AK, Eickhoff SB, Siebner HR. Altered sensorimotor activation patterns in idiopathic dystonia-an activation likelihood estimation meta-analysis of functional brain imaging studies. Hum Brain Mapp 2015; 37:547-57. [PMID: 26549606 PMCID: PMC4738472 DOI: 10.1002/hbm.23050] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 09/17/2015] [Accepted: 10/23/2015] [Indexed: 11/24/2022] Open
Abstract
Dystonia is characterized by sustained or intermittent muscle contractions causing abnormal, often repetitive, movements or postures. Functional neuroimaging studies have yielded abnormal task‐related sensorimotor activation in dystonia, but the results appear to be rather variable across studies. Further, study size was usually small including different types of dystonia. Here we performed an activation likelihood estimation (ALE) meta‐analysis of functional neuroimaging studies in patients with primary dystonia to test for convergence of dystonia‐related alterations in task‐related activity across studies. Activation likelihood estimates were based on previously reported regional maxima of task‐related increases or decreases in dystonia patients compared to healthy controls. The meta‐analyses encompassed data from 179 patients with dystonia reported in 18 functional neuroimaging studies using a range of sensorimotor tasks. Patients with dystonia showed bilateral increases in task‐related activation in the parietal operculum and ventral postcentral gyrus as well as right middle temporal gyrus. Decreases in task‐related activation converged in left supplementary motor area and left postcentral gyrus, right superior temporal gyrus and dorsal midbrain. Apart from the midbrain cluster, all between‐group differences in task‐related activity were retrieved in a sub‐analysis including only the 14 studies on patients with focal dystonia. For focal dystonia, an additional cluster of increased sensorimotor activation emerged in the caudal cingulate motor zone. The results show that dystonia is consistently associated with abnormal somatosensory processing in the primary and secondary somatosensory cortex along with abnormal sensorimotor activation of mesial premotor and right lateral temporal cortex. Hum Brain Mapp 37:547–557, 2016. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Annemette Løkkegaard
- Department of NeurologyCopenhagen University Hospital BispebjergCopenhagenDenmark
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and ResearchCopenhagen University Hospital HvidovreHvidovreDenmark
| | - Damian M. Herz
- Department of NeurologyCopenhagen University Hospital BispebjergCopenhagenDenmark
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and ResearchCopenhagen University Hospital HvidovreHvidovreDenmark
| | - Brian N. Haagensen
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and ResearchCopenhagen University Hospital HvidovreHvidovreDenmark
| | - Anne K. Lorentzen
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and ResearchCopenhagen University Hospital HvidovreHvidovreDenmark
| | - Simon B. Eickhoff
- Institute of Neuroscience and Medicine (INM‐1), Research Center JülichGermany
- Institute of Clinical Neuroscience and Medical Psychology, Heinrich‐Heine University DüsseldorfGermany
| | - Hartwig R. Siebner
- Department of NeurologyCopenhagen University Hospital BispebjergCopenhagenDenmark
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and ResearchCopenhagen University Hospital HvidovreHvidovreDenmark
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113
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Rose SJ, Yu XY, Heinzer AK, Harrast P, Fan X, Raike RS, Thompson VB, Pare JF, Weinshenker D, Smith Y, Jinnah HA, Hess EJ. A new knock-in mouse model of l-DOPA-responsive dystonia. Brain 2015. [PMID: 26220941 DOI: 10.1093/brain/awv212] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abnormal dopamine neurotransmission is associated with many different genetic and acquired dystonic disorders. For instance, mutations in genes critical for the synthesis of dopamine, including GCH1 and TH cause l-DOPA-responsive dystonia. Despite evidence that implicates abnormal dopamine neurotransmission in dystonia, the precise nature of the pre- and postsynaptic defects that result in dystonia are not known. To better understand these defects, we generated a knock-in mouse model of l-DOPA-responsive dystonia (DRD) mice that recapitulates the human p.381Q>K TH mutation (c.1141C>A). Mice homozygous for this mutation displayed the core features of the human disorder, including reduced TH activity, dystonia that worsened throughout the course of the active phase, and improvement in the dystonia in response to both l-DOPA and trihexyphenidyl. Although the gross anatomy of the nigrostriatal dopaminergic neurons was normal in DRD mice, the microstructure of striatal synapses was affected whereby the ratio of axo-spinous to axo-dendritic corticostriatal synaptic contacts was reduced. Microinjection of l-DOPA directly into the striatum ameliorated the dystonic movements but cerebellar microinjections of l-DOPA had no effect. Surprisingly, the striatal dopamine concentration was reduced to ∼1% of normal, a concentration more typically associated with akinesia, suggesting that (mal)adaptive postsynaptic responses may also play a role in the development of dystonia. Administration of D1- or D2-like dopamine receptor agonists to enhance dopamine signalling reduced the dystonic movements, whereas administration of D1- or D2-like dopamine receptor antagonists to further reduce dopamine signalling worsened the dystonia, suggesting that both receptors mediate the abnormal movements. Further, D1-dopamine receptors were supersensitive; adenylate cyclase activity, locomotor activity and stereotypy were exaggerated in DRD mice in response to the D1-dopamine receptor agonist SKF 81297. D2-dopamine receptors exhibited a change in the valence in DRD mice with an increase in adenylate cyclase activity and blunted behavioural responses after challenge with the D2-dopamine receptor agonist quinpirole. Together, our findings suggest that the development of dystonia may depend on a reduction in dopamine in combination with specific abnormal receptor responses.
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Affiliation(s)
- Samuel J Rose
- 1 Department of Pharmacology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Xin Y Yu
- 1 Department of Pharmacology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Ann K Heinzer
- 2 Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Porter Harrast
- 1 Department of Pharmacology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Xueliang Fan
- 1 Department of Pharmacology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Robert S Raike
- 1 Department of Pharmacology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Valerie B Thompson
- 1 Department of Pharmacology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Jean-Francois Pare
- 3 Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329, USA 4 Udall Center of Excellence for Parkinson's Disease, Emory University, Atlanta, GA 30329, USA
| | - David Weinshenker
- 5 Department of Human Genetics, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Yoland Smith
- 3 Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329, USA 4 Udall Center of Excellence for Parkinson's Disease, Emory University, Atlanta, GA 30329, USA 6 Department of Neurology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Hyder A Jinnah
- 5 Department of Human Genetics, Emory University School of Medicine, Atlanta, GA 30322, USA 6 Department of Neurology, Emory University School of Medicine, Atlanta, GA 30322, USA 7 Department of Pediatrics Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Ellen J Hess
- 1 Department of Pharmacology, Emory University School of Medicine, Atlanta, GA 30322, USA 6 Department of Neurology, Emory University School of Medicine, Atlanta, GA 30322, USA
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114
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Abstract
The dystonias are a group of disorders characterized by excessive involuntary muscle contractions leading to abnormal postures and/or repetitive movements. A careful assessment of the clinical manifestations is helpful for identifying syndromic patterns that focus diagnostic testing on potential causes. If a cause is identified, specific etiology-based treatments may be available. In most cases, a specific cause cannot be identified, and treatments are based on symptoms. Treatment options include counseling, education, oral medications, botulinum toxin injections, and several surgical procedures. A substantial reduction in symptoms and improved quality of life is achieved in most patients by combining these options.
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Affiliation(s)
- H A Jinnah
- Department of Neurology, Emory University School of Medicine, 6300 Woodruff Memorial Research Building, 101 Woodruff Circle, Emory University, Atlanta, GA 30322, USA; Department of Human Genetics, Emory University School of Medicine, 6300 Woodruff Memorial Research Building, 101 Woodruff Circle, Emory University, Atlanta, GA 30322, USA; Department of Pediatrics, Emory University School of Medicine, 6300 Woodruff Memorial Research Building, 101 Woodruff Circle, Emory University, Atlanta, GA 30322, USA.
| | - Stewart A Factor
- Department of Neurology, Emory University School of Medicine, 6300 Woodruff Memorial Research Building, 101 Woodruff Circle, Emory University, Atlanta, GA 30322, USA
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115
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Shaikh AG, Ghasia FF, DeLong MR, Jinnah HA, Freeman A, Factor SA. Ocular palatal tremor plus dystonia - new syndromic association. Mov Disord Clin Pract 2015; 2:267-270. [PMID: 26889496 DOI: 10.1002/mdc3.12193] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE Ocular palatal tremor typically develops after a breach in the Guillian-Mollaret triangle. We herein describe a variant of this syndrome in which dystonia is also present, hence called, here, ocular palatal tremor plus dystonia. METHODS We assessed eye-head movements and dystonia in six patients with ocular palatal plus dystonia. RESULTS Among six patients with ocular palatal tremor two had focal dystonia, three had multifocal dystonia, and one had generalized dystonia. The dystonia affected the upper extremities and neck in four patients, the lower extremities in three and the face in two. Three out of four cervical dystonia patients had head tremor. Two patients also had speech involvement. Lack of correlation between eye and head oscillations suggested that head oscillations were not compensatory or secondary to the eye oscillations and vice versa. CONCLUSIONS We describe a novel variant of ocular palatal tremor with dystonia. We speculate that in such variant the dystonia is possibly could be a result of abnormal cerebellar outflow in patients with a breach in Guillain-Mollaret triangle.
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116
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Abstract
Dystonia is a neurologic disorder characterized by sustained involuntary muscle contractions. Lesions responsible for unilateral secondary dystonia are confined to the putamen, caudate, globus pallidus, and thalamus. Dysfunction of these structures is suspected to play a role in both primary and secondary dystonia. Recent evidence has suggested that the cerebellum may play a role in the pathophysiology of dystonia. The role of the cerebellum in ataxia, a disorder of motor incoordination is well established. How may the cerebellum contribute to two apparently very different movement disorders? This review will discuss the idea of whether in some cases, ataxia and dystonia lie in the same clinical spectrum and whether graded perturbations in cerebellar function may explain a similar causative role for the cerebellum in these two different motor disorders. The review also proposes a model for cerebellar dystonia based on the available animal models of this disorder.
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117
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Iacono D, Geraci-Erck M, Peng H, Rabin ML, Kurlan R. Reduced Number of Pigmented Neurons in the Substantia Nigra of Dystonia Patients? Findings from Extensive Neuropathologic, Immunohistochemistry, and Quantitative Analyses. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2015; 5. [PMID: 26069855 PMCID: PMC4458735 DOI: 10.7916/d8t72g9g] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 03/07/2015] [Indexed: 01/05/2023]
Abstract
Background Dystonias (Dys) represent the third most common movement disorder after essential tremor (ET) and Parkinson's disease (PD). While some pathogenetic mechanisms and genetic causes of Dys have been identified, little is known about their neuropathologic features. Previous neuropathologic studies have reported generically defined neuronal loss in various cerebral regions of Dys brains, mostly in the basal ganglia (BG), and specifically in the substantia nigra (SN). Enlarged pigmented neurons in the SN of Dys patients with and without specific genetic mutations (e.g., GAG deletions in DYT1 dystonia) have also been described. Whether or not Dys brains are associated with decreased numbers or other morphometric changes of specific neuronal types is unknown and has never been addressed with quantitative methodologies. Methods Quantitative immunohistochemistry protocols were used to estimate neuronal counts and volumes of nigral pigmented neurons in 13 SN of Dys patients and 13 SN of age-matched control subjects (C). Results We observed a significant reduction (∼20%) of pigmented neurons in the SN of Dys compared to C (p<0.01). Neither significant volumetric changes nor evident neurodegenerative signs were observed in the remaining pool of nigral pigmented neurons in Dys brains. These novel quantitative findings were confirmed after exclusion of possible co-occurring SN pathologies including Lewy pathology, tau-neurofibrillary tangles, β-amyloid deposits, ubiquitin (ubiq), and phosphorylated-TAR DNA-binding protein 43 (pTDP43)-positive inclusions. Discussion A reduced number of nigral pigmented neurons in the absence of evident neurodegenerative signs in Dys brains could indicate previously unconsidered pathogenetic mechanisms of Dys such as neurodevelopmental defects in the SN.
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Affiliation(s)
- Diego Iacono
- Neuropathology Research, Biomedical Research Institute of New Jersey, BRInj, Cedar Knolls, NJ, USA ; Movement Disorders Program, Atlantic Neuroscience Institute, Overlook Medical Center, Summit, NJ, USA ; Department of Neurology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York City, NY, USA
| | - Maria Geraci-Erck
- Neuropathology Research, Biomedical Research Institute of New Jersey, BRInj, Cedar Knolls, NJ, USA
| | - Hui Peng
- Neuropathology Research, Biomedical Research Institute of New Jersey, BRInj, Cedar Knolls, NJ, USA
| | - Marcie L Rabin
- Movement Disorders Program, Atlantic Neuroscience Institute, Overlook Medical Center, Summit, NJ, USA
| | - Roger Kurlan
- Movement Disorders Program, Atlantic Neuroscience Institute, Overlook Medical Center, Summit, NJ, USA ; Department of Neurology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York City, NY, USA
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118
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Neumann WJ, Jha A, Bock A, Huebl J, Horn A, Schneider GH, Sander TH, Litvak V, Kühn AA. Cortico-pallidal oscillatory connectivity in patients with dystonia. Brain 2015; 138:1894-906. [PMID: 25935723 DOI: 10.1093/brain/awv109] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 02/26/2015] [Indexed: 12/12/2022] Open
Abstract
Primary dystonia has been associated with an underlying dysfunction of a wide network of brain regions including the motor cortex, basal ganglia, cerebellum, brainstem and spinal cord. Dystonia can be effectively treated by pallidal deep brain stimulation although the mechanism of this effect is not well understood. Here, we sought to characterize cortico-basal ganglia functional connectivity using a frequency-specific measure of connectivity-coherence. We recorded direct local field potentials from the human pallidum simultaneously with whole head magnetoencephalography to characterize functional connectivity in the cortico-pallidal oscillatory network in nine patients with idiopathic dystonia. Three-dimensional cortico-pallidal coherence images were compared to surrogate images of phase shuffled data across patients to reveal clusters of significant coherence (family-wise error P < 0.01, voxel extent 1000). Three frequency-specific, spatially-distinct cortico-pallidal networks have been identified: a pallido-temporal source of theta band (4-8 Hz) coherence, a pallido-cerebellar source of alpha band (7-13 Hz) coherence and a cortico-pallidal source of beta band (13-30 Hz) coherence over sensorimotor areas. Granger-based directionality analysis revealed directional coupling with the pallidal local field potentials leading in the theta and alpha band and the magnetoencephalographic cortical source leading in the beta band. The degree of pallido-cerebellar coupling showed an inverse correlation with dystonic symptom severity. Our data extend previous findings in patients with Parkinson's disease describing motor cortex-basal ganglia oscillatory connectivity in the beta band to patients with dystonia. Source coherence analysis revealed two additional frequency-specific networks involving the temporal cortex and the cerebellum. Pallido-cerebellar oscillatory connectivity and its association with dystonic symptoms provides further confirmation of cerebellar involvement in dystonia that has been recently reported using functional magnetic resonance imaging and fibre tracking.
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Affiliation(s)
- Wolf-Julian Neumann
- 1 Department of Neurology, Campus Virchow Klinikum, Charité-University Medicine Berlin, Augustenburger Platz 1,13353 Berlin, Germany 2 The Wellcome Trust Centre for Neuroimaging, UCL Institute of Neurology, 12 Queen Square, London WC1N 3BG, UK
| | - Ashwani Jha
- 3 Sobell Department of Movement Disorders, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK
| | - Antje Bock
- 1 Department of Neurology, Campus Virchow Klinikum, Charité-University Medicine Berlin, Augustenburger Platz 1,13353 Berlin, Germany
| | - Julius Huebl
- 1 Department of Neurology, Campus Virchow Klinikum, Charité-University Medicine Berlin, Augustenburger Platz 1,13353 Berlin, Germany
| | - Andreas Horn
- 1 Department of Neurology, Campus Virchow Klinikum, Charité-University Medicine Berlin, Augustenburger Platz 1,13353 Berlin, Germany
| | - Gerd-Helge Schneider
- 4 Department of Neurosurgery, Campus Virchow Klinikum, Charité-University Medicine Berlin, Augustenburger Platz 1,13353 Berlin, Germany
| | - Tillmann H Sander
- 5 Physikalisch-Technische Bundesanstalt, Institut Berlin, Abbestr. 2-12, 10587 Berlin, Germany
| | - Vladimir Litvak
- 2 The Wellcome Trust Centre for Neuroimaging, UCL Institute of Neurology, 12 Queen Square, London WC1N 3BG, UK
| | - Andrea A Kühn
- 1 Department of Neurology, Campus Virchow Klinikum, Charité-University Medicine Berlin, Augustenburger Platz 1,13353 Berlin, Germany 6 Berlin School of Mind and Brain, Charité - University Medicine Berlin, Unter den Linden 6, 10099 Berlin,Germany Berlin, Germany 7 NeuroCure, Charité - University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany
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119
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Gallea C, Balas M, Bertasi E, Valabregue R, García-Lorenzo D, Coynel D, Bonnet C, Grabli D, Pélégrini-Issac M, Doyon J, Benali H, Roze E, Vidailhet M, Lehericy S. Increased cortico-striatal connectivity during motor practice contributes to the consolidation of motor memory in writer's cramp patients. NEUROIMAGE-CLINICAL 2015; 8:180-92. [PMID: 26106542 PMCID: PMC4473821 DOI: 10.1016/j.nicl.2015.04.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 04/15/2015] [Accepted: 04/16/2015] [Indexed: 01/19/2023]
Abstract
Sensorimotor representations of movements are created in the sensorimotor network through repeated practice to support successful and effortless performance. Writer's cramp (WC) is a disorder acquired through extensive practice of finger movements, and it is likely associated with the abnormal acquisition of sensorimotor representations. We investigated (i) the activation and connectivity changes in the brain network supporting the acquisition of sensorimotor representations of finger sequences in patients with WC and (ii) the link between these changes and consolidation of motor performance 24 h after the initial practice. Twenty-two patients with WC and 22 age-matched healthy volunteers practiced a complex sequence with the right (pathological) hand during functional MRI recording. Speed and accuracy were measured immediately before and after practice (day 1) and 24 h after practice (day 2). The two groups reached equivalent motor performance on day 1 and day 2. During motor practice, patients with WC had (i) reduced hippocampal activation and hippocampal-striatal functional connectivity; and (ii) overactivation of premotor-striatal areas, whose connectivity correlated with motor performance after consolidation. These results suggest that patients with WC use alternative networks to reach equiperformance in the acquisition of new motor memories.
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Key Words
- BA, Brodmann area
- CD, consolidation dependent
- CV-RT, coefficient of variation for reaction time
- DT1, dual task 1
- DT2, dual task 2
- FA, fractional anisotropy
- FHD, focal hand dystonia
- Focal dystonia
- HV, healthy volunteers
- Hippocampus
- LD, longitudinal diffusivity
- MRI
- Motor cortex
- PD, practice dependent
- PMd, dorsal premotor cortex
- PMv, ventral premotor cortex
- PPI, psychophysiological interaction
- RD, radial diffusivity
- Striatum
- WC, writer's cramp
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Affiliation(s)
- C Gallea
- Université Pierre et Marie Curie (UPMC Univ Paris 6), Institut du Cerveau et de la Moelle épinière - ICM, UMR-S975, Inserm, U975, CNRS, UMR 7225, Paris, France ; Centre de Neuroimagerie de Recherche, CENIR, Institut du Cerveau et de la Moelle épinière - ICM, Paris, France
| | - M Balas
- Université Pierre et Marie Curie (UPMC Univ Paris 6), Institut du Cerveau et de la Moelle épinière - ICM, UMR-S975, Inserm, U975, CNRS, UMR 7225, Paris, France ; Centre de Neuroimagerie de Recherche, CENIR, Institut du Cerveau et de la Moelle épinière - ICM, Paris, France ; Laboratoire d'Imagerie NeuroFonctionnelle, Université Pierre et Marie Curie (UPMC Univ Paris 6), Inserm U678, Paris, France
| | - E Bertasi
- Université Pierre et Marie Curie (UPMC Univ Paris 6), Institut du Cerveau et de la Moelle épinière - ICM, UMR-S975, Inserm, U975, CNRS, UMR 7225, Paris, France ; Centre de Neuroimagerie de Recherche, CENIR, Institut du Cerveau et de la Moelle épinière - ICM, Paris, France
| | - R Valabregue
- Université Pierre et Marie Curie (UPMC Univ Paris 6), Institut du Cerveau et de la Moelle épinière - ICM, UMR-S975, Inserm, U975, CNRS, UMR 7225, Paris, France
| | - D García-Lorenzo
- Université Pierre et Marie Curie (UPMC Univ Paris 6), Institut du Cerveau et de la Moelle épinière - ICM, UMR-S975, Inserm, U975, CNRS, UMR 7225, Paris, France
| | - D Coynel
- Laboratoire d'Imagerie NeuroFonctionnelle, Université Pierre et Marie Curie (UPMC Univ Paris 6), Inserm U678, Paris, France
| | - C Bonnet
- Fédération de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France ; Centre d'Investigation Clinique, Groupe Hospitalier Pitié-Salpêtrière, Paris, France ; Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - D Grabli
- Université Pierre et Marie Curie (UPMC Univ Paris 6), Institut du Cerveau et de la Moelle épinière - ICM, UMR-S975, Inserm, U975, CNRS, UMR 7225, Paris, France ; Fédération de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France ; Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - M Pélégrini-Issac
- Laboratoire d'Imagerie NeuroFonctionnelle, Université Pierre et Marie Curie (UPMC Univ Paris 6), Inserm U678, Paris, France
| | - J Doyon
- Unité de Neuroimagerie Fonctionnelle et Département de Psychologie, Université de Montréal, Québec, Canada
| | - H Benali
- Laboratoire d'Imagerie NeuroFonctionnelle, Université Pierre et Marie Curie (UPMC Univ Paris 6), Inserm U678, Paris, France
| | - E Roze
- Université Pierre et Marie Curie (UPMC Univ Paris 6), Institut du Cerveau et de la Moelle épinière - ICM, UMR-S975, Inserm, U975, CNRS, UMR 7225, Paris, France ; Fédération de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France ; Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - M Vidailhet
- Université Pierre et Marie Curie (UPMC Univ Paris 6), Institut du Cerveau et de la Moelle épinière - ICM, UMR-S975, Inserm, U975, CNRS, UMR 7225, Paris, France ; Fédération de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France ; Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - S Lehericy
- Université Pierre et Marie Curie (UPMC Univ Paris 6), Institut du Cerveau et de la Moelle épinière - ICM, UMR-S975, Inserm, U975, CNRS, UMR 7225, Paris, France ; Centre de Neuroimagerie de Recherche, CENIR, Institut du Cerveau et de la Moelle épinière - ICM, Paris, France ; Groupe Hospitalier Pitié-Salpêtrière, Paris, France
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120
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Welter ML, Grabli D, Karachi C, Jodoin N, Fernandez-Vidal S, Brun Y, Navarro S, Rogers A, Cornu P, Pidoux B, Yelnik J, Roze E, Bardinet E, Vidailhet M. Pallidal activity in myoclonus dystonia correlates with motor signs. Mov Disord 2015; 30:992-6. [PMID: 25880339 DOI: 10.1002/mds.26244] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 03/18/2015] [Accepted: 03/21/2015] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Myoclonus-dystonia related to epsilon-sarcoglycan gene mutations is characterized by myoclonic jerks and mild to moderate dystonia. The role of basal ganglia dysfunction in the pathogenesis is unknown. METHODS Pallidal neuronal activity was recorded in six myoclonus-dystonia and six primary generalized dystonia patients operated on for internal globus pallidus deep brain stimulation. RESULTS In myoclonus-dystonia patients compared with primary-dystonia patients, internal pallidum neurons showed higher burst frequency, lower mean burst, and pause durations. External pallidum neurons showed higher mean pause frequency. Oscillatory activity was present in 33% and 35% of internal pallidum neurons in myoclonus-dystonia and primary-dystonia patients, respectively, predominantly in the theta frequency band (3-8 Hz). In myoclonus-dystonia patients with more severe myoclonus, internal pallidum neurons exhibited a higher bursting activity with high intraburst frequency and lower oscillatory activity frequency. CONCLUSIONS Myoclonus-dystonia appears to be related to specific changes in internal pallidum activity, leading to disruption in striato-pallido-thalamo-cortical circuits. © 2015 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Marie-Laure Welter
- Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle épiniere (CRICM), UMR-S975, Paris, France.,Inserm, U1127, Paris, France.,CNRS, UMR 7225, Paris, France.,Centre d'Investigation Clinique Pitié Neurosciences (Inserm CIC-1422), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.,Département de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - David Grabli
- Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle épiniere (CRICM), UMR-S975, Paris, France.,Inserm, U1127, Paris, France.,CNRS, UMR 7225, Paris, France.,Centre d'Investigation Clinique Pitié Neurosciences (Inserm CIC-1422), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.,Département de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Carine Karachi
- Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle épiniere (CRICM), UMR-S975, Paris, France.,Inserm, U1127, Paris, France.,CNRS, UMR 7225, Paris, France.,Centre d'Investigation Clinique Pitié Neurosciences (Inserm CIC-1422), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.,Service de Neurochirurgie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Nicolas Jodoin
- Centre d'Investigation Clinique Pitié Neurosciences (Inserm CIC-1422), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.,Service de Neurologie, Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Sara Fernandez-Vidal
- Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle épiniere (CRICM), UMR-S975, Paris, France.,Centre de Neuroimagerie de Recherche (CENIR), Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Yohann Brun
- Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle épiniere (CRICM), UMR-S975, Paris, France.,Inserm, U1127, Paris, France.,CNRS, UMR 7225, Paris, France
| | - Soledad Navarro
- Service de Neurochirurgie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Alister Rogers
- Service de Neurochirurgie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Philippe Cornu
- Service de Neurochirurgie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Bernard Pidoux
- Service de Neurochirurgie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jérôme Yelnik
- Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle épiniere (CRICM), UMR-S975, Paris, France.,Inserm, U1127, Paris, France.,CNRS, UMR 7225, Paris, France.,Centre d'Investigation Clinique Pitié Neurosciences (Inserm CIC-1422), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Emmanuel Roze
- Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle épiniere (CRICM), UMR-S975, Paris, France.,Inserm, U1127, Paris, France.,CNRS, UMR 7225, Paris, France.,Centre d'Investigation Clinique Pitié Neurosciences (Inserm CIC-1422), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.,Département de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Eric Bardinet
- Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle épiniere (CRICM), UMR-S975, Paris, France.,Centre de Neuroimagerie de Recherche (CENIR), Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Marie Vidailhet
- Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle épiniere (CRICM), UMR-S975, Paris, France.,Inserm, U1127, Paris, France.,CNRS, UMR 7225, Paris, France.,Centre d'Investigation Clinique Pitié Neurosciences (Inserm CIC-1422), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.,Département de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
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121
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Shaikh AG, Zee DS, Jinnah HA. Oscillatory head movements in cervical dystonia: Dystonia, tremor, or both? Mov Disord 2015; 30:834-42. [PMID: 25879911 DOI: 10.1002/mds.26231] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 02/14/2015] [Accepted: 03/05/2015] [Indexed: 11/09/2022] Open
Abstract
Cervical dystonia is characterized by abnormal posturing of the head, often combined with tremor-like oscillatory head movements. The nature and source of these oscillatory head movements is controversial, so they were quantified to delineate their characteristics and develop a hypothetical model for their genesis. A magnetic search coil system was used to measure head movements in 14 subjects with cervical dystonia. Two distinct types of oscillatory head movements were detected for most subjects, even when they were not clinically evident. One type had a relatively large amplitude and jerky irregular pattern, and the other had smaller amplitude with a more regular and sinusoidal pattern. The kinematic properties of these two types of oscillatory head movements were distinct, although both were often combined in the same subject. Both had features suggestive of a defect in a central neural integrator. The combination of different types of oscillatory head movements in cervical dystonia helps to clarify some of the current debates regarding whether they should be considered as manifestations of dystonia or tremor and provides novel insights into their potential pathogenesis.
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Affiliation(s)
- Aasef G Shaikh
- Department of Neurology, Emory University, Atlanta, GA, USA
| | - David S Zee
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - H A Jinnah
- Department of Neurology, Emory University, Atlanta, GA, USA
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122
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Thompson DM, Koppes AN, Hardy JG, Schmidt CE. Electrical stimuli in the central nervous system microenvironment. Annu Rev Biomed Eng 2015; 16:397-430. [PMID: 25014787 DOI: 10.1146/annurev-bioeng-121813-120655] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Electrical stimulation to manipulate the central nervous system (CNS) has been applied as early as the 1750s to produce visual sensations of light. Deep brain stimulation (DBS), cochlear implants, visual prosthetics, and functional electrical stimulation (FES) are being applied in the clinic to treat a wide array of neurological diseases, disorders, and injuries. This review describes the history of electrical stimulation of the CNS microenvironment; recent advances in electrical stimulation of the CNS, including DBS to treat essential tremor, Parkinson's disease, and depression; FES for the treatment of spinal cord injuries; and alternative electrical devices to restore vision and hearing via neuroprosthetics (retinal and cochlear implants). It also discusses the role of electrical cues during development and following injury and, importantly, manipulation of these endogenous cues to support regeneration of neural tissue.
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Affiliation(s)
- Deanna M Thompson
- Department of Biomedical Engineering and Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, Troy, New York 12180;
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123
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Dystonia and cerebellar degeneration in the leaner mouse mutant. Brain Res 2015; 1611:56-64. [PMID: 25791619 DOI: 10.1016/j.brainres.2015.03.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Accepted: 03/06/2015] [Indexed: 01/18/2023]
Abstract
Cerebellar degeneration is traditionally associated with ataxia. Yet, there are examples of both ataxia and dystonia occurring in individuals with cerebellar degeneration. There is also substantial evidence suggesting that cerebellar dysfunction alone may cause dystonia. The types of cerebellar defects that may cause ataxia, dystonia, or both have not been delineated. In the current study, we explored the relationship between cerebellar degeneration and dystonia using the leaner mouse mutant. Leaner mice have severe dystonia that is associated with dysfunctional and degenerating cerebellar Purkinje cells. Whereas the density of Purkinje cells was not significantly reduced in 4 week-old leaner mice, approximately 50% of the neurons was lost by 34 weeks of age. On the other hand, the dystonia and associated functional disability became significantly less severe during this same interval. In other words, dystonia improved as Purkinje cells were lost, suggesting that dysfunctional Purkinje cells, rather than Purkinje cell loss, contribute to the dystonia. These results provide evidence that distorted cerebellar function may cause dystonia and support the concept that different types of cerebellar defects can have different functional consequences.
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124
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Bao F, Wang Y, Liu J, Mao C, Ma S, Guo C, Ding H, Zhang M. Structural changes in the CNS of patients with hemifacial spasm. Neuroscience 2015; 289:56-62. [DOI: 10.1016/j.neuroscience.2014.12.070] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 11/26/2014] [Accepted: 12/23/2014] [Indexed: 12/20/2022]
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125
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Abstract
There has been considerable progress in our understanding of dystonia over the last century. Growing recognition of dystonia has enhanced awareness of its diverse motor phenomenology and brought attention to the importance that nonmotor features may play in this disorder, once considered to be purely motor. Using the latest technologies in human genetics, new genetic links are being discovered at an ever-quickening pace and expanding our knowledge of the disorder's complex pathogenesis. Furthermore, as we gain clearer insight into the pathophysiology of dystonia and an appreciation of the involvement of dysfunction outside the basal ganglia, dystonia has been increasingly viewed as a network disorder. Here we briefly discuss some of the recent noteworthy advances.
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Affiliation(s)
- Brian D Berman
- Department of Neurology (BDB), University of Colorado Denver, Aurora, CO; and Departments of Neurology, Human Genetics, and Pediatrics (HAJ), Emory University, Atlanta, GA
| | - H A Jinnah
- Department of Neurology (BDB), University of Colorado Denver, Aurora, CO; and Departments of Neurology, Human Genetics, and Pediatrics (HAJ), Emory University, Atlanta, GA
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126
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Schretlen DJ, Varvaris M, Vannorsdall TD, Gordon B, Harris JC, Jinnah HA. Brain white matter volume abnormalities in Lesch-Nyhan disease and its variants. Neurology 2014; 84:190-6. [PMID: 25503620 DOI: 10.1212/wnl.0000000000001128] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE We sought to examine brain white matter abnormalities based on MRI in adults with Lesch-Nyhan disease (LND) or an attenuated variant (LNV) of this rare, X-linked neurodevelopmental disorder of purine metabolism. METHODS In this observational study, we compared 21 adults with LND, 17 with LNV, and 33 age-, sex-, and race-matched healthy controls using voxel-based morphometry and analysis of covariance to identify white matter volume abnormalities in both patient groups. RESULTS Patients with classic LND showed larger reductions of white (26%) than gray (17%) matter volume relative to healthy controls. Those with LNV showed comparable reductions of white (14%) and gray (15%) matter volume. Both patient groups demonstrated reduced volume in medial inferior white matter regions. Compared with LNV, the LND group showed larger reductions in inferior frontal white matter adjoining limbic and temporal regions and the motor cortex. These regions likely include such long association fibers as the superior longitudinal and uncinate fasciculi. CONCLUSIONS Despite earlier reports that LND primarily involves the basal ganglia, this study reveals substantial white matter volume abnormalities. Moreover, white matter deficits are more severe than gray matter deficits in classic LND, and also characterize persons with LNV. The brain images acquired for these analyses cannot precisely localize white matter abnormalities or determine whether they involve changes in tract orientation or anisotropy. However, clusters of reduced white matter volume identified here affect regions that are consistent with the neurobehavioral phenotype.
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Affiliation(s)
- David J Schretlen
- From the Departments of Psychiatry and Behavioral Sciences (D.J.S., T.D.V., J.C.H.) and Neurology (M.V., B.G.), and Russell H. Morgan Department of Radiology and Radiological Science (D.J.S., T.D.V.), The Johns Hopkins University School of Medicine; Department of Cognitive Science (B.G.), The Johns Hopkins University, Baltimore, MD; and Departments of Neurology, Human Genetics, and Pediatrics (H.A.J.), Emory University School of Medicine, Atlanta, GA.
| | - Mark Varvaris
- From the Departments of Psychiatry and Behavioral Sciences (D.J.S., T.D.V., J.C.H.) and Neurology (M.V., B.G.), and Russell H. Morgan Department of Radiology and Radiological Science (D.J.S., T.D.V.), The Johns Hopkins University School of Medicine; Department of Cognitive Science (B.G.), The Johns Hopkins University, Baltimore, MD; and Departments of Neurology, Human Genetics, and Pediatrics (H.A.J.), Emory University School of Medicine, Atlanta, GA
| | - Tracy D Vannorsdall
- From the Departments of Psychiatry and Behavioral Sciences (D.J.S., T.D.V., J.C.H.) and Neurology (M.V., B.G.), and Russell H. Morgan Department of Radiology and Radiological Science (D.J.S., T.D.V.), The Johns Hopkins University School of Medicine; Department of Cognitive Science (B.G.), The Johns Hopkins University, Baltimore, MD; and Departments of Neurology, Human Genetics, and Pediatrics (H.A.J.), Emory University School of Medicine, Atlanta, GA
| | - Barry Gordon
- From the Departments of Psychiatry and Behavioral Sciences (D.J.S., T.D.V., J.C.H.) and Neurology (M.V., B.G.), and Russell H. Morgan Department of Radiology and Radiological Science (D.J.S., T.D.V.), The Johns Hopkins University School of Medicine; Department of Cognitive Science (B.G.), The Johns Hopkins University, Baltimore, MD; and Departments of Neurology, Human Genetics, and Pediatrics (H.A.J.), Emory University School of Medicine, Atlanta, GA
| | - James C Harris
- From the Departments of Psychiatry and Behavioral Sciences (D.J.S., T.D.V., J.C.H.) and Neurology (M.V., B.G.), and Russell H. Morgan Department of Radiology and Radiological Science (D.J.S., T.D.V.), The Johns Hopkins University School of Medicine; Department of Cognitive Science (B.G.), The Johns Hopkins University, Baltimore, MD; and Departments of Neurology, Human Genetics, and Pediatrics (H.A.J.), Emory University School of Medicine, Atlanta, GA
| | - H A Jinnah
- From the Departments of Psychiatry and Behavioral Sciences (D.J.S., T.D.V., J.C.H.) and Neurology (M.V., B.G.), and Russell H. Morgan Department of Radiology and Radiological Science (D.J.S., T.D.V.), The Johns Hopkins University School of Medicine; Department of Cognitive Science (B.G.), The Johns Hopkins University, Baltimore, MD; and Departments of Neurology, Human Genetics, and Pediatrics (H.A.J.), Emory University School of Medicine, Atlanta, GA
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127
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Klingelhoefer L, Martino D, Martinez-Martin P, Sauerbier A, Rizos A, Jost W, Warner TT, Chaudhuri KR. Nonmotor symptoms and focal cervical dystonia: Observations from 102 patients. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.baga.2014.10.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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128
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Jinnah H, Albanese A. The New Classification System for the Dystonias: Why Was it Needed and How was it Developed? Mov Disord Clin Pract 2014; 1:280-284. [PMID: 25485288 PMCID: PMC4254809 DOI: 10.1002/mdc3.12100] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 09/08/2014] [Accepted: 09/09/2014] [Indexed: 12/18/2022] Open
Affiliation(s)
- H.A. Jinnah
- Departments of Neurology, Human Genetics and PediatricsEmory UniversityAtlantaGeorgia30322USA
| | - Alberto Albanese
- Department of NeurologyCatholic UniversityMilanItaly
- Department of NeurologyCarlo Besta Institute of NeurologyMilanItaly
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129
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Alongi P, Iaccarino L, Perani D. PET Neuroimaging: Insights on Dystonia and Tourette Syndrome and Potential Applications. Front Neurol 2014; 5:183. [PMID: 25295029 PMCID: PMC4171987 DOI: 10.3389/fneur.2014.00183] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 09/09/2014] [Indexed: 11/13/2022] Open
Abstract
Primary dystonia (pD) is a movement disorder characterized by sustained or intermittent muscle contractions causing abnormal, often repetitive, movements, postures, or both. Gilles de la Tourette syndrome (GTS) is a childhood-onset neuropsychiatric developmental disorder characterized by motor and phonic tics, which could progress to behavioral changes. GTS and obsessive-compulsive disorders are often seen in comorbidity, also suggesting that a possible overlap in the pathophysiological bases of these two conditions. PET techniques are of considerable value in detecting functional and molecular abnormalities in vivo, according to the adopted radioligands. For example, PET is the unique technique that allows in vivo investigation of neurotransmitter systems, providing evidence of changes in GTS or pD. For example, presynaptic and post-synaptic dopaminergic studies with PET have shown alterations compatible with dysfunction or loss of D2-receptors bearing neurons, increased synaptic dopamine levels, or both. Measures of cerebral glucose metabolism with (18)F-fluorodeoxyglucose PET ((18)F-FDG PET) are very sensitive in showing brain functional alterations as well. (18)F-FDG PET data have shown metabolic changes within the cortico-striato-pallido-thalamo-cortical and cerebello-thalamo-cortical networks, revealing possible involvement of brain circuits not limited to basal ganglia in pD and GTS. The aim of this work is to overview PET consistent neuroimaging literature on pD and GTS that has provided functional and molecular knowledge of the underlying neural dysfunction. Furthermore, we suggest potential applications of these techniques in monitoring treatments.
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Affiliation(s)
- Pierpaolo Alongi
- Department of Nuclear Medicine, San Raffaele Hospital , Milan , Italy ; Bicocca University , Milan , Italy
| | - Leonardo Iaccarino
- Department of Nuclear Medicine, San Raffaele Hospital , Milan , Italy ; Vita-Salute San Raffaele University , Milan , Italy
| | - Daniela Perani
- Department of Nuclear Medicine, San Raffaele Hospital , Milan , Italy ; Vita-Salute San Raffaele University , Milan , Italy
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130
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Genetic animal models of dystonia: common features and diversities. Prog Neurobiol 2014; 121:91-113. [PMID: 25034123 DOI: 10.1016/j.pneurobio.2014.07.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 06/06/2014] [Accepted: 07/03/2014] [Indexed: 01/13/2023]
Abstract
Animal models are pivotal for studies of pathogenesis and treatment of disorders of the central nervous system which in its complexity cannot yet be modeled in vitro or using computer simulations. The choice of a specific model to test novel therapeutic strategies for a human disease should be based on validity of the model for the approach: does the model reflect symptoms, pathogenesis and treatment response present in human patients? In the movement disorder dystonia, prior to the availability of genetically engineered mice, spontaneous mutants were chosen based on expression of dystonic features, including abnormal muscle contraction, movements and postures. Recent discovery of a number of genes and gene products involved in dystonia initiated research on pathogenesis of the disorder, and the creation of novel models based on gene mutations. Here we present a review of current models of dystonia, with a focus on genetic rodent models, which will likely be first choice in the future either for pathophysiological or for preclinical drug testing or both. In order to help selection of a model depending on expression of a specific feature of dystonia, this review is organized by symptoms and current knowledge of pathogenesis of dystonia. We conclude that albeit there is increasing need for research on pathogenesis of the disease and development of improved models, current models do replicate features of dystonia and are useful tools to develop urgently demanded treatment for this debilitating disorder.
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131
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Luna-Cancalon K, Sikora KM, Pappas SS, Singh V, Wulff H, Paulson HL, Burmeister M, Shakkottai VG. Alterations in cerebellar physiology are associated with a stiff-legged gait in Atcay(ji-hes) mice. Neurobiol Dis 2014; 67:140-8. [PMID: 24727095 DOI: 10.1016/j.nbd.2014.03.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 03/25/2014] [Accepted: 03/31/2014] [Indexed: 01/17/2023] Open
Abstract
Recent evidence suggests that dystonia, a movement disorder characterized by sustained involuntary muscle contractions, can be associated with cerebellar abnormalities. The basis for how functional changes in the cerebellum can cause dystonia is poorly understood. Here we identify alterations in physiology in Atcay(ji-hes) mice which in addition to ataxia, have an abnormal gait with hind limb extension and toe walking, reminiscent of human dystonic gait. No morphological abnormalities in the brain accompany the dystonia, but partial cerebellectomy causes resolution of the stiff-legged gait, suggesting that cerebellar dysfunction contributes to the dystonic gait of Atcay(ji-hes) mice. Recordings from Purkinje and deep cerebellar nuclear (DCN) neurons in acute brain slices were used to determine the physiological correlates of dystonia in the Atcay(ji-hes) mice. Approximately 50% of cerebellar Purkinje neurons fail to display the normal repetitive firing characteristic of these cells. In addition, DCN neurons exhibit increased intrinsic firing frequencies with a subset of neurons displaying bursts of action potentials. This increased intrinsic excitability of DCN neurons is accompanied by a reduction in after-hyperpolarization currents mediated by small-conductance calcium-activated potassium (SK) channels. An activator of SK channels reduces DCN neuron firing frequency in acute cerebellar slices and improves the dystonic gait of Atcay(ji-hes) mice. These results suggest that a combination of reduced Purkinje neuron activity and increased DCN intrinsic excitability can result in a combination of ataxia and a dystonia-like gait in mice.
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Affiliation(s)
| | - Kristine M Sikora
- Program in Cellular and Molecular Biology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Samuel S Pappas
- Department of Neurology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Vikrant Singh
- Department of Pharmacology, University of California, Davis, CA 95616, USA
| | - Heike Wulff
- Department of Pharmacology, University of California, Davis, CA 95616, USA
| | - Henry L Paulson
- Department of Neurology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Margit Burmeister
- Molecular & Behavioral Neuroscience Institute, Departments of Psychiatry, Computational Medicine & Bioinformatics and Human Genetics, University of Michigan, Ann Arbor, MI 48109, USA
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132
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The reorganization of motor network in hemidystonia from the perspective of deep brain stimulation. Brain Imaging Behav 2014; 9:223-35. [DOI: 10.1007/s11682-014-9300-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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133
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Martella G, Maltese M, Nisticò R, Schirinzi T, Madeo G, Sciamanna G, Ponterio G, Tassone A, Mandolesi G, Vanni V, Pignatelli M, Bonsi P, Pisani A. Regional specificity of synaptic plasticity deficits in a knock-in mouse model of DYT1 dystonia. Neurobiol Dis 2014; 65:124-32. [PMID: 24503369 DOI: 10.1016/j.nbd.2014.01.016] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 01/24/2014] [Indexed: 01/07/2023] Open
Abstract
DYT1 dystonia is a movement disorder caused by a deletion in the C-terminal of the protein torsinA. It is unclear how torsinA mutation might disrupt cellular processes encoding motor activity, and whether this impairment occurs in specific brain regions. Here, we report a selective impairment of corticostriatal synaptic plasticity in knock-in mice heterozygous for Δ-torsinA (Tor1a(+/Δgag) mice) as compared to controls (Tor1a(+/+) mice). In striatal spiny neurons from Tor1a(+/Δgag) mice, high-frequency stimulation failed to induce long-term depression (LTD), whereas long-term potentiation (LTP) exhibited increased amplitude. Of interest, blockade of D2 dopamine receptors (D2Rs) increased LTP in Tor1a(+/+) mice to a level comparable to that measured in Tor1a(+/Δgag) mice and normalized the levels of potentiation across mouse groups. A low-frequency stimulation (LFS) protocol was unable to depotentiate corticostriatal synapses in Tor1a(+/Δgag) mice. Muscarinic M1 acetylcholine receptor (mAChR) blockade rescued plasticity deficits. Additionally, we found an abnormal responsiveness of cholinergic interneurons to D2R activation, consisting in an excitatory response rather than the expected inhibition, further confirming an imbalance between dopaminergic and cholinergic signaling in the striatum. Conversely, synaptic activity and plasticity in the CA1 hippocampal region were unaltered in Tor1a(+/Δgag) mice. Importantly, the M1 mAChR-dependent enhancement of hippocampal LTP was unaffected in both genotypes. Similarly, both basic properties of dopaminergic nigral neurons and their responses to D2R activation were normal. These results provide evidence for a regional specificity of the electrophysiological abnormalities observed and demonstrate the reproducibility of such alterations in distinct models of DYT1 dystonia.
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Affiliation(s)
- G Martella
- Department of System Medicine, University of Rome "Tor Vergata", Italy; Laboratory of Neurophysiology and Synaptic Plasticity, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - M Maltese
- Department of System Medicine, University of Rome "Tor Vergata", Italy
| | - R Nisticò
- Laboratory of Neurophysiology and Synaptic Plasticity, IRCCS Fondazione Santa Lucia, Rome, Italy; Department of Physiology and Pharmacology "V. Erspamer", Sapienza University of Rome, Italy
| | - T Schirinzi
- Department of System Medicine, University of Rome "Tor Vergata", Italy
| | - G Madeo
- Department of System Medicine, University of Rome "Tor Vergata", Italy
| | - G Sciamanna
- Department of System Medicine, University of Rome "Tor Vergata", Italy; Laboratory of Neurophysiology and Synaptic Plasticity, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - G Ponterio
- Department of System Medicine, University of Rome "Tor Vergata", Italy; Laboratory of Neurophysiology and Synaptic Plasticity, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - A Tassone
- Laboratory of Neurophysiology and Synaptic Plasticity, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - G Mandolesi
- Department of System Medicine, University of Rome "Tor Vergata", Italy; Laboratory of Neurophysiology and Synaptic Plasticity, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - V Vanni
- Laboratory of Neurophysiology and Synaptic Plasticity, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - M Pignatelli
- Department of Physiology and Pharmacology "V. Erspamer", Sapienza University of Rome, Italy
| | - P Bonsi
- Laboratory of Neurophysiology and Synaptic Plasticity, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - A Pisani
- Department of System Medicine, University of Rome "Tor Vergata", Italy; Laboratory of Neurophysiology and Synaptic Plasticity, IRCCS Fondazione Santa Lucia, Rome, Italy.
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134
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Dystonia as a network disorder: what is the role of the cerebellum? Neuroscience 2013; 260:23-35. [PMID: 24333801 DOI: 10.1016/j.neuroscience.2013.11.062] [Citation(s) in RCA: 188] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 11/20/2013] [Accepted: 11/20/2013] [Indexed: 01/02/2023]
Abstract
The dystonias are a group of disorders defined by sustained or intermittent muscle contractions that result in involuntary posturing or repetitive movements. There are many different clinical manifestations and causes. Although they traditionally have been ascribed to dysfunction of the basal ganglia, recent evidence has suggested dysfunction may originate from other regions, particularly the cerebellum. This recent evidence has led to an emerging view that dystonia is a network disorder that involves multiple brain regions. The new network model for the pathogenesis of dystonia has raised many questions, particularly regarding the role of the cerebellum. For example, if dystonia may arise from cerebellar dysfunction, then why are there no cerebellar signs in dystonia? Why are focal cerebellar lesions or degenerative cerebellar disorders more commonly associated with ataxia rather than dystonia? Why is dystonia more commonly associated with basal ganglia lesions rather than cerebellar lesions? Can answers obtained from animals be extrapolated to humans? Is there any evidence that the cerebellum is not involved? Finally, what is the practical value of this new model of pathogenesis for the neuroscientist and clinician? This article explores potential answers to these questions.
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135
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Lerner RP, Niethammer M, Eidelberg D. Understanding the anatomy of dystonia: determinants of penetrance and phenotype. Curr Neurol Neurosci Rep 2013; 13:401. [PMID: 24114145 PMCID: PMC3883436 DOI: 10.1007/s11910-013-0401-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The dystonias comprise a group of syndromes characterized by prolonged involuntary muscle contractions resulting in repetitive movements and abnormal postures. Primary dystonia has been associated with over 14 different genotypes, most of which follow an autosomal dominant inheritance pattern with reduced penetrance. Independent of etiology, the disease is characterized by extensive variability in disease phenotype and clinical severity. Recent neuroimaging studies investigating this phenomenon in manifesting and non-manifesting genetic carriers of dystonia have discovered microstructural integrity differences in the cerebello-thalamo-cortical tract in both groups related to disease penetrance. Further study suggests these differences to be specific to subrolandic white matter regions somatotopically related to clinical phenotype. Clinical severity was correlated to the degree of microstructural change. These findings suggest a mechanism for the penetrance and clinical variability observed in dystonia and may represent a novel therapeutic target for patients with refractory limb symptoms.
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Affiliation(s)
- Renata P Lerner
- Center for Neurosciences, The Feinstein Institute for Medical Research, 350 Community Drive, Manhasset, NY, 11030, USA
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136
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Prell T, Peschel T, Köhler B, Bokemeyer MH, Dengler R, Günther A, Grosskreutz J. Structural brain abnormalities in cervical dystonia. BMC Neurosci 2013; 14:123. [PMID: 24131497 PMCID: PMC3852757 DOI: 10.1186/1471-2202-14-123] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 10/09/2013] [Indexed: 12/13/2022] Open
Abstract
Background Idiopathic cervical dystonia is characterized by involuntary spasms, tremors or jerks. It is not restricted to a disturbance in the basal ganglia system because non-conventional voxel-based MRI morphometry (VBM) and diffusion tensor imaging (DTI) have detected numerous regional changes in the brains of patients. In this study scans of 24 patients with cervical dystonia and 24 age-and sex-matched controls were analysed using VBM, DTI and magnetization transfer imaging (MTI) using a voxel-based approach and a region-of-interest analysis. Results were correlated with UDRS, TWSTRS and disease duration. Results We found structural alterations in the basal ganglia; thalamus; motor cortex; premotor cortex; frontal, temporal and parietal cortices; visual system; cerebellum and brainstem of the patients with dystonia. Conclusions Cervical dystonia is a multisystem disease involving several networks such as the motor, sensory and visual systems.
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Affiliation(s)
- Tino Prell
- Hans-Berger Department of Neurology, Jena University Hospital, Erlanger Allee 101, 07747 Jena, Germany.
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Jinnah HA, DeLong M, Hallett M. The dystonias: past, present, and future. Mov Disord 2013; 28:849-50. [PMID: 23893441 PMCID: PMC3787865 DOI: 10.1002/mds.25564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 05/16/2013] [Indexed: 11/06/2022] Open
Affiliation(s)
- H. A. Jinnah
- Departments of Neurology, Human Genetics & Pediatrics, Emory University, Atlanta GA, USA
| | - Mahlon DeLong
- Department of Neurology, Pediatrics & Psychiatry, Emory University, Atlanta GA, USA
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda MD, USA
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138
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Jinnah HA, Berardelli A, Comella C, Defazio G, Delong MR, Factor S, Galpern WR, Hallett M, Ludlow CL, Perlmutter JS, Rosen AR. The focal dystonias: current views and challenges for future research. Mov Disord 2013; 28:926-43. [PMID: 23893450 PMCID: PMC3733486 DOI: 10.1002/mds.25567] [Citation(s) in RCA: 157] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Revised: 05/15/2013] [Accepted: 05/16/2013] [Indexed: 11/11/2022] Open
Abstract
The most common forms of dystonia are those that develop in adults and affect a relatively isolated region of the body. Although these adult-onset focal dystonias are most prevalent, knowledge of their etiologies and pathogenesis has lagged behind some of the rarer generalized dystonias, in which the identification of genetic defects has facilitated both basic and clinical research. This summary provides a brief review of the clinical manifestations of the adult-onset focal dystonias, focusing attention on less well understood clinical manifestations that need further study. It also provides a simple conceptual model for the similarities and differences among the different adult-onset focal dystonias as a rationale for lumping them together as a class of disorders while at the same time splitting them into subtypes. The concluding section outlines some of the most important research questions for the future. Answers to these questions are critical for advancing our understanding of this group of disorders and for developing novel therapeutics.
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Affiliation(s)
- H A Jinnah
- Department of Neurology, Emory University, Atlanta, Georgia 30322, USA.
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