151
|
Abstract
Major advances in our understanding of the neurology/pathology, anatomy/physiology, and molecular biology of the cerebellum have opened a new door for cerebellar ataxias (CAs). We have now entered in the ‘era of therapies’. Cures are knocking at the door. We discuss the hot topics in the therapeutic protocols available for CAs, including aminopyridines, noninvasive cerebellar stimulation, anti-oxidant drugs and therapies for immune-mediated cerbellar ataxias (IMCAs), topics emphasized in this issue. The history of the cerebellum is a typical example of the importance of apparently divergent and multi-disciplinary approaches.
Collapse
Affiliation(s)
- Hiroshi Mitoma
- Medical Education Promotion Center, Tokyo Medical University, Tokyo, Japan
| | - Mario Manto
- Service de Neurologie, CHUCharleroi, Charleroi, Belgium.,Service des Neurosciences, Université de Mons, 7000 Mons, Belgium
| |
Collapse
|
152
|
Arcuria G, Marcotulli C, Galasso C, Pierelli F, Casali C. 15-White Dots APP-Coo-Test: a reliable touch-screen application for assessing upper limb movement impairment in patients with cerebellar ataxias. J Neurol 2019; 266:1611-1622. [PMID: 30955123 DOI: 10.1007/s00415-019-09299-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 03/23/2019] [Accepted: 03/27/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Giuseppe Arcuria
- Department of Medical and Surgical Sciences and Biotechnologies (DSBMC), Polo Pontino-University of Rome "Sapienza", Via Faggiana 34, 40100, Latina, Italy.
| | - Christian Marcotulli
- Department of Medical and Surgical Sciences and Biotechnologies (DSBMC), Polo Pontino-University of Rome "Sapienza", Via Faggiana 34, 40100, Latina, Italy
| | - Claudio Galasso
- Department of Medical and Surgical Sciences and Biotechnologies (DSBMC), Polo Pontino-University of Rome "Sapienza", Via Faggiana 34, 40100, Latina, Italy
| | - Francesco Pierelli
- Department of Medical and Surgical Sciences and Biotechnologies (DSBMC), Polo Pontino-University of Rome "Sapienza", Via Faggiana 34, 40100, Latina, Italy
| | - Carlo Casali
- Department of Medical and Surgical Sciences and Biotechnologies (DSBMC), Polo Pontino-University of Rome "Sapienza", Via Faggiana 34, 40100, Latina, Italy
| |
Collapse
|
153
|
Crevecoeur F, Gevers M. Filtering Compensation for Delays and Prediction Errors during Sensorimotor Control. Neural Comput 2019; 31:738-764. [DOI: 10.1162/neco_a_01170] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Compensating for sensorimotor noise and for temporal delays has been identified as a major function of the nervous system. Although these aspects have often been described separately in the frameworks of optimal cue combination or motor prediction during movement planning, control-theoretic models suggest that these two operations are performed simultaneously, and mounting evidence supports that motor commands are based on sensory predictions rather than sensory states. In this letter, we study the benefit of state estimation for predictive sensorimotor control. More precisely, we combine explicit compensation for sensorimotor delays and optimal estimation derived in the context of Kalman filtering. We show, based on simulations of human-inspired eye and arm movements, that filtering sensory predictions improves the stability margin of the system against prediction errors due to low-dimensional predictions or to errors in the delay estimate. These simulations also highlight that prediction errors qualitatively account for a broad variety of movement disorders typically associated with cerebellar dysfunctions. We suggest that adaptive filtering in cerebellum, instead of often-assumed feedforward predictions, may achieve simple compensation for sensorimotor delays and support stable closed-loop control of movements.
Collapse
Affiliation(s)
- F. Crevecoeur
- Institute of Information and Communication Technologies, Electronics and Applied Mathematics, University of Louvain, Louvain-la-Neuve 1348, Belgium, and Institute of Neuroscience, University of Louvain, Brussels 1200, Belgium
| | - M. Gevers
- Institute of Information and Communication Technologies, Electronics and Applied Mathematics, University of Louvain, Louvain-la-Neuve 1348, Belgium
| |
Collapse
|
154
|
Shribman S, Warner TT, Dooley JS. Clinical presentations of Wilson disease. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:S60. [PMID: 31179297 DOI: 10.21037/atm.2019.04.27] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The main presenting features of Wilson disease, many of which mimic common hepatic and neurologic disorders, are discussed. There is a need for specialists in these and related fields to be aware of hints from within and, more importantly, outside their area of expertise that should alert them to consider the diagnosis. Delayed diagnosis and treatment are potentially damaging for the patient. The importance of recognising and promptly investigating Wilson disease at the initial presentation should be understood by all those who assess patients with hepatic or neurologic disorders and/or train others in their specialty.
Collapse
Affiliation(s)
- Samuel Shribman
- Reta Lila Weston Institute of Neurological Studies, UCL Queen Square Institute of Neurology, London, UK
| | - Thomas T Warner
- Reta Lila Weston Institute of Neurological Studies, UCL Queen Square Institute of Neurology, London, UK
| | - James S Dooley
- UCL Institute for Liver and Digestive Health, Division of Medicine, Royal Free Campus, London, UK
| |
Collapse
|
155
|
Trahan EM, Mercado JM. Familial Hemiplegic Migraines and Baseline Neuropsychological Testing: A Case Report. Headache 2019; 59:917-923. [PMID: 30869161 DOI: 10.1111/head.13505] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To explore the neuropsychological correlates and implications of familial hemiplegic migraines (FHMs). BACKGROUND FMH is a rare, autosomal dominant subtype of migraine that only occurs in 0.01% of the population. Little is known about the neuropsychological impact of FHMs; however, cognitive impairment associated with cerebellar syndrome has been identified in some cases. METHOD A single case study involving a 24-year-old male who recently endured an atypical, prolonged FHM episode. RESULTS The patient's overall neuropsychological functioning was intact with low average semantic fluency and processing speed, and mild indications of executive dysfunction. CONCLUSION Baseline and serial neuropsychological testing in individuals with FHM may help identify the potential progression and course of cognitive impairment associated with this condition.
Collapse
|
156
|
Salman MS, Manto M. Cerebellar malformations in children: determining long-term neurological outcomes. Dev Med Child Neurol 2019; 61:289-290. [PMID: 30320476 DOI: 10.1111/dmcn.14058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Michael S Salman
- Section of Pediatric Neurology, Winnipeg Children's Hospital, Winnipeg, Manitoba, Canada.,Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mario Manto
- Neurology Service, CHU-Charleroi, Charleroi and Neuroscience Service, Université de Mons, Mons, Belgium
| |
Collapse
|
157
|
Shipman ML, Green JT. Cerebellum and cognition: Does the rodent cerebellum participate in cognitive functions? Neurobiol Learn Mem 2019; 170:106996. [PMID: 30771461 DOI: 10.1016/j.nlm.2019.02.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 01/02/2019] [Accepted: 02/08/2019] [Indexed: 02/06/2023]
Abstract
There is a widespread, nearly complete consensus that the human and non-human primate cerebellum is engaged in non-motor, cognitive functions. This body of research has implicated the lateral portions of lobule VII (Crus I and Crus II) and the ventrolateral dentate nucleus. With rodents, however, it is not so clear. We review here approximately 40 years of experiments using a variety of cerebellar manipulations in rats and mice and measuring the effects on executive functions (working memory, inhibition, and cognitive flexibility), spatial navigation, discrimination learning, and goal-directed and stimulus-driven instrumental conditioning. Our conclusion is that there is a solid body of support for engagement of the rodent cerebellum in tests of cognitive flexibility and spatial navigation, and some support for engagement in working memory and certain types of discrimination learning. Future directions will involve determining the relevant cellular mechanisms, cerebellar regions, and precise cognitive functions of the rodent cerebellum.
Collapse
Affiliation(s)
- Megan L Shipman
- Department of Psychological Science, University of Vermont, 2 Colchester Avenue, Burlington, VT 05405, USA; Neuroscience Graduate Program, University of Vermont, 2 Colchester Avenue, Burlington, VT 05405, USA.
| | - John T Green
- Department of Psychological Science, University of Vermont, 2 Colchester Avenue, Burlington, VT 05405, USA.
| |
Collapse
|
158
|
Mallio CA, Piervincenzi C, Gianolio E, Cirimele V, Papparella LG, Marano M, Quintiliani L, Aime S, Carducci F, Parizel PM, Quattrocchi CC. Absence of dentate nucleus resting-state functional connectivity changes in nonneurological patients with gadolinium-related hyperintensity on T1
-weighted images. J Magn Reson Imaging 2019; 50:445-455. [DOI: 10.1002/jmri.26669] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/09/2019] [Accepted: 01/10/2019] [Indexed: 12/25/2022] Open
Affiliation(s)
- Carlo A. Mallio
- Departmental Faculty of Medicine and Surgery; Università Campus Bio-Medico di Roma; Rome Italy
| | - Claudia Piervincenzi
- Department of Physiology and Pharmacology, Neuroimaging Laboratory; Università La Sapienza; Rome Italy
| | - Eliana Gianolio
- Department of Molecular Biotechnology and Health Sciences; Università di Torino; Torino Italy
| | - Vincenzo Cirimele
- Departmental Faculty of Medicine and Surgery; Università Campus Bio-Medico di Roma; Rome Italy
| | - Luigi G. Papparella
- Departmental Faculty of Medicine and Surgery; Università Campus Bio-Medico di Roma; Rome Italy
| | - Massimo Marano
- Departmental Faculty of Medicine and Surgery; Università Campus Bio-Medico di Roma; Rome Italy
| | - Livia Quintiliani
- Departmental Faculty of Medicine and Surgery; Università Campus Bio-Medico di Roma; Rome Italy
| | - Silvio Aime
- Department of Molecular Biotechnology and Health Sciences; Università di Torino; Torino Italy
| | - Filippo Carducci
- Department of Physiology and Pharmacology, Neuroimaging Laboratory; Università La Sapienza; Rome Italy
| | - Paul M. Parizel
- Department of Radiology; Antwerp University Hospital; Edegem Belgium
| | - Carlo C. Quattrocchi
- Departmental Faculty of Medicine and Surgery; Università Campus Bio-Medico di Roma; Rome Italy
| |
Collapse
|
159
|
Abstract
Disorders of the developing nervous system may be of genetic origin, comprising congenital malformations of spine and brain as well as metabolic or vascular disorders that affect normal brain development. Acquired causes include congenital infections, hypoxic-ischemic or traumatic brain injury, and a number of rare neoplasms. This chapter focuses on the clinical presentation and workup of neurogenetic disorders presenting in the fetal or neonatal period. After a summary of the most frequent clinical presentations, clues from history taking and clinical examination are illustrated with short case reports. This is followed by a discussion of the different tools available for the workup of neurogenetic disorders, including the various genetic techniques with their advantages and disadvantages. The implications of a molecular genetic diagnosis for the patient and family are addressed in the section on counseling. The chapter concludes with a proposed workflow that may help the clinician when confronted with a potential neurogenetic disorder in the fetal or neonatal period.
Collapse
|
160
|
Amin SB, Smith T, Timler G. Developmental influence of unconjugated hyperbilirubinemia and neurobehavioral disorders. Pediatr Res 2019; 85:191-197. [PMID: 30397278 DOI: 10.1038/s41390-018-0216-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 10/10/2018] [Accepted: 10/15/2018] [Indexed: 11/09/2022]
Abstract
Bilirubin-induced brain injury in the neonatal period has detrimental effects on neurodevelopment that persist into childhood and adulthood, contributing to childhood developmental disorders. Unconjugated bilirubin is a potent antioxidant that may be useful for protecting against oxidative injuries, but it becomes a potent neurotoxin once it crosses the blood brain barrier. Because bilirubin toxicity involves a myriad of pathological mechanisms, can damage most types of brain cells, and affects brain circuits or loops that influence cognition, learning, behavior, sensory, and language, the clinical effects of bilirubin-induced neurotoxicity are likely to be manifold. One possible effect that several experts have identified is bilirubin-induced neurological dysfunction (subtle kernicterus). However, the underlying biological mechanisms or pathways by which subtle kernicterus could lead to developmental disorders has not been elucidated previously. Our aim in this review is to describe a spectrum of developmental disorders that may reflect subtle kernicterus and outline plausible biological mechanisms for this possible association. We review existing evidence that support or refute the association between unconjugated hyperbilirubinemia and developmental disorders, and limitations associated with these studies.
Collapse
Affiliation(s)
- Sanjiv B Amin
- Division of Neonatology, Department of Pediatrics, University of Rochester, Rochester, NY, USA.
| | - Tristram Smith
- Division of Developmental and Behavioral Pediatrics, University of Rochester, Rochester, NY, USA
| | - Geralyn Timler
- Communication Sciences and Disorders, James Madison University, Harrisonburg, VA, USA
| |
Collapse
|
161
|
Barca E, Emmanuele V, DiMauro S, Toscano A, Quinzii CM. Anti-Oxidant Drugs: Novelties and Clinical Implications in Cerebellar Ataxias. Curr Neuropharmacol 2019; 17:21-32. [PMID: 29119930 PMCID: PMC6341493 DOI: 10.2174/1570159x15666171109125643] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 01/01/1970] [Accepted: 11/07/2017] [Indexed: 12/06/2022] Open
Abstract
BACKGROUND Hereditary cerebellar ataxias are a group of disorders characterized by heterogeneous clinical manifestations, progressive clinical course, and diverse genetic causes. No disease modifying treatments are yet available for many of these disorders. Oxidative stress has been recurrently identified in different progressive cerebellar diseases, and it represents a widely investigated target for treatment. OBJECTIVE To review the main aspects and new perspectives of antioxidant therapy in cerebellar ataxias ranging from bench to bedside. METHOD This article is a summary of the state-of-the-art on the use of antioxidant molecules in cerebellar ataxia treatments. It also briefly summarizes aspects of oxidative stress production and general characteristics of antioxidant compounds. RESULTS Antioxidants represent a vast category of compounds; old drugs have been extensively studied and modified in order to achieve better biological effects. Despite the vast body of literature present on the use of antioxidants in cerebellar ataxias, for the majority of these disorders conclusive results on the efficacy are still missing. CONCLUSION Antioxidant therapy in cerebellar ataxias is a promising field of investigations. To achieve the success in identifying the correct treatment more work needs to be done. In particular, a combined effort is needed by basic scientists in developing more efficient molecules, and by clinical researchers together with patients communities, to run clinical trials in order to identify conclusive treatments strategies.
Collapse
Affiliation(s)
- Emanuele Barca
- Address correspondence to this author at the Department of Neurology, Columbia University Medical Center, 630 W 168 Street, P&S 4-424/A, New York, NY 10032, USA; Tel: +1-212-305-1637; Fax: +1-212-305-3986; E-mail:
| | | | | | | | | |
Collapse
|
162
|
Gama Marques J. Twenty years of misdiagnosis of schizophrenia in a patient with Dandy-Walker variant syndrome. Gen Psychiatr 2019; 32:e100031. [PMID: 30815635 PMCID: PMC6362872 DOI: 10.1136/gpsych-2018-100031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 12/17/2018] [Accepted: 12/18/2018] [Indexed: 11/13/2022] Open
Abstract
Various case reports of patients with Dandy-Walker variant syndrome mimicking schizophrenia have been published in the last 20 years, suggesting that this neurodevelopment disorder should be part of the differential diagnosis for every patient with a first episode of psychosis. In this report, it is presented that a patient who was diagnosed and treated as a paranoid schizophrenic for 20 years and had four bone fractures secondary to ataxic gait impairment, before performing a neuroimaging examination that revealed Dandy-Walker variant syndrome.
Collapse
Affiliation(s)
- João Gama Marques
- Hospital Júlio de Matos, Centro Hospitalar Psiquiátrico de Lisboa; Clínica Universitária de Psiquiatria e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| |
Collapse
|
163
|
Feil K, Strobl R, Schindler A, Krafczyk S, Goldschagg N, Frenzel C, Glaser M, Schöberl F, Zwergal A, Strupp M. What Is Behind Cerebellar Vertigo and Dizziness? THE CEREBELLUM 2018; 18:320-332. [DOI: 10.1007/s12311-018-0992-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
164
|
van Dun K, Mitoma H, Manto M. Cerebellar Cortex as a Therapeutic Target for Neurostimulation. THE CEREBELLUM 2018; 17:777-787. [PMID: 30276522 DOI: 10.1007/s12311-018-0976-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Non-invasive stimulation of the cerebellum is growingly applied both in the clinic and in research settings to modulate the activities of cerebello-cerebral loops. The anatomical location of the cerebellum, the high responsiveness of the cerebellar cortex to magnetic/electrical stimuli, and the implication of the cerebellum in numerous cerebello-cerebral networks make the cerebellum an ideal target for investigations and therapeutic purposes. In this mini-review, we discuss the potentials of cerebellar neuromodulation in major brain disorders in order to encourage large-scale sham-controlled research and explore this therapeutic aid further.
Collapse
Affiliation(s)
- Kim van Dun
- Clinical and Experimental Neurolinguistics, CLIN, Vrije Universiteit Brussels, Pleinlaan 2, 1050, Brussels, Belgium.
| | - Hiroshi Mitoma
- Medical Education Promotion Center, Tokyo Medical University, Tokyo, Japan
| | - Mario Manto
- Service de Neurologie, Médiathèque Jean Jacquy, CHU-Charleroi, Charleroi, Belgium.,Service des Neurosciences, UMons, Mons, Belgium
| |
Collapse
|
165
|
Oh AJ, Chen T, Shariati MA, Jehangir N, Hwang TN, Liao YJ. A simple saccadic reading test to assess ocular motor function in cerebellar ataxia. PLoS One 2018; 13:e0203924. [PMID: 30403759 PMCID: PMC6221255 DOI: 10.1371/journal.pone.0203924] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 08/30/2018] [Indexed: 01/09/2023] Open
Abstract
Cerebellar ataxia is a neurological disorder due to dysfunction of the cerebellum that affects coordination of fine movement, gait, and balance. Although ataxic patients commonly exhibit abnormal eye movement and have difficulties with saccadic reading, quantification of ocular motor abilities during reading in the clinical setting is rarely done. In this study, we assess visual performance with simple reading tests that can be used in the clinical setting and performed video infrared oculography in 11 patients with hereditary or acquired cerebellar ataxia and 11 age-matched controls. We found that compared with controls, ataxic patients read significantly slower on regularly and irregularly spaced 120 single-digit number reading tasks (read aloud) (p = 0.02 for both) but not on a word reading task (read silently), although there was large variability on the word reading task. Among the 3 reading tasks, the regularly spaced number reading task had the greatest difference (44%) between ataxic patients and controls. Analysis of oculography revealed that ataxic patients had slower reading speeds on the regularly spaced number reading task because of significantly higher saccade and fixation counts, impairment of small amplitude progressive saccades as well as large amplitude, line-changing saccades, greater fixation dispersion, and irregularity of scan paths and staircase gaze patterns. Our findings show that infrared oculography remains the gold standard in assessment of ocular motor difficulties during reading in ataxic patients. In the absence of this capability in the clinical setting, a simple 120 regularly spaced single-digit saccadic number reading test, which most patients can perform in less than 2 minutes, can be a possible biomarker for ocular motor abilities necessary for reading.
Collapse
Affiliation(s)
- Angela Jinsook Oh
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, California, United States of America
| | - Tiffany Chen
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, California, United States of America
| | - Mohammad Ali Shariati
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, California, United States of America
| | - Naz Jehangir
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, California, United States of America
| | - Thomas N. Hwang
- Department of Ophthalmology, Kaiser Permanente Redwood City Medical Center, Redwood City, California, United States of America
| | - Yaping Joyce Liao
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, California, United States of America
- Department of Neurology, Stanford University School of Medicine, Stanford, California, United States of America
- * E-mail:
| |
Collapse
|
166
|
Neurocognitive Characterization of an SCA28 Family Caused by a Novel AFG3L2 Gene Mutation. THE CEREBELLUM 2018; 16:979-985. [PMID: 28660440 DOI: 10.1007/s12311-017-0870-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
|
167
|
Insights from perceptual, sensory, and motor functioning in autism and cerebellar primary disturbances: Are there reliable markers for these disorders? Neurosci Biobehav Rev 2018; 95:263-279. [PMID: 30268434 DOI: 10.1016/j.neubiorev.2018.09.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 06/09/2018] [Accepted: 09/23/2018] [Indexed: 12/21/2022]
Abstract
The contribution of cerebellar circuitry alterations in the pathophysiology of Autism Spectrum Disorder (ASD) has been widely investigated in the last decades. Yet, experimental studies on neurocognitive markers of ASD have not been attentively compared with similar studies in patients with cerebellar primary disturbances (e.g., malformations, agenesis, degeneration, etc). Addressing this neglected issue could be useful to underline unexpected areas of overlap and/or underestimated differences between these sets of conditions. In fact, ASD and cerebellar primary disturbances (notably, Cerebellar Cognitive Affective Syndrome, CCAS) can share atypical manifestations in perceptual, sensory, and motor functions, but neural subcircuits involved in these anomalies/difficulties could be distinct. Here, we specifically deal with this issue focusing on four paradigmatic neurocognitive functions: visual and biological motion perception, multisensory integration, and high stages of the motor hierarchy. From a research perspective, this represents an essential challenge to more deeply understand neurocognitive markers of ASD and of cerebellar primary disturbances/CCAS. Although we cannot assume definitive conclusions, and beyond phenotypical similarities between ASD and CCAS, clinical and experimental evidence described in this work argues that ASD and CCAS are distinct phenomena. ASD and CCAS seem to be characterized by different pathophysiological mechanisms and mediated by distinct neural nodes. In parallel, from a clinical perspective, this characterization may furnish insights to tackle the distinction between autistic functioning/autistic phenotype (in ASD) and dysmetria of thought/autistic-like phenotype (in CCAS).
Collapse
|
168
|
Regionally specific TSC1 and TSC2 gene expression in tuberous sclerosis complex. Sci Rep 2018; 8:13373. [PMID: 30190613 PMCID: PMC6127129 DOI: 10.1038/s41598-018-31075-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 08/06/2018] [Indexed: 12/15/2022] Open
Abstract
Tuberous sclerosis complex (TSC), a heritable neurodevelopmental disorder, is caused by mutations in the TSC1 or TSC2 genes. To date, there has been little work to elucidate regional TSC1 and TSC2 gene expression within the human brain, how it changes with age, and how it may influence disease. Using a publicly available microarray dataset, we found that TSC1 and TSC2 gene expression was highest within the adult neo-cerebellum and that this pattern of increased cerebellar expression was maintained throughout postnatal development. During mid-gestational fetal development, however, TSC1 and TSC2 expression was highest in the cortical plate. Using a bioinformatics approach to explore protein and genetic interactions, we confirmed extensive connections between TSC1/TSC2 and the other genes that comprise the mammalian target of rapamycin (mTOR) pathway, and show that the mTOR pathway genes with the highest connectivity are also selectively expressed within the cerebellum. Finally, compared to age-matched controls, we found increased cerebellar volumes in pediatric TSC patients without current exposure to antiepileptic drugs. Considered together, these findings suggest that the cerebellum may play a central role in TSC pathogenesis and may contribute to the cognitive impairment, including the high incidence of autism spectrum disorder, observed in the TSC population.
Collapse
|
169
|
Singh H, Elarjani T, da Silva HB, Shetty R, Kim L, Sekhar LN. Brain Stem Cavernous Malformations: Operative Nuances of a Less-Invasive Resection Technique. Oper Neurosurg (Hagerstown) 2018; 15:153-173. [PMID: 29228395 DOI: 10.1093/ons/opx231] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 09/27/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Different operative techniques are reported for the resection of brainstem cavernous malformations (BSCMs). The senior author has previously reported on a less-invasive technique of entering the brain stem with piecemeal removal of BSCMs, especially the deep-seated ones. OBJECTIVE To present a larger series of these lesions, emphasizing the approach to the brain stem via case selection. We discuss the nuances of the less-invasive operative technique through case illustrations and intraoperative videos. METHODS A retrospective review of 46 consecutive cases of BSCMs, with their clinical and radiographic data, was performed. Nine cases were selected to illustrate 7 different operative approaches, and discuss surgical nuances of the less-invasive technique unique to each. RESULTS Postoperative morbidity, defined as an increase in modified Rankin Scale, was observed in 5 patients (10.9%). A residual BSCM was present in 2 patients (4.3%); both underwent reoperation to remove the remainder. At follow-up of 31.1 ± 27.8 mo, 3 patients experienced recurrence (6.5%). Overall, 65% of our patients improved, 20% stayed the same, and 11% worsened postsurgery. Two patients died, yielding a mortality of 4.3%. CONCLUSION Using the less-invasive resection technique for piecemeal BSCM removal, in appropriately selected patients, has yielded comparable to improved patient outcomes over existing large series. In our experience, lateral, anterolateral, and posterolateral approaches are favorable over direct midline (dorsal or ventral) approaches. A thorough understanding of brain-stem safe-entry zones, in conjunction with appropriate approach selection, is key to a good outcome in challenging cases.
Collapse
Affiliation(s)
- Harminder Singh
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Turki Elarjani
- Department of Neurological Surgery, University of Washington Medical Center, Seattle, Washington
| | - Harley Brito da Silva
- Department of Neurological Surgery, University of Washington Medical Center, Seattle, Washington
| | - Rakshith Shetty
- Department of Neurological Surgery, University of Washington Medical Center, Seattle, Washington
| | - Louis Kim
- Department of Neurological Surgery, University of Washington Medical Center, Seattle, Washington
| | - Laligam N Sekhar
- Department of Neurological Surgery, University of Washington Medical Center, Seattle, Washington
| |
Collapse
|
170
|
Goebel S, Mehdorn HM. A missing piece? Neuropsychiatric functioning in untreated patients with tumors within the cerebellopontine angle. J Neurooncol 2018; 140:145-153. [PMID: 29982872 DOI: 10.1007/s11060-018-2944-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 06/27/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE To date, little is known about neuropsychiatric symptoms in patients with tumors within the cerebellopontine angle (CPA). These, however, might be of clinical relevance. Aim of this study was thus to assess possible impairment in cognition, elevation in mood symptoms, and fatigue in this specific patient group. METHODS Forty-five patients with an untreated CPA tumor (27 vestibularis schwannoma, 18 meningioma) were tested within a cross-sectional observational study in a single institution prior to neurosurgical treatment. Patients were administered a multifaceted battery comprising of widely-used tests for assessment of neuropsychiatric functioning. RESULTS The majority of the included patients (69%) showed neurocognitive impairment, most frequently in the areas of attention and visuo-motor speed (e.g., alertness) (62%) as well as visuo-construction (44%). Impaired structural integrity of the brain stem was accompanied by more serious neurocognitive deficits. About one-third of the sample reported clinically relevant depression and/or anxiety and an even higher proportion (48%) described high levels of fatigue. Cognitive and affective symptoms as well as fatigue contributed significantly to patients' Quality of Life, indicating the clinical relevance of neuropsychiatric symptoms in patients with CPA tumors. CONCLUSIONS Although patients with untreated CPA tumors often suffer from devastating and prominent physical symptoms, neuropsychiatric problems are also frequent. Including these aspects in the routine clinical assessment and initiating treatment accordingly might thus improve clinical management of the patients and improve Quality of Life.
Collapse
Affiliation(s)
- Simone Goebel
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Christian-Albrechts University, Olshausenstraße 62, 24118, Kiel, Germany.
| | | |
Collapse
|
171
|
Neuroplasticity in the cerebello-thalamo-basal ganglia pathway: A longitudinal in vivo MRI study in male songbirds. Neuroimage 2018; 181:190-202. [PMID: 29981906 DOI: 10.1016/j.neuroimage.2018.07.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 07/04/2018] [Indexed: 12/12/2022] Open
Abstract
Similar to human speech, bird song is controlled by several pathways including a cortico-basal ganglia-thalamo-cortical (C-BG-T-C) loop. Neurotoxic disengagement of the basal ganglia component, i.e. Area X, induces long-term changes in song performance, while most of the lesioned area regenerates within the first months. Importantly however, the timing and spatial extent of structural neuroplastic events potentially affecting other constituents of the C-BG-T-C loop is not clear. We designed a longitudinal MRI study where changes in brain structure were evaluated relative to the time after neurotoxic lesioning or to vocal performance. By acquiring both Diffusion Tensor Imaging and 3-dimensional anatomical scans, we were able to track alterations in respectively intrinsic tissue properties and local volume. Voxel-based statistical analyses revealed structural remodeling remote to the lesion, i.e. in the thalamus and, surprisingly, the cerebellum, both peaking within the first two months after lesioning Area X. Voxel-wise correlations between song performance and MRI parameters uncovered intriguing brain-behavior relationships in several brain areas pertaining to the C-BG-T-C loop supervising vocal motor control. Our results clearly point to structural neuroplasticity in the cerebellum induced by basal ganglia (striatal) damage and might point to the existence of a human-like cerebello-thalamic-basal ganglia pathway capable of modifying vocal motor output.
Collapse
|
172
|
The role of the human cerebellum in linguistic prediction, word generation and verbal working memory: evidence from brain imaging, non-invasive cerebellar stimulation and lesion studies. Neuropsychologia 2018. [DOI: 10.1016/j.neuropsychologia.2018.03.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
|
173
|
Ma X, Su W, Li S, Li C, Wang R, Chen M, Chen H. Cerebellar atrophy in different subtypes of Parkinson's disease. J Neurol Sci 2018; 392:105-112. [PMID: 30036781 DOI: 10.1016/j.jns.2018.06.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 06/27/2018] [Accepted: 06/28/2018] [Indexed: 01/20/2023]
Abstract
BACKGROUND To investigate, using Magnetic Resonance Imaging (MRI) and voxel-based morphometry (VBM), morphometric changes of cerebellum in Parkinson's disease with different motor and affective subtypes. METHODS Fifty-four patients with idiopathic Parkinson's disease (PD) were classified into tremor-predominant-PD (PDT) (n = 37) and akinetic/rigidity-predominant-PD (PDAR) (n = 17). Moreover, PD groups were divided into four affective subtypes, including depressive but not anxious PD (dPD, n = 5), anxious but not depressive PD (aPD, n = 8), comorbid depressive and anxious PD (coPD, n = 8), and PD patients without depressive or anxious symptoms (nPD, n = 33). They were additionally compared at a group level with thirty-nine normal controls (NCs). An analysis of covariance followed by post hoc tests was performed to examine the alterations of cerebellar grey matter volume (GMV) in different groups of PD. RESULTS Compared with NCs, PD showed grey matter (GM) atrophy in the right Crus II, pyramis, culmen, the right lobules IV, and V, and the left lobule VI. PDT, PDAR and NCs did not differ in the volume of the cerebellum. Relative to nPD group, dPD group exhibited GMV reduction in the left Crus I, while aPD group showed GMV reduction in the tonsil and the right lobule VIII. The GM atrophy was also found in the coPD group compared to NCs, including the tonsil, the left lobule VIII, the right lobule VI, the left Crus I, and vermis IV, and V. There was a significant negative correlation between the Hamilton Rating Scale for Depression (HAMD) score and the right lobule IX volume, and a significant negative correlation between the Hamilton Rating Scale for Anxiety (HAMA) score and the right lobule VIII volume. CONCLUSIONS These findings suggest that cerebellar changes are involved in PD. It also supports a possible role of the cerebellum in the depressive and anxious symptoms in PD.
Collapse
Affiliation(s)
- Xinxin Ma
- Department of Neurology, Beijing Hospital, National Center of Gerontology, No. 1 Da-Hua Road, Dong Dan, Beijing 100730, China
| | - Wen Su
- Department of Neurology, Beijing Hospital, National Center of Gerontology, No. 1 Da-Hua Road, Dong Dan, Beijing 100730, China
| | - Shuhua Li
- Department of Neurology, Beijing Hospital, National Center of Gerontology, No. 1 Da-Hua Road, Dong Dan, Beijing 100730, China
| | - Chunmei Li
- Department of Radiology, Beijing Hospital, National Center of Gerontology, No. 1 Da-Hua Road, Dong Dan, Beijing 100730, China
| | - Rui Wang
- Department of Radiology, Beijing Hospital, National Center of Gerontology, No. 1 Da-Hua Road, Dong Dan, Beijing 100730, China
| | - Min Chen
- Department of Radiology, Beijing Hospital, National Center of Gerontology, No. 1 Da-Hua Road, Dong Dan, Beijing 100730, China
| | - Haibo Chen
- Department of Neurology, Beijing Hospital, National Center of Gerontology, No. 1 Da-Hua Road, Dong Dan, Beijing 100730, China.
| |
Collapse
|
174
|
Sarappa C, Salvatore E, Filla A, Cocozza S, Russo CV, Saccà F, Brunetti A, De Michele G, Quarantelli M. Functional MRI signal fluctuations highlight altered resting brain activity in Huntington's disease. Brain Imaging Behav 2018; 11:1459-1469. [PMID: 27734308 DOI: 10.1007/s11682-016-9630-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The fractional Amplitude of Low Frequency Fluctuations (fALFF) and the degree of local synchronization (Regional Homogeneity - ReHo) of resting-state BOLD signal have been suggested to map spontaneous neuronal activity and local functional connectivity, respectively. We compared voxelwise, independent of atrophy, the fALFF and ReHo patterns of 11 presymptomatic (ps-HD) and 28 symptomatic (sHD) Huntington's disease mutation carriers, with those of 40 normal volunteers, and tested their possible correlations with the motor and cognitive subscores of the Unified Huntington's Disease Rating Scale. In sHD patients, fALFF was mainly reduced bilaterally in parietal lobes (right precuneus being already affected in psHD), and in superior frontal gyri, and increased bilaterally in cerebellar lobules VI, VIII and IX, as well as in the right inferior temporal gyrus. In sHD, and to a lesser extent in psHD, ReHo was bilaterally reduced in putamina, cerebellar lobules III to VI, and superior medial frontal gyri, and increased in both psHD and sHD in fronto-basal cortices, and in the right temporal lobe. fALFF correlated inversely with cognitive scores in lobule IX of the cerebellum (mainly with total Stroop score, p < 0.0001), and in the medial portions of both thalami. These results are consistent with a reduced neuronal activity in the cortical components of the executive networks, known to be affected in Huntington's Disease, and with reduced local functional integration in subcortical and cerebellar components of the sensori-motor network. Cerebellar clusters of significant correlation of fALFF with executive function scores may be related to compensatory mechanisms.
Collapse
Affiliation(s)
- Chiara Sarappa
- Department of Advanced Biomedical Sciences, University "Federico II", Edificio 10, Via S. Pansini 5, 80131, Naples, Italy
| | - Elena Salvatore
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University "Federico II", Edificio 17, Via S. Pansini 5, 80131, Naples, Italy
| | - Alessandro Filla
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University "Federico II", Edificio 17, Via S. Pansini 5, 80131, Naples, Italy
| | - Sirio Cocozza
- Department of Advanced Biomedical Sciences, University "Federico II", Edificio 10, Via S. Pansini 5, 80131, Naples, Italy
| | - Cinzia Valeria Russo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University "Federico II", Edificio 17, Via S. Pansini 5, 80131, Naples, Italy
| | - Francesco Saccà
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University "Federico II", Edificio 17, Via S. Pansini 5, 80131, Naples, Italy
| | - Arturo Brunetti
- Department of Advanced Biomedical Sciences, University "Federico II", Edificio 10, Via S. Pansini 5, 80131, Naples, Italy
| | - Giuseppe De Michele
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University "Federico II", Edificio 17, Via S. Pansini 5, 80131, Naples, Italy
| | - Mario Quarantelli
- Biostructure and Bioimaging Institute, National Research Council, Via T. De Amicis 95, 80145, Naples, Italy.
| |
Collapse
|
175
|
Abstract
The neuropsychiatric examination includes standard neurological and cognitive examination techniques with several additional observations and tasks designed to capture abnormalities common among patients with neuropsychiatric disorders or neurocognitive complaints. Although useful as a screening tool, a single standardized rating scale such as the Mini Mental State Examination (MMSE) or the Montreal Cognitive Assessment (MoCA) is insufficient to establish a neuropsychiatric diagnosis. Extra attention is paid to findings commonly seen in the setting of psychiatric disorders, dementias, movement disorders, or dysfunction of cortical or subcortical structures. Dysmorphic features, dermatologic findings, neurodevelopmental signs, signs of embellishment, and expanded neurocognitive testing are included. The neuropsychiatric clinician utilizes the techniques described in this article to adapt the examination to each patient's situation, choosing the most appropriate techniques to supplement the basic neurological and psychiatric examinations in support of diagnostic hypotheses being considered. The added examination techniques facilitate diagnosis of neurocognitive disorders and enable neuropsychiatric formulation.
Collapse
|
176
|
Abstract
PURPOSE OF REVIEW Mutism of cerebellar origin may occur in the context of various causes but is most frequent in children after resection of a large midline cerebellar tumour. In this review, the endeavour to reach a consensus on name and definition of postoperative mutism of cerebellar origin and associated symptoms is highlighted. In addition, progress in understanding of cause and risk factors for the syndrome is discussed as well as the rehabilitation issues. RECENT FINDINGS Consensus on the term cerebellar mutism syndrome (CMS) has been reached. The exact pathogenesis of CMS remains unclear. Recently, attention was drawn to the hypothesis that thermal injury might be an important mechanism in the pathogenesis of CMS. Diffusion tensor imaging tractography was found to visualize the damage to relevant pathways that are associated with persistent impairments after recovery of CMS. There is still no established treatment for CMS to date. SUMMARY By reaching a consensus on terminology and description of CMS, a firm basis has been created for future research. The pathogenesis of CMS seems multifactorial and important risk factors have been found. However, CMS cannot be effectively prevented yet and no established or specific treatment is available, apart from very general rehabilitation and cognitive interventions.
Collapse
Affiliation(s)
- Coriene E Catsman-Berrevoets
- Department of Paediatric Neurology, Erasmus University Hospital/Sophia Children's Hospital, Rotterdam, The Netherlands
| |
Collapse
|
177
|
Lawrenson C, Bares M, Kamondi A, Kovács A, Lumb B, Apps R, Filip P, Manto M. The mystery of the cerebellum: clues from experimental and clinical observations. CEREBELLUM & ATAXIAS 2018; 5:8. [PMID: 29610671 PMCID: PMC5877388 DOI: 10.1186/s40673-018-0087-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 03/15/2018] [Indexed: 11/22/2022]
Abstract
The cerebellum has a striking homogeneous cytoarchitecture and participates in both motor and non-motor domains. Indeed, a wealth of evidence from neuroanatomical, electrophysiological, neuroimaging and clinical studies has substantially modified our traditional view on the cerebellum as a sole calibrator of sensorimotor functions. Despite the major advances of the last four decades of cerebellar research, outstanding questions remain regarding the mechanisms and functions of the cerebellar circuitry. We discuss major clues from both experimental and clinical studies, with a focus on rodent models in fear behaviour, on the role of the cerebellum in motor control, on cerebellar contributions to timing and our appraisal of the pathogenesis of cerebellar tremor. The cerebellum occupies a central position to optimize behaviour, motor control, timing procedures and to prevent body oscillations. More than ever, the cerebellum is now considered as a major actor on the scene of disorders affecting the CNS, extending from motor disorders to cognitive and affective disorders. However, the respective roles of the mossy fibres, the climbing fibres, cerebellar cortex and cerebellar nuclei remains unknown or partially known at best in most cases. Research is now moving towards a better definition of the roles of cerebellar modules and microzones. This will impact on the management of cerebellar disorders.
Collapse
Affiliation(s)
- Charlotte Lawrenson
- School of Physiology, Pharmacology and Neuroscience, Biomedical Sciences Building, University of Bristol, Tankard’s Close, University Walk, Bristol, BS8 1TD UK
| | - Martin Bares
- First Department of Neurology, Faculty of Medicine, Masaryk University and St. Anne’s Teaching Hospital, Brno, Czech Republic
- Department of Neurology, School of Medicine, University of Minnesota, Minneapolis, USA
| | - Anita Kamondi
- Department of Neurology, National Institute of Clinical Neurosciences, Amerikai út 57, Budapest, 1145 Hungary
- Department of Neurology, Semmelweis University, Üllői út 26, Budapest, 1083 Hungary
| | - Andrea Kovács
- Department of Neurology, National Institute of Clinical Neurosciences, Amerikai út 57, Budapest, 1145 Hungary
- János Szentágothai Doctoral School of Neurosciences, Semmelweis University, Üllői út 26, Budapest, 1083 Hungary
| | - Bridget Lumb
- School of Physiology, Pharmacology and Neuroscience, Biomedical Sciences Building, University of Bristol, Tankard’s Close, University Walk, Bristol, BS8 1TD UK
| | - Richard Apps
- School of Physiology, Pharmacology and Neuroscience, Biomedical Sciences Building, University of Bristol, Tankard’s Close, University Walk, Bristol, BS8 1TD UK
| | - Pavel Filip
- First Department of Neurology, Faculty of Medicine, Masaryk University and St. Anne’s Teaching Hospital, Brno, Czech Republic
| | - Mario Manto
- FNRS ULB-Erasme, 808 Route de Lennik, 1070 Bruxelles, Belgium
- Service des Neurosciences, UMons, 7000 Mons, Belgium
- Department of Neurology, Centre Hospitalier Universitaire (CHU) de Charleroi, 6000 Charleroi, Belgium
- Laboratoire de Médecine Expérimentale, Site Vésale, ULB Unité 222, 6110 Montigny-le-Tilleul, Belgium
| |
Collapse
|
178
|
Progression of Gait Ataxia in Patients with Degenerative Cerebellar Disorders: a 4-Year Follow-Up Study. THE CEREBELLUM 2018; 16:629-637. [PMID: 27924492 DOI: 10.1007/s12311-016-0837-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
In the present study, the progression of gait impairment in a group of patients with primary degenerative cerebellar ataxias was observed over a period of 4 years. A total of 30 patients underwent an initial gait analysis study, and thereafter only 12 were evaluated because they completed the 2- and 4-year follow-up evaluations. Time-distance parameters, trunk and joint range of motion (RoM), and variability parameters (e.g., coefficients of variation) were measured at the baseline and at each follow-up evaluation. The scale for the assessment and rating of ataxia (SARA) was used to evaluate disease severity. We found a significant increase in the SARA score at both the 2- and 4-year follow-up evaluations. Almost all the gait variables changed significantly only at the 4-year follow-up. Particularly, we found a significant decrease in the step length and in the hip, knee, and ankle joint RoM values and noted a significant increase in the trunk rotation RoM and stride-to-stride and step length variability. Furthermore, a significant difference in ankle joint RoM was found between spinocerebellar ataxia and sporadic adult-onset ataxia patients, with the value being lower in the former group of patients. Our findings suggest that patients with degenerative cerebellar ataxias exhibit gait decline after 4 years from the baseline. Moreover, patients try to maintain an effective gait by adopting different compensatory mechanisms during the course of the disease in spite of disease progression.
Collapse
|
179
|
Mohar M, Hartman K, Long B, Lee P, Didita A, Altschuler EL. Rehabilitation Course and Specification of Dysmetria of a Patient With Ataxia, Dysmetria, and Hemiparesis After a Stroke in the Corona Radiata: A Case Presentation. PM R 2018; 10:974-978. [PMID: 29425940 DOI: 10.1016/j.pmrj.2018.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 01/17/2018] [Accepted: 01/21/2018] [Indexed: 10/18/2022]
Abstract
We present a case of a patient with ataxia, dysmetria, and hemiparesis after a stroke in the corona radiata. The patient had an excellent clinical course with near resolution of symptoms in 2 and a half weeks and returned back to work full duty and full time a couple of weeks later. We use videos of several neurologic tests to demonstrate and characterize the dysmetria. Interestingly, a key characteristic of the dysmetria appears to be different from that seen in patients with dysmetria arising from a cerebellar, thalamic, or pontine lesion. We propose a possible neurophysiologic mechanism-damage to and redundancy of part of the corticopontine portion of the cerebellar circuit located in the corona radiata-respectively responsible for this condition and recovery. We also discuss how a simple noninvasive study of patients with ataxia and dysmetria secondary to corona radiata, thalamic, pontine, and possibly other brain lesions may be helpful in elucidating the contribution of pontocerebellar fibers and other structures to motor control. LEVEL OF EVIDENCE V.
Collapse
Affiliation(s)
- Monir Mohar
- Department of Physical Medicine and Rehabilitation, Metropolitan Hospital, New York, NY(∗)
| | | | | | - Peter Lee
- Department of Physical Medicine and Rehabilitation, Metropolitan Hospital, New York, NY(§)
| | - Adrian Didita
- Department of Physical Medicine and Rehabilitation, Metropolitan Hospital, New York, NY(¶)
| | - Eric L Altschuler
- Department of Physical Medicine and Rehabilitation, Metropolitan Hospital, 1901 First Avenue, New York, NY 10029(#).
| |
Collapse
|
180
|
Abstract
Essential tremor (ET) is currently classified as a syndrome rather than a unique disease, primarily involving monosymptomatic action tremor in both hands. Different etiologies are presumed to underlie this condition. Currently only a few monogenetic conditions are known to present with this syndrome. If accompanied by additional symptoms that do not in themselves constitute a new syndrome, such as abnormal tandem gait or postures, the syndrome should be diagnosed as "ET plus". ET is associated with abnormal rhythmic activation of the cerebello-thalamo-cortical tremor circuit. Despite its strong heritability, the genetics of ET have not been elucidated as yet. Age-correlated tremor is one of the presumed subgroups of ET. Late onset is associated with a shortened life expectancy. From a treatment perspective, propranolol and primidone represent the drugs of first choice, followed by topiramate. Deep brain stimulation of the Vim nucleus of the thalamus is a proven treatment option in severely affected patients.
Collapse
|
181
|
Nonnekes J, Goselink RJM, Růžička E, Fasano A, Nutt JG, Bloem BR. Neurological disorders of gait, balance and posture: a sign-based approach. Nat Rev Neurol 2018; 14:183-189. [DOI: 10.1038/nrneurol.2017.178] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
182
|
Vicari S, Piccini G, Mercuri E, Battini R, Chieffo D, Bulgheroni S, Pecini C, Lucibello S, Lenzi S, Moriconi F, Pane M, D’Amico A, Astrea G, Baranello G, Riva D, Cioni G, Alfieri P. Implicit learning deficit in children with Duchenne muscular dystrophy: Evidence for a cerebellar cognitive impairment? PLoS One 2018; 13:e0191164. [PMID: 29338029 PMCID: PMC5770044 DOI: 10.1371/journal.pone.0191164] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 12/31/2017] [Indexed: 11/19/2022] Open
Abstract
This study aimed at comparing implicit sequence learning in individuals affected by Duchenne Muscular Dystrophy without intellectual disability and age-matched typically developing children. A modified version of the Serial Reaction Time task was administered to 32 Duchenne children and 37 controls of comparable chronological age. The Duchenne group showed a reduced rate of implicit learning even if in the absence of global intellectual disability. This finding provides further evidence of the involvement of specific aspects of cognitive function in Duchenne muscular dystrophy and on its possible neurobiological substrate.
Collapse
Affiliation(s)
- Stefano Vicari
- Department of Neuroscience, Child Neuropsychiatric Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giorgia Piccini
- Department of Neuroscience, Child Neuropsychiatric Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Eugenio Mercuri
- Pediatric Neurology Unit, Catholic University and Nemo Center, Rome, Italy
| | - Roberta Battini
- Department of Developmental Neuroscience, IRCCS Stella Maris, Calambrone (Pisa), Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Daniela Chieffo
- Pediatric Neurology Unit, Catholic University and Nemo Center, Rome, Italy
| | - Sara Bulgheroni
- Developmental Neurology Division, IRCCS Fondazione Istituto Neurologico C. Besta, Milan, Italy
| | - Chiara Pecini
- Department of Developmental Neuroscience, IRCCS Stella Maris, Calambrone (Pisa), Italy
| | - Simona Lucibello
- Pediatric Neurology Unit, Catholic University and Nemo Center, Rome, Italy
| | - Sara Lenzi
- Department of Developmental Neuroscience, IRCCS Stella Maris, Calambrone (Pisa), Italy
| | - Federica Moriconi
- Pediatric Neurology Unit, Catholic University and Nemo Center, Rome, Italy
| | - Marika Pane
- Pediatric Neurology Unit, Catholic University and Nemo Center, Rome, Italy
| | - Adele D’Amico
- Department of Neurosciences, Neuromuscular and Neurodegenerative Diseases Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Guja Astrea
- Department of Developmental Neuroscience, IRCCS Stella Maris, Calambrone (Pisa), Italy
| | - Giovanni Baranello
- Developmental Neurology Division, IRCCS Fondazione Istituto Neurologico C. Besta, Milan, Italy
| | - Daria Riva
- Developmental Neurology Division, IRCCS Fondazione Istituto Neurologico C. Besta, Milan, Italy
| | - Giovanni Cioni
- Department of Developmental Neuroscience, IRCCS Stella Maris, Calambrone (Pisa), Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Paolo Alfieri
- Department of Neuroscience, Child Neuropsychiatric Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- * E-mail:
| |
Collapse
|
183
|
Sarikaya H, Steinlin M. Cerebellar stroke in adults and children. HANDBOOK OF CLINICAL NEUROLOGY 2018; 155:301-312. [DOI: 10.1016/b978-0-444-64189-2.00020-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
|
184
|
Abstract
Tremor is a phenomenon observed in a broad spectrum of diseases with different pathophysiologies. While patients with tremor may not complain in the clinic of symptoms of imbalance, gait difficulties, or falls, laboratory research studies using quantitative analysis of gait and posture and neurophysiologic techniques have demonstrated impaired gait and balance across a variety of tremor etiologies. These findings have been supported by careful epidemiologic studies assessing symptoms of imbalance. Imaging and neurophysiologic studies have identified cerebellar networks as important mediators of tremor, and therefore a likely common site of dysfunction to explain the phenomenologic overlap between impaired postural and gait control with tremor. Further understanding of these mechanisms and networks is of crucial importance in the development of new treatments, particularly surgical or minimally invasive lesional therapies.
Collapse
Affiliation(s)
- Hugo Morales-Briceño
- Movement Disorders Unit, Department of Neurology, Westmead Hospital, Sydney, NSW, Australia
| | - Alessandro F Fois
- Movement Disorders Unit, Department of Neurology, Westmead Hospital, Sydney, NSW, Australia
| | - Victor S C Fung
- Movement Disorders Unit, Department of Neurology, Westmead Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
| |
Collapse
|
185
|
Abstract
Beyond the classic clinical description, recent studies have quantitatively evaluated gait and balance dysfunction in cerebellar ataxias by means of modern motion analysis systems. These systems have the aim of clearly and quantitatively describing the differences, with respect to healthy subjects, in kinematic, kinetic, and surface electromyography variables, establishing the basis for a rehabilitation strategy and assessing its efficacy. The main findings which characterize the gait pattern of cerebellar patients are: increased step width, reduced ankle joint range of motion with increased coactivation of the antagonist muscles, and increased stride-to-stride variability. Whereas the former is a compensatory strategy adopted by patients to keep the center of mass within the base of support, the latter indicates the inability of patients to maintain dynamic balance through a regular walking pattern and may reflect the primary deficit directly related to cerebellar dysfunction and the consequent lack of muscle coordination during walking. Moreover, during the course of the disease, with the progressive loss of walking autonomy, step length, and lower-limb joint range of motion are drastically reduced. As to the joint coordination defect, abnormal intralimb joint coordination during walking, in terms of both joint kinematics and interaction torques, has been reported in several studies. Furthermore, patients with cerebellar ataxia show a poor intersegmental coordination, with a chaotic coordinative behavior between trunk and hip, leading to increased upper-body oscillations that affect gait performance and stability, sustaining a vicious circle that transforms the upper body into a generator of perturbations. The use of motion analysis laboratories allows a deeper segmental and global characterization of walking impairment in these patients and can shed light on the nature of both the primary specific gait disorder and compensatory mechanisms. Such deeper understanding might reasonably represent a valid prerequisite for establishing better-targeted rehabilitation strategies.
Collapse
Affiliation(s)
- Mariano Serrao
- Department of Medical and Surgical Sciences and Biotechnologies, University of Rome Sapienza, Latina, Italy.
| | - Alberto Ranavolo
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Istituto Nazionale per l'Assicurazione contro gli Infortuni sul Lavoro, Rome, Italy
| | - Carlo Casali
- Department of Medical and Surgical Sciences and Biotechnologies, University of Rome Sapienza, Latina, Italy
| |
Collapse
|
186
|
Molinari M, Masciullo M, Bulgheroni S, D'Arrigo S, Riva D. Cognitive aspects: sequencing, behavior, and executive functions. HANDBOOK OF CLINICAL NEUROLOGY 2018; 154:167-180. [PMID: 29903438 DOI: 10.1016/b978-0-444-63956-1.00010-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The question posed today is not whether the cerebellum plays a role in cognition, but instead, how the cerebellum contributes to cognitive processes, even in the developmental age. The central role of the cerebellum in many areas of human abilities, motor as well as cognitive, in childhood as well as in adulthood, is well established but cerebellar basic functioning is still not clear and is much debated. Of particular interest is the changing face of cerebellar influence on motor, higher cognitive, and behavioral functioning when adult and developmental lesions are compared. The idea that the cerebellum might play quite different roles during development and in adulthood has been proposed, and evidence from experimental and clinical literature has been provided, including for sequencing, behavioral aspects, and executive functions Still, more data are needed to fully understand the changes of cerebrocerebellar interactions within the segregated loops which connect cerebrum and cerebellum, not only between childhood and adulthood but also in health and disease.
Collapse
Affiliation(s)
- Marco Molinari
- Department of Neurorehabilitation, Fondazione Santa Lucia, Rome, Italy.
| | - Marcella Masciullo
- Translational Clinical Research Division, Fondazione Santa Lucia, Rome, Italy
| | - Sara Bulgheroni
- Translational Clinical Research Division, Fondazione Santa Lucia, Rome, Italy; Carlo Besta Neurological Institute, Milan, Italy
| | - Stefano D'Arrigo
- Translational Clinical Research Division, Fondazione Santa Lucia, Rome, Italy; Carlo Besta Neurological Institute, Milan, Italy
| | - Daria Riva
- Translational Clinical Research Division, Fondazione Santa Lucia, Rome, Italy; Carlo Besta Neurological Institute, Milan, Italy
| |
Collapse
|
187
|
Abstract
Cerebellar mutism most commonly, but not exclusively, develops in children after surgery for midline cerebellar or intraventricular tumors in the posterior fossa, typically medulloblastoma. Cerebellar mutism syndrome (CMS) comprises a complex set of neurologic and neurocognitive signs and symptoms, the cardinal and central component of which is an initially profound but usually reversible speech disorder. As such, CMS is currently recognized as an extreme form of the so-called cerebellar cognitive affective syndrome (Schmahmann syndrome). The putative cause of CMS is a substantial surgical injury to the proximal components of the bilateral efferent cerebellar pathways, disrupting cerebellar input to the supratentorial brain. The resultant cerebellocerebral diaschisis may lead to supratentorial cortical perfusion depression with frontal predominance. The speech disorder is, therefore, likely an apraxia. As our understanding of the mechanism and the clinical spectrum of CMS evolves, clinically useful preoperative risk stratification schemes, adjustments to surgical strategies and techniques, and possible early therapeutic-rehabilitative measures are being sought and developed to reduce the burden of this severe and particularly handicapping chronic morbidity on affected individuals and their families.
Collapse
|
188
|
Abstract
More than a century after the description of its cardinal components, the cerebellar motor syndrome (CMS) remains a cornerstone of daily clinical ataxiology, in both children and adults. Anatomically, motor cerebellum involves lobules I-V, VI, and VIII. CMS is typically associated with errors in the metrics of voluntary movements and a lack of coordination. Symptoms and motor signs consist of speech deficits, impairments of limb movements, and abnormalities of posture/gait. Ataxic dysarthria has a typical scanning (explosive with staccato) feature, voice has a nasal character, and speech is slurred. Cerebellar mutism is most common in children and occurs after resection of a large midline cerebellar tumor. Ataxia of limbs includes at various degrees dysmetria (hypermetria: overshoot, hypometria: undershoot), dysdiadochokinesia, cerebellar tremor (action tremor, postural tremor, kinetic tremor, some forms of orthostatic tremor), isometrataxia, disorders of muscle tone (both hypotonia and cerebellar fits), and impaired check and rebound. Handwriting is irregular and some patients exhibit megalographia. Cerebellar patients show an increased body sway with a broad-based stance (ataxia of stance). Gait is irregular and staggering. Delayed learning of complex motor skills may be a prominent feature in children. CMS is currently explained by the inability of the cerebellum to handle feedback signals during slow movements and to create, store, select, and update internal models during fast movements. The cerebellum is embedded in large-scale brain networks and is essential to perform accurate motor predictions related to body dynamics and environmental stimuli. Overall, the observations in children and adults exhibiting a CMS fit with the hypothesis that the cerebellum contains neural representations reproducing the dynamic properties of body, and generates and calibrates sensorimotor predictions. Therapies aiming at a reinforcement or restoration of internal models should be implemented to cancel CMS in cerebellar ataxias. The developmental trajectory of the cerebellum, the immature motor behavior in children, and the networks implicated in CMS need to be taken into account.
Collapse
Affiliation(s)
- Mario Manto
- Neurology Service, CHU-Charleroi, Charleroi, Belgium; Neuroscience Service, Université de Mons, Mons, Belgium.
| |
Collapse
|
189
|
Non-invasive Cerebellar Stimulation: a Promising Approach for Stroke Recovery? THE CEREBELLUM 2017; 17:359-371. [DOI: 10.1007/s12311-017-0906-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
|
190
|
Battini R, Chieffo D, Bulgheroni S, Piccini G, Pecini C, Lucibello S, Lenzi S, Moriconi F, Pane M, Astrea G, Baranello G, Alfieri P, Vicari S, Riva D, Cioni G, Mercuri E. Cognitive profile in Duchenne muscular dystrophy boys without intellectual disability: The role of executive functions. Neuromuscul Disord 2017; 28:122-128. [PMID: 29305139 DOI: 10.1016/j.nmd.2017.11.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 11/19/2017] [Accepted: 11/29/2017] [Indexed: 11/16/2022]
Abstract
The aim of our prospective observational study was to assess profiles of cognitive function and a possible impairment of executive functions in a cohort of boys with Duchenne muscular dystrophy without intellectual and behavior disability. Forty Duchenne boys (range of age: 6 years to 11 years and 6 months) were assessed by Wechsler Intelligence scale and battery of tests including tasks assessing working memory and executive functions (inhibition and switching, problem solving and planning). In our cohort some aspects of cognitive function were often impaired. These included multitasking, problem solving, inhibition and working memory necessary to plan and direct goal oriented behavior. Our results support the suggestion that aspects of cognitive function could be impaired even in boys without intellectual disability and support the hypothesis that executive functions may play an important role in specific aspects of cognitive impairment in Duchenne muscular dystrophy.
Collapse
Affiliation(s)
- R Battini
- Pediatric Neurology Unit, Fondazione Policlinico Gemelli, and Nemo Center, UCSC Rome, Italy; Department of Developmental Neuroscience, IRCCS Stella Maris, Calambrone (Pisa), Italy
| | - D Chieffo
- Pediatric Neurology Unit, Fondazione Policlinico Gemelli, and Nemo Center, UCSC Rome, Italy
| | - S Bulgheroni
- Developmental Neurology Division, IRCCS Fondazione Istituto Neurologico C. Besta, Milan, Italy
| | - G Piccini
- Unit of Child Neuropsichiatry, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - C Pecini
- Department of Developmental Neuroscience, IRCCS Stella Maris, Calambrone (Pisa), Italy
| | - S Lucibello
- Pediatric Neurology Unit, Fondazione Policlinico Gemelli, and Nemo Center, UCSC Rome, Italy
| | - S Lenzi
- Department of Developmental Neuroscience, IRCCS Stella Maris, Calambrone (Pisa), Italy
| | - F Moriconi
- Pediatric Neurology Unit, Fondazione Policlinico Gemelli, and Nemo Center, UCSC Rome, Italy
| | - M Pane
- Pediatric Neurology Unit, Fondazione Policlinico Gemelli, and Nemo Center, UCSC Rome, Italy
| | - G Astrea
- Department of Developmental Neuroscience, IRCCS Stella Maris, Calambrone (Pisa), Italy
| | - G Baranello
- Developmental Neurology Division, IRCCS Fondazione Istituto Neurologico C. Besta, Milan, Italy
| | - P Alfieri
- Unit of Child Neuropsichiatry, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - S Vicari
- Unit of Child Neuropsichiatry, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - D Riva
- Developmental Neurology Division, IRCCS Fondazione Istituto Neurologico C. Besta, Milan, Italy
| | - G Cioni
- Department of Developmental Neuroscience, IRCCS Stella Maris, Calambrone (Pisa), Italy; Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - E Mercuri
- Pediatric Neurology Unit, Fondazione Policlinico Gemelli, and Nemo Center, UCSC Rome, Italy.
| |
Collapse
|
191
|
Conte C, Serrao M, Cuius L, Ranavolo A, Conforto S, Pierelli F, Padua L. Effect of Restraining the Base of Support on the Other Biomechanical Features in Patients with Cerebellar Ataxia. THE CEREBELLUM 2017; 17:264-275. [PMID: 29143300 DOI: 10.1007/s12311-017-0897-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study aimed to analyze the biomechanical consequences of reducing the base of support in patients with ataxia. Specifically, we evaluated the spatio-temporal parameters, upper- and lower-body kinematics, muscle co-activation, and energy recovery and expenditure. The gaits of 13 patients were recorded using a motion analysis system in unperturbed and perturbed walking conditions. In the latter condition, patients had to walk using the same step width and speed of healthy controls. The perturbed walking condition featured reduced gait speed, step length, hip and knee range of motion, and energy recovery and increased double support duration, gait variability, trunk oscillation, and ankle joint muscle co-activation. Narrowing the base of support increased gait instability (e.g., gait variability and trunk oscillations) and induced patients to further use alternative compensatory mechanisms to maintain dynamic balance at the expense of a reduced ability to recover mechanical energy. A widened step width gait is a global strategy employed by patients to increase dynamic stability, reduce the need for further compensatory mechanisms, and thus recover mechanical energy. Our findings suggest that rehabilitative treatment should more specifically focus on step width training.
Collapse
Affiliation(s)
- C Conte
- Fondazione Don Carlo Gnocchi, Piazzale Morandi 6, 20121, Milan, Italy
| | - Mariano Serrao
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza, Polo Pontino, University of Rome, via Franco Faggiana 1668, 04100, Latina, Italy. .,Movement Analysis LAB, Rehabilitation Centre Policlinico Italia, Piazza del Campidano 6, 00162, Rome, Italy.
| | - L Cuius
- Biolab3, Department of Engineering, Roma TRE University, ViaVito Volterra 62, 00149, Rome, Italy
| | - A Ranavolo
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, via Fontana Candida 1, 00078, Monte Porzio Catone, Rome, Italy
| | - S Conforto
- Biolab3, Department of Engineering, Roma TRE University, ViaVito Volterra 62, 00149, Rome, Italy
| | - F Pierelli
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza, Polo Pontino, University of Rome, via Franco Faggiana 1668, 04100, Latina, Italy.,IRCSS, Neuromed, Pozzilli, IS, Italy
| | - L Padua
- Fondazione Don Carlo Gnocchi, Piazzale Morandi 6, 20121, Milan, Italy.,Department of Geriatrics, Neuroscience & Orthopaedics, Catholic University, L.go F. Vito, 1, 00168, Rome, Italy
| |
Collapse
|
192
|
Hoxha E, Gabriele RMC, Balbo I, Ravera F, Masante L, Zambelli V, Albergo C, Mitro N, Caruso D, Di Gregorio E, Brusco A, Borroni B, Tempia F. Motor Deficits and Cerebellar Atrophy in Elovl5 Knock Out Mice. Front Cell Neurosci 2017; 11:343. [PMID: 29163054 PMCID: PMC5670146 DOI: 10.3389/fncel.2017.00343] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 10/16/2017] [Indexed: 01/26/2023] Open
Abstract
Spino-Cerebellar-Ataxia type 38 (SCA38) is caused by missense mutations in the very long chain fatty acid elongase 5 gene, ELOVL5. The main clinical findings in this disease are ataxia, hyposmia and cerebellar atrophy. Mice in which Elovl5 has been knocked out represent a model of the loss of function hypothesis of SCA38. In agreement with this hypothesis, Elovl5 knock out mice reproduced the main symptoms of patients, motor deficits at the beam balance test and hyposmia. The cerebellar cortex of Elovl5 knock out mice showed a reduction of thickness of the molecular layer, already detectable at 6 months of age, confirmed at 12 and 18 months. The total perimeter length of the Purkinje cell (PC) layer was also reduced in Elovl5 knock out mice. Since Elovl5 transcripts are expressed by PCs, whose dendrites are a major component of the molecular layer, we hypothesized that an alteration of their dendrites might be responsible for the reduced thickness of this layer. Reconstruction of the dendritic tree of biocytin-filled PCs, followed by Sholl analysis, showed that the distribution of distal dendrites was significantly reduced in Elovl5 knock out mice. Dendritic spine density was conserved. These results suggest that Elovl5 knock out mice recapitulate SCA38 symptoms and that their cerebellar atrophy is due, at least in part, to a reduced extension of PC dendritic arborization.
Collapse
Affiliation(s)
- Eriola Hoxha
- Neurophysiology of Neurodegenerative Diseases, Neuroscience Institute Cavalieri Ottolenghi (NICO), Torino, Italy.,Department of Neuroscience, University of Torino, Torino, Italy
| | - Rebecca M C Gabriele
- Neurophysiology of Neurodegenerative Diseases, Neuroscience Institute Cavalieri Ottolenghi (NICO), Torino, Italy
| | - Ilaria Balbo
- Neurophysiology of Neurodegenerative Diseases, Neuroscience Institute Cavalieri Ottolenghi (NICO), Torino, Italy
| | - Francesco Ravera
- Neurophysiology of Neurodegenerative Diseases, Neuroscience Institute Cavalieri Ottolenghi (NICO), Torino, Italy
| | - Linda Masante
- Neurophysiology of Neurodegenerative Diseases, Neuroscience Institute Cavalieri Ottolenghi (NICO), Torino, Italy
| | - Vanessa Zambelli
- Neurophysiology of Neurodegenerative Diseases, Neuroscience Institute Cavalieri Ottolenghi (NICO), Torino, Italy
| | - Cristian Albergo
- Neurophysiology of Neurodegenerative Diseases, Neuroscience Institute Cavalieri Ottolenghi (NICO), Torino, Italy
| | - Nico Mitro
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy
| | - Donatella Caruso
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy
| | - Eleonora Di Gregorio
- Medical Genetics Unit, Città della Salute e della Scienza Hospital and Department of Medical Sciences, University of Torino, Torino, Italy
| | - Alfredo Brusco
- Medical Genetics Unit, Città della Salute e della Scienza Hospital and Department of Medical Sciences, University of Torino, Torino, Italy
| | - Barbara Borroni
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Filippo Tempia
- Neurophysiology of Neurodegenerative Diseases, Neuroscience Institute Cavalieri Ottolenghi (NICO), Torino, Italy.,Department of Neuroscience, University of Torino, Torino, Italy.,National Institute of Neuroscience, Torino, Italy
| |
Collapse
|
193
|
Abstract
Psychiatric comorbidities are common in movement disorders. This review provides a practical approach to help clinicians to recognize psychiatric disorders in the most frequent movement disorders. However, the extent of neurodegeneration, as well as the impact of medications with considerable CNS effects, influences the diverse psychiatric presentations that, in turn, are influenced by the stress of living with a movement disorder. Depression, anxiety, and psychosis are the most common psychiatric comorbidities in movement disorders and of the medications used to treat the motor disturbances. These psychiatric problems impair patients' functioning throughout the course of the chronic neurodegenerative diseases. Due to the direct connection between brain dysfunction and psychiatric symptoms, there is hope that understanding the psychiatric comorbidities in movement disorders will lead to a better quality-of-life.
Collapse
Affiliation(s)
- Adán Miguel-Puga
- a Unidad de Trastornos del Movimiento y Sueño (TMS) , Hospital General Dr. Manuel Gea González , Ciudad de México , México.,b Plan de Estudios Combinados en Medicina (PECEM) , Facultad de Medicina, Universidad Nacional Autónoma de México , Ciudad de México , México
| | - Gabriel Villafuerte
- a Unidad de Trastornos del Movimiento y Sueño (TMS) , Hospital General Dr. Manuel Gea González , Ciudad de México , México.,b Plan de Estudios Combinados en Medicina (PECEM) , Facultad de Medicina, Universidad Nacional Autónoma de México , Ciudad de México , México
| | - Oscar Arias-Carrión
- a Unidad de Trastornos del Movimiento y Sueño (TMS) , Hospital General Dr. Manuel Gea González , Ciudad de México , México
| |
Collapse
|
194
|
Identification of specific gait patterns in patients with cerebellar ataxia, spastic paraplegia, and Parkinson's disease: A non-hierarchical cluster analysis. Hum Mov Sci 2017; 57:267-279. [PMID: 28967438 DOI: 10.1016/j.humov.2017.09.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 09/07/2017] [Accepted: 09/07/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Patients with degenerative neurological diseases such as cerebellar ataxia, spastic paraplegia, and Parkinson's disease often display progressive gait function decline that inexorably impacts their autonomy and quality of life. Therefore, considering the related social and economic costs, one of the most important areas of intervention in neurorehabilitation should be the treatment of gait abnormalities. This study aims to determine whether an entire dataset of gait parameters recorded in patients with degenerative neurological diseases can be clustered into homogeneous groups distinct from each other and from healthy subjects. Patients affected by three different types of primary degenerative neurological diseases were studied. These diseases were: i) cerebellar ataxia (28 patients), ii) hereditary spastic paraplegia (31 patients), and iii) Parkinson's disease (70 patients). Sixty-five gender-age-matched healthy subjects were enrolled as a control group. An optoelectronic motion analysis system was used to measure time-distance parameters and lower limb joint kinematics during gait in both patients and healthy controls. When clustering single parameters, step width and ankle joint range of motion (RoM) in the sagittal plane differentiated cerebellar ataxia group from the other groups. When clustering sets of two, three, or four parameters, several pairs, triples, and quadruples of clusters differentiated the cerebellar ataxia group from the other groups. Interestingly, the ankle joint RoM parameter was present in 100% of the clusters and the step width in approximately 50% of clusters. In addition, in almost all clusters, patients with cerebellar ataxia showed the lowest ankle joint RoM and the largest step width values compared to healthy controls, patients with hereditary spastic paraplegia, and Parkinson's disease subjects. This study identified several clusters reflecting specific gait patterns in patients with degenerative neurological diseases. In particular, the specific gait pattern formed by the increased step width, reduced ankle joint RoM, and increased gait variability, can differentiate patients with cerebellar ataxia from healthy subjects and patients with spastic paraplegia or Parkinson's disease. These abnormal parameters may be adopted as sensitive tools for evaluating the effect of pharmacological and rehabilitative treatments.
Collapse
|
195
|
Kim HA, Yi HA, Lee H. Recent Advances in Cerebellar Ischemic Stroke Syndromes Causing Vertigo and Hearing Loss. THE CEREBELLUM 2017; 15:781-788. [PMID: 26573627 DOI: 10.1007/s12311-015-0745-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Cerebellar ischemic stroke is one of the common causes of vascular vertigo. It usually accompanies other neurological symptoms or signs, but a small infarct in the cerebellum can present with vertigo without other localizing symptoms. Approximately 11 % of the patients with isolated cerebellar infarction simulated acute peripheral vestibulopathy, and most patients had an infarct in the territory of the medial branch of the posterior inferior cerebellar artery (PICA). A head impulse test can differentiate acute isolated vertigo associated with PICA territory cerebellar infarction from more benign disorders involving the inner ear. Acute hearing loss (AHL) of a vascular cause is mostly associated with cerebellar infarction in the territory of the anterior inferior cerebellar artery (AICA), but PICA territory cerebellar infarction rarely causes AHL. To date, at least eight subgroups of AICA territory infarction have been identified according to the pattern of neurotological presentations, among which the most common pattern of audiovestibular dysfunction is the combined loss of auditory and vestibular functions. Sometimes acute isolated audiovestibular loss can be the initial symptom of impending posterior circulation ischemic stroke (particularly within the territory of the AICA). Audiovestibular loss from cerebellar infarction has a good long-term outcome than previously thought. Approximately half of patients with superior cerebellar artery territory (SCA) cerebellar infarction experienced true vertigo, suggesting that the vertigo and nystagmus in the SCA territory cerebellar infarctions are more common than previously thought. In this article, recent findings on clinical features of vertigo and hearing loss from cerebellar ischemic stroke syndrome are summarized.
Collapse
Affiliation(s)
- Hyun-Ah Kim
- Department of Neurology, School of Medicine, Keimyung University, 56 Dalseong-ro, Jung-gu, Daegu, 700-712, Republic of Korea.,Brain Research Institute, School of Medicine, Keimyung University, Daegu, Republic of Korea
| | - Hyon-Ah Yi
- Department of Neurology, School of Medicine, Keimyung University, 56 Dalseong-ro, Jung-gu, Daegu, 700-712, Republic of Korea.,Brain Research Institute, School of Medicine, Keimyung University, Daegu, Republic of Korea
| | - Hyung Lee
- Department of Neurology, School of Medicine, Keimyung University, 56 Dalseong-ro, Jung-gu, Daegu, 700-712, Republic of Korea. .,Brain Research Institute, School of Medicine, Keimyung University, Daegu, Republic of Korea.
| |
Collapse
|
196
|
Soghomonian JJ, Zhang K, Reprakash S, Blatt GJ. Decreased parvalbumin mRNA levels in cerebellar Purkinje cells in autism. Autism Res 2017; 10:1787-1796. [PMID: 28707805 DOI: 10.1002/aur.1835] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 06/13/2017] [Accepted: 06/16/2017] [Indexed: 01/06/2023]
Abstract
Recent neuropathology studies in human brains indicate that several areas of the prefrontal cortex have decreased numbers of parvalbumin interneurons or decreased parvalbumin expression in Autism Spectrum disorders (ASD) [Hashemi, Ariza, Rogers, Noctor, & Martinez-Cerdeno, 2017; Zikopoulos & Barbas, ]. These data suggest that a deficit in parvalbumin may be a key neuropathology of ASD and contribute to altered GABAergic inhibition. However, it is unclear if a deficit in parvalbumin is a phenomenon that occurs in regions other than the cerebral cortex. The cerebellum is a major region where neuropathology was first detected in ASD over three decades ago [Bauman & Kemper, ]. In view of the documented association between parvalbumin-expressing neurons and autism, the objective of the present study was to determine if parvalbumin gene expression is also altered in Purkinje neurons of the cerebellum. Radioisotopic in situ hybridization histochemistry was used on human tissue sections from control and ASD brains in order to detect and measure parvalbumin mRNA levels at the single cell level in Purkinje cells of Crus II of the lateral cerebellar hemispheres. Results indicate that parvalbumin mRNA levels are significantly lower in Purkinje cells in ASD compared to control brains. This decrease was not influenced by post-mortem interval or age at death. This result indicates that decreased parvalbumin expression is a more widespread feature of ASD. We discuss how this decrease may be implicated in altered cerebellar output to the cerebral cortex and in key ASD symptoms. Autism Res 2017, 10: 1787-1796. © 2017 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY The cerebellum of the brain controls movement and cognition, including memory and language. This study investigated mechanisms of cerebellar function in Autism. Our hypothesis is that parvalbumin, a molecule that controls and coordinate many cellular brain functions, contributes to the excitatory/inhibitory imbalance in Autism. We report that parvalbumin expression is depressed in Purkinje cells of the cerebellum in autism. This finding contributes to elucidate the cellular and molecular underpinings of autism and should provide a direction for future therapies.
Collapse
Affiliation(s)
- Jean-Jacques Soghomonian
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts
| | - Kunzhong Zhang
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts
| | - Sujithra Reprakash
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts
| | - Gene J Blatt
- Hussman Institute for Autism, Program in Neuroscience, Baltimore, Maryland
| |
Collapse
|
197
|
Butcher PA, Ivry RB, Kuo SH, Rydz D, Krakauer JW, Taylor JA. The cerebellum does more than sensory prediction error-based learning in sensorimotor adaptation tasks. J Neurophysiol 2017. [PMID: 28637818 DOI: 10.1152/jn.00451.2017] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Individuals with damage to the cerebellum perform poorly in sensorimotor adaptation paradigms. This deficit has been attributed to impairment in sensory prediction error-based updating of an internal forward model, a form of implicit learning. These individuals can, however, successfully counter a perturbation when instructed with an explicit aiming strategy. This successful use of an instructed aiming strategy presents a paradox: In adaptation tasks, why do individuals with cerebellar damage not come up with an aiming solution on their own to compensate for their implicit learning deficit? To explore this question, we employed a variant of a visuomotor rotation task in which, before executing a movement on each trial, the participants verbally reported their intended aiming location. Compared with healthy control participants, participants with spinocerebellar ataxia displayed impairments in both implicit learning and aiming. This was observed when the visuomotor rotation was introduced abruptly (experiment 1) or gradually (experiment 2). This dual deficit does not appear to be related to the increased movement variance associated with ataxia: Healthy undergraduates showed little change in implicit learning or aiming when their movement feedback was artificially manipulated to produce similar levels of variability (experiment 3). Taken together the results indicate that a consequence of cerebellar dysfunction is not only impaired sensory prediction error-based learning but also a difficulty in developing and/or maintaining an aiming solution in response to a visuomotor perturbation. We suggest that this dual deficit can be explained by the cerebellum forming part of a network that learns and maintains action-outcome associations across trials.NEW & NOTEWORTHY Individuals with cerebellar pathology are impaired in sensorimotor adaptation. This deficit has been attributed to an impairment in error-based learning, specifically, from a deficit in using sensory prediction errors to update an internal model. Here we show that these individuals also have difficulty in discovering an aiming solution to overcome their adaptation deficit, suggesting a new role for the cerebellum in sensorimotor adaptation tasks.
Collapse
Affiliation(s)
- Peter A Butcher
- Department of Psychology, Princeton University, Princeton, New Jersey; .,Princeton Neuroscience Institute, Princeton University, Princeton, New Jersey
| | - Richard B Ivry
- Department of Psychology, University of California, Berkeley, California.,Helen Wills Neuroscience Institute, University of California, Berkeley, California
| | - Sheng-Han Kuo
- Department of Neurology, Columbia Medical Center, Columbia University, New York, New York; and
| | - David Rydz
- Department of Neurology, Columbia Medical Center, Columbia University, New York, New York; and
| | - John W Krakauer
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jordan A Taylor
- Department of Psychology, Princeton University, Princeton, New Jersey.,Princeton Neuroscience Institute, Princeton University, Princeton, New Jersey
| |
Collapse
|
198
|
Sensorimotor adaptation as a behavioural biomarker of early spinocerebellar ataxia type 6. Sci Rep 2017; 7:2366. [PMID: 28539669 PMCID: PMC5443763 DOI: 10.1038/s41598-017-02469-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 04/11/2017] [Indexed: 11/08/2022] Open
Abstract
Early detection of the behavioural deficits of neurodegenerative diseases may help to describe the pathogenesis of such diseases and establish important biomarkers of disease progression. The aim of this study was to identify how sensorimotor adaptation of the upper limb, a cerebellar-dependent process restoring movement accuracy after introduction of a perturbation, is affected at the pre-clinical and clinical stages of spinocerebellar ataxia type 6 (SCA6), an inherited neurodegenerative disease. We demonstrate that initial adaptation to the perturbation was significantly impaired in the eighteen individuals with clinical motor symptoms but mostly preserved in the five pre-clinical individuals. Moreover, the amount of error reduction correlated with the clinical symptoms, with the most symptomatic patients adapting the least. Finally both pre-clinical and clinical individuals showed significantly reduced de-adaptation performance after the perturbation was removed in comparison to the control participants. Thus, in this large study of motor features in SCA6, we provide novel evidence for the existence of subclinical motor dysfunction at a pre-clinical stage of SCA6. Our findings show that testing sensorimotor de-adaptation could provide a potential predictor of future motor deficits in SCA6.
Collapse
|
199
|
Bologna M, Berardelli A. Cerebellum: An explanation for dystonia? CEREBELLUM & ATAXIAS 2017; 4:6. [PMID: 28515949 PMCID: PMC5429509 DOI: 10.1186/s40673-017-0064-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 04/28/2017] [Indexed: 11/29/2022]
Abstract
Dystonia is a movement disorder that is characterized by involuntary muscle contractions, abnormal movements and postures, as well as by non-motor symptoms, and is due to abnormalities in different brain areas. In this article, we focus on the growing number of experimental studies aimed at explaining the pathophysiological role of the cerebellum in dystonia. Lastly, we highlight gaps in current knowledge and issues that future research studies should focus on as well as some of the potential applications of this research avenue. Clarifying the pathophysiological role of cerebellum in dystonia is an important concern given the increasing availability of invasive and non-invasive stimulation techniques and their potential therapeutic role in this condition.
Collapse
Affiliation(s)
- Matteo Bologna
- Department of Neurology and Psychiatry and Neuromed Institute, Sapienza University of Rome, Viale dell'Università, 30, 00185 Rome, Italy.,Neuromed Institute IRCCS, Pozzilli, IS Italy
| | - Alfredo Berardelli
- Department of Neurology and Psychiatry and Neuromed Institute, Sapienza University of Rome, Viale dell'Università, 30, 00185 Rome, Italy.,Neuromed Institute IRCCS, Pozzilli, IS Italy
| |
Collapse
|
200
|
Ahmed MM, Block A, Tong S, Davisson MT, Gardiner KJ. Age exacerbates abnormal protein expression in a mouse model of Down syndrome. Neurobiol Aging 2017. [PMID: 28641136 DOI: 10.1016/j.neurobiolaging.2017.05.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The Ts65Dn is a popular mouse model of Down syndrome (DS). It displays DS-relevant features of learning/memory deficits and age-related loss of functional markers in basal forebrain cholinergic neurons. Here we describe protein expression abnormalities in brain regions of 12-month-old male Ts65Dn mice. We show that the magnitudes of abnormalities of human chromosome 21 and non-human chromosome 21 orthologous proteins are greater at 12 months than at ∼6 months. Age-related exacerbations involve the number of components affected in the mechanistic target of rapamycin pathway, the levels of components of the mitogen-activated protein kinase pathway, and proteins associated with Alzheimer's disease. Among brain regions, the number of abnormalities in cerebellum decreased while the number in cortex greatly increased with age. The Ts65Dn is being used in preclinical evaluations of drugs for cognition in DS. Most commonly, drug evaluations are tested in ∼4- to 6-month-old mice. Data on age-related changes in magnitude and specificity of protein perturbations can be used to understand the molecular basis of changes in cognitive ability and to predict potential age-related specificities in drug efficacies.
Collapse
Affiliation(s)
| | - Aaron Block
- Linda Crnic Institute for Down Syndrome, Aurora, CO, USA
| | - Suhong Tong
- School of Public Health, University of Colorado Denver School of Medicine, Aurora, CO, USA
| | | | - Katheleen J Gardiner
- Linda Crnic Institute for Down Syndrome, Aurora, CO, USA; Department of Pediatrics, University of Colorado Denver School of Medicine, Aurora, CO, USA; Human Medical Genetics and Genomics, and Neuroscience Programs, University of Colorado Denver School of Medicine, Aurora, CO, USA.
| |
Collapse
|