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Li X, Lei D, Qin K, Li L, Zhang Y, Zhou D, Kemp GJ, Gong Q. Effects of PRRT2 mutation on brain gray matter networks in paroxysmal kinesigenic dyskinesia. Cereb Cortex 2024; 34:bhad418. [PMID: 37955636 DOI: 10.1093/cercor/bhad418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 10/16/2023] [Accepted: 10/17/2023] [Indexed: 11/14/2023] Open
Abstract
Although proline-rich transmembrane protein 2 is the primary causative gene of paroxysmal kinesigenic dyskinesia, its effects on the brain structure of paroxysmal kinesigenic dyskinesia patients are not yet clear. Here, we explored the influence of proline-rich transmembrane protein 2 mutations on similarity-based gray matter morphological networks in individuals with paroxysmal kinesigenic dyskinesia. A total of 51 paroxysmal kinesigenic dyskinesia patients possessing proline-rich transmembrane protein 2 mutations, 55 paroxysmal kinesigenic dyskinesia patients possessing proline-rich transmembrane protein 2 non-mutation, and 80 healthy controls participated in the study. We analyzed the structural connectome characteristics across groups by graph theory approaches. Relative to paroxysmal kinesigenic dyskinesia patients possessing proline-rich transmembrane protein 2 non-mutation and healthy controls, paroxysmal kinesigenic dyskinesia patients possessing proline-rich transmembrane protein 2 mutations exhibited a notable increase in characteristic path length and a reduction in both global and local efficiency. Relative to healthy controls, both patient groups showed reduced nodal metrics in right postcentral gyrus, right angular, and bilateral thalamus; Relative to healthy controls and paroxysmal kinesigenic dyskinesia patients possessing proline-rich transmembrane protein 2 non-mutation, paroxysmal kinesigenic dyskinesia patients possessing proline-rich transmembrane protein 2 mutations showed almost all reduced nodal centralities and structural connections in cortico-basal ganglia-thalamo-cortical circuit including bilateral supplementary motor area, bilateral pallidum, and right caudate nucleus. Finally, we used support vector machine by gray matter network matrices to classify paroxysmal kinesigenic dyskinesia patients possessing proline-rich transmembrane protein 2 mutations and paroxysmal kinesigenic dyskinesia patients possessing proline-rich transmembrane protein 2 non-mutation, achieving an accuracy of 73%. These results show that proline-rich transmembrane protein 2 related gray matter network deficits may contribute to paroxysmal kinesigenic dyskinesia, offering new insights into its pathophysiological mechanisms.
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Affiliation(s)
- Xiuli Li
- Department of Radiology, Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, No. 37 Guoxue Lane, Wuhou District, Chengdu, 610041, China
| | - Du Lei
- Department of Radiology, Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, No. 37 Guoxue Lane, Wuhou District, Chengdu, 610041, China
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, 260 Stetson St., Suite 3326, Cincinnati, Ohio, 45219, United States
| | - Kun Qin
- Department of Radiology, Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, No. 37 Guoxue Lane, Wuhou District, Chengdu, 610041, China
| | - Lei Li
- Department of Radiology, Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, No. 37 Guoxue Lane, Wuhou District, Chengdu, 610041, China
| | - Yingying Zhang
- Department of Neurology, West China Hospital of Sichuan University, No. 37 Guoxue Lane, Wuhou District, Chengdu, 610041, China
| | - Dong Zhou
- Department of Neurology, West China Hospital of Sichuan University, No. 37 Guoxue Lane, Wuhou District, Chengdu, 610041, China
| | - Graham J Kemp
- Liverpool Magnetic Resonance Imaging Centre (LiMRIC) and Institute of Life Course and Medical Sciences, University of Liverpool, L69 3BX, Liverpool, L3 5TR, United Kingdom
| | - Qiyong Gong
- Department of Radiology, Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, No. 37 Guoxue Lane, Wuhou District, Chengdu, 610041, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, No. 37 Guoxue Lane, Wuhou District, Chengdu, 610041, China
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Xie F, Mao T, Tang J, Zhao L, Guo J, Lin H, Wang D, Zhou G. Evaluation of iron deposition in the motor CSTC loop of a Chinese family with paroxysmal kinesigenic dyskinesia using quantitative susceptibility mapping. Front Neurol 2023; 14:1164600. [PMID: 37483438 PMCID: PMC10358764 DOI: 10.3389/fneur.2023.1164600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/12/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction Previous studies have revealed structural, functional, and metabolic changes in brain regions inside the cortico-striatal-thalamo-cortical (CSTC) loop in patients with paroxysmal kinesigenic dyskinesia (PKD), whereas no quantitative susceptibility mapping (QSM)-related studies have explored brain iron deposition in these areas. Methods A total of eight familial PKD patients and 10 of their healthy family members (normal controls) were recruited and underwent QSM on a 3T magnetic resonance imaging system. Magnetic susceptibility maps were reconstructed using a multi-scale dipole inversion algorithm. Thereafter, we specifically analyzed changes in local mean susceptibility values in cortical regions and subcortical nuclei inside the motor CSTC loop. Results Compared with normal controls, PKD patients had altered brain iron levels. In the cortical gray matter area involved with the motor CSTC loop, susceptibility values were generally elevated, especially in the bilateral M1 and PMv regions. In the subcortical nuclei regions involved with the motor CSTC loop, susceptibility values were generally lower, especially in the bilateral substantia nigra regions. Conclusion Our results provide new evidence for the neuropathogenesis of PKD and suggest that an imbalance in brain iron levels may play a role in PKD.
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Affiliation(s)
- Fangfang Xie
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - Ting Mao
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - Jingyi Tang
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - Linmei Zhao
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - Jiuqing Guo
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - Huashan Lin
- Department of Pharmaceutical Diagnosis, GE Healthcare, Changsha, China
| | - Dongcui Wang
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Gaofeng Zhou
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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Li ZY, Tian WT, Huang XJ, Cao L. The Pathogenesis of Paroxysmal Kinesigenic Dyskinesia: Current Concepts. Mov Disord 2023; 38:537-544. [PMID: 36718795 DOI: 10.1002/mds.29326] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 12/31/2022] [Accepted: 01/06/2023] [Indexed: 02/01/2023] Open
Abstract
Paroxysmal kinesigenic dyskinesia (PKD) is a movement disorder characterized by recurrent and transient episodes of involuntary movements, including dystonia, chorea, ballism, or a combination of these, which are typically triggered by sudden voluntary movement. Disturbance of the basal ganglia-thalamo-cortical circuit has long been considered the cause of involuntary movements. Impairment of the gating function of the basal ganglia can cause an aberrant output toward the thalamus, which in turn leads to excessive activation of the cerebral cortex. Structural and functional abnormalities in the basal ganglia, thalamus, and cortex and abnormal connections between these brain regions have been found in patients with PKD. Recent studies have highlighted the role of the cerebellum in PKD. Insufficient suppression from the cerebellar cortex to the deep cerebellar nuclei could lead to overexcitation of the thalamocortical pathway. Therefore, this literature review aims to provide a comprehensive overview of the current research progress to explore the neural circuits and pathogenesis of PKD and promote further understanding and outlook on the pathophysiological mechanism of movement disorders. © 2023 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Zi-Yi Li
- Department of Neurology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wo-Tu Tian
- Department of Neurology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiao-Jun Huang
- Department of Neurology and Institute of Neurology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Li Cao
- Department of Neurology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Abstract
Within the past decade, multiple lines of evidence have converged to identify a critical role for activity-regulated myelination in tuning the function of neural networks. In this Review, we provide an overview of accumulating evidence that activity-regulated myelination is required for brain adaptation and learning across multiple domains. We then discuss dysregulation of activity-dependent myelination in the context of neurological disease, a novel frontier with the potential to uncover new mechanisms of disease pathogenesis and to develop new therapeutic strategies. Alterations in myelination and neural network function can result from deficient myelin plasticity that impairs neurological function or from maladaptive myelination, in which intact activity-dependent myelination contributes to the disease process by promoting pathological patterns of neuronal activity. These emerging mechanisms suggest new avenues for therapeutic intervention that could more fully address the complex interactions between neurons and oligodendroglia.
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MacIver CL, Tax CMW, Jones DK, Peall KJ. Structural magnetic resonance imaging in dystonia: A systematic review of methodological approaches and findings. Eur J Neurol 2022; 29:3418-3448. [PMID: 35785410 PMCID: PMC9796340 DOI: 10.1111/ene.15483] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/28/2022] [Accepted: 06/30/2022] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND PURPOSE Structural magnetic resonance techniques have been widely applied in neurological disorders to better understand tissue changes, probing characteristics such as volume, iron deposition and diffusion. Dystonia is a hyperkinetic movement disorder, resulting in abnormal postures and pain. Its pathophysiology is poorly understood, with normal routine clinical imaging in idiopathic forms. More advanced tools provide an opportunity to identify smaller scale structural changes which may underpin pathophysiology. This review aims to provide an overview of methodological approaches undertaken in structural brain imaging of dystonia cohorts, and to identify commonly identified pathways, networks or regions that are implicated in pathogenesis. METHODS Structural magnetic resonance imaging studies of idiopathic and genetic forms of dystonia were systematically reviewed. Adhering to strict inclusion and exclusion criteria, PubMed and Embase databases were searched up to January 2022, with studies reviewed for methodological quality and key findings. RESULTS Seventy-seven studies were included, involving 1945 participants. The majority of studies employed diffusion tensor imaging (DTI) (n = 45) or volumetric analyses (n = 37), with frequently implicated areas of abnormality in the brainstem, cerebellum, basal ganglia and sensorimotor cortex and their interconnecting white matter pathways. Genotypic and motor phenotypic variation emerged, for example fewer cerebello-thalamic tractography streamlines in genetic forms than idiopathic and higher grey matter volumes in task-specific than non-task-specific dystonias. DISCUSSION Work to date suggests microstructural brain changes in those diagnosed with dystonia, although the underlying nature of these changes remains undetermined. Employment of techniques such as multiple diffusion weightings or multi-exponential relaxometry has the potential to enhance understanding of these differences.
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Affiliation(s)
- Claire L. MacIver
- Neuroscience and Mental Health Research InstituteDivision of Psychological Medicine and Clinical NeurosciencesCardiff University School of MedicineCardiffUK,Cardiff University Brain Imaging Centre (CUBRIC)Cardiff UniversityCardiffUK
| | - Chantal M. W. Tax
- Cardiff University Brain Imaging Centre (CUBRIC)Cardiff UniversityCardiffUK,Image Sciences InstituteUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Derek K. Jones
- Cardiff University Brain Imaging Centre (CUBRIC)Cardiff UniversityCardiffUK
| | - Kathryn J. Peall
- Neuroscience and Mental Health Research InstituteDivision of Psychological Medicine and Clinical NeurosciencesCardiff University School of MedicineCardiffUK
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Kim MK, Suh SI, Kim JH. Cerebello-thalamofrontal dysconnectivity in paroxysmal kinesigenic dyskinesia: A resting-state fMRI study. Parkinsonism Relat Disord 2022; 99:1-7. [PMID: 35537274 DOI: 10.1016/j.parkreldis.2022.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 04/06/2022] [Accepted: 04/29/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The pathophysiology of paroxysmal kinesigenic dyskinesia (PKD) remains elusive to date; however, several lines of evidence from neuroimaging studies suggest involvement of the basal ganglia-thalamocortical network in PKD. We combined fractional amplitude of low-frequency fluctuation (fALFF) and seed-based functional connectivity (FC) analyses in order to comprehensively investigate intrinsic brain activity alterations and their relationships with disease severity in patients with idiopathic PKD. METHODS Resting-state functional MRI data were obtained and processed in 34 PKD patients and 34 matched controls. fALFF and seed-based FC maps were computed and compared between patients and controls. Linear regression analysis was further performed between regional fALFF values or FC strengths and clinical parameters in patients. RESULTS PKD patients had a significant increase in fALFF in bilateral thalamus and cerebellum compared with controls. FC analysis seeding at the thalamic clusters revealed significant FC increases in motor cortex and supplementary motor area in PKD patients relative to controls. Longer disease duration was associated with increasing FC strength between the thalamus and motor cortex. CONCLUSION We have provided evidence for abnormal intrinsic activity in the cerebello-thalamic circuit and increased thalamofrontal FC in PKD patients, implicating interictal cerebello-thalamofrontal dysconnectivity in the pathophysiology of PKD. Given the increasing FC strength in proportion to disease duration, the thalamofrontal hyperconnectivity might reflect either a consequence of recurrent dyskinesias on the brain or an innate pathology causing dyskinesias in PKD.
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Affiliation(s)
- Min Kyung Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Sang-Il Suh
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Ji Hyun Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea.
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Ramezani A, Alvani SR, Levy PT, McCarron R, Sheth S, Emamirad R. Paroxysmal dyskinesia and electrodermal volatility: The role of mindfulness, self-compassion and psychophysiological interventions. APPLIED NEUROPSYCHOLOGY. ADULT 2022:1-12. [PMID: 35465740 DOI: 10.1080/23279095.2022.2060749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
To date, there are no behavioral or psychophysiological treatment studies on paroxysmal dyskinesia (PD). PD is a group of debilitating movement disorders that present with severe episodes of dystonia, chorea, and/or ballistic like movements. This is a first case report of a 50-year-old male who received behavioral interventions (e.g., mindfulness, CBT, and biofeedback interventions) to manage his PD episodes in tandem with multidisciplinary treatments (e.g., neurology, psychiatry, etc.). The paper primarily discusses the serendipitous observation of galvanic skin response (GSR) elevations and spikes immediately before and after the onset of PD episodes. GSR volatility was noted in wave amplitude and wave morphology. Graphs are presented to illustrate GSR volatility associate with PD episodes and the reduction of GSR volatility in response to behavioral approaches. The discussion highlights the feasibility of using GSR biofeedback as an adjunct to mindfulness and CBT to manage PD as part of a multidisciplinary treatment approach. Peripherally, issues that related to misclassification of somatic symptoms and related disorders (e.g., psychogenic non-epileptic seizures) and aspects of neurocognitive disorders are discussed. The paper reviews neurological findings, MRI, neuropsychological data, and psychiatric assessment to highlight the dilemma clinician's face and clarify behavioral practices to further the management of PD.
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Affiliation(s)
| | - Seyed Reza Alvani
- Kashan University of Medical Sciences and Health Services, Kashan, Iran
| | | | | | - Samir Sheth
- University of California Davis, Davis, CA, USA
| | - Rasti Emamirad
- Kashan University of Medical Sciences and Health Services, Kashan, Iran
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Trapp SD, Noachtar S, Kaufmann E. Kinesigenic dyskinesias after ENT surgery misdiagnosed as focal epilepsy. BMJ Case Rep 2022; 15:e247760. [PMID: 35351750 PMCID: PMC8966546 DOI: 10.1136/bcr-2021-247760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2022] [Indexed: 11/03/2022] Open
Abstract
We describe a man in his 30s who presented with paroxysmal right-sided dyskinesias of the arm and neck, misdiagnosed with drug-resistant focal epilepsy. Two months earlier he had undergone surgery for chronic sinusitis. Immediately after this procedure, he developed hemiparesis, hemiataxia, paresthesias and disturbances in verbal fluency. Cranial MRI revealed a disruption of the left lamina cribrosa and an intracerebral injury resembling a branch canal spanning to the left dorsal third of the thalamus. Single-photon emission tomography imaging demonstrated malperfusion of the left ventral thalamus, left-sided cortex and right cerebellar hemisphere. During continuous video-EEG monitoring, three dyskinetic episodes with tremor of the right arm and dystonia of the finger and shoulder could be recorded. The paroxysmal dyskinesias did not improve with carbamazepine, valproate and tiapride. This case demonstrates an unusual symptomatic cause of a thalamic movement disorder misdiagnosed as focal epilepsy and highlights the postoperative complications, diagnostic and treatment efforts.
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Affiliation(s)
- Selina Denise Trapp
- Neurology, Faculty of Medicine, Ludwig Maximilians University Munich, Munich, Germany
| | - Soheyl Noachtar
- Epilepsy Center, Department of Neurology, University of Munich, Muenchen, Germany
| | - Elisabeth Kaufmann
- Neurology, Faculty of Medicine, Ludwig Maximilians University Munich, Munich, Germany
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Ekmen A, Meneret A, Valabregue R, Beranger B, Worbe Y, Lamy JC, Mehdi S, Herve A, Adanyeguh I, Temiz G, Damier P, Gras D, Roubertie A, Piard J, Navarro V, Mutez E, Riant F, Welniarz Q, Vidailhet M, Lehericy S, Meunier S, Gallea C, Roze E. Cerebellum Dysfunction in Patients With PRRT2-Related Paroxysmal Dyskinesia. Neurology 2022; 98:e1077-e1089. [DOI: 10.1212/wnl.0000000000200060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 01/03/2022] [Indexed: 11/15/2022] Open
Abstract
Background and Objectives:The main culprit gene for paroxysmal kinesigenic dyskinesia, characterized by brief and recurrent attacks of involuntary movements, is PRRT2. The location of the primary dysfunction associated with paroxysmal dyskinesia remains a matter of debate and may vary depending on the etiology. While striatal dysfunction has often been implicated in these patients, evidence from preclinical models indicate that the cerebellum could also play a role. We aimed to investigate the role of the cerebellum in the pathogenesis of PRRT2-related dyskinesia in humans.Methods:We enrolled 22 consecutive right-handed patients with paroxysmal kinesigenic dyskinesia with a pathogenic variant of PRRT2, and their matched controls. Participants underwent a multi-modal neuroimaging protocol. We recorded anatomic and diffusion-weighted MRI, as well as resting-state functional MRI during which we tested the after-effects of sham and repetitive transcranial magnetic stimulation applied to the cerebellum on endogenous brain activity. We quantified: (i) the structural integrity of gray matter using voxel-based morphometry; (ii) the structural integrity of white matter using fixel-based analysis; (iii) the strength and direction of functional cerebellar connections using spectral dynamic causal modeling.Results:PRRT2 patients had: (i) decreased gray matter volume in the cerebellar lobule VI and in the medial prefrontal cortex; (ii) microstructural alterations of white matter in the cerebellum and along the tracts connecting the cerebellum to the striatum and the cortical motor areas; (iii) dysfunction of cerebellar motor pathways to the striatum and the cortical motor areas, as well as abnormal communication between the associative cerebellum (Crus I) and the medial prefrontal cortex. Cerebellar stimulation modulated communication within the motor and associative cerebellar networks, and tended to restore this communication to the level observed in healthy controls.Discussion:Patients with PRRT2-related dyskinesia have converging structural alterations of the motor cerebellum and related pathways with a dysfunction of cerebellar output towards the cerebello-thalamo-striato-cortical network. We hypothesize that abnormal cerebellar output is the primary dysfunction in patients with a PRRT2 pathogenic variant, resulting in striatal dysregulation and paroxysmal dyskinesia. More broadly, striatal dysfunction in paroxysmal dyskinesia might be secondary to aberrant cerebellar output transmitted by thalamic relays in certain disorders.Clinical trial number:NCT03481491 (https://ichgcp.net/clinical-trials-registry/NCT03481491)
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Murakami M, Horisawa S, Azuma K, Akagawa H, Nonaka T, Kawamata T, Taira T. Case Report: Long-Term Suppression of Paroxysmal Kinesigenic Dyskinesia After Bilateral Thalamotomy. Front Neurol 2021; 12:789468. [PMID: 34925221 PMCID: PMC8678037 DOI: 10.3389/fneur.2021.789468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/05/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Paroxysmal kinesigenic dyskinesia (PKD) is a movement disorder characterized by transient dyskinetic movements, including dystonia, chorea, or both, triggered by sudden voluntary movements. Carbamazepine and other antiepileptic drugs (AEDs) are widely used in the treatment of PKD, and they provide complete remission in 80–90% of medically treated patients. However, the adverse effects of AEDs include drowsiness and dizziness, which interfere with patients' daily lives. For those with poor compatibility with AEDs, other treatment approaches are warranted. Case Report: A 19-year-old man presented to our institute with right hand and foot dyskinesia. He had a significant family history of PKD; his uncle, grandfather, and grandfather's brother had PKD. The patient first experienced paroxysmal involuntary left hand and toe flexion with left forearm pronation triggered by sudden voluntary movements at the age of 14. Carbamazepine (100 mg/day) was prescribed, which led to a significant reduction in the frequency of attacks. However, carbamazepine induced drowsiness, which significantly interfered with his daily life, especially school life. He underwent right-sided ventro-oral (Vo) thalamotomy at the age of 15, which resulted in complete resolution of PKD attacks immediately after the surgery. Four months after the thalamotomy, he developed right elbow, hand, and toe flexion. He underwent left-sided Vo thalamotomy at the age of 19. Immediately after the surgery, the PKD attacks resolved completely. However, mild dysarthria developed, which spontaneously resolved within three months. Left-sided PKD attacks never developed six years after the right Vo thalamotomy, and right-sided PKD attacks never developed two years after the left Vo thalamotomy without medication. Conclusion: The present case showed long-term suppression of bilateral PKDs after bilateral thalamotomy, which led to drug-free conditions.
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Affiliation(s)
- Masato Murakami
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Shiro Horisawa
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Kenko Azuma
- Institute for Integrated Medical Sciences, Tokyo Women's Medical University, Tokyo, Japan
| | - Hiroyuki Akagawa
- Institute for Integrated Medical Sciences, Tokyo Women's Medical University, Tokyo, Japan
| | - Taku Nonaka
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Takakazu Kawamata
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Takaomi Taira
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
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Li X, Lei D, Niu R, Li L, Suo X, Li W, Yang C, Yang T, Ren J, Pinaya WHL, Zhou D, Kemp GJ, Gong Q. Disruption of gray matter morphological networks in patients with paroxysmal kinesigenic dyskinesia. Hum Brain Mapp 2021; 42:398-411. [PMID: 33058379 PMCID: PMC7776009 DOI: 10.1002/hbm.25230] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/01/2020] [Accepted: 09/29/2020] [Indexed: 02/05/2023] Open
Abstract
This study explores the topological properties of brain gray matter (GM) networks in patients with paroxysmal kinesigenic dyskinesia (PKD) and asks whether GM network features have potential diagnostic value. We used 3D T1-weighted magnetic resonance imaging and graph theoretical approaches to investigate the topological organization of GM morphological networks in 87 PKD patients and 115 age- and sex-matched healthy controls. We applied a support vector machine to GM morphological network matrices to classify PKD patients versus healthy controls. Compared with the HC group, the GM morphological networks of PKD patients showed significant abnormalities at the global level, including an increase in characteristic path length (Lp) and decreases in local efficiency (Eloc ), clustering coefficient (Cp), normalized clustering coefficient (γ), and small-worldness (σ). The decrease in Cp was significantly correlated with disease duration and age of onset. The GM morphological networks of PKD patients also showed significant changes in nodal topological characteristics, mainly in the basal ganglia-thalamus circuitry, default-mode network and central executive network. Finally, we used the GM morphological network matrices to classify individuals as PKD patients versus healthy controls, achieving 87.8% accuracy. Overall, this study demonstrated disruption of GM morphological networks in PKD, which might extend our understanding of the pathophysiology of PKD; further, GM morphological network matrices might have the potential to serve as network neuroimaging biomarkers for the diagnosis of PKD.
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Affiliation(s)
- Xiuli Li
- Huaxi MR Research Center (HMRRC), Department of RadiologyWest China Hospital of Sichuan UniversityChengduSichuan ProvinceChina
- Department of RadiologySichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of ChinaChengduChina
| | - Du Lei
- Huaxi MR Research Center (HMRRC), Department of RadiologyWest China Hospital of Sichuan UniversityChengduSichuan ProvinceChina
- Department of Psychiatry and Behavioral NeuroscienceUniversity of CincinnatiCincinnatiOhioUSA
| | - Running Niu
- Department of RadiologySichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of ChinaChengduChina
| | - Lei Li
- Huaxi MR Research Center (HMRRC), Department of RadiologyWest China Hospital of Sichuan UniversityChengduSichuan ProvinceChina
| | - Xueling Suo
- Huaxi MR Research Center (HMRRC), Department of RadiologyWest China Hospital of Sichuan UniversityChengduSichuan ProvinceChina
| | - Wenbin Li
- Huaxi MR Research Center (HMRRC), Department of RadiologyWest China Hospital of Sichuan UniversityChengduSichuan ProvinceChina
| | - Chen Yang
- Huaxi MR Research Center (HMRRC), Department of RadiologyWest China Hospital of Sichuan UniversityChengduSichuan ProvinceChina
| | - Tianhua Yang
- Department of NeurologyWest China Hospital of Sichuan UniversityChengduSichuan ProvinceChina
| | - Jiechuan Ren
- Department of NeurologyWest China Hospital of Sichuan UniversityChengduSichuan ProvinceChina
| | - Walter H. L. Pinaya
- Department of Psychosis StudiesInstitute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUK
- Center of Mathematics, Computing, and CognitionUniversidade Federal do ABCSanto AndréBrazil
| | - Dong Zhou
- Department of NeurologyWest China Hospital of Sichuan UniversityChengduSichuan ProvinceChina
| | - Graham J. Kemp
- Liverpool Magnetic Resonance Imaging Centre (LiMRIC) and Institute of Life Course and Medical Sciences, University of LiverpoolLiverpoolUK
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of RadiologyWest China Hospital of Sichuan UniversityChengduSichuan ProvinceChina
- Research Unit of PsychoradiologyChinese Academy of Medical SciencesChengduChina
- Functional and Molecular Imaging Key Laboratory of Sichuan UniversityChengduChina
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Liu W, Xiao Y, Zheng T, Chen G. Neural Mechanisms of Paroxysmal Kinesigenic Dyskinesia: Insights from Neuroimaging. J Neuroimaging 2020; 31:272-276. [PMID: 33227178 DOI: 10.1111/jon.12811] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/20/2020] [Accepted: 11/06/2020] [Indexed: 11/27/2022] Open
Abstract
Paroxysmal kinesigenic dyskinesia (PKD) is a rare movement disorder of the nervous system, and little is known about its pathogenesis. Currently, the diagnosis of PKD is primarily based on clinical manifestations, with little objective evidence. Neuroimaging has been used to explore the pathological changes in cerebral structure and function associated with PKD. The current review highlights recent advances in neuroimaging to provide a better understanding of the neural mechanisms and early diagnosis of this disorder. Several studies utilizing single-photon emission computed tomography (CT), positron emission tomography, and structural and functional magnetic resonance imaging have found significant localized abnormalities in the caudate nucleus, putamen, pallidum, thalamus, and frontoparietal cortex in PKD patients. These studies have also revealed alterations in interhemispheric functional connectivity between the brain regions of bilateral cerebral hemispheres such as the putamen, primary motor cortex, supplementary motor area, dorsal lateral prefrontal cortex, and primary somatosensory cortex in these patients. In addition, proline-rich transmembrane protein 2 gene mutations can affect the functional organization of the brain in PKD. These results suggest that the neural mechanisms of PKD are associated with the disruption of both structural and/or functional properties in basal ganglia-thalamo-cortical circuitry and interhemispheric functional connectivity. PKD can be considered a circuitry/network disorder and is not restricted to localized structural and/or functional abnormalities. Multimodal neuroimaging combined with gene analysis can provide additional valuable information for a better understanding of the pathogenesis and early diagnosis of this disorder.
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Affiliation(s)
- Wei Liu
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Yan Xiao
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Ting Zheng
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Guangxiang Chen
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
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Matsuura R, Hamano SI, Hiwatari E, Ikemoto S, Hirata Y, Koichihara R, Kikuchi K. Zonisamide Therapy for Patients With Paroxysmal Kinesigenic Dyskinesia. Pediatr Neurol 2020; 111:23-26. [PMID: 32951651 DOI: 10.1016/j.pediatrneurol.2020.06.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND We evaluated zonisamide therapy in patients with paroxysmal kinesigenic dyskinesia (PKD). METHODS We analyzed zonisamide therapy in 17 patients with PKD at Saitama Children's Medical Center between November 1994 and April 2020. We collected information regarding family history, previous history, age at onset, age at zonisamide commencement, dyskinesia characteristics, brain magnetic resonance imaging, interictal electroencephalography, treatment lag, zonisamide efficacy, zonisamide dose, serum zonisamide concentration, and adverse effects. We evaluated PKD frequency at six months after zonisamide therapy commencement. RESULTS Fourteen patients met the inclusion criteria. The median age at zonisamide therapy commencement was 12.8 (9.4 to 16.3) years. Zonisamide therapy was effective in 13 of 14 (92.9%) patients: complete remission for more than three months after zonisamide therapy (n = 7), decreased dyskinesia frequency by more than 90% (n = 4), dyskinesia frequency by 75% to 90% (n = 2), and no change of dyskinesia frequency (n = 1). The initial and maintenance zonisamide doses were 2.0 (1.4 to 3.8) and 2.0 (1.5 to 5.9) mg/kg/day, respectively. The median duration between zonisamide therapy commencement and dyskinesia decrease or cessation was 4 (1 to 60) days: 10 of 14 (71.4%) patients responded to zonisamide within one week after zonisamide therapy commencement. Regarding adverse effects, two patients experienced somnolence and one developed reduced perspiration. CONCLUSIONS We suggest that zonisamide monotherapy is effective for patients with PKD as a first-line treatment. We can evaluate the efficacy of zonisamide therapy within one week. Because zonisamide lacks the enzyme-inducing effects of carbamazepine and phenytoin, it may be useful for PKD treatment.
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Affiliation(s)
- Ryuki Matsuura
- Division of Neurology, Saitama Children's Medical Center, Saitama, Japan; Department of Pediatrics, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan.
| | - Shin-Ichiro Hamano
- Division of Neurology, Saitama Children's Medical Center, Saitama, Japan; Division of Child Health and Human Development, Saitama Children's Medical Center, Saitama, Japan
| | - Erika Hiwatari
- Department of Pediatrics, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Satoru Ikemoto
- Department of Pediatrics, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Yuko Hirata
- Division of Neurology, Saitama Children's Medical Center, Saitama, Japan
| | - Reiko Koichihara
- Division of Child Health and Human Development, Saitama Children's Medical Center, Saitama, Japan
| | - Kenjiro Kikuchi
- Division of Child Health and Human Development, Saitama Children's Medical Center, Saitama, Japan
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Li L, Lei D, Suo X, Li X, Yang C, Yang T, Ren J, Chen G, Zhou D, Kemp GJ, Gong Q. Brain structural connectome in relation to PRRT2 mutations in paroxysmal kinesigenic dyskinesia. Hum Brain Mapp 2020; 41:3855-3866. [PMID: 32592228 PMCID: PMC7469858 DOI: 10.1002/hbm.25091] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 05/06/2020] [Accepted: 05/26/2020] [Indexed: 02/05/2023] Open
Abstract
This study explored the topological characteristics of brain white matter structural networks in patients with Paroxysmal Kinesigenic Dyskinesia (PKD), and the potential influence of the brain network stability gene PRRT2 on the structural connectome in PKD. Thirty-five PKD patients with PRRT2 mutations (PKD-M), 43 PKD patients without PRRT2 mutations (PKD-N), and 40 demographically-matched healthy control (HC) subjects underwent diffusion tensor imaging. Graph theory and network-based statistic (NBS) approaches were performed; the topological properties of the white matter structural connectome were compared across the groups, and their relationships with the clinical variables were assessed. Both disease groups PKD-M and PKD-N showed lower local efficiency (implying decreased segregation ability) compared to the HC group; PKD-M had longer characteristic path length and lower global efficiency (implying decreased integration ability) compared to PKD-N and HC, independently of the potential effects of medication. Both PKD-M and PKD-N had decreased nodal characteristics in the left thalamus and left inferior frontal gyrus, the alterations being more pronounced in PKD-M patients, who also showed abnormalities in the left fusiform and bilateral middle temporal gyrus. In the connectivity characteristics assessed by NBS, the alterations were more pronounced in the PKD-M group versus HC than in PKD-N versus HC. As well as the white matter alterations in the basal ganglia-thalamo-cortical circuit related to PKD with or without PRRT2 mutations, findings in the PKD-M group of weaker small-worldness and more pronounced regional disturbance show the adverse effects of PRRT2 gene mutations on brain structural connectome.
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Affiliation(s)
- Lei Li
- Huaxi MR Research Center (HMRRC), Department of RadiologyWest China Hospital of Sichuan UniversityChengduSichuan ProvinceChina
| | - Du Lei
- Huaxi MR Research Center (HMRRC), Department of RadiologyWest China Hospital of Sichuan UniversityChengduSichuan ProvinceChina
- Department of Psychiatry and Behavioral NeuroscienceUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Xueling Suo
- Huaxi MR Research Center (HMRRC), Department of RadiologyWest China Hospital of Sichuan UniversityChengduSichuan ProvinceChina
| | - Xiuli Li
- Huaxi MR Research Center (HMRRC), Department of RadiologyWest China Hospital of Sichuan UniversityChengduSichuan ProvinceChina
| | - Chen Yang
- Huaxi MR Research Center (HMRRC), Department of RadiologyWest China Hospital of Sichuan UniversityChengduSichuan ProvinceChina
| | - Tianhua Yang
- Department of NeurologyWest China Hospital of Sichuan UniversityChengduSichuan ProvinceChina
| | - Jiechuan Ren
- Department of NeurologyWest China Hospital of Sichuan UniversityChengduSichuan ProvinceChina
- Department of NeurologyBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Guangxiang Chen
- Department of RadiologyThe Affiliated Hospital of southwest Medical UniversityLuzhouChina
| | - Dong Zhou
- Department of NeurologyWest China Hospital of Sichuan UniversityChengduSichuan ProvinceChina
| | - Graham J. Kemp
- Liverpool Magnetic Resonance Imaging Center (LiMRIC) and Institute of Life course and Medical SciencesUniversity of LiverpoolLiverpoolUK
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of RadiologyWest China Hospital of Sichuan UniversityChengduSichuan ProvinceChina
- Psychoradiology Research Unit of Chinese Academy of Medical Sciences, Functional and Molecular Imaging Key Laboratory of Sichuan ProvinceWest China Hospital of Sichuan UniversityChengduSichuanChina
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Ahn H, Ko TS. The Genetic Relationship between Paroxysmal Movement Disorders and Epilepsy. ANNALS OF CHILD NEUROLOGY 2020. [DOI: 10.26815/acn.2020.00073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Zhang Y, Ren J, Qin Y, Yang C, Zhang T, Gong Q, Yang T, Zhou D. Altered topological organization of functional brain networks in drug-naive patients with paroxysmal kinesigenic dyskinesia. J Neurol Sci 2020; 411:116702. [DOI: 10.1016/j.jns.2020.116702] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/06/2020] [Accepted: 01/21/2020] [Indexed: 10/25/2022]
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Abstract
PURPOSE OF REVIEW Recent advancements in next-generation sequencing (NGS) have enabled techniques such as whole exome sequencing (WES) and whole genome sequencing (WGS) to be used to study paroxysmal movement disorders (PMDs). This review summarizes how the recent genetic advances have altered our understanding of the pathophysiology and treatment of the PMDs. Recently described disease entities are also discussed. RECENT FINDINGS With the recognition of the phenotypic and genotypic heterogeneity that occurs amongst the PMDs, an increasing number of gene mutations are now implicated to cause the disorders. PMDs can also occur as part of a complex phenotype. The increasing complexity of PMDs challenges the way we view and classify them. The identification of new causative genes and their genotype-phenotype correlation will shed more light on the underlying pathophysiology and will facilitate development of genetic testing guidelines and identification of novel drug targets for PMDs.
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Affiliation(s)
- Zheyu Xu
- Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Che-Kang Lim
- Department of Clinical Translational Research, Singapore General Hospital, Bukit Merah, Singapore, Singapore
- Division of Clinical Immunology and Transfusion Medicine, Department of Laboratory Medicine, Karolinska Institute, Solna, Sweden
| | - Louis C S Tan
- Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
- Duke-NUS Medical School, 8 College Rd, Singapore, 169857, Singapore
| | - Eng-King Tan
- Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.
- Duke-NUS Medical School, 8 College Rd, Singapore, 169857, Singapore.
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18
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Ismail II, Al‐Hashel JY, Alroughani R. Secondary Paroxysmal Dyskinesia as a Presenting Symptom of Multiple Sclerosis. Mov Disord Clin Pract 2019; 6:406-408. [DOI: 10.1002/mdc3.12764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 03/20/2019] [Accepted: 03/25/2019] [Indexed: 11/08/2022] Open
Affiliation(s)
| | - Jasem Yousef Al‐Hashel
- Department of NeurologyIbn Sina Hospital Kuwait
- Department of Medicine, Health Sciences CentreKuwait University Kuwait
| | - Raed Alroughani
- Division of Neurology, Department of MedicineAmiri Hospital Sharq Kuwait
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19
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Li HF, Yang L, Yin D, Chen WJ, Liu GL, Ni W, Wang N, Yu W, Wu ZY, Wang Z. Associations between neuroanatomical abnormality and motor symptoms in paroxysmal kinesigenic dyskinesia. Parkinsonism Relat Disord 2019; 62:134-140. [DOI: 10.1016/j.parkreldis.2018.12.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 12/17/2018] [Accepted: 12/31/2018] [Indexed: 02/04/2023]
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20
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Salmi M, Bolbos R, Bauer S, Minlebaev M, Burnashev N, Szepetowski P. Transient microstructural brain anomalies and epileptiform discharges in mice defective for epilepsy and language-related NMDA receptor subunit gene Grin2a. Epilepsia 2018; 59:1919-1930. [DOI: 10.1111/epi.14543] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 07/25/2018] [Accepted: 07/25/2018] [Indexed: 12/27/2022]
Affiliation(s)
- Manal Salmi
- INSERM, UMR1249; INMED; Aix-Marseille University; Marseille France
| | | | - Sylvian Bauer
- INSERM, UMR1249; INMED; Aix-Marseille University; Marseille France
| | - Marat Minlebaev
- INSERM, UMR1249; INMED; Aix-Marseille University; Marseille France
- Laboratory of Neurobiology; Kazan Federal University; Kazan Russia
| | - Nail Burnashev
- INSERM, UMR1249; INMED; Aix-Marseille University; Marseille France
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21
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The expanding spectrum of paroxysmal movement disorders: update from clinical features to therapeutics. Curr Opin Neurol 2018; 31:491-497. [DOI: 10.1097/wco.0000000000000576] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Kasikci T, Bek S, Koc G, Yucel M, Kutukcu Y, Odabasi Z. Transcallosal conduction in paroxysmal kinesigenic dyskinesia. Somatosens Mot Res 2018; 34:235-241. [PMID: 29334840 DOI: 10.1080/08990220.2017.1421158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Detecting whether a possible disequilibrium between the excitatory and inhibitory interhemispheric interactions in paroxysmal kinesigenic dyskinesia (PKD) exists. METHODS This study assessed measures of motor threshold, motor evoked potential latency, the cortical silent period, the ipsilateral silent period and the transcallosal conduction time (TCT) in PKD patients. Data were compared between the clinically affected hemisphere (aH) and the fellow hemisphere (fH). RESULTS The transcallosal conduction time from the aH to the fH was 11.8 ms (range = 2.3-20.7) and 13.6 ms (range = 2.8-67.7) from the fH to the aH. The difference in TCT in the affected side was significant (p = .019). CONCLUSION The findings demonstrated that, although inhibitory interneurons act normally and symmetrically between the motor cortices and transcallosal inhibition was normal and symmetrical between both sides, the onset of transcallosal inhibition was asymmetrical. The affected hemisphere's inhibition toward the unaffected hemisphere is faster compared to the inhibition provided by the fellow hemisphere. These results are consistent with an inhibitory deficit in the level of interhemispheric interactions. SIGNIFICANCE This study revealed a defect in inhibition of the motor axis could be responsible in the pathological mechanisms of kinesigenic dyskinesia.
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Affiliation(s)
| | - Semai Bek
- a Gulhane Medical Faculty , Ankara , Turkey
| | - Guray Koc
- a Gulhane Medical Faculty , Ankara , Turkey
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23
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Tan GH, Liu YY, Wang L, Li K, Zhang ZQ, Li HF, Yang ZF, Li Y, Li D, Wu MY, Yu CL, Long JJ, Chen RC, Li LX, Yin LP, Liu JW, Cheng XW, Shen Q, Shu YS, Sakimura K, Liao LJ, Wu ZY, Xiong ZQ. PRRT2 deficiency induces paroxysmal kinesigenic dyskinesia by regulating synaptic transmission in cerebellum. Cell Res 2017; 28:90-110. [PMID: 29056747 PMCID: PMC5752836 DOI: 10.1038/cr.2017.128] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 06/28/2017] [Accepted: 07/26/2017] [Indexed: 01/22/2023] Open
Abstract
Mutations in the proline-rich transmembrane protein 2 (PRRT2) are associated with paroxysmal kinesigenic dyskinesia (PKD) and several other paroxysmal neurological diseases, but the PRRT2 function and pathogenic mechanisms remain largely obscure. Here we show that PRRT2 is a presynaptic protein that interacts with components of the SNARE complex and downregulates its formation. Loss-of-function mutant mice showed PKD-like phenotypes triggered by generalized seizures, hyperthermia, or optogenetic stimulation of the cerebellum. Mutant mice with specific PRRT2 deletion in cerebellar granule cells (GCs) recapitulate the behavioral phenotypes seen in Prrt2-null mice. Furthermore, recording made in cerebellar slices showed that optogenetic stimulation of GCs results in transient elevation followed by suppression of Purkinje cell firing. The anticonvulsant drug carbamazepine used in PKD treatment also relieved PKD-like behaviors in mutant mice. Together, our findings identify PRRT2 as a novel regulator of the SNARE complex and provide a circuit mechanism underlying the PRRT2-related behaviors.
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Affiliation(s)
- Guo-He Tan
- Institute of Neuroscience and State Key Laboratory of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai 200031, China.,Department of Human Anatomy, Guangxi Key Laboratory of Regenerative Medicine & Guangxi Collaborative Innovation Center of Biomedicine, Guangxi Medical University, Nanning, Guangxi 530021, China
| | - Yuan-Yuan Liu
- Institute of Neuroscience and State Key Laboratory of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai 200031, China
| | - Lu Wang
- Institute of Neuroscience and State Key Laboratory of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai 200031, China
| | - Kui Li
- Institute of Neuroscience and State Key Laboratory of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai 200031, China
| | - Ze-Qiang Zhang
- Institute of Neuroscience and State Key Laboratory of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai 200031, China.,University of Chinese Academy of Sciences, Beijing 100049, China
| | - Hong-Fu Li
- Department of Neurology and Research Center of Neurology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, China
| | - Zhong-Fei Yang
- Institute of Neuroscience and State Key Laboratory of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai 200031, China
| | - Yang Li
- Institute of Neuroscience and State Key Laboratory of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai 200031, China
| | - Dan Li
- Institute of Neuroscience and State Key Laboratory of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai 200031, China
| | - Ming-Yue Wu
- Institute of Neuroscience and State Key Laboratory of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai 200031, China
| | - Chun-Lei Yu
- Shanghai Key Laboratory of Regulatory Biology, School of Life Sciences, East China Normal University, Shanghai 200241, China
| | - Juan-Juan Long
- Institute of Biochemistry and Cell Biology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai 200031, China
| | - Ren-Chao Chen
- Institute of Neuroscience and State Key Laboratory of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai 200031, China
| | - Li-Xi Li
- Department of Neurology and Research Center of Neurology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, China
| | - Lu-Ping Yin
- Institute of Neuroscience and State Key Laboratory of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai 200031, China
| | - Ji-Wei Liu
- Institute of Neuroscience and State Key Laboratory of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai 200031, China
| | - Xue-Wen Cheng
- Institute of Neuroscience and State Key Laboratory of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai 200031, China
| | - Qi Shen
- Institute of Neuroscience and State Key Laboratory of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai 200031, China
| | - You-Sheng Shu
- Institute of Neuroscience and State Key Laboratory of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai 200031, China
| | - Kenji Sakimura
- Department of Cellular Neurobiology, Brain Research Institute, Niigata University, Niigata 951-8585, Japan
| | - Lu-Jian Liao
- Shanghai Key Laboratory of Regulatory Biology, School of Life Sciences, East China Normal University, Shanghai 200241, China
| | - Zhi-Ying Wu
- Department of Neurology and Research Center of Neurology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, China
| | - Zhi-Qi Xiong
- Institute of Neuroscience and State Key Laboratory of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai 200031, China.,University of Chinese Academy of Sciences, Beijing 100049, China
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Horisawa S, Sumi M, Akagawa H, Kawamata T, Taira T. Thalamotomy for paroxysmal kinesigenic dyskinesias in a multiplex family. Eur J Neurol 2017; 24:e71-e72. [DOI: 10.1111/ene.13379] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 06/27/2017] [Indexed: 11/28/2022]
Affiliation(s)
- S. Horisawa
- Department of Neurosurgery Neurological Institute Tokyo Women's Medical University Tokyo Japan
| | - M. Sumi
- Department of Neurosurgery Neurological Institute Tokyo Women's Medical University Tokyo Japan
| | - H. Akagawa
- Tokyo Women's Medical University Institute for Integrated Medical Sciences Tokyo Japan
| | - T. Kawamata
- Department of Neurosurgery Neurological Institute Tokyo Women's Medical University Tokyo Japan
| | - T. Taira
- Department of Neurosurgery Neurological Institute Tokyo Women's Medical University Tokyo Japan
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25
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Long Z, Xu Q, Miao HH, Yu Y, Ding MP, Chen H, Liu ZR, Liao W. Thalamocortical dysconnectivity in paroxysmal kinesigenic dyskinesia: Combining functional magnetic resonance imaging and diffusion tensor imaging. Mov Disord 2017; 32:592-600. [PMID: 28186667 DOI: 10.1002/mds.26905] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 12/06/2016] [Accepted: 12/08/2016] [Indexed: 01/07/2023] Open
Affiliation(s)
- Zhiliang Long
- Key Laboratory for Neuroinformation of Ministry of Education, Center for Information in BioMedicine, School of Life Science and Technology; University of Electronic Science and Technology of China; Chengdu P.R. China
| | - Qiang Xu
- Department of Medical Imaging, Jinling Hospital; Nanjing University School of Medicine; Nanjing P.R. China
| | - Huan-Huan Miao
- Center for Cognition and Brain Disorders and the Affiliated Hospital; Hangzhou Normal University; Hangzhou P.R. China
| | - Yang Yu
- Mental Health Education and Counseling Center; Zhejiang University; Hangzhou China
| | - Mei-Ping Ding
- Department of Neurology, the Second Affiliated Hospital of Medial College; Zhejiang University; Hangzhou P.R. China
| | - Huafu Chen
- Key Laboratory for Neuroinformation of Ministry of Education, Center for Information in BioMedicine, School of Life Science and Technology; University of Electronic Science and Technology of China; Chengdu P.R. China
| | - Zhi-Rong Liu
- Department of Neurology, the Second Affiliated Hospital of Medial College; Zhejiang University; Hangzhou P.R. China
| | - Wei Liao
- Key Laboratory for Neuroinformation of Ministry of Education, Center for Information in BioMedicine, School of Life Science and Technology; University of Electronic Science and Technology of China; Chengdu P.R. China
- Department of Medical Imaging, Jinling Hospital; Nanjing University School of Medicine; Nanjing P.R. China
- Center for Cognition and Brain Disorders and the Affiliated Hospital; Hangzhou Normal University; Hangzhou P.R. China
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26
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Liu ZR, Miao HH, Yu Y, Ding MP, Liao W. Frequency-Specific Local Synchronization Changes in Paroxysmal Kinesigenic Dyskinesia. Medicine (Baltimore) 2016; 95:e3293. [PMID: 27043701 PMCID: PMC4998562 DOI: 10.1097/md.0000000000003293] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The neurobiological basis of paroxysmal kinesigenic dyskinesia (PKD) is poorly defined due to the lack of reliable neuroimaging differences that can distinguish PKD with dystonia (PKD-D) from PKD with chorea (PKD-C). Consequently, diagnosis of PKD remains largely based on the clinical phenotype. Understanding the pathophysiology of PKD may facilitate discrimination between PKD-D and PKD-C, potentially contributing to more accurate diagnosis. We conducted resting-state functional magnetic resonance imaging on patients with PKD-D (n = 22), PKD-C (n = 10), and healthy controls (n = 32). Local synchronization was measured in all 3 groups via regional homogeneity (ReHo) and evaluated using receiver operator characteristic analysis to distinguish between PKD-C and PKD-D. Cortical-basal ganglia circuitry differed significantly between the 2 groups at a specific frequency. Furthermore, the PKD-D and PKD-C patients were observed to show different spontaneous brain activity in the right precuneus, right putamen, and right angular gyrus at the slow-5 frequency band (0.01-0.027 Hz). The frequency-specific abnormal local synchronization between the 2 types of PKD offers new insights into the pathophysiology of this disorder to some extent.
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Affiliation(s)
- Zhi-Rong Liu
- From the Department of Neurology (Z-RL, M-PD), the Second Affiliated Hospital of Medial College, Zhejiang University, Hangzhou, China; Center for Cognition and Brain Disorders and the Affiliated Hospital (H-HM, YY, WL), Hangzhou Normal University, Hangzhou, China; Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments (H-HM, YY, WL), Hangzhou, China; Mental Health Education and Counseling Center (YY), Zhejiang University, Hangzhou, China; and Center for Information in BioMedicine (WL), Key Laboratory for Neuroinformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
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Ebrahimi-Fakhari D, Saffari A, Westenberger A, Klein C. The evolving spectrum ofPRRT2-associated paroxysmal diseases. Brain 2015; 138:3476-95. [DOI: 10.1093/brain/awv317] [Citation(s) in RCA: 175] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 09/30/2015] [Indexed: 02/01/2023] Open
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