1
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Courtin E, Poblete NH, Clot F, Guehl D, Burbaud P. Late-onset parkinsonism in a patient with a novel frameshift THAP1 variant. Parkinsonism Relat Disord 2024; 123:105900. [PMID: 37945392 DOI: 10.1016/j.parkreldis.2023.105900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/12/2023] [Accepted: 10/16/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Edouard Courtin
- Department of Clinical Neurophysiology, University Hospital, Bordeaux, France; Institut des maladies neurodégénératives, Université de Bordeaux, CNRS, UMR, 5293, Bordeaux, France.
| | | | - Fabienne Clot
- Department of Medical Genetics, Molecular and Cellular Neurogenetics Functional Unit, AP-HP Sorbonne University Pitié-Salpêtrière Hospitals, Paris, France
| | - Dominique Guehl
- Department of Clinical Neurophysiology, University Hospital, Bordeaux, France; Institut des maladies neurodégénératives, Université de Bordeaux, CNRS, UMR, 5293, Bordeaux, France
| | - Pierre Burbaud
- Department of Clinical Neurophysiology, University Hospital, Bordeaux, France; Institut des maladies neurodégénératives, Université de Bordeaux, CNRS, UMR, 5293, Bordeaux, France
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2
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Yellajoshyula D. Transcriptional regulatory network for neuron-glia interactions and its implication for DYT6 dystonia. DYSTONIA (LAUSANNE, SWITZERLAND) 2023; 2:11796. [PMID: 38737544 PMCID: PMC11087070 DOI: 10.3389/dyst.2023.11796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
Advances in sequencing technologies have identified novel genes associated with inherited forms of dystonia, providing valuable insights into its genetic basis and revealing diverse genetic pathways and mechanisms involved in its pathophysiology. Since identifying genetic variation in the transcription factor coding THAP1 gene linked to isolated dystonia, numerous investigations have employed transcriptomic studies in DYT-THAP1 models to uncover pathogenic molecular mechanisms underlying dystonia. This review examines key findings from transcriptomic studies conducted on in vivo and in vitro DYT-THAP1 models, which demonstrate that the THAP1-regulated transcriptome is diverse and cell-specific, yet it is bound and co-regulated by a common set of proteins. Prominent among its functions, THAP1 and its co-regulatory network target molecular pathways critical for generating myelinating oligodendrocytes that ensheath axons and generate white matter in the central nervous system. Several lines of investigation have demonstrated the importance of myelination and oligodendrogenesis in motor function during development and in adults, emphasizing the non-cell autonomous contributions of glial cells to neural circuits involved in motor function. Further research on the role of myelin abnormalities in motor deficits in DYT6 models will enhance our understanding of axon-glia interactions in dystonia pathophysiology and provide potential therapeutic interventions targeting these pathways.
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3
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Stephen CD, Dy-Hollins M, Gusmao CMD, Qahtani XA, Sharma N. Dystonias: Clinical Recognition and the Role of Additional Diagnostic Testing. Semin Neurol 2023; 43:17-34. [PMID: 36972613 DOI: 10.1055/s-0043-1764292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Dystonia is the third most common movement disorder, characterized by abnormal, frequently twisting postures related to co-contraction of agonist and antagonist muscles. Diagnosis is challenging. We provide a comprehensive appraisal of the epidemiology and an approach to the phenomenology and classification of dystonia, based on the clinical characteristics and underlying etiology of dystonia syndromes. We discuss the features of common idiopathic and genetic forms of dystonia, diagnostic challenges, and dystonia mimics. Appropriate workup is based on the age of symptom onset, rate of progression, whether dystonia is isolated or combined with another movement disorder or complex neurological and other organ system eatures. Based on these features, we discuss when imaging and genetic should be considered. We discuss the multidisciplinary treatment of dystonia, including rehabilitation and treatment principles according to the etiology, including when pathogenesis-direct treatment is available, oral pharmacological therapy, chemodenervation with botulinum toxin injections, deep brain stimulation and other surgical therapies, and future directions.
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Affiliation(s)
| | - Marisela Dy-Hollins
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Xena Al Qahtani
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Nutan Sharma
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
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4
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Bukhari-Parlakturk N, Frucht SJ. Isolated and combined dystonias: Update. HANDBOOK OF CLINICAL NEUROLOGY 2023; 196:425-442. [PMID: 37620082 DOI: 10.1016/b978-0-323-98817-9.00005-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
Dystonia is a hyperkinetic movement disorder with a unique motor phenomenology that can manifest as an isolated clinical syndrome or combined with other neurological features. This chapter reviews the characteristic features of dystonia phenomenology and the syndromic approach to evaluating the disorders that may allow us to differentiate the isolated and combined syndromes. We also present the most common types of isolated and combined dystonia syndromes. Since accelerated gene discoveries have increased our understanding of the molecular mechanisms of dystonia pathogenesis, we also present isolated and combined dystonia syndromes by shared biological pathways. Examples of these converging mechanisms of the isolated and combined dystonia syndromes include (1) disruption of the integrated response pathway through eukaryotic initiation factor 2 alpha signaling, (2) disease of dopaminergic signaling, (3) alterations in the cerebello-thalamic pathway, and (4) disease of protein mislocalization and stability. The discoveries that isolated and combined dystonia syndromes converge in shared biological pathways will aid in the development of clinical trials and therapeutic strategies targeting these convergent molecular pathways.
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Affiliation(s)
- Noreen Bukhari-Parlakturk
- Department of Neurology, Movement Disorders Division, Duke University (NBP), Durham, NC, United States.
| | - Steven J Frucht
- Department of Neurology, NYU Grossman School of Medicine (SJF), New York, NY, United States
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5
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Grofik M, Cibulka M, Olekšáková J, Turčanová Koprušáková M, Galanda T, Necpál J, Jungová P, Kurča E, Winkelmann J, Zech M, Jech R. A case of novel DYT6 dystonia variant with serious complications after deep brain stimulation therapy: a case report. BMC Neurol 2022; 22:344. [PMID: 36096774 PMCID: PMC9465909 DOI: 10.1186/s12883-022-02871-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/02/2022] [Indexed: 12/02/2022] Open
Abstract
Background DYT6 dystonia belongs to a group of isolated, genetically determined, generalized dystonia associated with mutations in the THAP1 gene. Case presentation We present the case of a young patient with DYT6 dystonia associated with a newly discovered c14G>A (p.Cys5Tyr) mutation in the THAP1 gene. We describe the clinical phenotype of this new mutation, effect of pallidal deep brain stimulation (DBS), which was accompanied by two rare postimplantation complications: an early intracerebral hemorrhage and delayed epileptic seizures. Among the published case reports of patients with DYT6 dystonia, the mentioned complications have not been described so far. Conclusions DBS in the case of DYT6 dystonia is a challenge to thoroughly consider possible therapeutic benefits and potential risks associated with surgery. Genetic heterogeneity of the disease may also play an important role in predicting the development of the clinical phenotype as well as the effect of treatment including DBS. Therefore, it is beneficial to analyze the genetic and clinical relationships of DYT6 dystonia.
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Affiliation(s)
- M Grofik
- Department of Neurology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava and University Hospital Martin, Martin, Slovakia
| | - M Cibulka
- Biomedical Centre Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Bratislava, Slovakia.
| | - J Olekšáková
- Department of Neurology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava and University Hospital Martin, Martin, Slovakia
| | - M Turčanová Koprušáková
- Department of Neurology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava and University Hospital Martin, Martin, Slovakia
| | - T Galanda
- Department of Neurosurgery, Slovak Medical University and Roosevelt Hospital, Banska Bystrica, Slovakia
| | - J Necpál
- Department of Neurology, Zvolen Hospital, Zvolen, Slovakia
| | - P Jungová
- Department of Molecular and Biochemical Genetics - Centre of Rare Genetic Diseases, Faculty of Medicine & Comenius University, University Hospital Bratislava, Bratislava, Slovakia
| | - E Kurča
- Department of Neurology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava and University Hospital Martin, Martin, Slovakia
| | - J Winkelmann
- Institute of Neurogenomics, Helmholtz Centrum, Munich, Germany.,Institute of Human Genetics, Technical University of Munich, Munich, Germany
| | - M Zech
- Department of Molecular and Biochemical Genetics - Centre of Rare Genetic Diseases, Faculty of Medicine & Comenius University, University Hospital Bratislava, Bratislava, Slovakia.,Institute of Neurogenomics, Helmholtz Centrum, Munich, Germany
| | - R Jech
- Department of Neurology, Charles University, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic
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6
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Yellajoshyula D, Rogers AE, Kim AJ, Kim S, Pappas SS, Dauer WT. A pathogenic DYT-THAP1 dystonia mutation causes hypomyelination and loss of YY1 binding. Hum Mol Genet 2022; 31:1096-1104. [PMID: 34686877 PMCID: PMC8976427 DOI: 10.1093/hmg/ddab310] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/27/2021] [Accepted: 10/19/2021] [Indexed: 12/24/2022] Open
Abstract
Dystonia is a disabling disease that manifests as prolonged involuntary twisting movements. DYT-THAP1 is an inherited form of isolated dystonia caused by mutations in THAP1 encoding the transcription factor THAP1. The phe81leu (F81L) missense mutation is representative of a category of poorly understood mutations that do not occur on residues critical for DNA binding. Here, we demonstrate that the F81L mutation (THAP1F81L) impairs THAP1 transcriptional activity and disrupts CNS myelination. Strikingly, THAP1F81L exhibits normal DNA binding but causes a significantly reduced DNA binding of YY1, its transcriptional partner that also has an established role in oligodendrocyte lineage progression. Our results suggest a model of molecular pathogenesis whereby THAP1F81L normally binds DNA but is unable to efficiently organize an active transcription complex.
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Affiliation(s)
| | - Abigail E Rogers
- Molecular Cellular and Developmental Biology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Audrey J Kim
- Peter O’Donnell Jr. Brain Institute, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Sumin Kim
- Department of Neurology, University of Michigan, Ann Arbor, MI 48109, USA
- Cellular and Molecular Biology Graduate Program, University of Michigan, Ann Arbor, MI 48109, USA
| | - Samuel S Pappas
- Peter O’Donnell Jr. Brain Institute, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - William T Dauer
- Peter O’Donnell Jr. Brain Institute, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
- Department of Neuroscience, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
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7
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THAP1 modulates oligodendrocyte maturation by regulating ECM degradation in lysosomes. Proc Natl Acad Sci U S A 2021; 118:2100862118. [PMID: 34312226 DOI: 10.1073/pnas.2100862118] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Mechanisms controlling myelination during central nervous system (CNS) maturation play a pivotal role in the development and refinement of CNS circuits. The transcription factor THAP1 is essential for timing the inception of myelination during CNS maturation through a cell-autonomous role in the oligodendrocyte lineage. Here, we demonstrate that THAP1 modulates the extracellular matrix (ECM) composition by regulating glycosaminoglycan (GAG) catabolism within oligodendrocyte progenitor cells (OPCs). Thap1 -/- OPCs accumulate and secrete excess GAGs, inhibiting their maturation through an autoinhibitory mechanism. THAP1 controls GAG metabolism by binding to and regulating the GusB gene encoding β-glucuronidase, a GAG-catabolic lysosomal enzyme. Applying GAG-degrading enzymes or overexpressing β-glucuronidase rescues Thap1 -/- OL maturation deficits in vitro and in vivo. Our studies establish lysosomal GAG catabolism within OPCs as a critical mechanism regulating oligodendrocyte development.
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8
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Staege S, Kutschenko A, Baumann H, Glaß H, Henkel L, Gschwendtberger T, Kalmbach N, Klietz M, Hermann A, Lohmann K, Seibler P, Wegner F. Reduced Expression of GABA A Receptor Alpha2 Subunit Is Associated With Disinhibition of DYT-THAP1 Dystonia Patient-Derived Striatal Medium Spiny Neurons. Front Cell Dev Biol 2021; 9:650586. [PMID: 34095114 PMCID: PMC8176025 DOI: 10.3389/fcell.2021.650586] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/08/2021] [Indexed: 12/18/2022] Open
Abstract
DYT-THAP1 dystonia (formerly DYT6) is an adolescent-onset dystonia characterized by involuntary muscle contractions usually involving the upper body. It is caused by mutations in the gene THAP1 encoding for the transcription factor Thanatos-associated protein (THAP) domain containing apoptosis-associated protein 1 and inherited in an autosomal-dominant manner with reduced penetrance. Alterations in the development of striatal neuronal projections and synaptic function are known from transgenic mice models. To investigate pathogenetic mechanisms, human induced pluripotent stem cell (iPSC)-derived medium spiny neurons (MSNs) from two patients and one family member with reduced penetrance carrying a mutation in the gene THAP1 (c.474delA and c.38G > A) were functionally characterized in comparison to healthy controls. Calcium imaging and quantitative PCR analysis revealed significantly lower Ca2+ amplitudes upon GABA applications and a marked downregulation of the gene encoding the GABAA receptor alpha2 subunit in THAP1 MSNs indicating a decreased GABAergic transmission. Whole-cell patch-clamp recordings showed a significantly lower frequency of miniature postsynaptic currents (mPSCs), whereas the frequency of spontaneous action potentials (APs) was elevated in THAP1 MSNs suggesting that decreased synaptic activity might have resulted in enhanced generation of APs. Our molecular and functional data indicate that a reduced expression of GABAA receptor alpha2 subunit could eventually lead to limited GABAergic synaptic transmission, neuronal disinhibition, and hyperexcitability of THAP1 MSNs. These data give pathophysiological insight and may contribute to the development of novel treatment strategies for DYT-THAP1 dystonia.
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Affiliation(s)
- Selma Staege
- Department of Neurology, Hannover Medical School, Hanover, Germany.,Center for Systems Neuroscience, Hanover, Germany
| | - Anna Kutschenko
- Department of Neurology, Hannover Medical School, Hanover, Germany
| | - Hauke Baumann
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Hannes Glaß
- Translational Neurodegeneration Section "Albrecht-Kossel", Department of Neurology, University of Rostock, Rostock, Germany
| | - Lisa Henkel
- Department of Neurology, Hannover Medical School, Hanover, Germany.,Center for Systems Neuroscience, Hanover, Germany
| | - Thomas Gschwendtberger
- Department of Neurology, Hannover Medical School, Hanover, Germany.,Center for Systems Neuroscience, Hanover, Germany
| | - Norman Kalmbach
- Department of Neurology, Hannover Medical School, Hanover, Germany
| | - Martin Klietz
- Department of Neurology, Hannover Medical School, Hanover, Germany
| | - Andreas Hermann
- Translational Neurodegeneration Section "Albrecht-Kossel", Department of Neurology, University of Rostock, Rostock, Germany.,German Center for Neurodegenerative Diseases Rostock/Greifswald, Rostock, Germany
| | - Katja Lohmann
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Philip Seibler
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Florian Wegner
- Department of Neurology, Hannover Medical School, Hanover, Germany.,Center for Systems Neuroscience, Hanover, Germany
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9
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The dystonia gene THAP1 controls DNA double-strand break repair choice. Mol Cell 2021; 81:2611-2624.e10. [PMID: 33857404 DOI: 10.1016/j.molcel.2021.03.034] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 02/01/2021] [Accepted: 03/19/2021] [Indexed: 12/26/2022]
Abstract
The Shieldin complex shields double-strand DNA breaks (DSBs) from nucleolytic resection. Curiously, the penultimate Shieldin component, SHLD1, is one of the least abundant mammalian proteins. Here, we report that the transcription factors THAP1, YY1, and HCF1 bind directly to the SHLD1 promoter, where they cooperatively maintain the low basal expression of SHLD1, thereby ensuring a proper balance between end protection and resection during DSB repair. The loss of THAP1-dependent SHLD1 expression confers cross-resistance to poly (ADP-ribose) polymerase (PARP) inhibitor and cisplatin in BRCA1-deficient cells and shorter progression-free survival in ovarian cancer patients. Moreover, the embryonic lethality and PARPi sensitivity of BRCA1-deficient mice is rescued by ablation of SHLD1. Our study uncovers a transcriptional network that directly controls DSB repair choice and suggests a potential link between DNA damage and pathogenic THAP1 mutations, found in patients with the neurodevelopmental movement disorder adult-onset torsion dystonia type 6.
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10
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Zorzi G, Danti FR, Reale C, Panteghini C, Invernizzi F, Moroni I, Garavaglia B, Nardocci N, Chiapparini L. THAP1 Dystonia with Globus Pallidus T2 Hypointensity: A Report of Two Cases. Mov Disord 2021; 36:1463-1464. [PMID: 33665847 DOI: 10.1002/mds.28555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/02/2021] [Accepted: 02/16/2021] [Indexed: 01/19/2023] Open
Affiliation(s)
- Giovanna Zorzi
- Department of Pediatric Neuroscience, Foundation IRCCS Carlo Besta Neurological Institute, Milan, Italy
| | - Federica R Danti
- Department of Pediatric Neuroscience, Foundation IRCCS Carlo Besta Neurological Institute, Milan, Italy
| | - Chiara Reale
- Medical Genetics and Neurogenetics Unit, Foundation IRCCS Carlo Besta Neurological Institute, Milan, Italy
| | - Celeste Panteghini
- Medical Genetics and Neurogenetics Unit, Foundation IRCCS Carlo Besta Neurological Institute, Milan, Italy
| | - Federica Invernizzi
- Medical Genetics and Neurogenetics Unit, Foundation IRCCS Carlo Besta Neurological Institute, Milan, Italy
| | - Isabella Moroni
- Department of Pediatric Neuroscience, Foundation IRCCS Carlo Besta Neurological Institute, Milan, Italy
| | - Barbara Garavaglia
- Medical Genetics and Neurogenetics Unit, Foundation IRCCS Carlo Besta Neurological Institute, Milan, Italy
| | - Nardo Nardocci
- Department of Pediatric Neuroscience, Foundation IRCCS Carlo Besta Neurological Institute, Milan, Italy
| | - Luisa Chiapparini
- Unit of Neuroradiology, Foundation IRCCS Carlo Besta Neurological Institute, Milan, Italy
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11
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Cif L, Demailly D, Lin JP, Barwick KE, Sa M, Abela L, Malhotra S, Chong WK, Steel D, Sanchis-Juan A, Ngoh A, Trump N, Meyer E, Vasques X, Rankin J, Allain MW, Applegate CD, Attaripour Isfahani S, Baleine J, Balint B, Bassetti JA, Baple EL, Bhatia KP, Blanchet C, Burglen L, Cambonie G, Seng EC, Bastaraud SC, Cyprien F, Coubes C, d'Hardemare V, Doja A, Dorison N, Doummar D, Dy-Hollins ME, Farrelly E, Fitzpatrick DR, Fearon C, Fieg EL, Fogel BL, Forman EB, Fox RG, Gahl WA, Galosi S, Gonzalez V, Graves TD, Gregory A, Hallett M, Hasegawa H, Hayflick SJ, Hamosh A, Hully M, Jansen S, Jeong SY, Krier JB, Krystal S, Kumar KR, Laurencin C, Lee H, Lesca G, François LL, Lynch T, Mahant N, Martinez-Agosto JA, Milesi C, Mills KA, Mondain M, Morales-Briceno H, Ostergaard JR, Pal S, Pallais JC, Pavillard F, Perrigault PF, Petersen AK, Polo G, Poulen G, Rinne T, Roujeau T, Rogers C, Roubertie A, Sahagian M, Schaefer E, Selim L, Selway R, Sharma N, Signer R, Soldatos AG, Stevenson DA, Stewart F, Tchan M, Verma IC, de Vries BBA, Wilson JL, Wong DA, Zaitoun R, Zhen D, Znaczko A, Dale RC, de Gusmão CM, Friedman J, Fung VSC, King MD, Mohammad SS, Rohena L, Waugh JL, Toro C, Raymond FL, Topf M, Coubes P, Gorman KM, Kurian MA. KMT2B-related disorders: expansion of the phenotypic spectrum and long-term efficacy of deep brain stimulation. Brain 2021; 143:3242-3261. [PMID: 33150406 DOI: 10.1093/brain/awaa304] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/28/2020] [Accepted: 07/13/2020] [Indexed: 12/31/2022] Open
Abstract
Heterozygous mutations in KMT2B are associated with an early-onset, progressive and often complex dystonia (DYT28). Key characteristics of typical disease include focal motor features at disease presentation, evolving through a caudocranial pattern into generalized dystonia, with prominent oromandibular, laryngeal and cervical involvement. Although KMT2B-related disease is emerging as one of the most common causes of early-onset genetic dystonia, much remains to be understood about the full spectrum of the disease. We describe a cohort of 53 patients with KMT2B mutations, with detailed delineation of their clinical phenotype and molecular genetic features. We report new disease presentations, including atypical patterns of dystonia evolution and a subgroup of patients with a non-dystonic neurodevelopmental phenotype. In addition to the previously reported systemic features, our study has identified co-morbidities, including the risk of status dystonicus, intrauterine growth retardation, and endocrinopathies. Analysis of this study cohort (n = 53) in tandem with published cases (n = 80) revealed that patients with chromosomal deletions and protein truncating variants had a significantly higher burden of systemic disease (with earlier onset of dystonia) than those with missense variants. Eighteen individuals had detailed longitudinal data available after insertion of deep brain stimulation for medically refractory dystonia. Median age at deep brain stimulation was 11.5 years (range: 4.5-37.0 years). Follow-up after deep brain stimulation ranged from 0.25 to 22 years. Significant improvement of motor function and disability (as assessed by the Burke Fahn Marsden's Dystonia Rating Scales, BFMDRS-M and BFMDRS-D) was evident at 6 months, 1 year and last follow-up (motor, P = 0.001, P = 0.004, and P = 0.012; disability, P = 0.009, P = 0.002 and P = 0.012). At 1 year post-deep brain stimulation, >50% of subjects showed BFMDRS-M and BFMDRS-D improvements of >30%. In the long-term deep brain stimulation cohort (deep brain stimulation inserted for >5 years, n = 8), improvement of >30% was maintained in 5/8 and 3/8 subjects for the BFMDRS-M and BFMDRS-D, respectively. The greatest BFMDRS-M improvements were observed for trunk (53.2%) and cervical (50.5%) dystonia, with less clinical impact on laryngeal dystonia. Improvements in gait dystonia decreased from 20.9% at 1 year to 16.2% at last assessment; no patient maintained a fully independent gait. Reduction of BFMDRS-D was maintained for swallowing (52.9%). Five patients developed mild parkinsonism following deep brain stimulation. KMT2B-related disease comprises an expanding continuum from infancy to adulthood, with early evidence of genotype-phenotype correlations. Except for laryngeal dysphonia, deep brain stimulation provides a significant improvement in quality of life and function with sustained clinical benefit depending on symptoms distribution.
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Affiliation(s)
- Laura Cif
- Département de Neurochirurgie, Unité des Pathologies Cérébrales Résistantes, Unité de Recherche sur les Comportements et Mouvements Anormaux, Hôpital Gui de Chauliac, Centre Hospitalier Régional Montpellier, Montpellier, France.,Faculté de médecine, Université de Montpellier, France
| | - Diane Demailly
- Département de Neurochirurgie, Unité des Pathologies Cérébrales Résistantes, Unité de Recherche sur les Comportements et Mouvements Anormaux, Hôpital Gui de Chauliac, Centre Hospitalier Régional Montpellier, Montpellier, France.,Faculté de médecine, Université de Montpellier, France
| | - Jean-Pierre Lin
- Complex Motor Disorder Service, Children's Neurosciences Department, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Children's Neuromodulation Group, Women and Children's Health Institute, Faculty of life Sciences and Medicine (FOLSM), King's Health Partners, London, UK
| | - Katy E Barwick
- Molecular Neurosciences, Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Mario Sa
- Complex Motor Disorder Service, Children's Neurosciences Department, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Lucia Abela
- Molecular Neurosciences, Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Sony Malhotra
- Institute of Structural and Molecular Biology, Department of Biological Sciences, Birkbeck College, University of London, London, UK
| | - Wui K Chong
- Developmental Imaging and Biophysics, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Dora Steel
- Molecular Neurosciences, Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, UK.,Department of Neurology, Great Ormond Street Hospital, London, UK
| | - Alba Sanchis-Juan
- NIHR BioResource, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Department of Haematology, NHS Blood and Transplant Centre, University of Cambridge, Cambridge, UK
| | - Adeline Ngoh
- Molecular Neurosciences, Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, UK.,Department of Neurology, Great Ormond Street Hospital, London, UK
| | - Natalie Trump
- Molecular Neurosciences, Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Esther Meyer
- Molecular Neurosciences, Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, UK
| | | | - Julia Rankin
- Clinical Genetics, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Meredith W Allain
- Division of Medical Genetics, Department of Pediatrics, Stanford University, Palo Alto, CA, USA
| | - Carolyn D Applegate
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sanaz Attaripour Isfahani
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Julien Baleine
- Unité de Soins Intensifs et Réanimation Pédiatrique et Néonatale, Hôpital Universitaire de Montpellier, Montpellier, France
| | - Bettina Balint
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK.,Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Jennifer A Bassetti
- Division of Medical Genetics, Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA
| | - Emma L Baple
- Clinical Genetics, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.,Institute of Biomedical and Clinical Science RILD Wellcome Wolfson Centre, University of Exeter Medical School, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Kailash P Bhatia
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK
| | - Catherine Blanchet
- Département d'Oto-Rhino-Laryngologie et Chirurgie Cervico-Faciale, Hôpital Universitaire de Montpellier, Montpellier, France
| | - Lydie Burglen
- Département de génétique médicale, APHP Hôpital Armand Trousseau, Paris, France
| | - Gilles Cambonie
- Unité de Soins Intensifs et Réanimation Pédiatrique et Néonatale, Hôpital Universitaire de Montpellier, Montpellier, France
| | - Emilie Chan Seng
- Département de Neurochirurgie, Unité des Pathologies Cérébrales Résistantes, Unité de Recherche sur les Comportements et Mouvements Anormaux, Hôpital Gui de Chauliac, Centre Hospitalier Régional Montpellier, Montpellier, France.,Faculté de médecine, Université de Montpellier, France
| | | | - Fabienne Cyprien
- Département de Neurochirurgie, Unité des Pathologies Cérébrales Résistantes, Unité de Recherche sur les Comportements et Mouvements Anormaux, Hôpital Gui de Chauliac, Centre Hospitalier Régional Montpellier, Montpellier, France.,Faculté de médecine, Université de Montpellier, France
| | - Christine Coubes
- Département de Génétique médicale, Maladies rares et médecine personnalisée, CHU Montpellier, Montpellier, France
| | - Vincent d'Hardemare
- Unité Dyspa, Neurochirurgie Pédiatrique, Hôpital Fondation Rothschild, Paris, France
| | | | - Asif Doja
- Division of Neurology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Nathalie Dorison
- Unité Dyspa, Neurochirurgie Pédiatrique, Hôpital Fondation Rothschild, Paris, France
| | - Diane Doummar
- Neuropédiatrie, Centre de référence neurogénétique mouvement anormaux de l'enfant, Hôpital Armand Trousseau, AP-HP, Sorbonne Université, France
| | - Marisela E Dy-Hollins
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Ellyn Farrelly
- Division of Medical Genetics, Department of Pediatrics, Stanford University, Palo Alto, CA, USA.,Department of Pediatrics, Lucile Packard Children's Hospital at Stanford, CA, USA
| | - David R Fitzpatrick
- Human Genetics Unit, Medical and Developmental Genetics, University of Edinburgh Western General Hospital, Edinburgh, Scotland, UK
| | - Conor Fearon
- Department of Neurology, The Dublin Neurological Institute at the Mater Misericordiae University Hospital, Dublin, Ireland
| | - Elizabeth L Fieg
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Brent L Fogel
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.,Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Eva B Forman
- Department of Paediatric Neurology and Clinical Neurophysiology, Children's Health Ireland at Temple Street, Dublin, Ireland
| | - Rachel G Fox
- Department of Molecular and Medical Genetics, Oregon Health and Science University, Portland, OR, USA
| | | | - William A Gahl
- Undiagnosed Diseases Program, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Serena Galosi
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Victoria Gonzalez
- Département de Neurochirurgie, Unité des Pathologies Cérébrales Résistantes, Unité de Recherche sur les Comportements et Mouvements Anormaux, Hôpital Gui de Chauliac, Centre Hospitalier Régional Montpellier, Montpellier, France.,Faculté de médecine, Université de Montpellier, France
| | - Tracey D Graves
- Department of Neurology, Hinchingbrooke Hospital, North West Anglia NHS Foundation Trust, Huntingdon, UK
| | - Allison Gregory
- Department of Molecular and Medical Genetics, Oregon Health and Science University, Portland, OR, USA
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Harutomo Hasegawa
- Complex Motor Disorder Service, Children's Neurosciences Department, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Children's Neuromodulation Group, Women and Children's Health Institute, Faculty of life Sciences and Medicine (FOLSM), King's Health Partners, London, UK
| | - Susan J Hayflick
- Department of Molecular and Medical Genetics, Oregon Health and Science University, Portland, OR, USA.,Department of Paediatrics, Oregon Health and Science University, Portland, OR, USA
| | - Ada Hamosh
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Marie Hully
- Département de Neurologie, APHP-Necker-Enfants Malades, Paris, France
| | - Sandra Jansen
- Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Suh Young Jeong
- Department of Molecular and Medical Genetics, Oregon Health and Science University, Portland, OR, USA
| | - Joel B Krier
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sidney Krystal
- Département de Neuroradiologie, Hôpital Fondation Rothschild, Paris
| | - Kishore R Kumar
- Translational Genomics Group, Kinghorn Centre for Clinical Genomics, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia.,Department of Neurogenetics, Kolling Institute, University of Sydney and Royal North Shore Hospital, St Leonards, NSW, Australia.,Molecular Medicine Laboratory, Concord Hospital, Sydney, NSW, Australia
| | - Chloé Laurencin
- Département de Neurologie, Hôpital Neurologique Pierre Wertheimer, Lyon, France
| | - Hane Lee
- Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.,Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Gaetan Lesca
- Département de Génétique, Hôpital Universitaire de Lyon, Lyon, France
| | | | - Timothy Lynch
- Department of Neurology, The Dublin Neurological Institute at the Mater Misericordiae University Hospital, Dublin, Ireland.,UCD School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - Neil Mahant
- Movement Disorders Unit, Department of Neurology, Westmead Hospital, Westmead, NSW, Australia
| | - Julian A Martinez-Agosto
- Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.,Division of Medical Genetics, Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Christophe Milesi
- Unité de Soins Intensifs et Réanimation Pédiatrique et Néonatale, Hôpital Universitaire de Montpellier, Montpellier, France
| | - Kelly A Mills
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michel Mondain
- Département d'Oto-Rhino-Laryngologie et Chirurgie Cervico-Faciale, Hôpital Universitaire de Montpellier, Montpellier, France
| | - Hugo Morales-Briceno
- Movement Disorders Unit, Department of Neurology, Westmead Hospital, Westmead, NSW, Australia.,Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | | | - John R Ostergaard
- Centre for Rare Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Swasti Pal
- Institute of Genetics and Genomics, Sir Ganga Ram Hospital, Rajender Nagar, New Delhi, India
| | - Juan C Pallais
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Frédérique Pavillard
- Département d'Anesthésie-Réanimation Gui de Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Pierre-Francois Perrigault
- Département d'Anesthésie-Réanimation Gui de Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | | | - Gustavo Polo
- Département de Neurochirurgie Fonctionnelle, Hôpital Neurologique et Neurochirurgical, Pierre Wertheimer, Lyon, France
| | - Gaetan Poulen
- Département de Neurochirurgie, Unité des Pathologies Cérébrales Résistantes, Unité de Recherche sur les Comportements et Mouvements Anormaux, Hôpital Gui de Chauliac, Centre Hospitalier Régional Montpellier, Montpellier, France.,Faculté de médecine, Université de Montpellier, France
| | - Tuula Rinne
- Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Thomas Roujeau
- Département de Neurochirurgie, Unité des Pathologies Cérébrales Résistantes, Unité de Recherche sur les Comportements et Mouvements Anormaux, Hôpital Gui de Chauliac, Centre Hospitalier Régional Montpellier, Montpellier, France
| | - Caleb Rogers
- Department of Molecular and Medical Genetics, Oregon Health and Science University, Portland, OR, USA
| | - Agathe Roubertie
- Département de Neuropédiatrie, Hôpital Universitaire de Montpellier, Montpellier, France.,INSERM U1051, Institut des Neurosciences de Montpellier, Montpellier, France
| | - Michelle Sahagian
- Division of Neurology, Rady Children's Hospital San Diego, CA, USA.,Department of Neuroscience, University of California San Diego, CA, USA
| | - Elise Schaefer
- Medical Genetics, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Laila Selim
- Cairo University Children Hospital, Pediatric Neurology and Metabolic division, Cairo, Egypt
| | - Richard Selway
- Department of Neurosurgery, King's College Hospital, London, UK
| | - Nutan Sharma
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Department of Neurology, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Rebecca Signer
- Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Ariane G Soldatos
- Undiagnosed Diseases Program, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - David A Stevenson
- Division of Medical Genetics, Department of Pediatrics, Stanford University, Palo Alto, CA, USA
| | - Fiona Stewart
- Department of Genetic Medicine, Belfast Health and Social Care Trust, Belfast, UK
| | - Michel Tchan
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Department of Genetics, Westmead Hospital, Westmead, NSW, Australia
| | | | - Ishwar C Verma
- Institute of Genetics and Genomics, Sir Ganga Ram Hospital, Rajender Nagar, New Delhi, India
| | - Bert B A de Vries
- Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jenny L Wilson
- Division of Pediatric Neurology, Department of Pediatrics, Oregon Health and Science University, Portland, OR, USA
| | - Derek A Wong
- Division of Medical Genetics, Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Raghda Zaitoun
- Department of Paediatrics, Neurology Division, Ain Shams University Hospital, Cairo, Egypt
| | - Dolly Zhen
- Department of Molecular and Medical Genetics, Oregon Health and Science University, Portland, OR, USA
| | - Anna Znaczko
- Department of Genetic Medicine, Belfast Health and Social Care Trust, Belfast, UK
| | - Russell C Dale
- Department of Paediatric Neurology, The Children's Hospital at Westmead, NSW, Australia.,Faculty of Medicine and Health, Sydney Medical School, University of Sydney, Sydney NSW, Australia
| | - Claudio M de Gusmão
- Department of Neurology, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | - Jennifer Friedman
- Division of Neurology, Rady Children's Hospital San Diego, CA, USA.,Department of Neuroscience, University of California San Diego, CA, USA.,Departments of Paediatrics, University of California, San Diego, CA, USA.,Rady Children's Institute for Genomic Medicine, San Diego, CA, USA
| | - Victor S C Fung
- Movement Disorders Unit, Department of Neurology, Westmead Hospital, Westmead, NSW, Australia.,Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Mary D King
- Department of Paediatric Neurology and Clinical Neurophysiology, Children's Health Ireland at Temple Street, Dublin, Ireland.,UCD School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - Shekeeb S Mohammad
- Department of Paediatric Neurology, The Children's Hospital at Westmead, NSW, Australia.,Faculty of Medicine and Health, Sydney Medical School, University of Sydney, Sydney NSW, Australia
| | - Luis Rohena
- Division of Medical Genetics, Department of Pediatrics, San Antonio Military Medical Center, San Antonio, TX, USA.,Department of Pediatrics, Long School of Medicine, UT Health, San Antonio, TX, USA
| | - Jeff L Waugh
- Division of Pediatric Neurology, Department of Pediatrics, University of Texas Southwestern, Dallas, TX, USA
| | - Camilo Toro
- Undiagnosed Diseases Program, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - F Lucy Raymond
- NIHR BioResource, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Department of Medical Genetics, Cambridge Institute for Medical Research, University of Cambridge, Cambridge, UK
| | - Maya Topf
- Institute of Structural and Molecular Biology, Department of Biological Sciences, Birkbeck College, University of London, London, UK
| | - Philippe Coubes
- Département de Neurochirurgie, Unité des Pathologies Cérébrales Résistantes, Unité de Recherche sur les Comportements et Mouvements Anormaux, Hôpital Gui de Chauliac, Centre Hospitalier Régional Montpellier, Montpellier, France.,Faculté de médecine, Université de Montpellier, France
| | - Kathleen M Gorman
- Molecular Neurosciences, Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, UK.,Department of Neurology, Great Ormond Street Hospital, London, UK
| | - Manju A Kurian
- Molecular Neurosciences, Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, UK.,Department of Neurology, Great Ormond Street Hospital, London, UK
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12
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Holla VV, Prasad S, Neeraja K, Kamble N, Yadav R, Pal PK. Late adulthood onset DYT-THAP1 secondary to a novel splice site mutation-A report from India. Parkinsonism Relat Disord 2020; 78:36-37. [DOI: 10.1016/j.parkreldis.2020.06.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/16/2020] [Accepted: 06/18/2020] [Indexed: 11/29/2022]
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13
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Frederick NM, Shah PV, Didonna A, Langley MR, Kanthasamy AG, Opal P. Loss of the dystonia gene Thap1 leads to transcriptional deficits that converge on common pathogenic pathways in dystonic syndromes. Hum Mol Genet 2019; 28:1343-1356. [PMID: 30590536 DOI: 10.1093/hmg/ddy433] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 11/26/2018] [Accepted: 12/11/2018] [Indexed: 12/15/2022] Open
Abstract
Dystonia is a movement disorder characterized by involuntary and repetitive co-contractions of agonist and antagonist muscles. Dystonia 6 (DYT6) is an autosomal dominant dystonia caused by loss-of-function mutations in the zinc finger transcription factor THAP1. We have generated Thap1 knock-out mice with a view to understanding its transcriptional role. While germ-line deletion of Thap1 is embryonic lethal, mice lacking one Thap1 allele-which in principle should recapitulate the haploinsufficiency of the human syndrome-do not show a discernable phenotype. This is because mice show autoregulation of Thap1 mRNA levels with upregulation at the non-affected locus. We then deleted Thap1 in glial and neuronal precursors using a nestin-conditional approach. Although these mice do not exhibit dystonia, they show pronounced locomotor deficits reflecting derangements in the cerebellar and basal ganglia circuitry. These behavioral features are associated with alterations in the expression of genes involved in nervous system development, synaptic transmission, cytoskeleton, gliosis and dopamine signaling that link DYT6 to other primary and secondary dystonic syndromes.
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Affiliation(s)
| | | | - Alessandro Didonna
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Monica R Langley
- Parkinson Disorders Research Program, Iowa Center for Advanced Neurotoxicology, Department of Biomedical Sciences, Iowa State University, Ames, IA, USA
| | - Anumantha G Kanthasamy
- Parkinson Disorders Research Program, Iowa Center for Advanced Neurotoxicology, Department of Biomedical Sciences, Iowa State University, Ames, IA, USA
| | - Puneet Opal
- Davee Department of Neurology.,Department of Cell and Molecular Biology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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14
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Siokas V, Aloizou AM, Tsouris Z, Michalopoulou A, Mentis AFA, Dardiotis E. Risk Factor Genes in Patients with Dystonia: A Comprehensive Review. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2019; 8:559. [PMID: 30643666 PMCID: PMC6329780 DOI: 10.7916/d8h438gs] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 11/20/2018] [Indexed: 12/20/2022]
Abstract
Background Dystonia is a movement disorder with high heterogeneity regarding phenotypic appearance and etiology that occurs in both sporadic and familial forms. The etiology of the disease remains unknown. However, there is increasing evidence suggesting that a small number of gene alterations may lead to dystonia. Although pathogenic variants to the familial type of dystonia have been extensively reviewed and discussed, relatively little is known about the contribution of single-nucleotide polymorphisms (SNPs) to dystonia. This review focuses on the potential role of SNPs and other variants in dystonia susceptibility. Methods We searched the PubMed database for peer-reviewed articles published in English, from its inception through January 2018, that concerned human studies of dystonia and genetic variants. The following search terms were included: “dystonia” in combination with the following terms: 1) “polymorphisms” and 2) “SNPs” as free words. Results A total of 43 published studies regarding TOR1A, BDNF, DRD5, APOE, ARSG, NALC, OR4X2, COL4A1, TH, DDC, DBH, MAO, COMT, DAT, GCH1, PRKRA, MR-1, SGCE, ATP1A3, TAF1, THAP1, GNAL, DRD2, HLA-DRB, CBS, MTHFR, and MS genes, were included in the current review. Discussion To date, a few variants, which are possibly involved in several molecular pathways, have been related to dystonia. Large cohort studies are needed to determine robust associations between variants and dystonia with adjustment for other potential cofounders, in order to elucidate the pathogenic mechanisms of dystonia and the net effect of the genes.
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Affiliation(s)
- Vasileios Siokas
- Department of Neurology, Laboratory of Neurogenetics, University of Thessaly, University Hospital of Larissa, Larissa, GR
| | - Athina-Maria Aloizou
- Department of Neurology, Laboratory of Neurogenetics, University of Thessaly, University Hospital of Larissa, Larissa, GR
| | - Zisis Tsouris
- Department of Neurology, Laboratory of Neurogenetics, University of Thessaly, University Hospital of Larissa, Larissa, GR
| | - Amalia Michalopoulou
- Department of Neurology, Laboratory of Neurogenetics, University of Thessaly, University Hospital of Larissa, Larissa, GR
| | - Alexios-Fotios A Mentis
- Department of Microbiology, University of Thessaly, University Hospital of Larissa, Larissa, GR.,Public Health Laboratories, Hellenic Pasteur Institute, Athens, GR
| | - Efthimios Dardiotis
- Department of Neurology, Laboratory of Neurogenetics, University of Thessaly, University Hospital of Larissa, Larissa, GR
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15
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Abstract
Dystonia is a neurological condition characterized by abnormal involuntary movements or postures owing to sustained or intermittent muscle contractions. Dystonia can be the manifesting neurological sign of many disorders, either in isolation (isolated dystonia) or with additional signs (combined dystonia). The main focus of this Primer is forms of isolated dystonia of idiopathic or genetic aetiology. These disorders differ in manifestations and severity but can affect all age groups and lead to substantial disability and impaired quality of life. The discovery of genes underlying the mendelian forms of isolated or combined dystonia has led to a better understanding of its pathophysiology. In some of the most common genetic dystonias, such as those caused by TOR1A, THAP1, GCH1 and KMT2B mutations, and idiopathic dystonia, these mechanisms include abnormalities in transcriptional regulation, striatal dopaminergic signalling and synaptic plasticity and a loss of inhibition at neuronal circuits. The diagnosis of dystonia is largely based on clinical signs, and the diagnosis and aetiological definition of this disorder remain a challenge. Effective symptomatic treatments with pharmacological therapy (anticholinergics), intramuscular botulinum toxin injection and deep brain stimulation are available; however, future research will hopefully lead to reliable biomarkers, better treatments and cure of this disorder.
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16
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Zorzi G, Carecchio M, Zibordi F, Garavaglia B, Nardocci N. Diagnosis and treatment of pediatric onset isolated dystonia. Eur J Paediatr Neurol 2018; 22:238-244. [PMID: 29396174 DOI: 10.1016/j.ejpn.2018.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 12/14/2017] [Accepted: 01/08/2018] [Indexed: 12/14/2022]
Abstract
Isolated dystonia refers to a genetic heterogeneous group of progressive conditions with onset of symptoms during childhood or adolescence, progressive course with frequent generalization and marked functional impairment. There are well-known monogenic forms of isolated dystonia with pediatric onset such as DYT1 and DYT6 transmitted with autosomal dominant inheritance and low penetrance. Genetic findings of the past years have widened the etiological spectrum and the phenotype. The recently discovered genes (GNAL, ANO-3, KTM2B) or variant of already known diseases, such as Ataxia-Teleangectasia, are emerging as another causes of pediatric onset dystonia, sometimes with a more complex phenotype, but their incidence is unknown and still a considerable number of cases remains genetically undetermined. Due to the severe disability of pediatric onset dystonia treatment remains unsatisfactory and still mainly based upon oral pharmacological agents. However, deep brain stimulation is now extensively applied with good to excellent results especially when patients are treated early during the course of the disease.
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Affiliation(s)
- Giovanna Zorzi
- Department of Paediatric Neurology, IRCCS Fondazione C. Besta, Milan, Italy.
| | - Miryam Carecchio
- Department of Paediatric Neurology, IRCCS Fondazione C. Besta, Milan, Italy; Molecular Neurogenetics Unit, IRCCS Fondazione C. Besta, Milan, Italy
| | - Federica Zibordi
- Department of Paediatric Neurology, IRCCS Fondazione C. Besta, Milan, Italy
| | | | - Nardo Nardocci
- Department of Paediatric Neurology, IRCCS Fondazione C. Besta, Milan, Italy
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18
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Weisheit CE, Pappas SS, Dauer WT. Inherited dystonias: clinical features and molecular pathways. HANDBOOK OF CLINICAL NEUROLOGY 2018; 147:241-254. [PMID: 29325615 DOI: 10.1016/b978-0-444-63233-3.00016-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Recent decades have witnessed dramatic increases in understanding of the genetics of dystonia - a movement disorder characterized by involuntary twisting and abnormal posture. Hampered by a lack of overt neuropathology, researchers are investigating isolated monogenic causes to pinpoint common molecular mechanisms in this heterogeneous disease. Evidence from imaging, cellular, and murine work implicates deficiencies in dopamine neurotransmission, transcriptional dysregulation, and selective vulnerability of distinct neuronal populations to disease mutations. Studies of genetic forms of dystonia are also illuminating the developmental dependence of disease symptoms that is typical of many forms of the disease. As understanding of monogenic forms of dystonia grows, a clearer picture will develop of the abnormal motor circuitry behind this relatively common phenomenology. This chapter focuses on the current data covering the etiology and epidemiology, clinical presentation, and pathogenesis of four monogenic forms of isolated dystonia: DYT-TOR1A, DYT-THAP1, DYT-GCH1, and DYT-GNAL.
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Affiliation(s)
- Corinne E Weisheit
- Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Samuel S Pappas
- Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, United States
| | - William T Dauer
- Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, United States.
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19
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Yellajoshyula D, Liang CC, Pappas SS, Penati S, Yang A, Mecano R, Kumaran R, Jou S, Cookson MR, Dauer WT. The DYT6 Dystonia Protein THAP1 Regulates Myelination within the Oligodendrocyte Lineage. Dev Cell 2017; 42:52-67.e4. [PMID: 28697333 DOI: 10.1016/j.devcel.2017.06.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 04/25/2017] [Accepted: 06/07/2017] [Indexed: 11/30/2022]
Abstract
The childhood-onset motor disorder DYT6 dystonia is caused by loss-of-function mutations in the transcription factor THAP1, but the neurodevelopmental processes in which THAP1 participates are unknown. We find that THAP1 is essential for the timing of myelination initiation during CNS maturation. Conditional deletion of THAP1 in the CNS retards maturation of the oligodendrocyte (OL) lineage, delaying myelination and causing persistent motor deficits. The CNS myelination defect results from a cell-autonomous requirement for THAP1 in the OL lineage and is recapitulated in developmental assays performed on OL progenitor cells purified from Thap1 null mice. Loss of THAP1 function disrupts a core set of OL maturation genes and reduces the DNA occupancy of YY1, a transcription factor required for OL maturation. These studies establish a role for THAP1 transcriptional regulation at the inception of myelination and implicate abnormal timing of myelination in the pathogenesis of childhood-onset dystonia.
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Affiliation(s)
- Dhananjay Yellajoshyula
- Department of Neurology, University of Michigan Medical School, 109 Zina Pitcher Place, Ann Arbor, MI 48109, USA
| | - Chun-Chi Liang
- Department of Neurology, University of Michigan Medical School, 109 Zina Pitcher Place, Ann Arbor, MI 48109, USA
| | - Samuel S Pappas
- Department of Neurology, University of Michigan Medical School, 109 Zina Pitcher Place, Ann Arbor, MI 48109, USA
| | - Silvia Penati
- Department of Neurology, University of Michigan Medical School, 109 Zina Pitcher Place, Ann Arbor, MI 48109, USA
| | - Angela Yang
- Department of Neurology, University of Michigan Medical School, 109 Zina Pitcher Place, Ann Arbor, MI 48109, USA
| | - Rodan Mecano
- Department of Neurology, University of Michigan Medical School, 109 Zina Pitcher Place, Ann Arbor, MI 48109, USA
| | - Ravindran Kumaran
- Cell Biology and Gene Expression Section, Laboratory of Neurogenetics, National Institute of Aging, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA
| | - Stephanie Jou
- Department of Neurology, University of Michigan Medical School, 109 Zina Pitcher Place, Ann Arbor, MI 48109, USA
| | - Mark R Cookson
- Cell Biology and Gene Expression Section, Laboratory of Neurogenetics, National Institute of Aging, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA
| | - William T Dauer
- Department of Neurology, University of Michigan Medical School, 109 Zina Pitcher Place, Ann Arbor, MI 48109, USA; Department of Cell and Developmental Biology, University of Michigan Medical School, 109 Zina Pitcher Place, Ann Arbor, MI 48109, USA; VAAAHS, University of Michigan Medical School, University of Michigan, 109 Zina Pitcher Place, Ann Arbor, MI 48109, USA.
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20
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Abstract
Mainly due to the advent of next-generation sequencing (NGS), the field of genetics of dystonia has rapidly grown in recent years, which led to the discovery of a number of novel dystonia genes and the development of a new classification and nomenclature for inherited dystonias. In addition, new findings from both in vivo and in vitro studies have been published on the role of previously known dystonia genes, extending our understanding of the pathophysiology of dystonia. We here review the current knowledge and recent findings in the known genes for isolated dystonia TOR1A, THAP1, and GNAL as well as for the combined dystonias due to mutations in GCH1, ATP1A3, and SGCE. We present confirmatory evidence for a role of dystonia genes that had not yet been unequivocally established including PRKRA, TUBB4A, ANO3, and TAF1. We finally discuss selected novel genes for dystonia such as KMT2B and VAC14 along with the challenges for gene identification in the NGS era and the translational importance of dystonia genetics in clinical practice.
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Hollstein R, Reiz B, Kötter L, Richter A, Schaake S, Lohmann K, Kaiser FJ. Dystonia-causing mutations in the transcription factor THAP1 disrupt HCFC1 cofactor recruitment and alter gene expression. Hum Mol Genet 2017; 26:2975-2983. [DOI: 10.1093/hmg/ddx187] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 05/05/2017] [Indexed: 12/14/2022] Open
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Genetic screening of THAP1 in primary dystonia patients of India. Neurosci Lett 2016; 637:31-37. [PMID: 27913194 DOI: 10.1016/j.neulet.2016.11.060] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 11/28/2016] [Accepted: 11/28/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Primary Dystonia is a common movement disorder manifested by dystonic symptoms only. DYT6, a major genetic factor, plays a significant role in primary pure dystonia pathogenesis. In this study we analyzed THAP1 (DYT 6) gene in primary pure dystonia patients, which has been widely studied in other populations but not in Indians. METHODS The study cohort contained 227 index primary pure dystonia patients with the involvement of cervical region and 254 neurologically control individuals collected from East Indian population. All three exons of THAP1 and their flanking sequences, including exon-intron boundaries, were screened by PCR, DNA sequencing and/or RFLP analysis. RESULTS A total of three nucleotide variants were detected, which include a reported missense mutation (c.427 A>G; p.Met143Val) in a juvenile onset generalized dystonia patient, a novel frameshift deletion mutation (c.208-209 ΔAA; p.K70VfsX15) in a juvenile onset cervical dystonia patient and a rare variant in 3' UTR of THAP1 (c.*157 T>C) in an adult-onset blepharospasm patient. In addition, two SNPs (rs71521601 and rs111989331) were detected both in the patients and controls with the major allele of the latter being significantly over represented in the patients. CONCLUSIONS Our study suggests that the THAP1 is likely to have a causative role in the pathogenesis of Indian primary pure dystonia patients. Though the phenotypic spectrum is extensively diverse, the cervical involvement with dystonic tremor and speech problem is common amongst the patients harboring mutations.
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Abstract
PURPOSE OF REVIEW This review focuses on important new findings in the field of tremor and illustrates the consequences for the current definition and classification of tremor. RECENT FINDINGS Since 1998 when the consensus criteria for tremor were proposed, new variants of tremors and new diagnostic methods were discovered that have changed particularly the concepts of essential tremor and dystonic tremor. Accumulating evidence exists that essential tremor is not a single entity rather different conditions that share the common symptom action tremor without other major abnormalities. Tremor is a common feature in patients with adult-onset focal dystonia and may involve several different body parts and forms of tremor. Recent advances, in particular, in the field of genetics, suggest that dystonic tremor may even be present without overt dystonia. Monosymptomatic asymmetric rest and postural tremor has been further delineated, and apart from tremor-dominant Parkinson's disease, there are several rare conditions including rest and action tremor with normal dopamine transporter imaging (scans without evidence of dopaminergic deficit) and essential tremor with tremor at rest. SUMMARY Increasing knowledge in the last decades changed the view on tremors and highlights several caveats in the current tremor classification. Given the ambiguous assignment between tremor phenomenology and tremor etiology, a more cautious definition of tremors on the basis of clinical assessment data is needed.
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Golanska E, Gajos A, Sieruta M, Szybka M, Rudzinska M, Ochudlo S, Kmiec T, Liberski PP, Bogucki A. Screening for THAP1 Mutations in Polish Patients with Dystonia Shows Known and Novel Substitutions. PLoS One 2015; 10:e0129656. [PMID: 26087139 PMCID: PMC4472661 DOI: 10.1371/journal.pone.0129656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 05/11/2015] [Indexed: 11/19/2022] Open
Abstract
The aim of this study was to assess the presence of DYT6 mutations in Polish patients with isolated dystonia and to characterize their phenotype. We sequenced THAP1 exons 1, 2 and 3 including exon-intron boundaries and 5'UTR fragment in 96 non-DYT1 dystonia patients. In four individuals single nucleotide variations were identified. The coding substitutions were: c. 238A>G (p.Ile80Val), found in two patients, and c.167A>G (p.Glu56Gly), found in one patient. The same variations were present also in the patients' symptomatic as well as asymptomatic relatives. Mutation penetration in the analyzed families was 50-66.7%. In the fourth patient, a novel c.-249C>A substitution in the promoter region was identified. The patient, initially suspected of idiopathic isolated dystonia, finally presented with pantothenate kinase 2-associated neurodegeneration phenotype and was a carrier of two PANK2 mutations. This is the first identified NBIA1 case carrying mutations in both PANK2 and THAP1 genes. In all symptomatic THAP1 mutation carriers (four probands and their three affected relatives) the first signs of dystonia occurred before the age of 23. A primary localization typical for DYT6 dystonia was observed in six individuals. Five subjects developed the first signs of dystonia in the upper limb. In one patient the disease began from laryngeal involvement. An uncommon primary involvement of lower limb was noted in the THAP1 and PANK2 mutations carrier. Neither of these THAP1 substitutions were found in 150 unrelated healthy controls. To the contrary, we identified a heterozygous C/T genotype of c.57C>T single nucleotide variation (p.Pro19Pro, rs146087734) in one healthy control, but in none of the patients. Therefore, a previously proposed association between this substitution and DYT6 dystonia seems unlikely. We found also no significant difference between cases and controls in genotypes distribution of the two-nucleotide -237-236 GA>TT (rs370983900 & rs1844977763) polymorphism.
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Affiliation(s)
- Ewa Golanska
- Department of Molecular Pathology and Neuropathology, Medical University of Lodz, Lodz, Poland
- * E-mail:
| | - Agata Gajos
- Department of Movement Disorders, Medical University of Lodz, Lodz, Poland
| | - Monika Sieruta
- Department of Molecular Pathology and Neuropathology, Medical University of Lodz, Lodz, Poland
| | - Malgorzata Szybka
- Department of Molecular Pathology and Neuropathology, Medical University of Lodz, Lodz, Poland
| | - Monika Rudzinska
- Department of Neurology, Medical University of Silesia, Central Clinical Hospital, Katowice, Poland
- Stroke Department and Department of Neurology, Central Clinical Hospital, Katowice, Poland
| | - Stanislaw Ochudlo
- Stroke Department and Department of Neurology, Central Clinical Hospital, Katowice, Poland
| | - Tomasz Kmiec
- Child Neurology Department, The Children’s Memorial Health Institute, Warsaw, Poland
| | - Pawel P. Liberski
- Department of Molecular Pathology and Neuropathology, Medical University of Lodz, Lodz, Poland
| | - Andrzej Bogucki
- Department of Movement Disorders, Medical University of Lodz, Lodz, Poland
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25
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Brüggemann N, Kühn A, Schneider SA, Kamm C, Wolters A, Krause P, Moro E, Steigerwald F, Wittstock M, Tronnier V, Lozano AM, Hamani C, Poon YY, Zittel S, Wächter T, Deuschl G, Krüger R, Kupsch A, Münchau A, Lohmann K, Volkmann J, Klein C. Short- and long-term outcome of chronic pallidal neurostimulation in monogenic isolated dystonia. Neurology 2015; 84:895-903. [PMID: 25653290 PMCID: PMC6170184 DOI: 10.1212/wnl.0000000000001312] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 11/12/2014] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Deep brain stimulation of the internal pallidum (GPi-DBS) is an established therapeutic option in treatment-refractory dystonia, and the identification of factors predicting surgical outcome is needed to optimize patient selection. METHODS In this retrospective multicenter study, GPi-DBS outcome of 8 patients with DYT6, 9 with DYT1, and 38 with isolated dystonia without known monogenic cause (non-DYT) was assessed at early (1-16 months) and late (22-92 months) follow-up using Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) scores. RESULTS At early follow-up, mean reduction of dystonia severity was greater in patients with DYT1 (BFMDRS score: -60%) and non-DYT dystonia (-52%) than in patients with DYT6 dystonia (-32%; p = 0.046). Accordingly, the rate of responders was considerably lower in the latter group (57% vs >90%; p = 0.017). At late follow-up, however, GPi-DBS resulted in comparable improvement in all 3 groups (DYT6, -42%; DYT1, -44; non-DYT, -61%). Additional DBS of the same or another brain target was performed in 3 of 8 patients with DYT6 dystonia with varying results. Regardless of the genotype, patients with a shorter duration from onset of dystonia to surgery had better control of dystonia postoperatively. CONCLUSIONS Long-term GPi-DBS is effective in patients with DYT6, DYT1, and non-DYT dystonia. However, the effect of DBS appears to be less predictable in patients with DYT6, suggesting that pre-DBS genetic testing and counseling for known dystonia gene mutations may be indicated. GPi-DBS should probably be considered earlier in the disease course. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that long-term GPi-DBS improves dystonia in patients with DYT1, DYT6, and non-DYT dystonia.
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Affiliation(s)
- Norbert Brüggemann
- From the Institute of Neurogenetics (N.B., S.A.S., S.Z., A.M., K.L., C. Klein), University of Lübeck; Department of Neurology (N.B.), University Hospital Schleswig-Holstein, Campus Lübeck; Department of Neurology (A. Kühn, P.K.), Virchow Clinics, University Berlin Charité; Department of Neurology (S.A.S., G.D.), University Hospital Schleswig-Holstein, Campus Kiel; Department of Neurology (C. Kamm, A.W., M.W.), University Hospital Rostock, Germany; Movement Disorders Center (E.M., Y.-Y.P.), Toronto Western Hospital, University of Toronto, UHN, Canada; Movement Disorders Unit (E.M.), Division of Psychiatry and Neurology, CHU Grenoble, Joseph Fourier University, Grenoble, France; Department of Neurology (F.S., J.V.), University Hospital Würzburg; Department of Neurosurgery (V.T.), University Hospital Lübeck, Germany; Division of Neurosurgery (A.M.L., C.H.), Department of Surgery, University of Toronto, Canada; Center for Neurology and Hertie-Institute for Clinical Brain Research (T.W., R.K.), University Hospital Tübingen, Center for Integrative Neurosciences, University of Tübingen and German Center for Neurodegenerative Diseases (DZNE), Tübingen; Clinical and Experimental Neuroscience (R.K.), Luxembourg Centre for Systems Biomedicine, University of Luxembourg; and Department of Neurology and Stereotactic Neurosurgery (A. Kupsch), Basal Ganglia Research Group, Otto von Guericke University Magdeburg, Germany.
| | - Andrea Kühn
- From the Institute of Neurogenetics (N.B., S.A.S., S.Z., A.M., K.L., C. Klein), University of Lübeck; Department of Neurology (N.B.), University Hospital Schleswig-Holstein, Campus Lübeck; Department of Neurology (A. Kühn, P.K.), Virchow Clinics, University Berlin Charité; Department of Neurology (S.A.S., G.D.), University Hospital Schleswig-Holstein, Campus Kiel; Department of Neurology (C. Kamm, A.W., M.W.), University Hospital Rostock, Germany; Movement Disorders Center (E.M., Y.-Y.P.), Toronto Western Hospital, University of Toronto, UHN, Canada; Movement Disorders Unit (E.M.), Division of Psychiatry and Neurology, CHU Grenoble, Joseph Fourier University, Grenoble, France; Department of Neurology (F.S., J.V.), University Hospital Würzburg; Department of Neurosurgery (V.T.), University Hospital Lübeck, Germany; Division of Neurosurgery (A.M.L., C.H.), Department of Surgery, University of Toronto, Canada; Center for Neurology and Hertie-Institute for Clinical Brain Research (T.W., R.K.), University Hospital Tübingen, Center for Integrative Neurosciences, University of Tübingen and German Center for Neurodegenerative Diseases (DZNE), Tübingen; Clinical and Experimental Neuroscience (R.K.), Luxembourg Centre for Systems Biomedicine, University of Luxembourg; and Department of Neurology and Stereotactic Neurosurgery (A. Kupsch), Basal Ganglia Research Group, Otto von Guericke University Magdeburg, Germany
| | - Susanne A Schneider
- From the Institute of Neurogenetics (N.B., S.A.S., S.Z., A.M., K.L., C. Klein), University of Lübeck; Department of Neurology (N.B.), University Hospital Schleswig-Holstein, Campus Lübeck; Department of Neurology (A. Kühn, P.K.), Virchow Clinics, University Berlin Charité; Department of Neurology (S.A.S., G.D.), University Hospital Schleswig-Holstein, Campus Kiel; Department of Neurology (C. Kamm, A.W., M.W.), University Hospital Rostock, Germany; Movement Disorders Center (E.M., Y.-Y.P.), Toronto Western Hospital, University of Toronto, UHN, Canada; Movement Disorders Unit (E.M.), Division of Psychiatry and Neurology, CHU Grenoble, Joseph Fourier University, Grenoble, France; Department of Neurology (F.S., J.V.), University Hospital Würzburg; Department of Neurosurgery (V.T.), University Hospital Lübeck, Germany; Division of Neurosurgery (A.M.L., C.H.), Department of Surgery, University of Toronto, Canada; Center for Neurology and Hertie-Institute for Clinical Brain Research (T.W., R.K.), University Hospital Tübingen, Center for Integrative Neurosciences, University of Tübingen and German Center for Neurodegenerative Diseases (DZNE), Tübingen; Clinical and Experimental Neuroscience (R.K.), Luxembourg Centre for Systems Biomedicine, University of Luxembourg; and Department of Neurology and Stereotactic Neurosurgery (A. Kupsch), Basal Ganglia Research Group, Otto von Guericke University Magdeburg, Germany
| | - Christoph Kamm
- From the Institute of Neurogenetics (N.B., S.A.S., S.Z., A.M., K.L., C. Klein), University of Lübeck; Department of Neurology (N.B.), University Hospital Schleswig-Holstein, Campus Lübeck; Department of Neurology (A. Kühn, P.K.), Virchow Clinics, University Berlin Charité; Department of Neurology (S.A.S., G.D.), University Hospital Schleswig-Holstein, Campus Kiel; Department of Neurology (C. Kamm, A.W., M.W.), University Hospital Rostock, Germany; Movement Disorders Center (E.M., Y.-Y.P.), Toronto Western Hospital, University of Toronto, UHN, Canada; Movement Disorders Unit (E.M.), Division of Psychiatry and Neurology, CHU Grenoble, Joseph Fourier University, Grenoble, France; Department of Neurology (F.S., J.V.), University Hospital Würzburg; Department of Neurosurgery (V.T.), University Hospital Lübeck, Germany; Division of Neurosurgery (A.M.L., C.H.), Department of Surgery, University of Toronto, Canada; Center for Neurology and Hertie-Institute for Clinical Brain Research (T.W., R.K.), University Hospital Tübingen, Center for Integrative Neurosciences, University of Tübingen and German Center for Neurodegenerative Diseases (DZNE), Tübingen; Clinical and Experimental Neuroscience (R.K.), Luxembourg Centre for Systems Biomedicine, University of Luxembourg; and Department of Neurology and Stereotactic Neurosurgery (A. Kupsch), Basal Ganglia Research Group, Otto von Guericke University Magdeburg, Germany
| | - Alexander Wolters
- From the Institute of Neurogenetics (N.B., S.A.S., S.Z., A.M., K.L., C. Klein), University of Lübeck; Department of Neurology (N.B.), University Hospital Schleswig-Holstein, Campus Lübeck; Department of Neurology (A. Kühn, P.K.), Virchow Clinics, University Berlin Charité; Department of Neurology (S.A.S., G.D.), University Hospital Schleswig-Holstein, Campus Kiel; Department of Neurology (C. Kamm, A.W., M.W.), University Hospital Rostock, Germany; Movement Disorders Center (E.M., Y.-Y.P.), Toronto Western Hospital, University of Toronto, UHN, Canada; Movement Disorders Unit (E.M.), Division of Psychiatry and Neurology, CHU Grenoble, Joseph Fourier University, Grenoble, France; Department of Neurology (F.S., J.V.), University Hospital Würzburg; Department of Neurosurgery (V.T.), University Hospital Lübeck, Germany; Division of Neurosurgery (A.M.L., C.H.), Department of Surgery, University of Toronto, Canada; Center for Neurology and Hertie-Institute for Clinical Brain Research (T.W., R.K.), University Hospital Tübingen, Center for Integrative Neurosciences, University of Tübingen and German Center for Neurodegenerative Diseases (DZNE), Tübingen; Clinical and Experimental Neuroscience (R.K.), Luxembourg Centre for Systems Biomedicine, University of Luxembourg; and Department of Neurology and Stereotactic Neurosurgery (A. Kupsch), Basal Ganglia Research Group, Otto von Guericke University Magdeburg, Germany
| | - Patricia Krause
- From the Institute of Neurogenetics (N.B., S.A.S., S.Z., A.M., K.L., C. Klein), University of Lübeck; Department of Neurology (N.B.), University Hospital Schleswig-Holstein, Campus Lübeck; Department of Neurology (A. Kühn, P.K.), Virchow Clinics, University Berlin Charité; Department of Neurology (S.A.S., G.D.), University Hospital Schleswig-Holstein, Campus Kiel; Department of Neurology (C. Kamm, A.W., M.W.), University Hospital Rostock, Germany; Movement Disorders Center (E.M., Y.-Y.P.), Toronto Western Hospital, University of Toronto, UHN, Canada; Movement Disorders Unit (E.M.), Division of Psychiatry and Neurology, CHU Grenoble, Joseph Fourier University, Grenoble, France; Department of Neurology (F.S., J.V.), University Hospital Würzburg; Department of Neurosurgery (V.T.), University Hospital Lübeck, Germany; Division of Neurosurgery (A.M.L., C.H.), Department of Surgery, University of Toronto, Canada; Center for Neurology and Hertie-Institute for Clinical Brain Research (T.W., R.K.), University Hospital Tübingen, Center for Integrative Neurosciences, University of Tübingen and German Center for Neurodegenerative Diseases (DZNE), Tübingen; Clinical and Experimental Neuroscience (R.K.), Luxembourg Centre for Systems Biomedicine, University of Luxembourg; and Department of Neurology and Stereotactic Neurosurgery (A. Kupsch), Basal Ganglia Research Group, Otto von Guericke University Magdeburg, Germany
| | - Elena Moro
- From the Institute of Neurogenetics (N.B., S.A.S., S.Z., A.M., K.L., C. Klein), University of Lübeck; Department of Neurology (N.B.), University Hospital Schleswig-Holstein, Campus Lübeck; Department of Neurology (A. Kühn, P.K.), Virchow Clinics, University Berlin Charité; Department of Neurology (S.A.S., G.D.), University Hospital Schleswig-Holstein, Campus Kiel; Department of Neurology (C. Kamm, A.W., M.W.), University Hospital Rostock, Germany; Movement Disorders Center (E.M., Y.-Y.P.), Toronto Western Hospital, University of Toronto, UHN, Canada; Movement Disorders Unit (E.M.), Division of Psychiatry and Neurology, CHU Grenoble, Joseph Fourier University, Grenoble, France; Department of Neurology (F.S., J.V.), University Hospital Würzburg; Department of Neurosurgery (V.T.), University Hospital Lübeck, Germany; Division of Neurosurgery (A.M.L., C.H.), Department of Surgery, University of Toronto, Canada; Center for Neurology and Hertie-Institute for Clinical Brain Research (T.W., R.K.), University Hospital Tübingen, Center for Integrative Neurosciences, University of Tübingen and German Center for Neurodegenerative Diseases (DZNE), Tübingen; Clinical and Experimental Neuroscience (R.K.), Luxembourg Centre for Systems Biomedicine, University of Luxembourg; and Department of Neurology and Stereotactic Neurosurgery (A. Kupsch), Basal Ganglia Research Group, Otto von Guericke University Magdeburg, Germany
| | - Frank Steigerwald
- From the Institute of Neurogenetics (N.B., S.A.S., S.Z., A.M., K.L., C. Klein), University of Lübeck; Department of Neurology (N.B.), University Hospital Schleswig-Holstein, Campus Lübeck; Department of Neurology (A. Kühn, P.K.), Virchow Clinics, University Berlin Charité; Department of Neurology (S.A.S., G.D.), University Hospital Schleswig-Holstein, Campus Kiel; Department of Neurology (C. Kamm, A.W., M.W.), University Hospital Rostock, Germany; Movement Disorders Center (E.M., Y.-Y.P.), Toronto Western Hospital, University of Toronto, UHN, Canada; Movement Disorders Unit (E.M.), Division of Psychiatry and Neurology, CHU Grenoble, Joseph Fourier University, Grenoble, France; Department of Neurology (F.S., J.V.), University Hospital Würzburg; Department of Neurosurgery (V.T.), University Hospital Lübeck, Germany; Division of Neurosurgery (A.M.L., C.H.), Department of Surgery, University of Toronto, Canada; Center for Neurology and Hertie-Institute for Clinical Brain Research (T.W., R.K.), University Hospital Tübingen, Center for Integrative Neurosciences, University of Tübingen and German Center for Neurodegenerative Diseases (DZNE), Tübingen; Clinical and Experimental Neuroscience (R.K.), Luxembourg Centre for Systems Biomedicine, University of Luxembourg; and Department of Neurology and Stereotactic Neurosurgery (A. Kupsch), Basal Ganglia Research Group, Otto von Guericke University Magdeburg, Germany
| | - Matthias Wittstock
- From the Institute of Neurogenetics (N.B., S.A.S., S.Z., A.M., K.L., C. Klein), University of Lübeck; Department of Neurology (N.B.), University Hospital Schleswig-Holstein, Campus Lübeck; Department of Neurology (A. Kühn, P.K.), Virchow Clinics, University Berlin Charité; Department of Neurology (S.A.S., G.D.), University Hospital Schleswig-Holstein, Campus Kiel; Department of Neurology (C. Kamm, A.W., M.W.), University Hospital Rostock, Germany; Movement Disorders Center (E.M., Y.-Y.P.), Toronto Western Hospital, University of Toronto, UHN, Canada; Movement Disorders Unit (E.M.), Division of Psychiatry and Neurology, CHU Grenoble, Joseph Fourier University, Grenoble, France; Department of Neurology (F.S., J.V.), University Hospital Würzburg; Department of Neurosurgery (V.T.), University Hospital Lübeck, Germany; Division of Neurosurgery (A.M.L., C.H.), Department of Surgery, University of Toronto, Canada; Center for Neurology and Hertie-Institute for Clinical Brain Research (T.W., R.K.), University Hospital Tübingen, Center for Integrative Neurosciences, University of Tübingen and German Center for Neurodegenerative Diseases (DZNE), Tübingen; Clinical and Experimental Neuroscience (R.K.), Luxembourg Centre for Systems Biomedicine, University of Luxembourg; and Department of Neurology and Stereotactic Neurosurgery (A. Kupsch), Basal Ganglia Research Group, Otto von Guericke University Magdeburg, Germany
| | - Volker Tronnier
- From the Institute of Neurogenetics (N.B., S.A.S., S.Z., A.M., K.L., C. Klein), University of Lübeck; Department of Neurology (N.B.), University Hospital Schleswig-Holstein, Campus Lübeck; Department of Neurology (A. Kühn, P.K.), Virchow Clinics, University Berlin Charité; Department of Neurology (S.A.S., G.D.), University Hospital Schleswig-Holstein, Campus Kiel; Department of Neurology (C. Kamm, A.W., M.W.), University Hospital Rostock, Germany; Movement Disorders Center (E.M., Y.-Y.P.), Toronto Western Hospital, University of Toronto, UHN, Canada; Movement Disorders Unit (E.M.), Division of Psychiatry and Neurology, CHU Grenoble, Joseph Fourier University, Grenoble, France; Department of Neurology (F.S., J.V.), University Hospital Würzburg; Department of Neurosurgery (V.T.), University Hospital Lübeck, Germany; Division of Neurosurgery (A.M.L., C.H.), Department of Surgery, University of Toronto, Canada; Center for Neurology and Hertie-Institute for Clinical Brain Research (T.W., R.K.), University Hospital Tübingen, Center for Integrative Neurosciences, University of Tübingen and German Center for Neurodegenerative Diseases (DZNE), Tübingen; Clinical and Experimental Neuroscience (R.K.), Luxembourg Centre for Systems Biomedicine, University of Luxembourg; and Department of Neurology and Stereotactic Neurosurgery (A. Kupsch), Basal Ganglia Research Group, Otto von Guericke University Magdeburg, Germany
| | - Andres M Lozano
- From the Institute of Neurogenetics (N.B., S.A.S., S.Z., A.M., K.L., C. Klein), University of Lübeck; Department of Neurology (N.B.), University Hospital Schleswig-Holstein, Campus Lübeck; Department of Neurology (A. Kühn, P.K.), Virchow Clinics, University Berlin Charité; Department of Neurology (S.A.S., G.D.), University Hospital Schleswig-Holstein, Campus Kiel; Department of Neurology (C. Kamm, A.W., M.W.), University Hospital Rostock, Germany; Movement Disorders Center (E.M., Y.-Y.P.), Toronto Western Hospital, University of Toronto, UHN, Canada; Movement Disorders Unit (E.M.), Division of Psychiatry and Neurology, CHU Grenoble, Joseph Fourier University, Grenoble, France; Department of Neurology (F.S., J.V.), University Hospital Würzburg; Department of Neurosurgery (V.T.), University Hospital Lübeck, Germany; Division of Neurosurgery (A.M.L., C.H.), Department of Surgery, University of Toronto, Canada; Center for Neurology and Hertie-Institute for Clinical Brain Research (T.W., R.K.), University Hospital Tübingen, Center for Integrative Neurosciences, University of Tübingen and German Center for Neurodegenerative Diseases (DZNE), Tübingen; Clinical and Experimental Neuroscience (R.K.), Luxembourg Centre for Systems Biomedicine, University of Luxembourg; and Department of Neurology and Stereotactic Neurosurgery (A. Kupsch), Basal Ganglia Research Group, Otto von Guericke University Magdeburg, Germany
| | - Clement Hamani
- From the Institute of Neurogenetics (N.B., S.A.S., S.Z., A.M., K.L., C. Klein), University of Lübeck; Department of Neurology (N.B.), University Hospital Schleswig-Holstein, Campus Lübeck; Department of Neurology (A. Kühn, P.K.), Virchow Clinics, University Berlin Charité; Department of Neurology (S.A.S., G.D.), University Hospital Schleswig-Holstein, Campus Kiel; Department of Neurology (C. Kamm, A.W., M.W.), University Hospital Rostock, Germany; Movement Disorders Center (E.M., Y.-Y.P.), Toronto Western Hospital, University of Toronto, UHN, Canada; Movement Disorders Unit (E.M.), Division of Psychiatry and Neurology, CHU Grenoble, Joseph Fourier University, Grenoble, France; Department of Neurology (F.S., J.V.), University Hospital Würzburg; Department of Neurosurgery (V.T.), University Hospital Lübeck, Germany; Division of Neurosurgery (A.M.L., C.H.), Department of Surgery, University of Toronto, Canada; Center for Neurology and Hertie-Institute for Clinical Brain Research (T.W., R.K.), University Hospital Tübingen, Center for Integrative Neurosciences, University of Tübingen and German Center for Neurodegenerative Diseases (DZNE), Tübingen; Clinical and Experimental Neuroscience (R.K.), Luxembourg Centre for Systems Biomedicine, University of Luxembourg; and Department of Neurology and Stereotactic Neurosurgery (A. Kupsch), Basal Ganglia Research Group, Otto von Guericke University Magdeburg, Germany
| | - Yu-Yan Poon
- From the Institute of Neurogenetics (N.B., S.A.S., S.Z., A.M., K.L., C. Klein), University of Lübeck; Department of Neurology (N.B.), University Hospital Schleswig-Holstein, Campus Lübeck; Department of Neurology (A. Kühn, P.K.), Virchow Clinics, University Berlin Charité; Department of Neurology (S.A.S., G.D.), University Hospital Schleswig-Holstein, Campus Kiel; Department of Neurology (C. Kamm, A.W., M.W.), University Hospital Rostock, Germany; Movement Disorders Center (E.M., Y.-Y.P.), Toronto Western Hospital, University of Toronto, UHN, Canada; Movement Disorders Unit (E.M.), Division of Psychiatry and Neurology, CHU Grenoble, Joseph Fourier University, Grenoble, France; Department of Neurology (F.S., J.V.), University Hospital Würzburg; Department of Neurosurgery (V.T.), University Hospital Lübeck, Germany; Division of Neurosurgery (A.M.L., C.H.), Department of Surgery, University of Toronto, Canada; Center for Neurology and Hertie-Institute for Clinical Brain Research (T.W., R.K.), University Hospital Tübingen, Center for Integrative Neurosciences, University of Tübingen and German Center for Neurodegenerative Diseases (DZNE), Tübingen; Clinical and Experimental Neuroscience (R.K.), Luxembourg Centre for Systems Biomedicine, University of Luxembourg; and Department of Neurology and Stereotactic Neurosurgery (A. Kupsch), Basal Ganglia Research Group, Otto von Guericke University Magdeburg, Germany
| | - Simone Zittel
- From the Institute of Neurogenetics (N.B., S.A.S., S.Z., A.M., K.L., C. Klein), University of Lübeck; Department of Neurology (N.B.), University Hospital Schleswig-Holstein, Campus Lübeck; Department of Neurology (A. Kühn, P.K.), Virchow Clinics, University Berlin Charité; Department of Neurology (S.A.S., G.D.), University Hospital Schleswig-Holstein, Campus Kiel; Department of Neurology (C. Kamm, A.W., M.W.), University Hospital Rostock, Germany; Movement Disorders Center (E.M., Y.-Y.P.), Toronto Western Hospital, University of Toronto, UHN, Canada; Movement Disorders Unit (E.M.), Division of Psychiatry and Neurology, CHU Grenoble, Joseph Fourier University, Grenoble, France; Department of Neurology (F.S., J.V.), University Hospital Würzburg; Department of Neurosurgery (V.T.), University Hospital Lübeck, Germany; Division of Neurosurgery (A.M.L., C.H.), Department of Surgery, University of Toronto, Canada; Center for Neurology and Hertie-Institute for Clinical Brain Research (T.W., R.K.), University Hospital Tübingen, Center for Integrative Neurosciences, University of Tübingen and German Center for Neurodegenerative Diseases (DZNE), Tübingen; Clinical and Experimental Neuroscience (R.K.), Luxembourg Centre for Systems Biomedicine, University of Luxembourg; and Department of Neurology and Stereotactic Neurosurgery (A. Kupsch), Basal Ganglia Research Group, Otto von Guericke University Magdeburg, Germany
| | - Tobias Wächter
- From the Institute of Neurogenetics (N.B., S.A.S., S.Z., A.M., K.L., C. Klein), University of Lübeck; Department of Neurology (N.B.), University Hospital Schleswig-Holstein, Campus Lübeck; Department of Neurology (A. Kühn, P.K.), Virchow Clinics, University Berlin Charité; Department of Neurology (S.A.S., G.D.), University Hospital Schleswig-Holstein, Campus Kiel; Department of Neurology (C. Kamm, A.W., M.W.), University Hospital Rostock, Germany; Movement Disorders Center (E.M., Y.-Y.P.), Toronto Western Hospital, University of Toronto, UHN, Canada; Movement Disorders Unit (E.M.), Division of Psychiatry and Neurology, CHU Grenoble, Joseph Fourier University, Grenoble, France; Department of Neurology (F.S., J.V.), University Hospital Würzburg; Department of Neurosurgery (V.T.), University Hospital Lübeck, Germany; Division of Neurosurgery (A.M.L., C.H.), Department of Surgery, University of Toronto, Canada; Center for Neurology and Hertie-Institute for Clinical Brain Research (T.W., R.K.), University Hospital Tübingen, Center for Integrative Neurosciences, University of Tübingen and German Center for Neurodegenerative Diseases (DZNE), Tübingen; Clinical and Experimental Neuroscience (R.K.), Luxembourg Centre for Systems Biomedicine, University of Luxembourg; and Department of Neurology and Stereotactic Neurosurgery (A. Kupsch), Basal Ganglia Research Group, Otto von Guericke University Magdeburg, Germany
| | - Günther Deuschl
- From the Institute of Neurogenetics (N.B., S.A.S., S.Z., A.M., K.L., C. Klein), University of Lübeck; Department of Neurology (N.B.), University Hospital Schleswig-Holstein, Campus Lübeck; Department of Neurology (A. Kühn, P.K.), Virchow Clinics, University Berlin Charité; Department of Neurology (S.A.S., G.D.), University Hospital Schleswig-Holstein, Campus Kiel; Department of Neurology (C. Kamm, A.W., M.W.), University Hospital Rostock, Germany; Movement Disorders Center (E.M., Y.-Y.P.), Toronto Western Hospital, University of Toronto, UHN, Canada; Movement Disorders Unit (E.M.), Division of Psychiatry and Neurology, CHU Grenoble, Joseph Fourier University, Grenoble, France; Department of Neurology (F.S., J.V.), University Hospital Würzburg; Department of Neurosurgery (V.T.), University Hospital Lübeck, Germany; Division of Neurosurgery (A.M.L., C.H.), Department of Surgery, University of Toronto, Canada; Center for Neurology and Hertie-Institute for Clinical Brain Research (T.W., R.K.), University Hospital Tübingen, Center for Integrative Neurosciences, University of Tübingen and German Center for Neurodegenerative Diseases (DZNE), Tübingen; Clinical and Experimental Neuroscience (R.K.), Luxembourg Centre for Systems Biomedicine, University of Luxembourg; and Department of Neurology and Stereotactic Neurosurgery (A. Kupsch), Basal Ganglia Research Group, Otto von Guericke University Magdeburg, Germany
| | - Rejko Krüger
- From the Institute of Neurogenetics (N.B., S.A.S., S.Z., A.M., K.L., C. Klein), University of Lübeck; Department of Neurology (N.B.), University Hospital Schleswig-Holstein, Campus Lübeck; Department of Neurology (A. Kühn, P.K.), Virchow Clinics, University Berlin Charité; Department of Neurology (S.A.S., G.D.), University Hospital Schleswig-Holstein, Campus Kiel; Department of Neurology (C. Kamm, A.W., M.W.), University Hospital Rostock, Germany; Movement Disorders Center (E.M., Y.-Y.P.), Toronto Western Hospital, University of Toronto, UHN, Canada; Movement Disorders Unit (E.M.), Division of Psychiatry and Neurology, CHU Grenoble, Joseph Fourier University, Grenoble, France; Department of Neurology (F.S., J.V.), University Hospital Würzburg; Department of Neurosurgery (V.T.), University Hospital Lübeck, Germany; Division of Neurosurgery (A.M.L., C.H.), Department of Surgery, University of Toronto, Canada; Center for Neurology and Hertie-Institute for Clinical Brain Research (T.W., R.K.), University Hospital Tübingen, Center for Integrative Neurosciences, University of Tübingen and German Center for Neurodegenerative Diseases (DZNE), Tübingen; Clinical and Experimental Neuroscience (R.K.), Luxembourg Centre for Systems Biomedicine, University of Luxembourg; and Department of Neurology and Stereotactic Neurosurgery (A. Kupsch), Basal Ganglia Research Group, Otto von Guericke University Magdeburg, Germany
| | - Andreas Kupsch
- From the Institute of Neurogenetics (N.B., S.A.S., S.Z., A.M., K.L., C. Klein), University of Lübeck; Department of Neurology (N.B.), University Hospital Schleswig-Holstein, Campus Lübeck; Department of Neurology (A. Kühn, P.K.), Virchow Clinics, University Berlin Charité; Department of Neurology (S.A.S., G.D.), University Hospital Schleswig-Holstein, Campus Kiel; Department of Neurology (C. Kamm, A.W., M.W.), University Hospital Rostock, Germany; Movement Disorders Center (E.M., Y.-Y.P.), Toronto Western Hospital, University of Toronto, UHN, Canada; Movement Disorders Unit (E.M.), Division of Psychiatry and Neurology, CHU Grenoble, Joseph Fourier University, Grenoble, France; Department of Neurology (F.S., J.V.), University Hospital Würzburg; Department of Neurosurgery (V.T.), University Hospital Lübeck, Germany; Division of Neurosurgery (A.M.L., C.H.), Department of Surgery, University of Toronto, Canada; Center for Neurology and Hertie-Institute for Clinical Brain Research (T.W., R.K.), University Hospital Tübingen, Center for Integrative Neurosciences, University of Tübingen and German Center for Neurodegenerative Diseases (DZNE), Tübingen; Clinical and Experimental Neuroscience (R.K.), Luxembourg Centre for Systems Biomedicine, University of Luxembourg; and Department of Neurology and Stereotactic Neurosurgery (A. Kupsch), Basal Ganglia Research Group, Otto von Guericke University Magdeburg, Germany
| | - Alexander Münchau
- From the Institute of Neurogenetics (N.B., S.A.S., S.Z., A.M., K.L., C. Klein), University of Lübeck; Department of Neurology (N.B.), University Hospital Schleswig-Holstein, Campus Lübeck; Department of Neurology (A. Kühn, P.K.), Virchow Clinics, University Berlin Charité; Department of Neurology (S.A.S., G.D.), University Hospital Schleswig-Holstein, Campus Kiel; Department of Neurology (C. Kamm, A.W., M.W.), University Hospital Rostock, Germany; Movement Disorders Center (E.M., Y.-Y.P.), Toronto Western Hospital, University of Toronto, UHN, Canada; Movement Disorders Unit (E.M.), Division of Psychiatry and Neurology, CHU Grenoble, Joseph Fourier University, Grenoble, France; Department of Neurology (F.S., J.V.), University Hospital Würzburg; Department of Neurosurgery (V.T.), University Hospital Lübeck, Germany; Division of Neurosurgery (A.M.L., C.H.), Department of Surgery, University of Toronto, Canada; Center for Neurology and Hertie-Institute for Clinical Brain Research (T.W., R.K.), University Hospital Tübingen, Center for Integrative Neurosciences, University of Tübingen and German Center for Neurodegenerative Diseases (DZNE), Tübingen; Clinical and Experimental Neuroscience (R.K.), Luxembourg Centre for Systems Biomedicine, University of Luxembourg; and Department of Neurology and Stereotactic Neurosurgery (A. Kupsch), Basal Ganglia Research Group, Otto von Guericke University Magdeburg, Germany
| | - Katja Lohmann
- From the Institute of Neurogenetics (N.B., S.A.S., S.Z., A.M., K.L., C. Klein), University of Lübeck; Department of Neurology (N.B.), University Hospital Schleswig-Holstein, Campus Lübeck; Department of Neurology (A. Kühn, P.K.), Virchow Clinics, University Berlin Charité; Department of Neurology (S.A.S., G.D.), University Hospital Schleswig-Holstein, Campus Kiel; Department of Neurology (C. Kamm, A.W., M.W.), University Hospital Rostock, Germany; Movement Disorders Center (E.M., Y.-Y.P.), Toronto Western Hospital, University of Toronto, UHN, Canada; Movement Disorders Unit (E.M.), Division of Psychiatry and Neurology, CHU Grenoble, Joseph Fourier University, Grenoble, France; Department of Neurology (F.S., J.V.), University Hospital Würzburg; Department of Neurosurgery (V.T.), University Hospital Lübeck, Germany; Division of Neurosurgery (A.M.L., C.H.), Department of Surgery, University of Toronto, Canada; Center for Neurology and Hertie-Institute for Clinical Brain Research (T.W., R.K.), University Hospital Tübingen, Center for Integrative Neurosciences, University of Tübingen and German Center for Neurodegenerative Diseases (DZNE), Tübingen; Clinical and Experimental Neuroscience (R.K.), Luxembourg Centre for Systems Biomedicine, University of Luxembourg; and Department of Neurology and Stereotactic Neurosurgery (A. Kupsch), Basal Ganglia Research Group, Otto von Guericke University Magdeburg, Germany
| | - Jens Volkmann
- From the Institute of Neurogenetics (N.B., S.A.S., S.Z., A.M., K.L., C. Klein), University of Lübeck; Department of Neurology (N.B.), University Hospital Schleswig-Holstein, Campus Lübeck; Department of Neurology (A. Kühn, P.K.), Virchow Clinics, University Berlin Charité; Department of Neurology (S.A.S., G.D.), University Hospital Schleswig-Holstein, Campus Kiel; Department of Neurology (C. Kamm, A.W., M.W.), University Hospital Rostock, Germany; Movement Disorders Center (E.M., Y.-Y.P.), Toronto Western Hospital, University of Toronto, UHN, Canada; Movement Disorders Unit (E.M.), Division of Psychiatry and Neurology, CHU Grenoble, Joseph Fourier University, Grenoble, France; Department of Neurology (F.S., J.V.), University Hospital Würzburg; Department of Neurosurgery (V.T.), University Hospital Lübeck, Germany; Division of Neurosurgery (A.M.L., C.H.), Department of Surgery, University of Toronto, Canada; Center for Neurology and Hertie-Institute for Clinical Brain Research (T.W., R.K.), University Hospital Tübingen, Center for Integrative Neurosciences, University of Tübingen and German Center for Neurodegenerative Diseases (DZNE), Tübingen; Clinical and Experimental Neuroscience (R.K.), Luxembourg Centre for Systems Biomedicine, University of Luxembourg; and Department of Neurology and Stereotactic Neurosurgery (A. Kupsch), Basal Ganglia Research Group, Otto von Guericke University Magdeburg, Germany
| | - Christine Klein
- From the Institute of Neurogenetics (N.B., S.A.S., S.Z., A.M., K.L., C. Klein), University of Lübeck; Department of Neurology (N.B.), University Hospital Schleswig-Holstein, Campus Lübeck; Department of Neurology (A. Kühn, P.K.), Virchow Clinics, University Berlin Charité; Department of Neurology (S.A.S., G.D.), University Hospital Schleswig-Holstein, Campus Kiel; Department of Neurology (C. Kamm, A.W., M.W.), University Hospital Rostock, Germany; Movement Disorders Center (E.M., Y.-Y.P.), Toronto Western Hospital, University of Toronto, UHN, Canada; Movement Disorders Unit (E.M.), Division of Psychiatry and Neurology, CHU Grenoble, Joseph Fourier University, Grenoble, France; Department of Neurology (F.S., J.V.), University Hospital Würzburg; Department of Neurosurgery (V.T.), University Hospital Lübeck, Germany; Division of Neurosurgery (A.M.L., C.H.), Department of Surgery, University of Toronto, Canada; Center for Neurology and Hertie-Institute for Clinical Brain Research (T.W., R.K.), University Hospital Tübingen, Center for Integrative Neurosciences, University of Tübingen and German Center for Neurodegenerative Diseases (DZNE), Tübingen; Clinical and Experimental Neuroscience (R.K.), Luxembourg Centre for Systems Biomedicine, University of Luxembourg; and Department of Neurology and Stereotactic Neurosurgery (A. Kupsch), Basal Ganglia Research Group, Otto von Guericke University Magdeburg, Germany
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Skogseid IM. Dystonia--new advances in classification, genetics, pathophysiology and treatment. Acta Neurol Scand 2014:13-9. [PMID: 24588501 DOI: 10.1111/ane.12231] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2014] [Indexed: 02/03/2023]
Abstract
Dystonia is a heterogeneous movement disorder and has been defined as 'a syndrome of sustained muscle contractions, frequently causing twisted and repetitive movements, or abnormal postures'. The classification of dystonia has developed along with increasing knowledge, and different schemes have been suggested, including age at onset, body distribution, and etiology as the main differentiating factors. A revised definition and a new classification of dystonia have now been proposed by a group of leading dystonia experts and will be referred here. The discovery of the first two gene mutations causing primary generalized dystonia (DYT1-TOR1A and DYT6-THAP1) has facilitated studies on pathogenesis and pathophysiology of primary dystonias, by comparing neurophysiology between manifesting and non-manifesting carriers, and by studying the molecular biology of the mutant gene products. During recent years, several other gene mutations causing primary dystonia, dystonia-plus, and paroxysmal dystonia disorders have been discovered. Only during the last year, by the use of whole-exome sequencing techniques, mutations in three different genes in families with predominantly cervical dystonia were found, which may lead to improved insight into the pathogenesis also of the more frequent focal dystonias. Botulinum neurotoxin (BoNT) and deep brain stimulation (DBS) have revolutionized the symptomatic treatment for dystonia during the last two decades and continue to be refined to improve efficacy and expand their indications. Unfortunately, no progress has been made in the oral medication of dystonia. Current and future new insights into pathogenetic and pathophysiological mechanisms of dystonia will hopefully lead to improvement also in this area soon.
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Affiliation(s)
- I. M. Skogseid
- Department of Neurology; Oslo University Hospital; Oslo Norway
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Abstract
Isolated inherited dystonia-formerly referred to as primary dystonia-is characterized by abnormal motor functioning of a grossly normal appearing brain. The disease manifests as abnormal involuntary twisting movements. The absence of overt neuropathological lesions, while intriguing, has made it particularly difficult to unravel the pathogenesis of isolated inherited dystonia. The explosion of genetic techology enabling the identification of the causative gene mutations is transforming our understanding of dystonia pathogenesis, as the molecular, cellular and circuit level consequences of these mutations are identified in experimental systems. Here, I review the clinical genetics and cell biology of three forms of inherited dystonia for which the causative mutation is known: DYT1 (TOR1A), DYT6 (THAP1), DYT25 (GNAL).
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Affiliation(s)
- William Dauer
- Department of Neurology, Department of Cell and Developmental Biology, University of Michigan Medical School, Ann Arbor, MI, 48109-220, USA,
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Erogullari A, Hollstein R, Seibler P, Braunholz D, Koschmidder E, Depping R, Eckhold J, Lohnau T, Gillessen-Kaesbach G, Grünewald A, Rakovic A, Lohmann K, Kaiser FJ. THAP1, the gene mutated in DYT6 dystonia, autoregulates its own expression. BIOCHIMICA ET BIOPHYSICA ACTA-GENE REGULATORY MECHANISMS 2014; 1839:1196-204. [PMID: 25088175 DOI: 10.1016/j.bbagrm.2014.07.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Revised: 07/22/2014] [Accepted: 07/24/2014] [Indexed: 02/07/2023]
Abstract
THAP1 encodes a transcription factor but its regulation is largely elusive. TOR1A was shown to be repressed by THAP1 in vitro. Notably, mutations in both of these genes lead to dystonia (DYT6 or DYT1). Surprisingly, expressional changes of TOR1A in THAP1 mutation carriers have not been detected indicating additional levels of regulation. Here, we investigated whether THAP1 is able to autoregulate its own expression. Using in-silico prediction, luciferase reporter gene assays, and (quantitative) chromatin immunoprecipitation (ChIP), we defined the THAP1 minimal promoter to a 480bp-fragment and demonstrated specific binding of THAP1 to this region which resulted in repression of the THAP1 promoter. This autoregulation was disturbed by different DYT6-causing mutations. Two mutants (Ser6Phe, Arg13His) were shown to be less stable than wildtype THAP1 adding to the effect of reduced binding to the THAP1 promoter. Overexpressed THAP1 is preferably degraded through the proteasome. Notably, endogenous THAP1 expression was significantly reduced in cells overexpressing wildtype THAP1 as demonstrated by quantitative PCR. In contrast, higher THAP1 levels were detected in induced pluripotent stem cell (iPS)-derived neurons from THAP1 mutation carriers. Thus, we identified a feedback-loop in the regulation of THAP1 expression and demonstrated that mutant THAP1 leads to higher THAP1 expression levels. This compensatory autoregulation may contribute to the mean age at onset in the late teen years or even reduced penetrance in some THAP1 mutation carriers.
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Affiliation(s)
- Alev Erogullari
- Sektion für Funktionelle Genetik am Institut für Humangenetik, University of Luebeck, Luebeck 23538, Germany
| | - Ronja Hollstein
- Sektion für Funktionelle Genetik am Institut für Humangenetik, University of Luebeck, Luebeck 23538, Germany
| | - Philip Seibler
- Institute of Neurogenetics, University of Luebeck, Luebeck 23538, Germany
| | - Diana Braunholz
- Sektion für Funktionelle Genetik am Institut für Humangenetik, University of Luebeck, Luebeck 23538, Germany
| | - Eva Koschmidder
- Institute of Neurogenetics, University of Luebeck, Luebeck 23538, Germany
| | - Reinhard Depping
- Institute of Physiology, Center of Structural and Cell Biology in Medicine, University of Luebeck, Luebeck 23538, Germany
| | - Juliane Eckhold
- Sektion für Funktionelle Genetik am Institut für Humangenetik, University of Luebeck, Luebeck 23538, Germany; Institut für Humangenetik, University of Luebeck, Luebeck 23538, Germany
| | - Thora Lohnau
- Institute of Neurogenetics, University of Luebeck, Luebeck 23538, Germany
| | | | - Anne Grünewald
- Institute of Neurogenetics, University of Luebeck, Luebeck 23538, Germany
| | - Aleksandar Rakovic
- Institute of Neurogenetics, University of Luebeck, Luebeck 23538, Germany
| | - Katja Lohmann
- Institute of Neurogenetics, University of Luebeck, Luebeck 23538, Germany.
| | - Frank J Kaiser
- Sektion für Funktionelle Genetik am Institut für Humangenetik, University of Luebeck, Luebeck 23538, Germany
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Camargo CHF, Camargos ST, Raskin S, Cardoso FEC, Teive HAG. DYT6 in Brazil: Genetic Assessment and Clinical Characteristics of Patients. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2014; 4:226. [PMID: 24757586 PMCID: PMC3992363 DOI: 10.7916/d83776rc] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Accepted: 03/11/2014] [Indexed: 12/13/2022]
Abstract
Background Several genes associated with dystonia have been identified. A mutation in one of these, THAP1 (DYT6), is linked to isolated dystonia. The aim of this study was to assess the prevalence of THAP1 gene mutations and the clinical characteristics of patients with these mutations in a clinical population in Brazil. Methods Seventy-four patients presenting with dystonia involving the cervical muscles and without mutations in the TOR1A (DYT1) gene or any other movement disorders were recruited at a movement disorders clinic between June 2008 and June 2009. All the patients underwent clinical examination and were screened for mutations of the THAP1 gene. Results Three patients had the novel p.Gln97Ter THAP1 nonsense mutation in heterozygosis. One of them had no family history of dystonia. Symptoms in this patient first appeared in his right arm, and the condition progressed to the generalized form. The other two patients belonged to the same family (cousins). Symptoms in the first patient started in her right arm at the age of 18 years and the condition progressed to the segmental form. The second patient, who carried the p.Arg169Gln missense mutation, developed dystonia in her left arm at the age of 6 years. The condition progressed to generalized dystonia. Discussion We conclude that THAP1 mutations are also a cause, albeit uncommon, of segmental and generalized dystonia in the Brazilian population.
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Affiliation(s)
- Carlos Henrique F Camargo
- Movement Disorders Unit, Neurology Service, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil ; Neurology Service, Medicine Department, Hospital Universitário, State University of Ponta Grossa, Ponta Grossa, Brazil
| | | | - Salmo Raskin
- Genetika Laboratory and Catholic University of Paraná, Curitiba, Brazil
| | | | - Hélio Afonso G Teive
- Movement Disorders Unit, Neurology Service, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
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Ledoux MS, Dauer WT, Warner TT. Emerging common molecular pathways for primary dystonia. Mov Disord 2014; 28:968-81. [PMID: 23893453 DOI: 10.1002/mds.25547] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 05/03/2013] [Accepted: 05/06/2013] [Indexed: 12/23/2022] Open
Abstract
The dystonias are a group of hyperkinetic movement disorders whose principal cause is neuron dysfunction at 1 or more interconnected nodes of the motor system. The study of genes and proteins that cause familial dystonia provides critical information about the cellular pathways involved in this dysfunction, which disrupts the motor pathways at the systems level. In recent years study of the increasing number of DYT genes has implicated a number of cell functions that appear to be involved in the pathogenesis of dystonia. A review of the literature published in English-language publications available on PubMed relating to the genetics and cellular pathology of dystonia was performed. Numerous potential pathogenetic mechanisms have been identified. We describe those that fall into 3 emerging thematic groups: cell-cycle and transcriptional regulation in the nucleus, endoplasmic reticulum and nuclear envelope function, and control of synaptic function. © 2013 Movement Disorder Society.
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Affiliation(s)
- Mark S Ledoux
- Department of Neurology, University of Tennessee Health Science Center Memphis, Tennessee 38163, USA
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Stamelou M, Charlesworth G, Cordivari C, Schneider SA, Kägi G, Sheerin UM, Rubio-Agusti I, Batla A, Houlden H, Wood NW, Bhatia KP. The phenotypic spectrum of DYT24 due to ANO3 mutations. Mov Disord 2014; 29:928-34. [PMID: 24442708 PMCID: PMC4150528 DOI: 10.1002/mds.25802] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 11/14/2013] [Accepted: 12/09/2013] [Indexed: 12/13/2022] Open
Abstract
Genes causing primary dystonia are rare. Recently, pathogenic mutations in the anoctamin 3 gene (ANO3) have been identified to cause autosomal dominant craniocervical dystonia and have been assigned to the dystonia locus dystonia-24 (DYT24). Here, we expand on the phenotypic spectrum of DYT24 and provide demonstrative videos. Moreover, tremor recordings were performed, and back-averaged electroencephalography, sensory evoked potentials, and C-reflex studies were carried out in two individuals who carried two different mutations in ANO3. Ten patients from three families are described. The age at onset ranged from early childhood to the forties. Cervical dystonia was the most common site of onset followed by laryngeal dystonia. The characteristic feature in all affected individuals was the presence of tremor, which contrasts DYT24 from the typical DYT6 phenotype. Tremor was the sole initial manifestation in some individuals with ANO3 mutations, leading to misdiagnosis as essential tremor. Electrophysiology in two patients with two different mutations showed co-contraction of antagonist muscles, confirming dystonia, and a 6-Hz arm tremor at rest, which increased in amplitude during action. In one of the studied patients, clinically superimposed myoclonus was observed. The duration of the myoclonus was in the range of 250 msec at about 3 Hz, which is more consistent with subcortical myoclonus. In summary, ANO3 causes a varied phenotype of young-onset or adult-onset craniocervical dystonia with tremor and/or myoclonic jerks. Patients with familial cervical dystonia who also have myoclonus-dystonia as well as patients with prominent tremor and mild dystonia should be tested for ANO3 mutations. © 2014 The Authors. Movement Disorders published by International Parkinson and Movement Disorder Society
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Affiliation(s)
- Maria Stamelou
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London (UCL) Institute of Neurology, London, United Kingdom; Neurology Clinic, Attiko Hospital, University of Athens, Greece
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Baker M, Strongosky AJ, Sanchez-Contreras MY, Yang S, Ferguson W, Calne DB, Calne S, Stoessl AJ, Allanson JE, Broderick DF, Hutton ML, Dickson DW, Ross OA, Wszolek ZK, Rademakers R. SLC20A2 and THAP1 deletion in familial basal ganglia calcification with dystonia. Neurogenetics 2013; 15:23-30. [PMID: 24135862 DOI: 10.1007/s10048-013-0378-5] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 09/22/2013] [Indexed: 01/30/2023]
Abstract
Idiopathic basal ganglia calcification (IBGC) is characterized by bilateral calcification of the basal ganglia associated with a spectrum of neuropsychiatric and motor syndromes. In this study, we set out to determine the frequency of the recently identified IBGC gene SLC20A2 in 27 IBGC cases from the Mayo Clinic Florida Brain Bank using both Sanger sequencing and TaqMan copy number analysis to cover the complete spectrum of possible mutations. We identified SLC20A2 pathogenic mutations in two of the 27 cases of IBGC (7 %). Sequencing analysis identified a p.S113* nonsense mutation in SLC20A2 in one case. TaqMan copy number analysis of SLC20A2 further revealed a genomic deletion in a second case, which was part of a large previously reported Canadian IBGC family with dystonia. Subsequent whole-genome sequencing in this family revealed a 563,256-bp genomic deletion with precise breakpoints on chromosome 8 affecting multiple genes including SLC20A2 and the known dystonia-related gene THAP1. The deletion co-segregated with disease in all family members. The deletion of THAP1 in addition to SLC20A2 in the Canadian IBGC family may contribute to the severe and early onset dystonia in this family. The identification of an SLC20A2 genomic deletion in a familial form of IBGC demonstrates that reduced SLC20A2 in the absence of mutant protein is sufficient to cause neurodegeneration and that previously reported SLC20A2 mutation frequencies may be underestimated.
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Affiliation(s)
- Matt Baker
- Department of Neuroscience, Mayo Clinic Jacksonville, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
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Jinnah HA, Berardelli A, Comella C, Defazio G, Delong MR, Factor S, Galpern WR, Hallett M, Ludlow CL, Perlmutter JS, Rosen AR. The focal dystonias: current views and challenges for future research. Mov Disord 2013; 28:926-43. [PMID: 23893450 PMCID: PMC3733486 DOI: 10.1002/mds.25567] [Citation(s) in RCA: 148] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Revised: 05/15/2013] [Accepted: 05/16/2013] [Indexed: 11/11/2022] Open
Abstract
The most common forms of dystonia are those that develop in adults and affect a relatively isolated region of the body. Although these adult-onset focal dystonias are most prevalent, knowledge of their etiologies and pathogenesis has lagged behind some of the rarer generalized dystonias, in which the identification of genetic defects has facilitated both basic and clinical research. This summary provides a brief review of the clinical manifestations of the adult-onset focal dystonias, focusing attention on less well understood clinical manifestations that need further study. It also provides a simple conceptual model for the similarities and differences among the different adult-onset focal dystonias as a rationale for lumping them together as a class of disorders while at the same time splitting them into subtypes. The concluding section outlines some of the most important research questions for the future. Answers to these questions are critical for advancing our understanding of this group of disorders and for developing novel therapeutics.
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Affiliation(s)
- H A Jinnah
- Department of Neurology, Emory University, Atlanta, Georgia 30322, USA.
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Newman JRB, Lehn AC, Boyle RS, Silburn PA, Mellick GD. Screening for rare sequence variants in the THAP1 gene in a primary dystonia cohort. Mov Disord 2013; 28:1752-3. [PMID: 23649788 DOI: 10.1002/mds.25479] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 03/03/2013] [Accepted: 03/20/2013] [Indexed: 12/27/2022] Open
Affiliation(s)
- Jeremy R B Newman
- Eskitis Institute for Cell and Molecular Therapies, Griffith University, Brisbane, Australia
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Petrucci S, Valente EM. Genetic issues in the diagnosis of dystonias. Front Neurol 2013; 4:34. [PMID: 23596437 PMCID: PMC3622056 DOI: 10.3389/fneur.2013.00034] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 03/27/2013] [Indexed: 12/29/2022] Open
Abstract
Dystonias are heterogeneous hyperkinetic movement disorders characterized by involuntary muscle contractions which result in twisting and repetitive movements and abnormal postures. Several causative genes have been identified, but their genetic bases still remain elusive. Primary Torsion Dystonias (PTDs), in which dystonia is the only clinical sign, can be inherited in a monogenic fashion, and many genes and loci have been identified for autosomal dominant (DYT1/TOR1A; DYT6/THAP1; DYT4/TUBB4a; DYT7; DYT13; DYT21; DYT23/CIZ1; DYT24/ANO3; DYT25/GNAL) and recessive (DYT2; DYT17) forms. However most sporadic cases, especially those with late-onset, are likely multifactorial, with genetic and environmental factors interplaying to reach a threshold of disease. At present, genetic counseling of dystonia patients remains a difficult task. Recently non-motor clinical findings in dystonias, new highlights in the pathophysiology of the disease, and the availability of high-throughput genome-wide techniques are proving useful tools to better understand the complexity of PTD genetics. We briefly review the genetic basis of the most common forms of hereditary PTDs, and discuss relevant issues related to molecular diagnosis and genetic counseling.
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Affiliation(s)
- Simona Petrucci
- Neurogenetics Unit, CSS-Mendel Laboratory, IRCCS Casa Sollievo della Sofferenza San Giovanni Rotondo, Italy ; Department of Experimental Medicine, "Sapienza" University of Rome Rome, Italy
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Roos RA. Genetic diagnosis of hyperkinetic movement disorders. ACTA ACUST UNITED AC 2013; 6:439-47. [PMID: 23480808 DOI: 10.1517/17530059.2012.704017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION People with hyperkinetic movements have always attracted the attention of the public and professionals. Alert colleagues noticed families in which a disease passed from generation to generation around Lake Maracaibo in Venezuela. This study led in 1993 to the localization of the gene for Huntington disease on chromosome 4. The genetic basis of many other familial and sporadic diseases has been identified on human DNA. AREAS COVERED The clinical presentation of hyperkinesias remains the starting point for diagnosis, but differential diagnosis is a long, difficult process, the first step being to differentiate between inherited and non-inherited forms. The need to know the diagnosis is of major importance for patient and family. Knowledge about the cause limits the number of extra diagnostics. This review of the literature presents the most frequently occurring genetically-determined forms of hyperkinesias, mainly chorea and dystonia and tries to give some practical guidelines. EXPERT OPINION The final part of the review will offer some thoughts and views for future development in a world which probably has more knowledge than we can handle. The drive to find a diagnosis is rewarded by the patient but one also needs to reflect on the use of medical care.
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Affiliation(s)
- Raymund Ac Roos
- Leiden University Medical Centre, Department of Neurology , K5Q 112, LUMC, PO Box 9600, 2300RC Leiden , The Netherlands +0031 71 526 2197 ; +0031 71 524 8253 ;
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Abstract
Progressive dystonias are a clinically and genetically heterogeneous group of movement disorders. In the primary forms, dystonia is the only sign of the disease, and the cause is either unknown or genetic. In the secondary forms, dystonia is usually only one of several disease manifestations and the cause may be genetic or due to other insults. Monogenic defects have been found to underlie many forms of dystonia syndromes, which are designated DYT1-20. Dystonias with known genes include DYT1 and DYT6 dystonia, presenting as isolated torsion dystonia, as well as DYT5 (dopa-responsive dystonia), DYT11 (myoclonus-dystonia), and DYT12 (rapid-onset dystonia-parkinsonism), where dystonia occurs in conjunction with other types of movement disorders. All of these conditions follow an autosomal dominant mode of inheritance, usually develop in childhood or early adolescence, and show an initially progressive course with stabilization in early adulthood. In secondary dystonias, there are often atypical features and additional neurological signs, such as prominent tongue and perioral involvement, pyramidal signs, ataxia, oculomotor abnormalities, or cognitive disturbances. Acquired brain lesions typically affect the putamen, thalamus, or globus pallidus and cause contralateral hemidystonia. Dystonia can be part of the clinical syndrome in many heredodegenerative disorders, or may be drug-induced or psychogenic.
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Affiliation(s)
- Christine Klein
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany.
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Fuchs T, Saunders-Pullman R, Masuho I, Luciano MS, Raymond D, Factor S, Lang AE, Liang TW, Trosch RM, White S, Ainehsazan E, Hervé D, Sharma N, Ehrlich ME, Martemyanov KA, Bressman SB, Ozelius LJ. Mutations in GNAL cause primary torsion dystonia. Nat Genet 2012; 45:88-92. [PMID: 23222958 PMCID: PMC3530620 DOI: 10.1038/ng.2496] [Citation(s) in RCA: 223] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 11/16/2012] [Indexed: 12/12/2022]
Abstract
Dystonia is a movement disorder characterized by repetitive twisting muscle contractions and postures1,2. Its molecular pathophysiology is poorly understood, in part due to limited knowledge of the genetic basis of the disorder. Only three genes for primary torsion dystonia (PTD), TOR1A (DYT1)3, THAP1 (DYT6)4, and CIZ15 have been identified. Using exome sequencing in two PTD families we identified a novel causative gene, GNAL, with a nonsense p.S293X mutation resulting in premature stop codon in one family and a missense p.V137M mutation in the other. Screening of GNAL in 39 PTD families, revealed six additional novel mutations in this gene. Impaired function of several of the mutations was shown by bioluminescence resonance energy transfer (BRET) assays.
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Affiliation(s)
- Tania Fuchs
- Department of Genetics and Genomic Sciences, Mount Sinai School of Medicine, New York, New York, USA
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40
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Zhao Y, Xiao J, Gong S, Clara JA, Ledoux MS. Neural expression of the transcription factor THAP1 during development in rat. Neuroscience 2012; 231:282-95. [PMID: 23219941 DOI: 10.1016/j.neuroscience.2012.11.049] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 11/24/2012] [Accepted: 11/27/2012] [Indexed: 10/27/2022]
Abstract
Loss of function mutations in THAP1 has been associated with primary generalized and focal dystonia in children and adults. THAP1 encodes a transcription factor (THAP1) that harbors an atypical zinc finger domain and plays a critical role in G(1)-S cell cycle control. Current thinking suggests that dystonia may be a neurodevelopmental circuit disorder. Hence, THAP1 may participate in the development of the nervous system. Herein, we report the neurodevelopmental expression patterns of Thap1 transcript and THAP1 protein from the early postnatal period through adulthood in the rat brain, spinal cord and dorsal root ganglia (DRG). We detected Thap1 transcript and THAP1-immunoreactivity (IR) in the cerebral cortex, cerebellum, striatum, substantia nigra, thalamus, spinal cord and DRG. Thap1 transcript expression was higher in the brain than in spinal cord and DRG at P1 and P7 and declined to similar levels at P14 and later time points in all regions except the cerebellum, where it remained high through adulthood. In the brain, THAP1 expression was highest in early development, particularly in the cerebellum at P7. In addition to Purkinje cells in the cerebellum, THAP1-IR was also localized to pyramidal neurons in the cerebral cortex, relay neurons in the thalamus, medium spiny and cholinergic neurons in the striatum, dopaminergic neurons in the substantia nigra, and pyramidal and interneurons in the hippocampus. In the cerebellar cortex, THAP1-IR was prominently distributed in the perikarya and proximal dendrites of Purkinje cells at early time-points. In contrast, it was more diffusely distributed throughout the dendritic arbor of adult Purkinje cells producing a moderate diffuse staining pattern in the molecular layer. At all time points, nuclear IR was weaker than cytoplasmic IR. The prominent cytoplasmic and developmentally regulated expression of THAP1 suggests that THAP1 may function as part of a cell surface-nucleus signaling cascade involved in terminal neural differentiation.
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Affiliation(s)
- Y Zhao
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN 38163, USA
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41
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Dobričić VS, Kresojević ND, Svetel MV, Janković MZ, Petrović IN, Tomić AD, Novaković IV, Kostić VS. Mutation screening of the DYT6/THAP1 gene in Serbian patients with primary dystonia. J Neurol 2012. [PMID: 23180184 DOI: 10.1007/s00415-012-6753-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Primary dystonia (PrD) is characterized by sustained muscle contractions, causing twisting and repetitive movements and abnormal postures. Besides DYT1/TOR1A gene, DYT6/THAP1 gene is the second gene known to cause primary pure dystonia. We screened 281 Serbian primary dystonia patients and 106 neurologically healthy control individuals for the GAG deletion in TOR1A gene and for mutations in THAP1 gene by direct sequencing. Nine subjects were found to have the GAG deletion in TOR1A gene. Four coding mutations, including two novel mutations, were identified in the THAP1 gene in five unrelated patients. Two mutations were missense, one was nonsense, and one was 24 bp duplication. None of the coding mutations were seen in 106 control individuals. In addition, one novel nucleotide change in the 5'UTR region of THAP1 gene was detected in two unrelated patients. The mutation frequency of THAP1 gene in Serbian patients with primary dystonia was 1.8 %, similar to the mutation frequency in other populations. Most of the patients reported here with THAP1 mutations had the clinical features of predominantly laryngeal or oromandibular dystonia. Our data expand the genotypic spectrum of THAP1 and strengthen the association with upper body involvement, including the cranial and cervical regions that are usually spared in DYT1-PrD.
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Affiliation(s)
- Valerija S Dobričić
- Institute of Neurology CCS, School of Medicine, University of Belgrade, Dr Subotića 6, 11000 Belgrade, Serbia
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Paudel R, Hardy J, Revesz T, Holton JL, Houlden H. Review: Genetics and neuropathology of primary pure dystonia. Neuropathol Appl Neurobiol 2012; 38:520-34. [PMID: 22897341 DOI: 10.1111/j.1365-2990.2012.01298.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- R Paudel
- Department of Molecular Neuroscience Queen Square Brain Bank and UCL Institute of Neurology, London, UK
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43
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Xiromerisiou G, Houlden H, Scarmeas N, Stamelou M, Kara E, Hardy J, Lees AJ, Korlipara P, Limousin P, Paudel R, Hadjigeorgiou GM, Bhatia KP. THAP1 mutations and dystonia phenotypes: genotype phenotype correlations. Mov Disord 2012; 27:1290-4. [PMID: 22903657 PMCID: PMC3664430 DOI: 10.1002/mds.25146] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Revised: 05/30/2012] [Accepted: 07/17/2012] [Indexed: 01/17/2023] Open
Abstract
THAP1 mutations have been shown to be the cause of DYT6. A number of different mutation types and locations in the THAP1 gene have been associated with a range of severity and dystonia phenotypes, but, as yet, it has been difficult to identify clear genotype phenotype patterns. Here, we screened the THAP1 gene in a further series of dystonia cases and evaluated the mutation pathogenicity in this series as well as previously reported mutations to investigate possible phenotype-genotype correlations. THAP1 mutations have been identified throughout the coding region of the gene, with the greatest concentration of variants localized to the THAP1 domain. In the additional cases analyzed here, a further two mutations were found. No obvious, indisputable genotype-phenotype correlation emerged from these data. However, we managed to find a correlation between the pathogenicity of mutations, distribution, and age of onset of dystonia. THAP1 mutations are an important cause of dystonia, but, as yet, no clear genotype-phenotype correlations have been identified. Greater mutation numbers in different populations will be important and mutation-specific functional studies will be essential to identify the pathogenicity of the various THAP1 mutations. © 2012 Movement Disorder Society
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Affiliation(s)
- Georgia Xiromerisiou
- Department of Molecular Neuroscience and Reta Lila Weston Institute, University College London Institute of Neurology, London, London, United Kingdom; Department of Neurology, Faculty of Medicine University of Thessaly, Larissa, Greece.
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Campagne S, Muller I, Milon A, Gervais V. Towards the classification of DYT6 dystonia mutants in the DNA-binding domain of THAP1. Nucleic Acids Res 2012; 40:9927-40. [PMID: 22844099 PMCID: PMC3479173 DOI: 10.1093/nar/gks703] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The transcription factor THAP1 (THanatos Associated Protein 1) has emerged recently as the cause of DYT6 primary dystonia, a type of rare, familial and mostly early-onset syndrome that leads to involuntary muscle contractions. Many of the mutations described in the DYT6 patients fall within the sequence-specific DNA-binding domain (THAP domain) of THAP1 and are believed to negatively affect DNA binding. Here, we have used an integrated approach combining spectroscopic (NMR, fluorescence, DSF) and calorimetric (ITC) methods to evaluate the effect of missense mutations, within the THAP domain, on the structure, stability and DNA binding. Our study demonstrates that none of the mutations investigated failed to bind DNA and some of them even bind DNA stronger than the wild-type protein. However, some mutations could alter DNA-binding specificity. Furthermore, the most striking effect is the decrease of stability observed for mutations at positions affecting the zinc coordination, the hydrophobic core or the C-terminal AVPTIF motif, with unfolding temperatures ranging from 46°C for the wild-type to below 37°C for two mutations. These findings suggest that reduction in population of folded protein under physiological conditions could also account for the disease.
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Affiliation(s)
- Sébastien Campagne
- CNRS; IPBS (Institut de Pharmacologie et de Biologie Structurale); 205 route de Narbonne, BP64182, F-31077 Toulouse, France
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45
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Miyamoto R, Ohta E, Kawarai T, Koizumi H, Sako W, Izumi Y, Obata F, Kaji R. Broad spectrum of dystonia associated with a novel thanatosis-associated protein domain-containing apoptosis-associated protein 1 mutation in a Japanese family with dystonia 6, torsion. Mov Disord 2012; 27:1324-5. [DOI: 10.1002/mds.25106] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Revised: 05/22/2012] [Accepted: 06/11/2012] [Indexed: 11/12/2022] Open
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Cheng FB, Wan XH, Feng JC, Ma LY, Hou B, Feng F, Wang L, Yang YM. Subcellular distribution of THAP1 and alterations in the microstructure of brain white matter in DYT6 dystonia. Parkinsonism Relat Disord 2012; 18:978-82. [PMID: 22652465 DOI: 10.1016/j.parkreldis.2012.05.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Revised: 03/29/2012] [Accepted: 05/09/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUND Mutations in the THAP1 gene have recently been identified as the cause of DYT6 primary dystonia. However, the changes in THAP1 gene function and in the microstructure of brain white matter have not been well-characterized. METHODS Four different mutations of THAP1 expression (clones F22fs71X, C54F, F25fs53X, and L180S) were transfected into HEK-293T cells. The subcellular distribution of THAP1 in each clone was identified using immunofluorescence microscopy and Western blot. Six patients who harbored these THAP1 mutations underwent diffusion tensor magnetic resonance imaging (DTI) of the brain. The fractional anisotropy (FA) and mean diffusivity (MD) were measured in twenty-four regions of interest (ROI). RESULTS In two truncated mutations (F22fs71X and F25fs53X), the subcellular distribution of THAP1 were both in the cytoplasm and nucleus. However, the subcellular distribution was detected almost in the nucleus in two missense mutations (C54F and L180S). In the DTI maps, the average values of fractional anisotropy (FA), a measure of axonal integrity and coherence, was reduced (p < 0.005) in the subgyral white matter of the sensorimotor cortex of the DYT1 carriers, comparing with controls. CONCLUSIONS Truncated THAP1 mutations (F22fs71X and F25fs53X) can alter the subcellular distributions, while some missense mutation (C54F and L180S) can not. The axonal integrity and coherence in the region of sensorimotor area of the brain was damaged in DYT6 dystonia.
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Affiliation(s)
- Fu Bo Cheng
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1# Shuaifuyuan, Wangfujing Street, Beijing, PR China
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Fernández-Alvarez E, Nardocci N. Update on pediatric dystonias: etiology, epidemiology, and management. Degener Neurol Neuromuscul Dis 2012; 2:29-41. [PMID: 30890876 DOI: 10.2147/dnnd.s16082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Dystonia is a movement disorder characterized by sustained muscle contractions producing twisting, repetitive, and patterned movements or abnormal postures. Dystonia is among the most commonly observed movement disorders in clinical practice both in adults and children. It is classified on the basis of etiology, age at onset of symptoms, and distribution of affected body regions. Etiology The etiology of pediatric dystonia is quite heterogeneous. There are many different genetic syndromes and several causes of symptomatic syndromes. Dystonia can be secondary to virtually any pathological process that affects the motor system, and particularly the basal ganglia. Classification The etiological classification distinguishes primary dystonia with no identifiable exogenous cause or evidence of neurodegeneration and secondary syndromes. Treatment Treatment for most forms of dystonia is symptomatic and includes drugs (systemic or focal treatments, such as botulinum toxin) and surgical procedures. There are several medications including anticholinergic, dopamine-blocking and depleting agents, baclofen, and benzodiazepines. In patients with dopamine synthesis defects L-dopa treatment may be very useful. Botulinum toxin treatment may be helpful in controlling the most disabling symptoms of segmental or focal dystonia. Long-term electrical stimulation of the globus pallidum internum appears to be especially successful in children suffering from generalized dystonia.
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Affiliation(s)
| | - Nardo Nardocci
- Child Neurology Department, Fondazione IRCCS Istituto Neurologico "C. Besta", Milano, Italy
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