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Májovská J, Nestrašil I, Ahmed A, Bondy MT, Klempíř J, Jahnová H, Schneider SA, Horáková D, Krásenský J, Ješina P, Vaneckova M, Nascene DR, Whitley CB, Jarnes JR, Magner M, Dušek P. Quantitative brain morphometry identifies cerebellar, cortical, and subcortical gray and white matter atrophy in late-onset Tay-Sachs disease. J Inherit Metab Dis 2024; 47:327-339. [PMID: 38112342 PMCID: PMC10947897 DOI: 10.1002/jimd.12700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/08/2023] [Accepted: 12/05/2023] [Indexed: 12/21/2023]
Abstract
Cerebellar atrophy is a characteristic sign of late-onset Tay-Sachs disease (LOTS). Other structural neuroimaging abnormalities are inconsistently reported. Our study aimed to perform a detailed whole-brain analysis and quantitatively characterize morphometric changes in LOTS patients. Fourteen patients (8 M/6F) with LOTS from three centers were included in this retrospective study. For morphometric brain analyses, we used deformation-based morphometry, voxel-based morphometry, surface-based morphometry, and spatially unbiased cerebellar atlas template. The quantitative whole-brain morphometric analysis confirmed the finding of profound pontocerebellar atrophy with most affected cerebellar lobules V and VI in LOTS patients. Additionally, the atrophy of structures mainly involved in motor control, including bilateral ventral and lateral thalamic nuclei, primary motor and sensory cortex, supplementary motor area, and white matter regions containing corticospinal tract, was present. The atrophy of the right amygdala, hippocampus, and regions of occipital, parietal and temporal white matter was also observed in LOTS patients in contrast with controls (p < 0.05, FWE corrected). Patients with dysarthria and those initially presenting with ataxia had more severe cerebellar atrophy. Our results show predominant impairment of cerebellar regions responsible for speech and hand motor function in LOTS patients. Widespread morphological changes of motor cortical and subcortical regions and tracts in white matter indicate abnormalities in central motor circuits likely coresponsible for impaired speech and motor function.
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Affiliation(s)
- Jitka Májovská
- Department of Pediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital Prague, Czech Republic
| | - Igor Nestrašil
- Division of Clinical Behavioral Neuroscience, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Alia Ahmed
- Advanced Therapies Program, Division of Genetics and Metabolism, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Monica T Bondy
- Division of Clinical Behavioral Neuroscience, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Jiří Klempíř
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - Helena Jahnová
- Department of Pediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital Prague, Czech Republic
| | | | - Dana Horáková
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - Jan Krásenský
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - Pavel Ješina
- Department of Pediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital Prague, Czech Republic
| | - Manuela Vaneckova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - David R Nascene
- Department of Neuroradiology, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Chester B Whitley
- Advanced Therapies Program, Division of Genetics and Metabolism, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, USA
- Gene Therapy and Diagnostic Laboratory, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, USA
- Department of Experimental and Clinical Pharmacology, University of Minnesota, College of Pharmacy, Minneapolis, MN, USA
| | - Jeanine R Jarnes
- Advanced Therapies Program, Division of Genetics and Metabolism, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, USA
- Department of Experimental and Clinical Pharmacology, University of Minnesota, College of Pharmacy, Minneapolis, MN, USA
| | - Martin Magner
- Department of Pediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital Prague, Czech Republic
| | - Petr Dušek
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
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Letter response: Intra-familial phenotype variability in Late-Onset Tay-Sachs disease. Tremor Other Hyperkinet Mov (N Y) 2023; 13:6. [PMID: 36873913 PMCID: PMC9983494 DOI: 10.5334/tohm.756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 02/07/2023] [Indexed: 02/24/2023] Open
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Krishnan S, Saraf U, Chandarana M, Divya KP. Oromandibular dystonia – A systematic review. Ann Indian Acad Neurol 2022; 25:26-34. [PMID: 35342238 PMCID: PMC8954320 DOI: 10.4103/aian.aian_242_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 08/10/2021] [Accepted: 09/04/2021] [Indexed: 11/04/2022] Open
Abstract
Oromandibular dystonia (OMD) is a clinical problem which is commonly encountered in the practice of movement disorders. OMD results from a variety of genetic and acquired etiologies and can occur as an isolated manifestation, or as part of an isolated generalized or a combined dystonia syndrome. There are only very few systematic reviews on this condition which often causes significant disability. We review here the etiology, clinical features, diagnostic approach and management of OMD.
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Saini A, Kaur J, Bhanudeep S, Suresh R, Bhatia V. Neurodegeneration with progressive dystonia: Juvenile-onset tay–Sachs disease. Ann Indian Acad Neurol 2022; 25:324-325. [PMID: 35693683 PMCID: PMC9175441 DOI: 10.4103/aian.aian_419_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 11/04/2021] [Accepted: 11/25/2021] [Indexed: 11/08/2022] Open
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Diagnostic Tips from a Video Series and Literature Review of Patients with Late-Onset Tay-Sachs Disease. Tremor Other Hyperkinet Mov (N Y) 2022; 12:34. [PMID: 36618998 PMCID: PMC9801838 DOI: 10.5334/tohm.726] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 12/13/2022] [Indexed: 12/28/2022] Open
Abstract
Background Late-Onset Tay-Sachs (LOTS) disease is a rare, progressive neurological condition that can dramatically affect the life of these patients. The diagnosis of LOTS is easily missed because of the multifaced presentation of these patients, who can initially be assessed by neuromuscular or movement disorder specialists, or psychiatrists. Clinical trials are now becoming available for LOTS. Therefore, early diagnosis can be detrimental for these patients and for insuring informative research outcomes. Methods We characterized a cohort of nine patients with LOTS through a detailed clinical and video description. We then reviewed the available literature regarding the clinical description of patients with LOTS. Our findings were summarized based on the predominant phenotype of presentation to highlight diagnostic clues to guide the diagnosis of LOTS for different neurology specialists (neuromuscular, movement disorders) and psychiatrist. Results We described a cohort of 9 new patients with LOTS seen at our clinic. Our literature review identified 76 patients mainly presenting with a neuromuscular, cerebellar, psychiatric, stuttering, or movement disorder phenotype. Diagnostic tips, such as the triceps sign, distinct speech patterns, early psychiatric presentation and impulsivity, as well as neurological symptoms (cerebellar or neuromuscular) in patients with a prominent psychiatric presentation, are described. Discussion Specific diagnostics clues can help neurologists and psychiatrists in the early diagnosis of LOTS disease. Our work also represent the first video presentation of a cohort of patients with LOTS that can help different specialists to familiarize with these features and improve diagnostic outcomes. Highlights Late-Onset Tay-Sachs (LOTS) disease, a severe progressive neurological condition, has multifaced presentations causing diagnostic delays that can significantly affect research outcomes now that clinical trials are available. We highlight useful diagnostic clues from our cohort (including the first video representation of a LOTS cohort) and comprehensive literature review.
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The GM2 gangliosidoses: Unlocking the mysteries of pathogenesis and treatment. Neurosci Lett 2021; 764:136195. [PMID: 34450229 PMCID: PMC8572160 DOI: 10.1016/j.neulet.2021.136195] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/13/2021] [Accepted: 08/20/2021] [Indexed: 12/28/2022]
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Rowe OE, Rangaprakash D, Weerasekera A, Godbole N, Haxton E, James PF, Stephen CD, Barry RL, Eichler FS, Ratai EM. Magnetic resonance imaging and spectroscopy in late-onset GM2-gangliosidosis. Mol Genet Metab 2021; 133:386-396. [PMID: 34226107 PMCID: PMC8289742 DOI: 10.1016/j.ymgme.2021.06.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 06/18/2021] [Accepted: 06/19/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Our study aimed to quantify structural changes in relation to metabolic abnormalities in the cerebellum, thalamus, and parietal cortex of patients with late-onset GM2-gangliosidosis (LOGG), which encompasses late-onset Tay-Sachs disease (LOTS) and Sandhoff disease (LOSD). METHODS We enrolled 10 patients with LOGG (7 LOTS, 3 LOSD) who underwent a neurological assessment battery and 7 age-matched controls. Structural MRI and MRS were performed on a 3 T scanner. Structural volumes were obtained from FreeSurfer and normalized by total intracranial volume. Quantified metabolites included N-acetylaspartate (NAA), choline (Cho), myo-inositol (mI), creatine (Cr), and combined glutamate-glutamine (Glx). Metabolic concentrations were corrected for partial volume effects. RESULTS Structural analyses revealed significant cerebellar atrophy in the LOGG cohort, which was primarily driven by LOTS patients. NAA was lower and mI higher in LOGG, but this was also significantly driven by the LOTS patients. Clinical ataxia deficits (via the Scale for the Assessment and Rating of Ataxia) were associated with neuronal injury (via NAA), neuroinflammation (via mI), and volumetric atrophy in the cerebellum. INTERPRETATION The decrease of NAA in the cerebellum suggests that, in addition to cerebellar atrophy, there is ongoing impaired neuronal function and/or loss, while an increase in mI indicates possible neuroinflammation in LOGG (more so within the LOTS subvariant). Quantifying cerebellar atrophy in relation to neurometabolic differences in LOGG may lead to improvements in assessing disease severity, progression, and pharmacological efficacy. Lastly, additional neuroimaging studies in LOGG are required to contrast LOTS and LOSD more accurately.
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Affiliation(s)
- Olivia E Rowe
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - D Rangaprakash
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Akila Weerasekera
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Neha Godbole
- Leukodystrophy Clinic, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Center for Rare Neurological Diseases, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Elizabeth Haxton
- Leukodystrophy Clinic, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Center for Rare Neurological Diseases, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Peter F James
- Leukodystrophy Clinic, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Center for Rare Neurological Diseases, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Christopher D Stephen
- Center for Rare Neurological Diseases, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Movement Disorders Division and Ataxia Center, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Robert L Barry
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA; Harvard-Massachusetts Institute of Technology Health Sciences & Technology, Cambridge, MA, USA
| | - Florian S Eichler
- Leukodystrophy Clinic, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Center for Rare Neurological Diseases, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Eva-Maria Ratai
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA; Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
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Robertson SC, Diaz K. Case Report of Acquired Stuttering After Soccer-Related Concussion: Functional Magnetic Resonance Imaging as a Prognostic Tool. World Neurosurg 2020; 142:401-403. [DOI: 10.1016/j.wneu.2020.06.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/28/2020] [Accepted: 06/30/2020] [Indexed: 10/23/2022]
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Stephen CD, Balkwill D, James P, Haxton E, Sassower K, Schmahmann JD, Eichler F, Lewis R. Quantitative oculomotor and nonmotor assessments in late-onset GM2 gangliosidosis. Neurology 2020; 94:e705-e717. [PMID: 31964693 DOI: 10.1212/wnl.0000000000008959] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 08/23/2019] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE A cross-sectional study was performed to evaluate whether quantitative oculomotor measures correlate with disease severity in late-onset GM2 gangliosidosis (LOGG) and assess cognition and sleep as potential early nonmotor features. METHODS Ten patients with LOGG underwent quantitative oculomotor recordings, including measurements of the angular vestibulo-ocular reflex (VOR), with results compared to age- and sex-matched controls. Disease severity was assessed by ataxia rating scales. Cognitive/neuropsychiatric features were assessed by the cerebellar cognitive affective syndrome (CCAS) scale, Cerebellar Neuropsychiatric Rating Scale, and sleep quality evaluated using subjective sleep scales. RESULTS Oculomotor abnormalities were found in all participants, including 3/10 with clinically normal eye movements. Abnormalities involved impaired saccadic accuracy (5/10), abnormal vertical (8/10) and horizontal (4/10) pursuit, reduced optokinetic nystagmus (OKN) responses (7/10), low VOR gain (10/10), and impaired VOR cancellation (2/10). Compared to controls, the LOGG group showed significant differences in saccade, VOR, OKN, and visually enhanced VOR gains. Severity of saccadic dysmetria, OKN, and VOR fixation-suppression impairments correlated with ataxia scales (p < 0.05). Nine out of ten patients with LOGG had evidence of the CCAS (5/10 definite, 2/10 probable, 2/10 possible). Excessive daytime sleepiness was present in 4/10 and 8/10 had poor subjective sleep quality. CONCLUSIONS Cerebellar oculomotor abnormalities were present in all patients with LOGG, including those with normal clinical oculomotor examinations. Saccade accuracy (dorsal cerebellar vermis localization), fixation suppression, and OKN gain (cerebellar flocculus/paraflocculus localization) correlated with disease severity, suggesting that quantitative oculomotor measurements could be used to track disease progression. We found evidence of the CCAS, suggesting that cerebellar dysfunction may explain the cognitive disorder in LOGG. Sleep impairments were prevalent and require further study.
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Affiliation(s)
- Christopher D Stephen
- From the Ataxia Unit (C.D.S., J.D.S.), Center for Rare Neurological Diseases (C.D.S., P.J., E.H., F.E.), Cognitive Behavioral Neurology Unit (J.D.S.), Laboratory for Neuroanatomy and Cerebellar Neurobiology (C.D.S., J.D.S.), and Sleep Division, Department of Neurology (K.S.), Massachusetts General Hospital, and Jenks Vestibular Physiology Laboratory (D.B., R.L.), Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston.
| | - David Balkwill
- From the Ataxia Unit (C.D.S., J.D.S.), Center for Rare Neurological Diseases (C.D.S., P.J., E.H., F.E.), Cognitive Behavioral Neurology Unit (J.D.S.), Laboratory for Neuroanatomy and Cerebellar Neurobiology (C.D.S., J.D.S.), and Sleep Division, Department of Neurology (K.S.), Massachusetts General Hospital, and Jenks Vestibular Physiology Laboratory (D.B., R.L.), Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
| | - Peter James
- From the Ataxia Unit (C.D.S., J.D.S.), Center for Rare Neurological Diseases (C.D.S., P.J., E.H., F.E.), Cognitive Behavioral Neurology Unit (J.D.S.), Laboratory for Neuroanatomy and Cerebellar Neurobiology (C.D.S., J.D.S.), and Sleep Division, Department of Neurology (K.S.), Massachusetts General Hospital, and Jenks Vestibular Physiology Laboratory (D.B., R.L.), Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
| | - Elizabeth Haxton
- From the Ataxia Unit (C.D.S., J.D.S.), Center for Rare Neurological Diseases (C.D.S., P.J., E.H., F.E.), Cognitive Behavioral Neurology Unit (J.D.S.), Laboratory for Neuroanatomy and Cerebellar Neurobiology (C.D.S., J.D.S.), and Sleep Division, Department of Neurology (K.S.), Massachusetts General Hospital, and Jenks Vestibular Physiology Laboratory (D.B., R.L.), Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
| | - Kenneth Sassower
- From the Ataxia Unit (C.D.S., J.D.S.), Center for Rare Neurological Diseases (C.D.S., P.J., E.H., F.E.), Cognitive Behavioral Neurology Unit (J.D.S.), Laboratory for Neuroanatomy and Cerebellar Neurobiology (C.D.S., J.D.S.), and Sleep Division, Department of Neurology (K.S.), Massachusetts General Hospital, and Jenks Vestibular Physiology Laboratory (D.B., R.L.), Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
| | - Jeremy D Schmahmann
- From the Ataxia Unit (C.D.S., J.D.S.), Center for Rare Neurological Diseases (C.D.S., P.J., E.H., F.E.), Cognitive Behavioral Neurology Unit (J.D.S.), Laboratory for Neuroanatomy and Cerebellar Neurobiology (C.D.S., J.D.S.), and Sleep Division, Department of Neurology (K.S.), Massachusetts General Hospital, and Jenks Vestibular Physiology Laboratory (D.B., R.L.), Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
| | - Florian Eichler
- From the Ataxia Unit (C.D.S., J.D.S.), Center for Rare Neurological Diseases (C.D.S., P.J., E.H., F.E.), Cognitive Behavioral Neurology Unit (J.D.S.), Laboratory for Neuroanatomy and Cerebellar Neurobiology (C.D.S., J.D.S.), and Sleep Division, Department of Neurology (K.S.), Massachusetts General Hospital, and Jenks Vestibular Physiology Laboratory (D.B., R.L.), Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
| | - Richard Lewis
- From the Ataxia Unit (C.D.S., J.D.S.), Center for Rare Neurological Diseases (C.D.S., P.J., E.H., F.E.), Cognitive Behavioral Neurology Unit (J.D.S.), Laboratory for Neuroanatomy and Cerebellar Neurobiology (C.D.S., J.D.S.), and Sleep Division, Department of Neurology (K.S.), Massachusetts General Hospital, and Jenks Vestibular Physiology Laboratory (D.B., R.L.), Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
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