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Sugumaran R, Bhuvaneswaran R. A Man With Progressive Chorea and Abnormal Trunk Movements. Cureus 2024; 16:e62004. [PMID: 38989367 PMCID: PMC11233200 DOI: 10.7759/cureus.62004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2024] [Indexed: 07/12/2024] Open
Abstract
Neuroacanthocytosis (NA) syndromes are a group of rare genetic disorders characterized by the presence of abnormally shaped red blood cells (acanthocytes) and the progressive degeneration of the basal ganglia, leading to various neurological and systemic symptoms. The "rubber man" gait, characterized by distinctive flexions of the neck (manifesting as head drops) and the trunk, is seen in advanced chorea-acanthocytosis. A 35-year-old male patient presented with progressive abnormal movements affecting his limbs and face, along with dysphagia resulting from involuntary protrusion of the tongue and biting of the cheeks and lips over the past three years. He used to place the food on the back of his tongue and throw his head back to begin swallowing. He also kept a towel in his mouth to absorb saliva and prevent cheek and lip biting. The neurologic examination revealed generalized chorea, severe orolingual dystonia (eating dystonia), and sudden loss of tone while walking, resulting in flexion of the trunk followed by extension. We believe that these features could serve as definitive clinical indicators for chorea-acanthocytosis, providing valuable diagnostic insights, especially when accompanied by self-mutilatory mouth movements or feeding-related tongue dystonia.
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Affiliation(s)
- Ramkumar Sugumaran
- Neurology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
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2
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Dal Pai J, da Silva JC, Sanabria V, Amorim RP, Predebon G, Cossa AC, Trindade-Filho E, Amado D. Non-Status Epilepticus female rats show seizure-like behaviors in the chronic phase of Pilocarpine experimental model. BRAZ J BIOL 2023; 83:e237412. [DOI: 10.1590/1519-6984.237412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 06/04/2021] [Indexed: 11/22/2022] Open
Abstract
Abstract Only few studies have focus on animals that received Pilocarpine (Pilo) and did not develop behavioral status epilepticus (SE) and, whether they may become epileptic in the model’s chronic phase. Previews works observed mossy fiber sprouting in the hippocampus of Non-SE (NSE) rats, while others observed spontaneous and recurrent seizures (SRS) 6 - 8 months after animals received Pilo. It is known that neuronal excitability is influenced by female hormones, as well as, the occurrence of SE in castrated and non-castrated female rats. However, it is not known whether females that received Pilo and did not show SE, may have SRS. The aim of this work was to investigate whether castrated and non-castrated female rats that did not show behavioral SE after Pilo, will develop SRS in the following one-year. For that, animals received 360 mg/kg of Pilo and were video monitored for 12 months. SE females from castrated and non-castrated groups became epileptic since the first month after drug injection. Epileptic behaviors were identified watching video monitoring recordings in the fast speed. Castrated and Non-castrated NSE animals showed behaviors resembling seizures described by Racine Scale stages 1 - 3. Motor alterations showed by NSE groups could be observed only when recordings were analyzed in slow speed. In addition, behavioral manifestations as, rhythmic head movements, sudden head movements, whole body movements and immobility were also observed in both, SE and NSE groups. We concluded that NSE female rats may have become epileptic. Adding to it, slow speed analysis of motor alterations was essential for the observation of NSE findings, which suggests that possibly many motor alterations have been underestimated in epilepsy experimental research.
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Affiliation(s)
- J. Dal Pai
- Universidade Federal de São Paulo, Brasil
| | - J. C. da Silva
- Universidade Estadual de Ciências da Saúde de Alagoas, Brasil; Centro Universitário CESMAC, Brasil
| | | | | | | | | | - E. Trindade-Filho
- Universidade Estadual de Ciências da Saúde de Alagoas, Brasil; Centro Universitário CESMAC, Brasil
| | - D. Amado
- Universidade Federal de São Paulo, Brasil
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3
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Soman Pillai K, Maramattom BV, Gopalannair Santhamma S, Kishore A. Head Drop and Trunk Flexion as an Early Manifestation of Anti-IgLON5 Disease. Mov Disord Clin Pract 2023; 10:135-137. [PMID: 36704078 PMCID: PMC9847274 DOI: 10.1002/mdc3.13575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/09/2022] [Accepted: 09/04/2022] [Indexed: 01/29/2023] Open
Affiliation(s)
- Kanchana Soman Pillai
- Parkinson and Movement Disorder Centre, Aster MedcityKochiIndia
- Centre of Excellence in Neurosciences, Aster MedcityKochiIndia
| | | | | | - Asha Kishore
- Parkinson and Movement Disorder Centre, Aster MedcityKochiIndia
- Centre of Excellence in Neurosciences, Aster MedcityKochiIndia
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4
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Cisterna A, González-Vidal A, Ruiz D, Ortiz J, Gómez-Pascual A, Chen Z, Nalls M, Faghri F, Hardy J, Díez I, Maietta P, Álvarez S, Ryten M, Botía JA. PhenoExam: gene set analyses through integration of different phenotype databases. BMC Bioinformatics 2022; 23:567. [PMID: 36587217 PMCID: PMC9805686 DOI: 10.1186/s12859-022-05122-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 12/22/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Gene set enrichment analysis (detecting phenotypic terms that emerge as significant in a set of genes) plays an important role in bioinformatics focused on diseases of genetic basis. To facilitate phenotype-oriented gene set analysis, we developed PhenoExam, a freely available R package for tool developers and a web interface for users, which performs: (1) phenotype and disease enrichment analysis on a gene set; (2) measures statistically significant phenotype similarities between gene sets and (3) detects significant differential phenotypes or disease terms across different databases. RESULTS PhenoExam generates sensitive and accurate phenotype enrichment analyses. It is also effective in segregating gene sets or Mendelian diseases with very similar phenotypes. We tested the tool with two similar diseases (Parkinson and dystonia), to show phenotype-level similarities but also potentially interesting differences. Moreover, we used PhenoExam to validate computationally predicted new genes potentially associated with epilepsy. CONCLUSIONS We developed PhenoExam, a freely available R package and Web application, which performs phenotype enrichment and disease enrichment analysis on gene set G, measures statistically significant phenotype similarities between pairs of gene sets G and G' and detects statistically significant exclusive phenotypes or disease terms, across different databases. We proved with simulations and real cases that it is useful to distinguish between gene sets or diseases with very similar phenotypes. Github R package URL is https://github.com/alexcis95/PhenoExam . Shiny App URL is https://alejandrocisterna.shinyapps.io/phenoexamweb/ .
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Affiliation(s)
- Alejandro Cisterna
- Departamento de Ingeniería de la Información y las Comunicaciones, Universidad de Murcia, Murcia, Spain
| | - Aurora González-Vidal
- Departamento de Ingeniería de la Información y las Comunicaciones, Universidad de Murcia, Murcia, Spain
| | - Daniel Ruiz
- Departamento de Ingeniería de la Información y las Comunicaciones, Universidad de Murcia, Murcia, Spain
| | - Jordi Ortiz
- Departamento de Ingeniería de la Información y las Comunicaciones, Universidad de Murcia, Murcia, Spain
| | - Alicia Gómez-Pascual
- Departamento de Ingeniería de la Información y las Comunicaciones, Universidad de Murcia, Murcia, Spain
| | - Zhongbo Chen
- Department of Neurodegenerative Disease, UCL, Institute of Neurology, London, UK
| | - Mike Nalls
- Data Tecnica International LLC, Glen Echo, MD, USA
- Laboratory of Neurogenetics, NIA/NIH, Bethesda, MD, USA
- Center for Alzheimer's and Related Dememtias, NIH, Bethesda, MD, USA
| | - Faraz Faghri
- Data Tecnica International LLC, Glen Echo, MD, USA
- Laboratory of Neurogenetics, NIA/NIH, Bethesda, MD, USA
- Center for Alzheimer's and Related Dememtias, NIH, Bethesda, MD, USA
| | - John Hardy
- Department of Neurodegenerative Disease, UCL, Institute of Neurology, London, UK
- Reta Lila Weston Institute, UCL Queen Square Institute of Neurology, London, UK
- UCL Movement Disorders Centre, University College London, London, UK
- Institute for Advanced Study, The Hong Kong University of Science and Technology, Hong Kong, China
| | - Irene Díez
- NIMGenetics Genómica y Medicina S.L, Madrid, Spain
| | | | - Sara Álvarez
- NIMGenetics Genómica y Medicina S.L, Madrid, Spain
| | - Mina Ryten
- Department of Neurodegenerative Disease, UCL, Institute of Neurology, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London, London, UK
- Genetics and Genomic Medicine, Great Ormond Street Institute of Child Health, University College London, London, WC1E 6BT, UK
| | - Juan A Botía
- Departamento de Ingeniería de la Información y las Comunicaciones, Universidad de Murcia, Murcia, Spain.
- Department of Neurodegenerative Disease, UCL, Institute of Neurology, London, UK.
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5
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He W, Li C, Dong H, Shao L, Yin B, Li D, Ye L, Hu P, Zhang C, Yi W. Pallidus Stimulation for Chorea-Acanthocytosis: A Systematic Review and Meta-Analysis of Individual Data. J Mov Disord 2022; 15:197-205. [PMID: 35880382 PMCID: PMC9536914 DOI: 10.14802/jmd.22003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 05/27/2022] [Indexed: 11/24/2022] Open
Abstract
A significant proportion of patients with chorea-acanthocytosis (ChAc) fail to respond to standard therapies. Recent evidence suggests that globus pallidus internus (GPi) deep brain stimulation (DBS) is a promising treatment option; however, reports are few and limited by sample sizes. We conducted a systematic literature review to evaluate the clinical outcome of GPi-DBS for ChAc. PubMed, Embase, and Cochrane Library databases were searched for relevant articles published before August 2021. The improvement of multiple motor and nonmotor symptoms was qualitatively presented. Improvements in the Unified Huntington’s Disease Rating Scale motor score (UHDRS-MS) were also analyzed during different follow-up periods. A multivariate linear regression analysis was conducted to identify potential predictors of clinical outcomes. Twenty articles, including 27 patients, were eligible. Ninety-six percent of patients with oromandibular dystonia reported significant improvement. GPi-DBS significantly improved the UHDRS-motor score at < 6 months (p < 0.001) and ≥ 6 months (p < 0.001). The UHDRS-motor score improvement rate was over 25% in 75% (15/20 cases) of patients at long-term follow-up (≥ 6 months). The multiple linear regression analysis showed that sex, age at onset, course of disease, and preoperative movement score had no linear relationship with motor improvement at long-term follow-up (p > 0.05). GPi-DBS is an effective and safe treatment in most patients with ChAc, but no reliable predictor of efficacy has been found. Oromandibular dystonia-dominant patients might be the best candidates for GPi-DBS.
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Affiliation(s)
- Weibin He
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Chenhui Li
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Hongjuan Dong
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Lingmin Shao
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Bo Yin
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Dianyou Li
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liguo Ye
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ping Hu
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Chencheng Zhang
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Yi
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
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6
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Deep brain stimulation for chorea-acanthocytosis: a systematic review. Neurosurg Rev 2022; 45:1861-1871. [PMID: 35020105 DOI: 10.1007/s10143-022-01735-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/22/2021] [Accepted: 01/03/2022] [Indexed: 02/05/2023]
Abstract
Deep brain stimulation (DBS) is a reversible treatment for chorea-acanthocytosis (ChAc). Its safety and efficacy remain elusive due to the low prevalence of ChAc. We aimed to investigate the safety and efficacy of DBS for ChAc by systematically reviewing literature through PubMed and EMBASE. Inclusion criteria were reports on the efficacy or safety of DBS for ChAc and English language articles, and exclusion criteria were other movement disorders, non-human subjects, and studies without original data. Most studies were published as case reports, and we therefore pooled these cases in one cohort. Twenty studies with 34 patients were included. The mean age of symptom onset was 29.3 years (range, 17-48). The median follow-up was 12 months (range, 2-84). Twenty-nine patients underwent GPi-DBS, two received STN-DBS, and one underwent Vop-DBS. Electrodes were implanted into the ventralis oralis complex of the thalamus and the pallidal in two patients. Symptoms seemed to be easier relieved in chorea (88.5%) and dystonia (76.9%) but dysarthria of most patients (85.7%) was no response after DBS. The Unified Huntington's Disease Rating Scale-Motor Score was used to assess the efficacy of DBS in 25 patients; the mean score decreased from 43.2 to 22.3 and the median improvement rate was 46.7%. Of 24 patients with data on adverse events, complications occurred in 9 patients (37.5%; mostly transient and mild events). DBS is a promising treatment for ChAc with satisfactory efficacy and safety based on the review. Pallidal and thalamic DBS have been applied in ChAc; GPi-DBS seems to be more widely used.
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McIntosh P, Scott B. Clinical Reasoning: A 55-Year-Old Man With Odd Behavior and Abnormal Movements. Neurology 2021; 97:1090-1093. [PMID: 34400586 DOI: 10.1212/wnl.0000000000012663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Paul McIntosh
- From the Duke University Medical Center, Durham, NC.
| | - Burton Scott
- From the Duke University Medical Center, Durham, NC
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8
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Skripkina NA, Datieva VK, Levin OS. [Case-report of neuroacanthocytosis associated with a compound mutation in the VPS13A gene]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:104-110. [PMID: 34693697 DOI: 10.17116/jnevro2021121091104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Neuroacanthocytosis is a group of neurodegenerative diseases manifested by a combition of neurological symptoms (most often choreic hyperkinesis) and the presence of an increased number of acanthocytes (erythrocytes with horns) in the peripheral blood. This group includes chorea-acanthocytosis, MacLeod's syndrome, pantothenate kinase-associated neurodegeneration, Huntington-like disease type 2, and some other very rare diseases. This article presents a genetically confirmed clinical case of chorea-acanthocytosis associated with a compound mutation in the VPS13A gene, discusses in detail the stages of a diagnostic search, presents an algorithm for examining patients with chorea.
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Affiliation(s)
- N A Skripkina
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - V K Datieva
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - O S Levin
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
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Neeraja K, Prasad S, Holla VV, Kamble N, Yadav R, Pal PK. The Spectrum of Movement Disorders in Neuroacanthocytosis Syndromes: A Video Series. Mov Disord Clin Pract 2021; 8:983-986. [PMID: 34405112 DOI: 10.1002/mdc3.13269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 06/01/2021] [Accepted: 06/06/2021] [Indexed: 11/05/2022] Open
Affiliation(s)
- Koti Neeraja
- Department of Neurology National Institute of Mental Health and Neurosciences (NIMHANS) Bengaluru India
| | - Shweta Prasad
- Department of Neurology National Institute of Mental Health and Neurosciences (NIMHANS) Bengaluru India.,Department of Clinical Neurosciences National Institute of Mental Health and Neurosciences (NIMHANS) Bengaluru India
| | - Vikram V Holla
- Department of Neurology National Institute of Mental Health and Neurosciences (NIMHANS) Bengaluru India
| | - Nitish Kamble
- Department of Neurology National Institute of Mental Health and Neurosciences (NIMHANS) Bengaluru India
| | - Ravi Yadav
- Department of Neurology National Institute of Mental Health and Neurosciences (NIMHANS) Bengaluru India
| | - Pramod K Pal
- Department of Neurology National Institute of Mental Health and Neurosciences (NIMHANS) Bengaluru India
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10
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Mulroy E, Baschieri F, Magrinelli F, Latorre A, Cortelli P, Bhatia KP. Movement Disorders and Liver Disease. Mov Disord Clin Pract 2021; 8:828-842. [PMID: 34401403 PMCID: PMC8354085 DOI: 10.1002/mdc3.13238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 04/24/2021] [Accepted: 04/27/2021] [Indexed: 12/15/2022] Open
Abstract
The association of movement disorders with structural or functional hepatic disease occurs in three principal scenarios: (1) combined involvement of both organ systems from a single disease entity, (2) nervous system dysfunction resulting from exposure to toxic compounds in the setting of defective hepatic clearance, or (3) hepatic and/or neurological injury secondary to exposure to exogenous drugs or toxins. An important early step in the workup of any patient with combined movement disorders and liver disease is the exclusion of Wilson's disease. Diagnostic delay remains common for this treatable disorder, and this has major implications for patient outcomes. Thereafter, a structured approach integrating variables such as age of onset, tempo of progression, nature and severity of liver involvement, movement disorder phenomenology, exposure to drugs/toxins and laboratory/neuroimaging findings is key to ensuring timely diagnosis and disease‐specific therapy. Herein, we provide an overview of disorders which may manifest with a combination of movement disorders and liver disease, structured under the three headings as detailed above. In each section, the most common disorders are discussed, along with important clinical pearls, suggested diagnostic workup, differential diagnoses and where appropriate, treatment considerations.
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Affiliation(s)
- Eoin Mulroy
- Department of Clinical and Movement Neurosciences UCL Queen Square Institute of Neurology London United Kingdom
| | - Francesca Baschieri
- IRCCS Istituto delle Scienze Neurologiche di Bologna Bologna Italy.,Dipartimento di Scienze Biomediche e Neuromotorie Università di Bologna Bologna Italy
| | - Francesca Magrinelli
- Department of Clinical and Movement Neurosciences UCL Queen Square Institute of Neurology London United Kingdom.,Department of Neurosciences Biomedicine and Movement Sciences, University of Verona Verona Italy
| | - Anna Latorre
- Department of Clinical and Movement Neurosciences UCL Queen Square Institute of Neurology London United Kingdom
| | - Pietro Cortelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna Bologna Italy.,Dipartimento di Scienze Biomediche e Neuromotorie Università di Bologna Bologna Italy
| | - Kailash P Bhatia
- Department of Clinical and Movement Neurosciences UCL Queen Square Institute of Neurology London United Kingdom
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Maciel R, Maia DP, Cardoso F. Comment on: Voluntary Inhibitory Control of Chorea. Mov Disord Clin Pract 2021; 8:634-635. [PMID: 33981804 DOI: 10.1002/mdc3.13187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 01/05/2021] [Indexed: 11/11/2022] Open
Affiliation(s)
- Ricardo Maciel
- Movement Disorders Unit Hospital das Clínicas, Federal University of Minas Gerais Belo Horizonte Brazil
| | - Débora P Maia
- Movement Disorders Unit Hospital das Clínicas, Federal University of Minas Gerais Belo Horizonte Brazil
| | - Francisco Cardoso
- Movement Disorders Unit Hospital das Clínicas, Federal University of Minas Gerais Belo Horizonte Brazil
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12
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Stephen CD, Go CL, Acuna P, Sharma N. Phasic Knee Bending Dystonic and Parkinsonian Gait: A Characteristic Finding in X-Linked Dystonia Parkinsonism. Mov Disord Clin Pract 2020; 7:448-452. [PMID: 32373662 DOI: 10.1002/mdc3.12929] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 01/22/2020] [Accepted: 02/26/2020] [Indexed: 11/11/2022] Open
Abstract
Background X-linked dystonia parkinsonism (XDP) is a rare disorder characterized by adult-onset, progressive dystonia that, over time, is combined with or replaced by features of parkinsonism. Gait impairment is common. Methods Case series of 4 XDP patients with a unique gait disorder. Results The patients displayed a characteristic gait disorder with combined dystonic and parkinsonian gait features, with phasic knee bending. Of these patients, all had parkinsonism and three-quarters had prominent dystonic features, but 1 had predominant parkinsonism and subtle dystonic features. Conclusion Although XDP is a classic form of dystonia parkinsonism, some cases can mimic idiopathic Parkinson's disease. We describe a gait disorder which appears unique to XDP, involving phasic dystonic knee bending superimposed on parkinsonian shuffling, and may help clinically differentiate one of our parkinsonian-predominant patients from more-common forms of parkinsonism. The gait is distinct from other complex dystonic disorders with gait involvement.
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Affiliation(s)
- Christopher D Stephen
- Dystonia Clinic and Movement Disorders Unit Department of Neurology, Massachusetts General Hospital and Harvard Medical School Boston MA USA
| | - Criscely L Go
- Department of Behavioral Medicine Jose Reyes Memorial Medical Center Manila Philippines
| | - Patrick Acuna
- Dystonia Clinic and Movement Disorders Unit Department of Neurology, Massachusetts General Hospital and Harvard Medical School Boston MA USA
| | - Nutan Sharma
- Dystonia Clinic and Movement Disorders Unit Department of Neurology, Massachusetts General Hospital and Harvard Medical School Boston MA USA
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13
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A Wilted Flower: Lotus Position Dystonia. Mov Disord Clin Pract 2020; 7:206-207. [DOI: 10.1002/mdc3.12886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 11/21/2019] [Accepted: 12/07/2019] [Indexed: 11/07/2022] Open
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Abstract
PURPOSE OF REVIEW This article provides an overview of the approach to chorea in clinical practice, beginning with a discussion of the phenomenologic features of chorea and how to differentiate it from other movement disorders. The diagnostic approach, clinical features of important acquired and genetic choreas, and therapeutic principles are also discussed. Practical clinical points and caveats are included. RECENT FINDINGS C9orf72 disease is the most common Huntington disease phenocopy, according to studies in the European population. Anti-IgLON5 disease can present with chorea. The role of immunotherapies in Sydenham chorea has increased, and further clinical studies may be useful. Benign hereditary chorea is a syndrome or phenotype due to mutations in several genes, including NKX2-1, ADCY5, GNAO1, and PDE10A. New-generation presynaptic dopamine-depleting agents provide more options for symptomatic treatment of chorea with fewer adverse effects. Deep brain stimulation has been performed in several choreic disorders, but features other than chorea and the neurodegenerative nature should be taken into consideration. Studies on genetic interventions for Huntington disease are ongoing. SUMMARY Clinical features remain crucial in guiding the differential diagnosis and appropriate investigations in chorea. Given the complexity of most choreic disorders, treating only the chorea is not sufficient. A comprehensive and multidisciplinary approach is required.
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Criminal Behaviour Associated with a Novel Mutation in the VPS13A-Gene Causing Chorea-Acanthocytosis. Case Rep Psychiatry 2019; 2019:5947416. [PMID: 31139485 PMCID: PMC6500623 DOI: 10.1155/2019/5947416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 04/01/2019] [Indexed: 11/29/2022] Open
Abstract
Heralded by obsessive-compulsive disorder and anxiety, chorea-acanthocytosis may initially present in a psychiatric setting. As insidious onset of involuntary movements is commonly precipitated by dopamine blocking agents, this may not prompt further neurological investigation until symptoms progress after withdrawal of the suspected offending drug. Oromandibular dystonia and frontal disinhibition should call for early neurologic evaluation.
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Paramanandam V, Lizarraga KJ, Soh D, Algarni M, Rohani M, Fasano A. Unusual gait disorders: a phenomenological approach and classification. Expert Rev Neurother 2018; 19:119-132. [DOI: 10.1080/14737175.2019.1562337] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Vijayashankar Paramanandam
- Edmond J. Safra Program in Parkinson’s Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital and Division of Neurology, UHN, Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Karlo J. Lizarraga
- Edmond J. Safra Program in Parkinson’s Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital and Division of Neurology, UHN, Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Derrick Soh
- Edmond J. Safra Program in Parkinson’s Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital and Division of Neurology, UHN, Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Musleh Algarni
- Edmond J. Safra Program in Parkinson’s Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital and Division of Neurology, UHN, Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Mohammad Rohani
- Department of Neurology, Hazrat Rasool Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson’s Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital and Division of Neurology, UHN, Division of Neurology, University of Toronto, Toronto, ON, Canada
- Krembil Brain Institute, Toronto, ON, Canada
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17
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Liu Z, Liu Y, Wan X, Yang Y, Wang L, Dou W, Guo J, Wang Y, Guo Y, Ma W, Wang R. Pallidal Deep Brain Stimulation in Patients With Chorea-Acanthocytosis. Neuromodulation 2018; 21:741-747. [DOI: 10.1111/ner.12763] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 01/08/2018] [Accepted: 01/31/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Ziyuan Liu
- Department of Neurosurgery; Peking Union Medical College Hospital, Chinese Academy of Medical Sciences; Beijing People's Republic of China
| | - Yang Liu
- Department of Neurosurgery; Peking Union Medical College Hospital, Chinese Academy of Medical Sciences; Beijing People's Republic of China
| | - Xinhua Wan
- Department of Neurology; Peking Union Medical College Hospital, Chinese Academy of Medical Sciences; Beijing People's Republic of China
| | - Yingmai Yang
- Department of Neurology; Peking Union Medical College Hospital, Chinese Academy of Medical Sciences; Beijing People's Republic of China
| | - Lin Wang
- Department of Neurology; Peking Union Medical College Hospital, Chinese Academy of Medical Sciences; Beijing People's Republic of China
| | - Wanchen Dou
- Department of Neurosurgery; Peking Union Medical College Hospital, Chinese Academy of Medical Sciences; Beijing People's Republic of China
| | - Jinzhu Guo
- Department of Neurosurgery; Peking Union Medical College Hospital, Chinese Academy of Medical Sciences; Beijing People's Republic of China
| | - Yu Wang
- Department of Neurosurgery; Peking Union Medical College Hospital, Chinese Academy of Medical Sciences; Beijing People's Republic of China
| | - Yi Guo
- Department of Neurosurgery; Peking Union Medical College Hospital, Chinese Academy of Medical Sciences; Beijing People's Republic of China
| | - Wenbin Ma
- Department of Neurosurgery; Peking Union Medical College Hospital, Chinese Academy of Medical Sciences; Beijing People's Republic of China
| | - Renzhi Wang
- Department of Neurosurgery; Peking Union Medical College Hospital, Chinese Academy of Medical Sciences; Beijing People's Republic of China
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Termsarasab P, Frucht SJ. The "Stutter-Step": A Peculiar Gait Feature in Advanced Huntington's Disease and Chorea-Acanthocytosis. Mov Disord Clin Pract 2018; 5:223-224. [PMID: 30746406 DOI: 10.1002/mdc3.12586] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 12/10/2017] [Accepted: 12/28/2017] [Indexed: 11/11/2022] Open
Affiliation(s)
| | - Steven J Frucht
- Movement Disorder Division, Neurology Department New York University School of Medicine New York New York USA
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19
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Liu J, Heinsen H, Grinberg LT, Alho E, Amaro E, Pasqualucci CA, Rüb U, den Dunnen W, Arzberger T, Schmitz C, Kiessling M, Bader B, Danek A. Subcortical neurodegeneration in chorea: Similarities and differences between chorea-acanthocytosis and Huntington's disease. Parkinsonism Relat Disord 2018; 49:54-59. [PMID: 29402698 DOI: 10.1016/j.parkreldis.2018.01.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 12/05/2017] [Accepted: 01/07/2018] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Chorea-acanthocytosis (ChAc) and Huntington's disease (HD) are neurodegenerative conditions that share clinical and neuropathological features, despite their distinct genetic etiologies. METHODS In order to compare these neuropathologies, serial gallocyanin-stained brain sections from three subjects with ChAc were analyzed and compared with our previous studies of eight HD cases, in addition to three hemispheres from two male controls. RESULTS Astrogliosis was much greater in the ChAc striatum, as compared to that found in HD, with dramatic increase in total striatal glia numbers and the number of glia per striatal neuron. Striatal astrocytes are most likely derived from the striatal subependymal layer in ChAc, which showed massive proliferation. The thalamic centromedian-parafascicular complex is reciprocally connected to the striatum and is more heavily affected in HD than in ChAc. CONCLUSION The distinct patterns of selective vulnerability and gliosis observed in HD and ChAc challenge simplistic views on the pathogenesis of these two diseases with rather similar clinical signs. The particular roles played by astroglia in ChAc and in HD clearly need to be elucidated in more detail.
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Affiliation(s)
- Jia Liu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China; Neurologische Klinik und Poliklinik, Ludwig-Maximilians-Universität München, Germany.
| | - Helmut Heinsen
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital Würzburg, Germany; Departments of Pathology and Radiology, University of São Paulo Medical School, São Paulo, Brazil.
| | - Lea T Grinberg
- Department of Neurology, University of California, San Francisco, USA
| | - Eduardo Alho
- Praça Amadeu Amaral, 27, cj 31, Bela Vista, São Paulo, Brazil
| | - Edson Amaro
- Department of Radiology, University of São Paulo Medical School, São Paulo, Brazil
| | - Carlos A Pasqualucci
- Departments of Pathology and Radiology, University of São Paulo Medical School, São Paulo, Brazil
| | - Udo Rüb
- Dr. Senckenbergisches Chronomedizinisches Institut, Goethe-Universität, Frankfurt/Main, Germany
| | - Wilfred den Dunnen
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Thomas Arzberger
- Center for Neuropathology and Prion Research, Ludwig-Maximilians-University Munich, Germany; Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Germany
| | - Christoph Schmitz
- Department of Neuroanatomy, Ludwig-Maximilians-Universität München, Germany
| | - Maren Kiessling
- Department of Neuroanatomy, Ludwig-Maximilians-Universität München, Germany
| | - Benedikt Bader
- Neurologische Klinik und Poliklinik, Ludwig-Maximilians-Universität München, Germany; Clienia Privatklinik für Psychiatrie und Psychotherapie, Oetwil am See, Switzerland
| | - Adrian Danek
- Neurologische Klinik und Poliklinik, Ludwig-Maximilians-Universität München, Germany
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20
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Phenomenology and disease progression of chorea-acanthocytosis patients in Spain. Parkinsonism Relat Disord 2017; 49:17-21. [PMID: 29317187 DOI: 10.1016/j.parkreldis.2017.10.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 09/28/2017] [Accepted: 10/19/2017] [Indexed: 11/23/2022]
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21
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Bhidayasiri R, Jitkritsadakul O, Walker RH. Axial Sensory Tricks in Chorea-Acanthocytosis: Insights into Phenomenology. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2017; 7:475. [PMID: 28690922 PMCID: PMC5498799 DOI: 10.7916/d8pv6rww] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 05/22/2017] [Indexed: 12/01/2022]
Abstract
Background Trunk flexion and axial extension are characteristic symptoms of chorea–acanthocytosis (ChAc). Phenomenology Shown A 41-year-old male with ChAc (confirmed by VPS13A mutations) reported that his involuntary axial movements were significantly ameliorated by either folding his arms over his chest or putting his hands behind his head. Educational Value These apparent “sensory tricks” suggest a dystonic pathophysiology, and also merit further study to analyze their potential for symptom control in ChAc.
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Affiliation(s)
- Roongroj Bhidayasiri
- Chulalongkorn Center of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.,Department of Neurology, Juntendo University, Tokyo, Japan
| | - Onanong Jitkritsadakul
- Chulalongkorn Center of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Ruth H Walker
- Department of Neurology, James J. Peters Veterans Affairs Medical Center, New York, NY, USA.,Department of Neurology, Mount Sinai School of Medicine, New York, NY, USA
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22
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Ehrlich DJ, Walker RH. Functional neuroimaging and chorea: a systematic review. JOURNAL OF CLINICAL MOVEMENT DISORDERS 2017. [PMID: 28649394 PMCID: PMC5479019 DOI: 10.1186/s40734-017-0056-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Chorea is a hyperkinetic movement disorder consisting of involuntary irregular, flowing movements of the trunk, neck or face. Although Huntington’s disease is the most common cause of chorea in adults, chorea can also result from many other neurodegenerative, metabolic, and autoimmune conditions. While the pathophysiology of these different conditions is quite variable, recent advances in functional imaging have enabled the development of new methods for analysis of brain activity and neuronal dysfunction. In this paper we review the growing body of functional imaging data that has been performed in chorea syndromes and identify particular trends, which can be used to better understand the underlying network changes within the basal ganglia. While it can be challenging to identify whether changes are primary, secondary, or compensatory, identification of these trends can ultimately be useful in diagnostic testing and treatment in many of the conditions that cause chorea.
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Affiliation(s)
- Debra J Ehrlich
- Department of Neurology, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, 1st Floor, Box 1637, New York, NY 10029 USA
| | - Ruth H Walker
- Department of Neurology, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, 1st Floor, Box 1637, New York, NY 10029 USA.,Department of Neurology, James J Peters Veterans Affairs Medical Center, 130 West Kingsbridge Road, Bronx, NY 10468 USA
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23
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24
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Tozawa T, Yokochi K, Kono S, Konishi T, Yamamoto T, Nishimura A, Chiyonobu T, Morimoto M, Hosoi H. A Video Report of Brain-Lung-Thyroid Syndrome in a Japanese Female With a Novel Frameshift Mutation of the NKX2-1 Gene. Child Neurol Open 2017; 3:2329048X16665012. [PMID: 28503612 PMCID: PMC5417288 DOI: 10.1177/2329048x16665012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 06/08/2016] [Accepted: 07/12/2016] [Indexed: 11/29/2022] Open
Abstract
Benign hereditary chorea is a rare autosomal-dominant disorder that is characterized by childhood-onset nonprogressive chorea and normal cognitive function. Defects in NKX2-1 on chromosome 14q13, which encodes thyroid transcription factor 1, produce a concurrent clinical manifestation of chorea, respiratory distress, and hypothyroidism known as “brain–lung–thyroid syndrome.” Here, the authors describe a video report of benign hereditary chorea in a Japanese female with a novel frameshift mutation of NKX2-1 (c.915_916insC) (p.Ala303ArgfsX132) that was initially misdiagnosed as ataxic cerebral palsy. In early infancy, especially before the appearance of chorea, benign hereditary chorea can be misdiagnosed as ataxic and dyskinetic cerebral palsy due to shared clinical features including motor delay, hypotonia, ataxic gait, and dystonia.
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Affiliation(s)
| | - Kenji Yokochi
- Department of Pediatric Neurology, Seirei-Mikatahara General Hospital, Hamamatsu, Japan
| | - Satoshi Kono
- First Department of Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Takashi Konishi
- First Department of Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Toshiyuki Yamamoto
- Tokyo Women's Medical University Institute for Integrated Medical Sciences, Tokyo, Japan
| | - Akira Nishimura
- Department of Neonatology, Japanese Red Cross Society Kyoto Daiichi Hospital, Kyoto, Japan
| | - Tomohiro Chiyonobu
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masafumi Morimoto
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hajime Hosoi
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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25
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Carecchio M, Mencacci NE, Iodice A, Pons R, Panteghini C, Zorzi G, Zibordi F, Bonakis A, Dinopoulos A, Jankovic J, Stefanis L, Bhatia KP, Monti V, R'Bibo L, Veneziano L, Garavaglia B, Fusco C, Wood N, Stamelou M, Nardocci N. ADCY5-related movement disorders: Frequency, disease course and phenotypic variability in a cohort of paediatric patients. Parkinsonism Relat Disord 2017; 41:37-43. [PMID: 28511835 PMCID: PMC5549507 DOI: 10.1016/j.parkreldis.2017.05.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 04/27/2017] [Accepted: 05/08/2017] [Indexed: 12/11/2022]
Abstract
Introduction ADCY5 mutations have been recently identified as an important cause of early-onset hyperkinetic movement disorders. The phenotypic spectrum associated with mutations in this gene is expanding. However, the ADCY5 mutational frequency in cohorts of paediatric patients with hyperkinetic movement disorders has not been evaluated. Methods We performed a screening of the entire ADCY5 coding sequence in 44 unrelated subjects with genetically undiagnosed childhood-onset hyperkinetic movement disorders, featuring chorea alone or in combination with myoclonus and dystonia. All patients had normal CSF analysis and brain imaging and were regularly followed-up in tertiary centers for paediatric movement disorders. Results We identified five unrelated subjects with ADCY5 mutations (11% of the cohort). Three carried the p. R418W mutation, one the p. R418Q and one the p. R418G mutation. Mutations arose de novo in four cases, while one patient inherited the mutation from his similarly affected father. All patients had delayed motor and/or language milestones with or without axial hypotonia and showed generalized chorea and dystonia, with prominent myoclonic jerks in one case. Episodic exacerbations of the baseline movement disorder were observed in most cases, being the first disease manifestation in two patients. The disease course was variable, from stability to spontaneous improvement during adolescence. Conclusion Mutations in ADCY5 are responsible for a hyperkinetic movement disorder that can be preceded by episodic attacks before the movement disorder becomes persistent and is frequently misdiagnosed as dyskinetic cerebral palsy. A residual degree of neck hypotonia and a myopathy-like facial appearance are frequently observed in patients with ADCY5 mutations. ADCY5 mutational frequency in paediatric patients is unknown. 5/44 (11%) subjects in our cohort carried pathogenic ADCY5 mutations. Chorea-dystonia, exacerbations and developmental delay are often observed together. Disease course and clinical features are variable among patients with ADCY5 mutations. Residual cervical hypotonia and a myopathy-like face are additional diagnostic clues.
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Affiliation(s)
- Miryam Carecchio
- Molecular Neurogenetics Unit, IRCCS Foundation Neurological Institute C. Besta, Via L. Temolo 4, 20126 Milan, Italy; Department of Pediatric Neurology, IRCCS Foundation Neurological Institute C. Besta, Via Celoria 11, 20133 Milan, Italy; Department of Medicine and Surgery, PhD Programme in Molecular and Translational Medicine, University of Milan Bicocca, Via Cadore 48, 20900 Monza, Italy
| | - Niccolò E Mencacci
- Department of Molecular Neuroscience, UCL Institute of Neurology, WC1N 3BG London, United Kingdom; Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, 60611 Illinois, USA.
| | - Alessandro Iodice
- Child Neurology and Psychiatry Unit, Department of Pediatrics, IRCCS Santa Maria Nuova Hospital, Viale Risorgimento 80, 42123 Reggio nell'Emilia, Italy
| | - Roser Pons
- First Pediatric Clinic, University of Athens, Agia Sofia Children's Hospital, Thivon and Levadias, 11527 Athens, Greece
| | - Celeste Panteghini
- Molecular Neurogenetics Unit, IRCCS Foundation Neurological Institute C. Besta, Via L. Temolo 4, 20126 Milan, Italy
| | - Giovanna Zorzi
- Department of Pediatric Neurology, IRCCS Foundation Neurological Institute C. Besta, Via Celoria 11, 20133 Milan, Italy
| | - Federica Zibordi
- Department of Pediatric Neurology, IRCCS Foundation Neurological Institute C. Besta, Via Celoria 11, 20133 Milan, Italy
| | - Anastasios Bonakis
- Second Department of Neurology, Attiko University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Argyris Dinopoulos
- Third Department of Paediatrics, Attiko University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Athens, Greece
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, 7200 Cambridge, Houston, TX 77030-4202, USA
| | - Leonidas Stefanis
- Second Department of Neurology, Attiko University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Kailash P Bhatia
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London, Institute of Neurology, London WC1N 3BG, United Kingdom
| | - Valentina Monti
- Molecular Neurogenetics Unit, IRCCS Foundation Neurological Institute C. Besta, Via L. Temolo 4, 20126 Milan, Italy
| | - Lea R'Bibo
- Department of Molecular Neuroscience, UCL Institute of Neurology, WC1N 3BG London, United Kingdom
| | - Liana Veneziano
- Institute of Translational Pharmacology, National Research Council, Via Fosso del Cavaliere, 100, 00133 Rome, Italy
| | - Barbara Garavaglia
- Molecular Neurogenetics Unit, IRCCS Foundation Neurological Institute C. Besta, Via L. Temolo 4, 20126 Milan, Italy
| | - Carlo Fusco
- Child Neurology and Psychiatry Unit, Department of Pediatrics, IRCCS Santa Maria Nuova Hospital, Viale Risorgimento 80, 42123 Reggio nell'Emilia, Italy
| | - Nicholas Wood
- Department of Molecular Neuroscience, UCL Institute of Neurology, WC1N 3BG London, United Kingdom
| | - Maria Stamelou
- Movement Disorders Department, HYGEIA Hospital, Athens, Greece; Second Department of Neurology, Attiko University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nardo Nardocci
- Department of Pediatric Neurology, IRCCS Foundation Neurological Institute C. Besta, Via Celoria 11, 20133 Milan, Italy
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26
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Antelmi E, Plazzi G. Head drops: electromyography may give the way. Sleep Med 2017; 33:68-69. [DOI: 10.1016/j.sleep.2016.11.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 10/11/2016] [Accepted: 11/08/2016] [Indexed: 01/09/2023]
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27
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Abstract
PURPOSE OF REVIEW This article reviews the clinical approach to the diagnosis of adult patients presenting with chorea, using Huntington disease (HD) as a point of reference, and presents the clinical elements that help in the diagnostic workup. Principles of management for chorea and some of the associated features of other choreic syndromes are also described. RECENT FINDINGS Mutations in the C9orf72 gene, previously identified in families with a history of frontotemporal dementia, amyotrophic lateral sclerosis, or both, have been recognized as one of the most prevalent causes of HD phenocopies in the white population. SUMMARY The diagnosis of chorea in adult patients is challenging. A varied number of associated causes require a physician to prioritize the investigations, and a detailed history of chorea and associated findings will help. For chorea presenting as part of a neurodegenerative syndrome, the consideration of a mutation in the C9orf72 gene is a new recommendation after excluding HD. There are no new treatment options for chorea, aside from dopamine blockers and tetrabenazine. There are no disease-modifying treatments for HD or other neurodegenerative choreic syndromes.
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28
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Ortega MCP, Skármeta NP, Diaz YJ. Management of oromandibular dystonia on a chorea acanthocytosis: a brief review of the literature and a clinical case. Cranio 2016; 34:332-7. [DOI: 10.1179/2151090315y.0000000027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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29
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Antelmi E, Plazzi G, Erro R, Tinuper P, Balint B, Liguori R, Bhatia KP. Intermittent head drops: the differential spectrum. J Neurol Neurosurg Psychiatry 2016; 87:414-9. [PMID: 26085650 DOI: 10.1136/jnnp-2015-310864] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 05/27/2015] [Indexed: 01/18/2023]
Abstract
Intermittent Head Drops are episodic head flexion movements that can occur in a number of conditions. Typically, the term has mainly been related to epileptic episodes, but the spectrum of clinical conditions associated with this feature is wide-ranging even if never discussed in detail. By searching the electronic database, we may find that apart from the epileptic conditions, Intermittent Head Drops have been in fact reported in the setting of movement disorders, sleep disorders and even internal medicine disorders, such as Sandifer syndrome. We render an in-depth description of this characteristic phenomenon in different diseases, describing the clinical clues and neurophysiological patterns that may help the clinician to distinguish between the different settings of occurrence.
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Affiliation(s)
- Elena Antelmi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy Sobell Department of Motor Neuroscience and Movement Disorders, University College London (UCL) Institute of Neurology, London, UK
| | - Giuseppe Plazzi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Roberto Erro
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London (UCL) Institute of Neurology, London, UK
| | - Paolo Tinuper
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Bettina Balint
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London (UCL) Institute of Neurology, London, UK
| | - Rocco Liguori
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Kailash P Bhatia
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London (UCL) Institute of Neurology, London, UK
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30
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Thapa L, Bhattarai S, Shrestha MP, Panth R, Gongal DN, Devkota UP. Chorea-acanthocytosis: a case report. Int Med Case Rep J 2016; 9:39-42. [PMID: 26955294 PMCID: PMC4772938 DOI: 10.2147/imcrj.s95882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Neuroacanthocytosis is a group of rare disorders. We report a 36-year-old right-handed female who presented with gradually progressive abnormal facial movements, generalized weakness, and lower-lip biting starting 4 years ago. On examination, she had lower-lip ulcer, orofacial dyskinesias, and peripheral neuropathy. Her peripheral blood smears showed acanthocytosis and magnetic resonance imaging revealed atrophied head of caudate nuclei and putaminal hyperintensities on T2-weighted and fluid attenuated inversion recovery images. Work-up for autoimmune and metabolic causes was negative. She was diagnosed with chorea-acanthocytosis, an entity under neuroacanthocytosis syndrome and the patient was offered symptomatic treatment.
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Affiliation(s)
- Lekhjung Thapa
- Department of Neurology, National Institute of Neurological and Allied Sciences, Kathmandu, Nepal
| | - Suman Bhattarai
- Department of Neurology, National Institute of Neurological and Allied Sciences, Kathmandu, Nepal
| | - Milan P Shrestha
- Department of Neurology, National Institute of Neurological and Allied Sciences, Kathmandu, Nepal
| | - Rajesh Panth
- Department of Pathology, National Institute of Neurological and Allied Sciences, Kathmandu, Nepal
| | - Dinesh Nath Gongal
- Department of Neurosurgery, National Institute of Neurological and Allied Sciences, Kathmandu, Nepal
| | - Upendra Prasad Devkota
- Department of Neurosurgery, National Institute of Neurological and Allied Sciences, Kathmandu, Nepal
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31
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Schneider SA, Bird T. Huntington's Disease, Huntington's Disease Look-Alikes, and Benign Hereditary Chorea: What's New? Mov Disord Clin Pract 2016; 3:342-354. [PMID: 30713928 DOI: 10.1002/mdc3.12312] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 11/22/2015] [Accepted: 11/23/2015] [Indexed: 12/17/2022] Open
Abstract
Background The differential diagnosis of chorea syndromes is complex. It includes inherited forms, the most common of which is autosomal dominant Huntington's disease (HD). In addition, there are disorders mimicking HD, the so-called HD-like (HDL) syndromes. Methods and Results Here we review main clinical, genetic, and pathophysiological characteristics of HD and the rare HD phenocopies in order to familiarize clinicians with them. Molecular studies have shown that HD phenocopies account for about 1% of suspected HD cases, most commonly due to mutations in C9orf72 (also the main cause of frontotemporal dementia and amyotrophic lateral sclerosis syndromes), TATA box-binding protein (spinocerebellar ataxia type 17 [SCA17]/HDL4), and JPH3 (HDL2). Systematic screening studies also revealed mutations in PRNP (prion disease), VPS13A (chorea-acanthocytosis), ATXN8OS-ATXN8 (SCA8), and FXN (late-onset Friedreich's Ataxia) in single cases. Further differential diagnoses to consider in patients presenting with a clinical diagnosis consistent with HD, but without the HD expansion, include dentatorubral-pallidoluysian atrophy and benign hereditary chorea (TITF1), as well as the recently described form of ADCY5-associated neurodegeneration. Lastly, biallelic mutations in RNF216 and FRRS1L have recently been reported as autosomal recessive phenocopies of HD. Conclusion There is a growing list of genes associated with chorea, yet a substantial percentage of patients remain undiagnosed. It is likely that more genes will be discovered in the future and that the clinical spectrum of the described disorders will broaden.
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Affiliation(s)
- Susanne A Schneider
- Department of Neurology Ludwig-Maximilians-Universität München Munich Germany.,University of Kiel Kiel Germany
| | - Thomas Bird
- Department of Neurology University of Washington Seattle Seattle Washington U.S.A.,VA Puget Sound Health Care System Geriatric Research Education and Clinical Center Seattle Washington U.S.A
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32
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Nagy A, Noyce A, Velayos-Baeza A, Lees AJ, Warner TT, Ling H. Late Emergence of Parkinsonian Phenotype and Abnormal Dopamine Transporter Scan in Chorea-Acanthocytosis. Mov Disord Clin Pract 2015; 2:182-186. [PMID: 30713892 DOI: 10.1002/mdc3.12138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 11/14/2014] [Accepted: 11/21/2014] [Indexed: 11/05/2022] Open
Abstract
Chorea-acanthocytosis (ChAc) is a neurodegenerative condition predominantly manifesting with chorea and often acanthocytes on peripheral blood film. Abnormal appearances with 123I-FP-CIT single-photon emission computed tomography (SPECT) have not previously been reported in ChAc. We describe 2 cases with typical presentations of ChAc and late development of parkinsonism with asymmetric reduction in presynaptic striatal uptake on 123I-FP-CIT SPECT. Case 1, a 50-year-old male, developed micrographia and limb bradykinesia 14 years after initial presentation at the age of 30. Case 2, a 42-year-old female presenting with vocal tics and generalized dystonia at the age of 25, developed tremor, bradykinesia, and rigidity 11 years into the disease course. These cases represent the best description to date of the natural history of ChAc, in which the early hyperkinetic clinical syndromes give way to a parkinsonian phenotype. This is consistent with a gradual deterioration of presynaptic nigrostriatal projections, reflected in the clinical parkinsonism and abnormal 123I FP-CIT SPECT.
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Affiliation(s)
- Anna Nagy
- Reta Lila Weston Institute of Neurological Studies UCL Institute of Neurology London United Kingdom.,Barts and the London School of Medicine and Dentistry London United Kingdom
| | - Alastair Noyce
- Reta Lila Weston Institute of Neurological Studies UCL Institute of Neurology London United Kingdom.,Queen Square Brain Bank Department of Molecular Neuroscience UCL Institute of Neurology United Kingdom
| | | | - Andrew J Lees
- Reta Lila Weston Institute of Neurological Studies UCL Institute of Neurology London United Kingdom.,Queen Square Brain Bank Department of Molecular Neuroscience UCL Institute of Neurology United Kingdom
| | - Thomas T Warner
- Reta Lila Weston Institute of Neurological Studies UCL Institute of Neurology London United Kingdom.,Queen Square Brain Bank Department of Molecular Neuroscience UCL Institute of Neurology United Kingdom
| | - Helen Ling
- Reta Lila Weston Institute of Neurological Studies UCL Institute of Neurology London United Kingdom.,Queen Square Brain Bank Department of Molecular Neuroscience UCL Institute of Neurology United Kingdom
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Merwick Á, Mok T, McNamara B, Parfrey NA, Moore H, Sweeney BJ, Hand CK, Ryan AM. Phenotypic Variation in a Caucasian Kindred with Chorea-Acanthocytosis. Mov Disord Clin Pract 2014; 2:86-89. [PMID: 30713887 DOI: 10.1002/mdc3.12117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 10/15/2014] [Accepted: 10/17/2014] [Indexed: 11/06/2022] Open
Affiliation(s)
- Áine Merwick
- National Neuroscience Center Cork University Hospital Cork Ireland.,National Hospital for Neurology and Neurosurgery London United Kingdom
| | - Tzehow Mok
- National Neuroscience Center Cork University Hospital Cork Ireland.,National Hospital for Neurology and Neurosurgery London United Kingdom
| | - Brian McNamara
- National Neuroscience Center Cork University Hospital Cork Ireland
| | | | - Helena Moore
- National Neuroscience Center Cork University Hospital Cork Ireland
| | - Brian J Sweeney
- National Neuroscience Center Cork University Hospital Cork Ireland
| | - Collette K Hand
- Department of Pathology University College Cork Cork Ireland
| | - Aisling M Ryan
- National Neuroscience Center Cork University Hospital Cork Ireland
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Cardoso F. Differential diagnosis of Huntington's disease: what the clinician should know. Neurodegener Dis Manag 2014; 4:67-72. [PMID: 24640980 DOI: 10.2217/nmt.13.78] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Huntington's disease (HD), an autosomal-dominant illness caused by an expansion of the CAG repeats on the short arm of chromosome 4, is clinically characterized by a combination of movement disorders, cognitive decline and behavioral changes. HD accounts for 90-99% of patients who present with this clinical picture. The remaining patients that are negative for the HD genetic mutation are said to have HD phenocopies. Autosomal-dominant diseases that can mimic HD are HD-like 2, C9orf72 mutations, spinocerebellar ataxia type 2, spinocerebellar ataxia type 17 (HD-like 4), benign hereditary chorea, neuroferritinopathy (neurodegeneration with brain iron accumulation type 3), dentatorubropallidoluysian atrophy and HD-like 1. There are also autosomal-recessive choreas that can be HD phenocopies: Friedreich's ataxia, neuroacanthocytosis, several forms of neurodegeneration with brain iron accumulation, ataxia telangiectasia, HD-like 3 and ataxia with oculomotor apraxia. Among X‑linked conditions, McLeod syndrome can mimic the clinical features of HD. Although less frequently, sporadic conditions, such as tardive dyskinesia and non-Wilsonian hepatolenticular degeneration, can also mimic HD.
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Affiliation(s)
- Francisco Cardoso
- Neurology Service, Department of Internal Medicine, The Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
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Abstract
PURPOSE OF REVIEW The differential diagnosis of chorea syndromes may be complex and includes various genetic disorders such as Huntington's disease and mimicking disorders called Huntington's disease-like (HDL) phenotypes. To familiarize clinicians with these (in some cases very rare) conditions we will summarize the main characteristics. RECENT FINDINGS HDL disorders are rare and account for about 1% of cases presenting with a Huntington's disease phenotype. They share overlapping clinical features, so making the diagnosis purely on clinical grounds may be challenging, however presence of certain characteristics may be a clue (e.g. prominent orofacial involvement in neuroferritinopathy etc.), Information of ethnic descent will also guide genetic work-up [HDL2 in Black Africans; dentatorubral-pallidoluysian atrophy (DRPLA) in Japanese etc.], Huntington's disease, the classical HDL disorders (except HDL3) and DRPLA are repeat disorders with anticipation effect and age-dependent phenotype in some, but genetic underpinnings may be more complicated in the other chorea syndromes. SUMMARY With advances in genetics more and more rare diseases are disentangled, allowing molecular diagnoses in a growing number of choreic patients. Hopefully, with better understanding of their pathophysiology we are moving towards mechanistic therapies.
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Miquel M, Spampinato U, Latxague C, Aviles-Olmos I, Bader B, Bertram K, Bhatia K, Burbaud P, Burghaus L, Cho JW, Cuny E, Danek A, Foltynie T, Garcia Ruiz PJ, Giménez-Roldán S, Guehl D, Guridi J, Hariz M, Jarman P, Kefalopoulou ZM, Limousin P, Lipsman N, Lozano AM, Moro E, Ngy D, Rodriguez-Oroz MC, Shang H, Shin H, Walker RH, Yokochi F, Zrinzo L, Tison F. Short and long term outcome of bilateral pallidal stimulation in chorea-acanthocytosis. PLoS One 2013; 8:e79241. [PMID: 24223913 PMCID: PMC3818425 DOI: 10.1371/journal.pone.0079241] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 09/19/2013] [Indexed: 11/28/2022] Open
Abstract
Background Chorea-acanthocytosis (ChAc) is a neuroacanthocytosis syndrome presenting with severe movement disorders poorly responsive to drug therapy. Case reports suggest that bilateral deep brain stimulation (DBS) of the ventro-postero-lateral internal globus pallidus (GPi) may benefit these patients. To explore this issue, the present multicentre (n=12) retrospective study collected the short and long term outcome of 15 patients who underwent DBS. Methods Data were collected in a standardized way 2-6 months preoperatively, 1-5 months (early) and 6 months or more (late) after surgery at the last follow-up visit (mean follow-up: 29.5 months). Results Motor severity, assessed by the Unified Huntington’s Disease Rating Scale-Motor Score, UHDRS-MS), was significantly reduced at both early and late post-surgery time points (mean improvement 54.3% and 44.1%, respectively). Functional capacity (UHDRS-Functional Capacity Score) was also significantly improved at both post-surgery time points (mean 75.5% and 73.3%, respectively), whereas incapacity (UHDRS-Independence Score) improvement reached significance at early post-surgery only (mean 37.3%). Long term significant improvement of motor symptom severity (≥20 % from baseline) was observed in 61.5 % of the patients. Chorea and dystonia improved, whereas effects on dysarthria and swallowing were variable. Parkinsonism did not improve. Linear regression analysis showed that preoperative motor severity predicted motor improvement at both post-surgery time points. The most serious adverse event was device infection and cerebral abscess, and one patient died suddenly of unclear cause, 4 years after surgery. Conclusion This study shows that bilateral DBS of the GPi effectively reduces the severity of drug-resistant hyperkinetic movement disorders such as present in ChAc.
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Affiliation(s)
- Marie Miquel
- Service de Neurologie, CHU Bordeaux, Bordeaux, France
- Service de Neurologie, CH François Mitterrand, Pau, France
| | - Umberto Spampinato
- Service de Neurologie, CHU Bordeaux, Bordeaux, France
- Univ.Bordeaux-INSERM U862, Neurocentre Magendie, Bordeaux, France
- * E-mail:
| | | | - Iciar Aviles-Olmos
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London, United Kingdom
| | - Benedikt Bader
- Neurologische Klinik und Poliklinik, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Kelly Bertram
- Neurosciences, Alfred Hospital, Commercial Road, Melbourne, Victoria, Australia
- Van Cleef Roet Centre for Nervous Diseases, Monash University, Melbourne, Victoria, Australia
| | - Kailash Bhatia
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London, Institute of Neurology, Queen Square, London, United Kingdom
| | - Pierre Burbaud
- Service de Neurophysiologie Clinique, CHU Bordeaux, Bordeaux, France
| | - Lothar Burghaus
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Jin Whan Cho
- Department of Neurology, Samsung Medical Centre, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Emmanuel Cuny
- Service de Neurochirurgie, CHU Bordeaux, Bordeaux, France
| | - Adrian Danek
- Neurologische Klinik und Poliklinik, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Thomas Foltynie
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London, United Kingdom
| | | | | | - Dominique Guehl
- Service de Neurophysiologie Clinique, CHU Bordeaux, Bordeaux, France
| | - Jorge Guridi
- Neurology and Neurosurgical Department, Clinica Universidad de Navarra, Pamplona, Spain
| | - Marwan Hariz
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London, United Kingdom
| | - Paul Jarman
- National Hospital of Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Zinovia Maria Kefalopoulou
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London, United Kingdom
| | - Patricia Limousin
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London, United Kingdom
| | - Nir Lipsman
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, University Health Network, Toronto, Ontario, Canada
| | - Andres M. Lozano
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, University Health Network, Toronto, Ontario, Canada
| | - Elena Moro
- Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, University of Toronto, University Health Network, Toronto, Ontario, Canada
- Movement Disorders Center, Department of Psychiatry and Neurology, University Hospital Centre of Grenoble, Grenoble, France
| | - Dhita Ngy
- Department of Neurology, Mount Sinai School of Medicine, New York, New York, United States of America
- Avicenna Medical Center, New York, New York, United States of America
| | - Maria Cruz Rodriguez-Oroz
- Department of Neurology, University Hospital Donostia, Neuroscience Unit, BioDonostia Research Institute, San Sebastian, Spain
| | - Huifang Shang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hyeeun Shin
- Department of Neurology, Samsung Medical Centre, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Ruth H. Walker
- Department of Neurology, Mount Sinai School of Medicine, New York, New York, United States of America
- Department of Neurology, James J. Peters Veterans Affairs Medical Center, Bronx, New York, United States of America
| | - Fusako Yokochi
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
| | - Ludvic Zrinzo
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London, United Kingdom
| | - François Tison
- Service de Neurologie, CHU Bordeaux, Bordeaux, France
- Université Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France
- CNRS, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France
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Gatto E, Parisi V, Persi G, Sanguinetti A. Head drops in advanced Huntington's disease. Parkinsonism Relat Disord 2013; 20:570-1. [PMID: 24064111 DOI: 10.1016/j.parkreldis.2013.08.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 08/28/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Emilia Gatto
- Department of Movement Disorders, Instituto Neurociencias de Buenos Aires, INEBA, Guardia Vieja 4435, CP1039 Buenos Aires, Argentina; Department of Neurology, Sanatorio de la Trinidad Mitre, Buenos Aires, Argentina.
| | - Virginia Parisi
- Department of Neurology, Sanatorio de la Trinidad Mitre, Buenos Aires, Argentina
| | - Gabriel Persi
- Department of Neurology, Sanatorio de la Trinidad Mitre, Buenos Aires, Argentina
| | - Ana Sanguinetti
- Department of Movement Disorders, Instituto Neurociencias de Buenos Aires, INEBA, Guardia Vieja 4435, CP1039 Buenos Aires, Argentina
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Martino D, Stamelou M, Bhatia KP. The differential diagnosis of Huntington's disease-like syndromes: 'red flags' for the clinician. J Neurol Neurosurg Psychiatry 2013; 84:650-6. [PMID: 22993450 PMCID: PMC3646286 DOI: 10.1136/jnnp-2012-302532] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A growing number of progressive heredodegenerative conditions mimic the presentation of Huntington's disease (HD). Differentiating among these HD-like syndromes is necessary when a patient with a combination of movement disorders, cognitive decline, behavioural abnormalities and progressive disease course proves negative to the genetic testing for HD causative mutations, that is, IT15 gene trinucleotide-repeat expansion. The differential diagnosis of HD-like syndromes is complex and may lead to unnecessary and costly investigations. We propose here a guide to this differential diagnosis focusing on a limited number of clinical features ('red flags') that can be identified through accurate clinical examination, collection of historical data and a few routine ancillary investigations. These features include the ethnic background of the patient, the involvement of the facio-bucco-lingual and cervical district by the movement disorder, the co-occurrence of cerebellar features and seizures, the presence of peculiar gait patterns and eye movement abnormalities, and an atypical progression of illness. Additional help may derive from the cognitive-behavioural presentation of the patient, as well as by a restricted number of ancillary investigations, mainly MRI and routine blood tests. These red flags should be constantly updated as the phenotypic characterisation and identification of more reliable diagnostic markers for HD-like syndromes progress over the following years.
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Affiliation(s)
- Davide Martino
- Neuroscience & Trauma Centre, Barts and The London School of Medicine and Dentistry, Queen Mary University London, London, UK.
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Head drops are also observed in advanced Huntington disease. Parkinsonism Relat Disord 2013; 19:569-70. [PMID: 23422157 DOI: 10.1016/j.parkreldis.2013.01.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Revised: 01/26/2013] [Accepted: 01/26/2013] [Indexed: 11/21/2022]
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Kefalopoulou Z, Zrinzo L, Aviles-Olmos I, Bhatia K, Jarman P, Jahanshahi M, Limousin P, Hariz M, Foltynie T. Deep brain stimulation as a treatment for chorea-acanthocytosis. J Neurol 2012; 260:303-5. [PMID: 23086180 DOI: 10.1007/s00415-012-6714-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 10/09/2012] [Accepted: 10/10/2012] [Indexed: 11/30/2022]
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Jung HH, Danek A, Walker RH. Neuroacanthocytosis syndromes. Orphanet J Rare Dis 2011; 6:68. [PMID: 22027213 PMCID: PMC3212896 DOI: 10.1186/1750-1172-6-68] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Accepted: 10/25/2011] [Indexed: 11/10/2022] Open
Abstract
Neuroacanthocytosis (NA) syndromes are a group of genetically defined diseases characterized by the association of red blood cell acanthocytosis and progressive degeneration of the basal ganglia. NA syndromes are exceptionally rare with an estimated prevalence of less than 1 to 5 per 1'000'000 inhabitants for each disorder. The core NA syndromes include autosomal recessive chorea-acanthocytosis and X-linked McLeod syndrome which have a Huntington´s disease-like phenotype consisting of a choreatic movement disorder, psychiatric manifestations and cognitive decline, and additional multi-system features including myopathy and axonal neuropathy. In addition, cardiomyopathy may occur in McLeod syndrome. Acanthocytes are also found in a proportion of patients with autosomal dominant Huntington's disease-like 2, autosomal recessive pantothenate kinase-associated neurodegeneration and several inherited disorders of lipoprotein metabolism, namely abetalipoproteinemia (Bassen-Kornzweig syndrome) and hypobetalipoproteinemia leading to vitamin E malabsorption. The latter disorders are characterized by a peripheral neuropathy and sensory ataxia due to dorsal column degeneration, but movement disorders and cognitive impairment are not present. NA syndromes are caused by disease-specific genetic mutations. The mechanism by which these mutations cause neurodegeneration is not known. The association of the acanthocytic membrane abnormality with selective degeneration of the basal ganglia, however, suggests a common pathogenetic pathway. Laboratory tests include blood smears to detect acanthocytosis and determination of serum creatine kinase. Cerebral magnetic resonance imaging may demonstrate striatal atrophy. Kell and Kx blood group antigens are reduced or absent in McLeod syndrome. Western blot for chorein demonstrates absence of this protein in red blood cells of chorea-acanthocytosis patients. Specific genetic testing is possible in all NA syndromes. Differential diagnoses include Huntington disease and other causes of progressive hyperkinetic movement disorders. There are no curative therapies for NA syndromes. Regular cardiologic studies and avoidance of transfusion complications are mandatory in McLeod syndrome. The hyperkinetic movement disorder may be treated as in Huntington disease. Other symptoms including psychiatric manifestations should be managed in a symptom-oriented manner. NA syndromes have a relentlessly progressive course usually over two to three decades.
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Affiliation(s)
- Hans H Jung
- Department of Neurology, University Hospital Zürich, Zürich, Switzerland.
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Chauveau M, Damon-Perriere N, Latxague C, Spampinato U, Jung H, Burbaud P, Tison F. Head drops are also observed in McLeod syndrome. Mov Disord 2011; 26:1562-3. [PMID: 21469202 DOI: 10.1002/mds.23605] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2010] [Revised: 11/12/2010] [Accepted: 11/29/2010] [Indexed: 11/06/2022] Open
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Bader B, Vollmar C, Ackl N, Ebert A, la Fougère C, Noachtar S, Danek A. Bilateral temporal lobe epilepsy confirmed with intracranial EEG in chorea-acanthocytosis. Seizure 2011; 20:340-2. [PMID: 21251854 DOI: 10.1016/j.seizure.2010.12.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Revised: 12/10/2010] [Accepted: 12/14/2010] [Indexed: 11/25/2022] Open
Abstract
Chorea-acanthocytosis (ChAc) is an uncommon basal ganglia disorder, in which the movement disorder element may be obscured by the predominance of seizures. We report a pertinent case of a patient who had undergone extensive evaluation for epilepsy, including intracranial EEG before finally the diagnosis of ChAc was made and confirmed by Western blot. We suggest that in patients with epilepsy, particularly of temporal lobe origin and with onset in the third decade with inconclusive findings on clinical examination and neuroimaging such as dyskinesias, dystonia and basal ganglia involvement, ChAc should be considered.
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Affiliation(s)
- Benedikt Bader
- Neurologische Klinik und Poliklinik, Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377 München, Germany.
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