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Liu HK, Hao HL, You H, Feng F, Qi XH, Huang XY, Hou B, Tian CG, Wang H, Yang HM, Wang J, Wu R, Fang H, Zhou JN, Zhang JG, Zhang ZX. A Cysteinyl-tRNA Synthetase Mutation Causes Novel Autosomal-Dominant Inheritance of a Parkinsonism/Spinocerebellar-Ataxia Complex. Neurosci Bull 2024:10.1007/s12264-024-01231-0. [PMID: 38869703 DOI: 10.1007/s12264-024-01231-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 12/22/2023] [Indexed: 06/14/2024] Open
Abstract
This study aimed to identify possible pathogenic genes in a 90-member family with a rare combination of multiple neurodegenerative disease phenotypes, which has not been depicted by the known neurodegenerative disease. We performed physical and neurological examinations with International Rating Scales to assess signs of ataxia, Parkinsonism, and cognitive function, as well as brain magnetic resonance imaging scans with seven sequences. We searched for co-segregations of abnormal repeat-expansion loci, pathogenic variants in known spinocerebellar ataxia-related genes, and novel rare mutations via whole-genome sequencing and linkage analysis. A rare co-segregating missense mutation in the CARS gene was validated by Sanger sequencing and the aminoacylation activity of mutant CARS was measured by spectrophotometric assay. This pedigree presented novel late-onset core characteristics including cerebellar ataxia, Parkinsonism, and pyramidal signs in all nine affected members. Brain magnetic resonance imaging showed cerebellar/pons atrophy, pontine-midline linear hyperintensity, decreased rCBF in the bilateral basal ganglia and cerebellar dentate nucleus, and hypo-intensities of the cerebellar dentate nuclei, basal ganglia, mesencephalic red nuclei, and substantia nigra, all of which suggested neurodegeneration. Whole-genome sequencing identified a novel pathogenic heterozygous mutation (E795V) in the CARS gene, meanwhile, exhibited none of the known repeat-expansions or point mutations in pathogenic genes. Remarkably, this CARS mutation causes a 20% decrease in aminoacylation activity to charge tRNACys with L-cysteine in protein synthesis compared with that of the wild type. All family members carrying a heterozygous mutation CARS (E795V) had the same clinical manifestations and neuropathological changes of Parkinsonism and spinocerebellar-ataxia. These findings identify novel pathogenesis of Parkinsonism-spinocerebellar ataxia and provide insights into its genetic architecture.
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Affiliation(s)
- Han-Kui Liu
- BGI Genomics and BGI Research, Shenzhen, 518083, China
- Hebei Industrial Technology Research Institute of Genomics in Maternal and Child Health, Clin Lab, BGI Genomics, Shijiazhuang, 050011, China
| | - Hong-Lin Hao
- Department of Neurology, Clinical Epidemiology Unit, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Hui You
- Department of Neurology, Clinical Epidemiology Unit, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Feng Feng
- Department of Neurology, Clinical Epidemiology Unit, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Xiu-Hong Qi
- Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230026, China
| | | | - Bo Hou
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | | | - Han Wang
- Department of Neurology, Clinical Epidemiology Unit, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | | | - Jian Wang
- BGI Genomics and BGI Research, Shenzhen, 518083, China
| | - Rui Wu
- Department of Pathology, Beijing Key Laboratory of Biomarker Research and Transformation for Neurodegenerative Diseases, Peking University Third Hospital, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, 100191, China
| | - Hui Fang
- Anhui Provincial Children's Hospital, Children's Hospital of Fudan University, Hefei, 230051, China
| | - Jiang-Ning Zhou
- Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230026, China
- Institute of Brain Science, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Jian-Guo Zhang
- BGI Genomics and BGI Research, Shenzhen, 518083, China.
- Hebei Industrial Technology Research Institute of Genomics in Maternal and Child Health, Clin Lab, BGI Genomics, Shijiazhuang, 050011, China.
| | - Zhen-Xin Zhang
- Department of Neurology, Clinical Epidemiology Unit, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China.
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2
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Stephen CD. Childhood-onset writer's cramp, with later ataxia: A clue to COQ8A-related disorders. Parkinsonism Relat Disord 2024; 123:106014. [PMID: 38355377 PMCID: PMC11144560 DOI: 10.1016/j.parkreldis.2024.106014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 01/25/2024] [Indexed: 02/16/2024]
Affiliation(s)
- Christopher D Stephen
- Ataxia Center, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Dystonia Center, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
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3
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van der Heijden ME. Converging and Diverging Cerebellar Pathways for Motor and Social Behaviors in Mice. CEREBELLUM (LONDON, ENGLAND) 2024:10.1007/s12311-024-01706-w. [PMID: 38780757 DOI: 10.1007/s12311-024-01706-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/17/2024] [Indexed: 05/25/2024]
Abstract
Evidence from clinical and preclinical studies has shown that the cerebellum contributes to cognitive functions, including social behaviors. Now that the cerebellum's role in a wider range of behaviors has been confirmed, the question arises whether the cerebellum contributes to social behaviors via the same mechanisms with which it modulates movements. This review seeks to answer whether the cerebellum guides motor and social behaviors through identical pathways. It focuses on studies in which cerebellar cells, synapses, or genes are manipulated in a cell-type specific manner followed by testing of the effects on social and motor behaviors. These studies show that both anatomically restricted and cerebellar cortex-wide manipulations can lead to social impairments without abnormal motor control, and vice versa. These studies suggest that the cerebellum employs different cellular, synaptic, and molecular pathways for social and motor behaviors. Future studies warrant a focus on the diverging mechanisms by which the cerebellum contributes to a wide range of neural functions.
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Affiliation(s)
- Meike E van der Heijden
- Fralin Biomedical Research Institute, Virginia Tech Carilion, Roanoke, VA, USA.
- Center for Neurobiology Research, Virginia Tech Carilion, Roanoke, VA, USA.
- School of Neuroscience, Virginia Tech, Blacksburg, VA, USA.
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4
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Sorrentino U, Romito LM, Garavaglia B, Fichera M, Colangelo I, Prokisch H, Winkelmann J, Necpal J, Jech R, Zech M. Myoclonus and Dystonia as Recurrent Presenting Features in Patients with the SCA21-Associated TMEM240 p.Pro170Leu Variant. Tremor Other Hyperkinet Mov (N Y) 2024; 14:16. [PMID: 38617829 PMCID: PMC11012930 DOI: 10.5334/tohm.858] [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: 01/11/2024] [Accepted: 03/23/2024] [Indexed: 04/16/2024] Open
Abstract
Background Spinocerebellar ataxia 21 (SCA21) is a rare neurological disorder caused by heterozygous variants in TMEM240. A growing, yet still limited number of reports suggested that hyperkinetic movements should be considered a defining component of the disease. Case Series We describe two newly identified families harboring the recurrent pathogenic TMEM240 p.Pro170Leu variant. Both index patients and the mother of the first proband developed movement disorders, manifesting as myoclonic dystonia and action-induced dystonia without co-occurring ataxia in one case, and pancerebellar syndrome complicated by action-induced dystonia in the other. We reviewed the literature on TMEM240 variants linked to hyperkinetic disorders, comparing our cases to described phenotypes. Discussion Adding to prior preliminary observations, our series highlights the relevance of hyperkinetic movements as clinically meaningful features of SCA21. TMEM240 mutation should be included in the differential diagnosis of myoclonic dystonia and ataxia-dystonia syndromes.
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Affiliation(s)
- Ugo Sorrentino
- Clinical Genetics Unit, Department of Women’s and Children’s Health, University of Padova, Padova, Italy
- Institute of Neurogenomics, Helmholtz Munich, Neuherberg, Germany
- Institute of Human Genetics, Technical University of Munich, School of Medicine, Munich, Germany
| | - Luigi M. Romito
- Parkinson and Movement Disorders Unit, Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Barbara Garavaglia
- Medical Genetics and Neurogenetics Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Mario Fichera
- Medical Genetics and Neurogenetics Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Isabel Colangelo
- Medical Genetics and Neurogenetics Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Holger Prokisch
- Institute of Neurogenomics, Helmholtz Munich, Neuherberg, Germany
- Institute of Human Genetics, Technical University of Munich, School of Medicine, Munich, Germany
| | - Juliane Winkelmann
- Institute of Neurogenomics, Helmholtz Munich, Neuherberg, Germany
- Institute of Human Genetics, Technical University of Munich, School of Medicine, Munich, Germany
- DZPG, Deutsches Zentrum für Psychische Gesundheit, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Jan Necpal
- 2nd Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
- Department of Neurology, Zvolen Hospital, Zvolen, Slovakia
| | - Robert Jech
- Department of Neurology and Centre of Clinical Neuroscience, General University Hospital and First Faculty of Medicine, Charles University, Kateřinská30, 12 800, Prague, Czech Republic
| | - Michael Zech
- Institute of Neurogenomics, Helmholtz Munich, Neuherberg, Germany
- Institute of Human Genetics, Technical University of Munich, School of Medicine, Munich, Germany
- Institute for Advanced Study, Technical University of Munich, Garching, Germany
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Aloisio S, Satolli S, Bellini G, Lopriore P. Parkinsonism in complex neurogenetic disorders: lessons from hereditary dementias, adult-onset ataxias and spastic paraplegias. Neurol Sci 2023; 44:3379-3388. [PMID: 37648940 PMCID: PMC10495519 DOI: 10.1007/s10072-023-07044-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 08/22/2023] [Indexed: 09/01/2023]
Abstract
Parkinsonism is a syndrome characterized by bradykinesia in combination with either rest tremor, rigidity, or both. These features are the cardinal manifestations of Parkinson's disease, the most common cause of parkinsonism, and atypical parkinsonian disorders. However, parkinsonism can be a manifestation of complex neurological and neurodegenerative genetically determined disorders, which have a vast and heterogeneous motor and non-motor phenotypic features. Hereditary dementias, adult-onset ataxias and spastic paraplegias represent only few of this vast group of neurogenetic diseases. This review will provide an overview of parkinsonism's clinical features within adult-onset neurogenetic diseases which a neurologist could face with. Understanding parkinsonism and its characteristics in the context of the aforementioned neurological conditions may provide insights into pathophysiological mechanisms and have important clinical implications, including diagnostic and therapeutic aspects.
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Affiliation(s)
- Simone Aloisio
- Department of Advanced Medical and Surgical Sciences (DAMSS), University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Sara Satolli
- Molecular Medicine for Neurodegenerative and Neuromuscular Diseases Unit, IRCCS Fondazione Stella Maris, Pisa, Italy
| | - Gabriele Bellini
- Department of Clinical and Experimental Medicine, Neurological Institute, University of Pisa, Pisa, Italy
| | - Piervito Lopriore
- Department of Clinical and Experimental Medicine, Neurological Institute, University of Pisa, Pisa, Italy.
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6
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Rossi M, Hamed M, Rodríguez-Antigüedad J, Cornejo-Olivas M, Breza M, Lohmann K, Klein C, Rajalingam R, Marras C, van de Warrenburg BP. Genotype-Phenotype Correlations for ATX-TBP (SCA17): MDSGene Systematic Review. Mov Disord 2023; 38:368-377. [PMID: 36374860 DOI: 10.1002/mds.29278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/31/2022] [Accepted: 10/31/2022] [Indexed: 11/16/2022] Open
Abstract
Spinocerebellar ataxia type 17 or ATX-TBP is a CAG/CAA repeat expansion disorder characterized by marked clinical heterogeneity. Reports of affected carriers with subthreshold repeat expansions and of patients with Parkinson's disease (PD) with expanded repeats have cast doubt on the established cutoff values of the expansions and the phenotypic spectrum of this disorder. The objective of this systematic review was to explore the genotype-phenotype relationships for repeat expansions in TBP to delineate the ATX-TBP phenotype and reevaluate the pathological range of repeat expansions. The International Parkinson and Movement Disorder Society Genetic Mutation Database (MDSGene) standardized data extraction protocol was followed. Clinically affected carriers of reported ATX-TBP expansions were included. Publications that contained repeat sizes in screened cohorts of patients with PD and/or healthy individuals were included for a separate evaluation of cutoff values. Phenotypic and genotypic data for 346 ATX-TBP patients were curated. Overall, 97.7% of the patients had ≥41 repeats, while 99.6% of patients with PD and 99.9% of healthy individuals had ≤42 repeats, with a gray zone of reduced penetrance between 41 and 45 repeats. Pure parkinsonism was more common in ATX-TBP patients with 41 to 45 repeats than in the group with ≥46 repeats, which conversely more often presented with a complex phenotype with mixed movement disorders. An updated genotype-phenotype assessment for ATX-TBP is provided, and new repeat expansion cutoff values of reduced penetrance (41-45 expanded repeats) and full penetrance (46-66 expanded repeats) are proposed. These adjusted cutoff values will have diagnostic and counseling implications and may guide future clinical trial protocol. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Malco Rossi
- Sección de Movimientos Anormales, Departamento de Neurología, Fleni, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Moath Hamed
- New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, USA
| | - Jon Rodríguez-Antigüedad
- Movement Disorders Unit, Neurology Department, Sant Pau Hospital, Barcelona, Spain
- Institut d'Investigacions Biomediques-Sant Pau, Barcelona, Spain
| | - Mario Cornejo-Olivas
- Neurogenetics Research Center, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
- Carrera de Medicina, Universidad Científica del Sur, Lima, Peru
| | - Marianthi Breza
- 1st Department of Neurology, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
- Department of Neuromuscular Disease, UCL Queen Square Institute of Neurology, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Katja Lohmann
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Christine Klein
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Rajasumi Rajalingam
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada
| | - Connie Marras
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada
| | - Bart P van de Warrenburg
- Department of Neurology, Donders Institute for Brain, Cognition & Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
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7
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Garofalo M, Vansenne F, Verbeek DS, Sival DA. The pathogenetic basis for a disease continuum in early- and late-onset ataxia-dystonia supports a unified genetic diagnostic approach. Eur J Paediatr Neurol 2023; 43:44-51. [PMID: 36905829 DOI: 10.1016/j.ejpn.2023.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 02/02/2023] [Accepted: 02/23/2023] [Indexed: 03/02/2023]
Abstract
INTRODUCTION Genetically inherited ataxic disorders are classified by their age of disease presentation into early- and late-onset ataxia (EOA and LOA, presenting before or after the 25th year-of-life). In both disease groups, comorbid dystonia co-occurs frequently. Despite overlapping genes and pathogenetic features, EOA, LOA and dystonia are considered as different genetic entities with a separate diagnostic approach. This often leads to diagnostic delay. So far, the possibility of a disease continuum between EOA, LOA and mixed ataxia-dystonia has not been explored in silico. In the present study, we analyzed the pathogenetic mechanisms underlying EOA, LOA and mixed ataxia-dystonia. METHODS We analyzed the association of 267 ataxia genes with comorbid dystonia and anatomical MRI lesions in literature. We compared anatomical damage, biological pathways, and temporal cerebellar gene expression between EOA, LOA and mixed ataxia-dystonia. RESULTS The majority (≈65%) of ataxia genes were associated with comorbid dystonia in literature. Both EOA and LOA gene groups with comorbid dystonia were significantly associated with lesions in the cortico-basal-ganglia-pontocerebellar network. EOA, LOA and mixed ataxia-dystonia gene groups were enriched for biological pathways related to nervous system development, neural signaling and cellular processes. All genes revealed similar cerebellar gene expression levels before and after 25 years of age and during cerebellar development. CONCLUSION In EOA, LOA and mixed ataxia-dystonia gene groups, our findings show similar anatomical damage, underlying biological pathways and temporal cerebellar gene expression patterns. These findings may suggest the existence of a disease continuum, supporting the diagnostic use of a unified genetic approach.
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Affiliation(s)
- M Garofalo
- Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - F Vansenne
- Department of Clinical Genetics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - D S Verbeek
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - D A Sival
- Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
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Yao T, Qiao H, Sun J, Li X, Song Y, Xu F, Gao L, Zhang D, Yan Z, Ye C, Lai H, Liang Z, Wu T, Wang CD. Clinical and Preclinical Neuroimaging Changes in Spinocerebellar Ataxia Type 12: A Study of Three Chinese Pedigrees. Eur Neurol 2022; 85:467-477. [PMID: 35853433 DOI: 10.1159/000525272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 05/18/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Spinocerebellar ataxia type 12 (SCA12) is a rare SCA subtype with unclear clinical and imaging features. Also, the radiological changes in prodromal and early stages remain unknown. METHODS Ten symptomatic and two pre-symptomatic cases from three Chinese pedigrees received clinical assessments and imaging studies including routine magnetic resonance imaging (MRI), diffusion kurtosis imaging (DKI), and positron emission tomography (PET) using 18F-flurodeoxyglucose (FDG) to investigate glucose metabolism in brain and 18F-vesicle monoamine transporter 2 (VMAT2) to inspect the integrity of the dopaminergic neuron. Seventy-two healthy individuals were recruited as controls in the quantitative FDG-PET analysis. Imaging parameters were compared between symptomatic and presymptomatic cases with different disease durations. RESULTS Patients displayed prominent action tremor, moderate ataxia, and subtle parkinsonism with poor levodopa-response. MRI showed extensive but heterogeneous cerebral atrophy, which was most evident in the frontoparietal lobes. Cerebellar atrophy was apparent in later stages. DKI detected impaired fibers in the cerebellar peduncles. In both symptomatic and pre-symptomatic cases, PET-CT showed an earlier FDG decline than atrophic changes in multiple regions, and the frontoparietal lobes were the earliest and most severe. However, the VMAT2 density were normal in the putamen and caudate nucleus of most cases (7/8). CONCLUSIONS We first found that hypometabolism in the cerebral cortex, but not cerebellum, is an early and prominent change in SCA12. The integrity of presynaptic dopaminergic neurons remains largely spared during the whole disease process.
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Affiliation(s)
- Tingyan Yao
- Department of Neurology, Xuanwu Hospital of Capital Medical University, National Clinical Research Center for Geriatric Disorders, Beijing, China
| | - Hongwen Qiao
- Department of Nuclear Medicine, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Junyan Sun
- Department of Neurobiology, Neurology and Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing Institute of Geriatrics, Beijing, China
| | - Xuying Li
- Department of Neurology, Xuanwu Hospital of Capital Medical University, National Clinical Research Center for Geriatric Disorders, Beijing, China
| | - Yang Song
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Fanxi Xu
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Linlin Gao
- Department of Neurobiology, Neurology and Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing Institute of Geriatrics, Beijing, China
| | - Dongling Zhang
- Department of Neurobiology, Neurology and Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing Institute of Geriatrics, Beijing, China
| | - Zehong Yan
- School of Electronic and Information Engineering, Harbin Institute of Technology at Shenzhen, Shenzhen, China
| | | | - Hong Lai
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Zhigang Liang
- Department of Nuclear Medicine, Information Center Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Tao Wu
- Department of Neurobiology, Neurology and Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing Institute of Geriatrics, Beijing, China
| | - Chao-Dong Wang
- Department of Neurology, Xuanwu Hospital of Capital Medical University, National Clinical Research Center for Geriatric Disorders, Beijing, China
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9
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Sival DA, Noort SAMV, Tijssen MAJ, de Koning TJ, Verbeek DS. Developmental neurobiology of cerebellar and Basal Ganglia connections. Eur J Paediatr Neurol 2022; 36:123-129. [PMID: 34954622 DOI: 10.1016/j.ejpn.2021.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 10/03/2021] [Accepted: 12/01/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND The high prevalence of mixed phenotypes of Early Onset Ataxia (EOA) with comorbid dystonia has shifted the pathogenetic concept from the cerebellum towards the interconnected cerebellar motor network. This paper on EOA with comorbid dystonia (EOA-dystonia) explores the conceptual relationship between the motor phenotype and the cortico-basal-ganglia-ponto-cerebellar network. METHODS In EOA-dystonia, we reviewed anatomic-, genetic- and biochemical-studies on the comorbidity between ataxia and dystonia. RESULTS In a clinical EOA cohort, the prevalence of dystonia was over 60%. Both human and animal studies converge on the underlying role for the cortico-basal-ganglia-ponto-cerebellar network. Genetic -clinical and -in silico network studies reveal underlying biological pathways for energy production and neural signal transduction. CONCLUSIONS EOA-dystonia phenotypes are attributable to the cortico-basal-ganglia-ponto-cerebellar network, instead of to the cerebellum, alone. The underlying anatomic and pathogenetic pathways have clinical implications for our understanding of the heterogeneous phenotype, neuro-metabolic and genetic testing and potentially also for new treatment strategies, including neuro-modulation.
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Affiliation(s)
- Deborah A Sival
- Department of Pediatrics, University of Groningen, Groningen, the Netherlands.
| | - Suus A M van Noort
- Department of Neurology and University of Groningen, Groningen, the Netherlands
| | - Marina A J Tijssen
- Department of Neurology and University of Groningen, Groningen, the Netherlands
| | - Tom J de Koning
- Department of Neurology and University of Groningen, Groningen, the Netherlands
| | - Dineke S Verbeek
- Genetics University Medical Center, University of Groningen, Groningen, the Netherlands
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10
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van Prooije T, Ibrahim NM, Azmin S, van de Warrenburg B. Spinocerebellar ataxias in Asia: Prevalence, phenotypes and management. Parkinsonism Relat Disord 2021; 92:112-118. [PMID: 34711523 DOI: 10.1016/j.parkreldis.2021.10.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/05/2021] [Accepted: 10/19/2021] [Indexed: 11/19/2022]
Abstract
This paper reviews and summarizes three main aspects of spinocerebellar ataxias (SCA) in the Asian population. First, epidemiological studies were comprehensively reviewed. Overall, the most common subtypes include SCA1, SCA2, SCA3, and SCA6, but there are large differences in the relative prevalence of these and other SCA subtypes between Asian countries. Some subtypes such as SCA12 and SCA31 are rather specific to certain Asian populations. Second, we summarized distinctive phenotypic manifestations of SCA patients of Asian origin, for example a frequent co-occurrence of parkinsonism in some SCA subtypes. Lastly, we have conducted an exploratory survey study to map SCA-specific expertise, resources, and management in various Asian countries. This showed large differences in accessibility, genetic testing facilities, and treatment options between lower and higher income Asian countries. Currently, many Asian SCA patients remain without a final genetic diagnosis. Lack of prevalence data on SCA, lack of patient registries, and insufficient access to genetic testing facilities hamper a wider understanding of these diseases in several (particularly lower income) Asian countries.
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Affiliation(s)
- Teije van Prooije
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, 6500 HB, Nijmegen, the Netherlands
| | - Norlinah Mohamed Ibrahim
- Neurology Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Shahrul Azmin
- Neurology Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Bart van de Warrenburg
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, 6500 HB, Nijmegen, the Netherlands.
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11
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Morigaki R, Miyamoto R, Matsuda T, Miyake K, Yamamoto N, Takagi Y. Dystonia and Cerebellum: From Bench to Bedside. Life (Basel) 2021; 11:life11080776. [PMID: 34440520 PMCID: PMC8401781 DOI: 10.3390/life11080776] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/20/2021] [Accepted: 07/29/2021] [Indexed: 12/31/2022] Open
Abstract
Dystonia pathogenesis remains unclear; however, findings from basic and clinical research suggest the importance of the interaction between the basal ganglia and cerebellum. After the discovery of disynaptic pathways between the two, much attention has been paid to the cerebellum. Basic research using various dystonia rodent models and clinical studies in dystonia patients continues to provide new pieces of knowledge regarding the role of the cerebellum in dystonia genesis. Herein, we review basic and clinical articles related to dystonia focusing on the cerebellum, and clarify the current understanding of the role of the cerebellum in dystonia pathogenesis. Given the recent evidence providing new hypotheses regarding dystonia pathogenesis, we discuss how the current evidence answers the unsolved clinical questions.
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Affiliation(s)
- Ryoma Morigaki
- Department of Advanced Brain Research, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima 770-8501, Japan; (N.Y.); (Y.T.)
- Department of Neurosurgery, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima 770-8501, Japan; (T.M.); (K.M.)
- Correspondence:
| | - Ryosuke Miyamoto
- Department of Neurology, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima 770-8501, Japan;
| | - Taku Matsuda
- Department of Neurosurgery, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima 770-8501, Japan; (T.M.); (K.M.)
| | - Kazuhisa Miyake
- Department of Neurosurgery, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima 770-8501, Japan; (T.M.); (K.M.)
| | - Nobuaki Yamamoto
- Department of Advanced Brain Research, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima 770-8501, Japan; (N.Y.); (Y.T.)
- Department of Neurology, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima 770-8501, Japan;
| | - Yasushi Takagi
- Department of Advanced Brain Research, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima 770-8501, Japan; (N.Y.); (Y.T.)
- Department of Neurosurgery, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima 770-8501, Japan; (T.M.); (K.M.)
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12
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Gazulla J, Izquierdo-Alvarez S, Ruiz-Fernández E, Berciano J. Initial Cerebellar Ataxia in Hereditary Adult-Onset Primary Lateral Sclerosis. Case Rep Neurol 2021; 13:414-421. [PMID: 34326749 PMCID: PMC8299400 DOI: 10.1159/000515157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 02/09/2021] [Indexed: 12/13/2022] Open
Abstract
Cerebellar ataxia preceding the apparition of primary lateral sclerosis (PLS) is reported herein. Three individuals from 2 independent kindreds experienced ataxia before developing clinical signs of PLS. Disease onset was during the sixth decade or later, and an insidious onset, with progression exceeding 11 years, was observed. Pathochrony was homogenous, consisting of initial gait instability, followed by hand dysmetria 2 years later. During a 5-year follow-up, cerebellar ataxia remained the sole clinical manifestation, preceding the appearance of muscle stiffness, which progressed to a paraparesis, and then to a purely spastic quadriparesis, over 4 years; pseudobulbar dysarthria and dysphagia appeared later. At this disease stage, limb spasticity, hyperactive jaw and limb stretch reflexes, extensor plantar responses, and a spastic dysarthria were found on examination; limb dysmetria and an ataxo-spastic gait were also found. No muscle atrophy or fasciculation was observed. Among ancillary tests, electromyographic studies performed 6 years after disease onset revealed normal motor unit action potentials and absence of spontaneous activity, in 2 individuals. MRI revealed normal cerebellum and brainstem in 2 cases. Inheritance was dominant in both kindreds, and extensive genetic testing was negative. It is concluded that cerebellar ataxia preceded the appearance of a purely spastic spinobulbar syndrome (which fulfilled the clinical diagnostic criteria for PLS) during a 5-year period in 3 patients with a hereditary, adult-onset form of PLS; subsequent disease progression was equivalent to that of sporadic PLS. Further studies are needed to fully delineate the clinical and genetic spectra of adult-onset PLS.
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Affiliation(s)
- José Gazulla
- Department of Neurology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Silvia Izquierdo-Alvarez
- Section of Genetics, Department of Clinical Biochemistry, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - José Berciano
- Department of Neurology, Hospital Universitario Marqués de Valdecilla (IDIVAL), University of Cantabria, CIBERNED, Santander, Spain
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13
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Kim M, Ahn JH, Mun JK, Choi EH, Kim JS, Youn J, Cho JW. Extracerebellar Signs and Symptoms in 117 Korean Patients with Early-Stage Spinocerebellar Ataxia. J Clin Neurol 2021; 17:242-248. [PMID: 33835745 PMCID: PMC8053557 DOI: 10.3988/jcn.2021.17.2.242] [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: 06/16/2020] [Revised: 11/18/2020] [Accepted: 11/18/2020] [Indexed: 01/07/2023] Open
Abstract
Background and Purpose Spinocerebellar ataxias (SCAs) are the most common form of hereditary ataxias. Extracerebellar signs have been well described and are helpful in differentiating the SCA subtypes. However, there are few reports on the early-stage extracerebellar signs in various SCA subtypes. This study explored the clinical and magnetic resonance imaging (MRI) characteristics of early-stage SCAs in the Korean population. Methods We retrospectively reviewed the medical records of genetically confirmed SCA patients with a disease duration of <5 years. Data on baseline characteristics, extracerebellar signs, and initial MRI findings were organized based on SCA subtypes. Results This study included 117 SCA patients with a median age at onset of 40.6 years. The family history was positive in 71.8% of the patients, and the median disease duration and the score on the Scale for the Assessment and Rating of Ataxia at the initial visit were 2.6 years and 5.0, respectively. SCA3 was the most prevalent subtype, and oculomotor abnormalities were the most frequent extracerebellar signs in early-stage SCAs. Saccadic slowing was characteristic of SCA2 and SCA7, and gaze-evoked nystagmus was prominent in SCA6. Parkinsonism was relatively frequent in SCA8 and SCA3. Decreased visual acuity was specific for SCA7. Dementia was not an early manifestation of SCAs. Brain MRI revealed a pattern of pontocerebellar atrophy in SCA2 and SCA7, while SCA6 demonstrated only cerebellar cortical atrophy. Conclusions SCA patients exhibited diverse extracerebellar signs even in the early stage. Specific extracerebellar signs were characteristic of specific subtypes, which could facilitate differential diagnoses of early-stage SCAs.
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Affiliation(s)
- Minkyeong Kim
- Department of Neurology, Gyeongsang National University Hospital, Jinju, Korea
| | - Jong Hyeon Ahn
- Department of Neurology, Samsung Medical Center, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea
| | - Jun Kyu Mun
- Department of Neurology, Samsung Medical Center, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea
| | - Eun Hyeok Choi
- Department of Neurology, Samsung Medical Center, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea
| | - Ji Sun Kim
- Department of Neurology, Samsung Medical Center, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea
| | - Jinyoung Youn
- Department of Neurology, Samsung Medical Center, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea.,Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Whan Cho
- Department of Neurology, Samsung Medical Center, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea.,Sungkyunkwan University School of Medicine, Seoul, Korea.
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14
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van de Warrenburg BP. Family history as a clue to the diagnosis of orofacial movements in a 30-year-old man: Expert commentary. Parkinsonism Relat Disord 2021; 85:149-150. [PMID: 33549492 DOI: 10.1016/j.parkreldis.2021.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/20/2021] [Accepted: 01/23/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Bart P van de Warrenburg
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, PO Box 9101, 6500 HB, Nijmegen, the Netherlands.
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15
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Early Onset Ataxia with Comorbid Dystonia: Clinical, Anatomical and Biological Pathway Analysis Expose Shared Pathophysiology. Diagnostics (Basel) 2020; 10:diagnostics10120997. [PMID: 33255407 PMCID: PMC7760948 DOI: 10.3390/diagnostics10120997] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/15/2020] [Accepted: 11/16/2020] [Indexed: 01/01/2023] Open
Abstract
In degenerative adult onset ataxia (AOA), dystonic comorbidity is attributed to one disease continuum. However, in early adult onset ataxia (EOA), the prevalence and pathogenesis of dystonic comorbidity (EOAD+), are still unclear. In 80 EOA-patients, we determined the EOAD+-prevalence in association with MRI-abnormalities. Subsequently, we explored underlying biological pathways by genetic network and functional enrichment analysis. We checked pathway-outcomes in specific EOAD+-genotypes by comparing results with non-specifically (in-silico-determined) shared genes in up-to-date EOA, AOA and dystonia gene panels (that could concurrently cause ataxia and dystonia). In the majority (65%) of EOA-patients, mild EOAD+-features concurred with extra-cerebellar MRI abnormalities (at pons and/or basal-ganglia and/or thalamus (p = 0.001)). Genetic network and functional enrichment analysis in EOAD+-genotypes indicated an association with organelle- and cellular-component organization (important for energy production and signal transduction). In non-specifically, in-silico-determined shared EOA, AOA and dystonia genes, pathways were enriched for Krebs-cycle and fatty acid/lipid-metabolic processes. In frequently occurring EOAD+-phenotypes, clinical, anatomical and biological pathway analyses reveal shared pathophysiology between ataxia and dystonia, associated with cellular energy metabolism and network signal transduction. Insight in the underlying pathophysiology of heterogeneous EOAD+-phenotype-genotype relationships supports the rationale for testing with complete, up-to-date movement disorder gene lists, instead of single EOA gene-panels.
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16
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Rossi M, van der Veen S, Merello M, Tijssen MAJ, van de Warrenburg B. Myoclonus-Ataxia Syndromes: A Diagnostic Approach. Mov Disord Clin Pract 2020; 8:9-24. [PMID: 33426154 DOI: 10.1002/mdc3.13106] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 09/30/2020] [Accepted: 10/14/2020] [Indexed: 12/30/2022] Open
Abstract
Background A myriad of disorders combine myoclonus and ataxia. Most causes are genetic and an increasing number of genes are being associated with myoclonus-ataxia syndromes (MAS), due to recent advances in genetic techniques. A proper etiologic diagnosis of MAS is clinically relevant, given the consequences for genetic counseling, treatment, and prognosis. Objectives To review the causes of MAS and to propose a diagnostic algorithm. Methods A comprehensive and structured literature search following PRISMA criteria was conducted to identify those disorders that may combine myoclonus with ataxia. Results A total of 135 causes of combined myoclonus and ataxia were identified, of which 30 were charted as the main causes of MAS. These include four acquired entities: opsoclonus-myoclonus-ataxia syndrome, celiac disease, multiple system atrophy, and sporadic prion diseases. The distinction between progressive myoclonus epilepsy and progressive myoclonus ataxia poses one of the main diagnostic dilemmas. Conclusions Diagnostic algorithms for pediatric and adult patients, based on clinical manifestations including epilepsy, are proposed to guide the differential diagnosis and corresponding work-up of the most important and frequent causes of MAS. A list of genes associated with MAS to guide genetic testing strategies is provided. Priority should be given to diagnose or exclude acquired or treatable disorders.
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Affiliation(s)
- Malco Rossi
- Movement Disorders Section Neuroscience Department Buenos Aires Argentina.,Argentine National Scientific and Technological Research Council (CONICET) Buenos Aires Argentina
| | - Sterre van der Veen
- Pontificia Universidad Católica Argentina (UCA) Buenos Aires Argentina.,Department of Neurology University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - Marcelo Merello
- Movement Disorders Section Neuroscience Department Buenos Aires Argentina.,Argentine National Scientific and Technological Research Council (CONICET) Buenos Aires Argentina.,Pontificia Universidad Católica Argentina (UCA) Buenos Aires Argentina
| | - Marina A J Tijssen
- Department of Neurology University of Groningen, University Medical Center Groningen Groningen The Netherlands.,Expertise Center Movement Disorders Groningen University Medical Center Groningen (UMCG) Groningen The Netherlands
| | - Bart van de Warrenburg
- Department of Neurology, Donders Institute for Brain, Cognition & Behaviour Radboud University Medical Center Nijmegen The Netherlands
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17
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Guo J, Chen H, Biswal BB, Guo X, Zhang H, Dai L, Zhang Y, Li L, Fan Y, Han S, Liu J, Feng L, Wang Q, Wang J, Liu C, Chen H. Gray matter atrophy patterns within the cerebellum-neostriatum-cortical network in SCA3. Neurology 2020; 95:e3036-e3044. [PMID: 33024025 DOI: 10.1212/wnl.0000000000010986] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 07/22/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To investigate the spatial patterns and the probable sequences of gray matter atrophy in spinocerebellar ataxia type 3 (SCA3). METHODS A total of 47 patients with SCA3 and 49 age- and sex-matched healthy controls participated in the study. High-resolution T1-weighted MRI were examined in all participants. We used the causal network of structural covariance (CasCN) to identify the sequence of gray matter atrophy patterns. This was achieved by applying Granger causality analysis to a gray matter atrophy staging scheme performed by voxel-based morphometry from the network level. RESULTS Participants in the premanifest stage of the disease showed the presence of focal gray matter atrophy in the vermis. As the disease duration increased, there was progressive gray matter atrophy in the cerebellar, neostriatum, frontal lobe, and parietal lobe. The patients with SCA3 also showed proximal and distal cortical atrophy sequences exerting from the vermis to the regions mainly located in the cerebellum-neostriatum-cortical network. CONCLUSION Our results, although preliminary in nature, indicate that the gray matter atrophy in SCA3 lies and extends to involve more regions according to distinct anatomical patterns, mainly in the cerebellum-neostriatum-cortical network. These findings advance our understanding on the natural history of structural damage in SCA3, while confirming known clinical features. This could provide unique insight into the ordered sequential process of regional brain atrophy that targets a particular network.
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Affiliation(s)
- Jing Guo
- From The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation (J.G., B.B.B., X.G., H.Z., L.L., Y.F., S.H., Huafu Chen), School of Medicine (J.G.), and School of Life Science and Technology, Center for Information in Medicine (X.G., H.Z., L.L., Y.F., S.H.), University of Electronic Science and Technology of China, Chengdu; Departments of Radiology (Hui Chen, Y.Z., J.L, J.W., C.L., Huafu Chen) and Laboratory Medicine (L.F.), Southwest Hospital, Department of Medical Genetics, College of Basic Medical Science (L.D.), and Department of Biomedical Engineering & Imaging Medicine (Q.W.), Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China; and Department of Biomedical Engineering (B.B.B.), New Jersey Institute of Technology, Newark
| | - Hui Chen
- From The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation (J.G., B.B.B., X.G., H.Z., L.L., Y.F., S.H., Huafu Chen), School of Medicine (J.G.), and School of Life Science and Technology, Center for Information in Medicine (X.G., H.Z., L.L., Y.F., S.H.), University of Electronic Science and Technology of China, Chengdu; Departments of Radiology (Hui Chen, Y.Z., J.L, J.W., C.L., Huafu Chen) and Laboratory Medicine (L.F.), Southwest Hospital, Department of Medical Genetics, College of Basic Medical Science (L.D.), and Department of Biomedical Engineering & Imaging Medicine (Q.W.), Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China; and Department of Biomedical Engineering (B.B.B.), New Jersey Institute of Technology, Newark.
| | - Bharat B Biswal
- From The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation (J.G., B.B.B., X.G., H.Z., L.L., Y.F., S.H., Huafu Chen), School of Medicine (J.G.), and School of Life Science and Technology, Center for Information in Medicine (X.G., H.Z., L.L., Y.F., S.H.), University of Electronic Science and Technology of China, Chengdu; Departments of Radiology (Hui Chen, Y.Z., J.L, J.W., C.L., Huafu Chen) and Laboratory Medicine (L.F.), Southwest Hospital, Department of Medical Genetics, College of Basic Medical Science (L.D.), and Department of Biomedical Engineering & Imaging Medicine (Q.W.), Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China; and Department of Biomedical Engineering (B.B.B.), New Jersey Institute of Technology, Newark
| | - Xiaonan Guo
- From The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation (J.G., B.B.B., X.G., H.Z., L.L., Y.F., S.H., Huafu Chen), School of Medicine (J.G.), and School of Life Science and Technology, Center for Information in Medicine (X.G., H.Z., L.L., Y.F., S.H.), University of Electronic Science and Technology of China, Chengdu; Departments of Radiology (Hui Chen, Y.Z., J.L, J.W., C.L., Huafu Chen) and Laboratory Medicine (L.F.), Southwest Hospital, Department of Medical Genetics, College of Basic Medical Science (L.D.), and Department of Biomedical Engineering & Imaging Medicine (Q.W.), Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China; and Department of Biomedical Engineering (B.B.B.), New Jersey Institute of Technology, Newark
| | - Huangbin Zhang
- From The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation (J.G., B.B.B., X.G., H.Z., L.L., Y.F., S.H., Huafu Chen), School of Medicine (J.G.), and School of Life Science and Technology, Center for Information in Medicine (X.G., H.Z., L.L., Y.F., S.H.), University of Electronic Science and Technology of China, Chengdu; Departments of Radiology (Hui Chen, Y.Z., J.L, J.W., C.L., Huafu Chen) and Laboratory Medicine (L.F.), Southwest Hospital, Department of Medical Genetics, College of Basic Medical Science (L.D.), and Department of Biomedical Engineering & Imaging Medicine (Q.W.), Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China; and Department of Biomedical Engineering (B.B.B.), New Jersey Institute of Technology, Newark
| | - Limeng Dai
- From The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation (J.G., B.B.B., X.G., H.Z., L.L., Y.F., S.H., Huafu Chen), School of Medicine (J.G.), and School of Life Science and Technology, Center for Information in Medicine (X.G., H.Z., L.L., Y.F., S.H.), University of Electronic Science and Technology of China, Chengdu; Departments of Radiology (Hui Chen, Y.Z., J.L, J.W., C.L., Huafu Chen) and Laboratory Medicine (L.F.), Southwest Hospital, Department of Medical Genetics, College of Basic Medical Science (L.D.), and Department of Biomedical Engineering & Imaging Medicine (Q.W.), Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China; and Department of Biomedical Engineering (B.B.B.), New Jersey Institute of Technology, Newark
| | - Yuhan Zhang
- From The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation (J.G., B.B.B., X.G., H.Z., L.L., Y.F., S.H., Huafu Chen), School of Medicine (J.G.), and School of Life Science and Technology, Center for Information in Medicine (X.G., H.Z., L.L., Y.F., S.H.), University of Electronic Science and Technology of China, Chengdu; Departments of Radiology (Hui Chen, Y.Z., J.L, J.W., C.L., Huafu Chen) and Laboratory Medicine (L.F.), Southwest Hospital, Department of Medical Genetics, College of Basic Medical Science (L.D.), and Department of Biomedical Engineering & Imaging Medicine (Q.W.), Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China; and Department of Biomedical Engineering (B.B.B.), New Jersey Institute of Technology, Newark
| | - Liang Li
- From The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation (J.G., B.B.B., X.G., H.Z., L.L., Y.F., S.H., Huafu Chen), School of Medicine (J.G.), and School of Life Science and Technology, Center for Information in Medicine (X.G., H.Z., L.L., Y.F., S.H.), University of Electronic Science and Technology of China, Chengdu; Departments of Radiology (Hui Chen, Y.Z., J.L, J.W., C.L., Huafu Chen) and Laboratory Medicine (L.F.), Southwest Hospital, Department of Medical Genetics, College of Basic Medical Science (L.D.), and Department of Biomedical Engineering & Imaging Medicine (Q.W.), Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China; and Department of Biomedical Engineering (B.B.B.), New Jersey Institute of Technology, Newark.
| | - Yunshuang Fan
- From The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation (J.G., B.B.B., X.G., H.Z., L.L., Y.F., S.H., Huafu Chen), School of Medicine (J.G.), and School of Life Science and Technology, Center for Information in Medicine (X.G., H.Z., L.L., Y.F., S.H.), University of Electronic Science and Technology of China, Chengdu; Departments of Radiology (Hui Chen, Y.Z., J.L, J.W., C.L., Huafu Chen) and Laboratory Medicine (L.F.), Southwest Hospital, Department of Medical Genetics, College of Basic Medical Science (L.D.), and Department of Biomedical Engineering & Imaging Medicine (Q.W.), Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China; and Department of Biomedical Engineering (B.B.B.), New Jersey Institute of Technology, Newark
| | - Shaoqiang Han
- From The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation (J.G., B.B.B., X.G., H.Z., L.L., Y.F., S.H., Huafu Chen), School of Medicine (J.G.), and School of Life Science and Technology, Center for Information in Medicine (X.G., H.Z., L.L., Y.F., S.H.), University of Electronic Science and Technology of China, Chengdu; Departments of Radiology (Hui Chen, Y.Z., J.L, J.W., C.L., Huafu Chen) and Laboratory Medicine (L.F.), Southwest Hospital, Department of Medical Genetics, College of Basic Medical Science (L.D.), and Department of Biomedical Engineering & Imaging Medicine (Q.W.), Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China; and Department of Biomedical Engineering (B.B.B.), New Jersey Institute of Technology, Newark
| | - Juan Liu
- From The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation (J.G., B.B.B., X.G., H.Z., L.L., Y.F., S.H., Huafu Chen), School of Medicine (J.G.), and School of Life Science and Technology, Center for Information in Medicine (X.G., H.Z., L.L., Y.F., S.H.), University of Electronic Science and Technology of China, Chengdu; Departments of Radiology (Hui Chen, Y.Z., J.L, J.W., C.L., Huafu Chen) and Laboratory Medicine (L.F.), Southwest Hospital, Department of Medical Genetics, College of Basic Medical Science (L.D.), and Department of Biomedical Engineering & Imaging Medicine (Q.W.), Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China; and Department of Biomedical Engineering (B.B.B.), New Jersey Institute of Technology, Newark.
| | - Liu Feng
- From The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation (J.G., B.B.B., X.G., H.Z., L.L., Y.F., S.H., Huafu Chen), School of Medicine (J.G.), and School of Life Science and Technology, Center for Information in Medicine (X.G., H.Z., L.L., Y.F., S.H.), University of Electronic Science and Technology of China, Chengdu; Departments of Radiology (Hui Chen, Y.Z., J.L, J.W., C.L., Huafu Chen) and Laboratory Medicine (L.F.), Southwest Hospital, Department of Medical Genetics, College of Basic Medical Science (L.D.), and Department of Biomedical Engineering & Imaging Medicine (Q.W.), Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China; and Department of Biomedical Engineering (B.B.B.), New Jersey Institute of Technology, Newark
| | - Qiannan Wang
- From The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation (J.G., B.B.B., X.G., H.Z., L.L., Y.F., S.H., Huafu Chen), School of Medicine (J.G.), and School of Life Science and Technology, Center for Information in Medicine (X.G., H.Z., L.L., Y.F., S.H.), University of Electronic Science and Technology of China, Chengdu; Departments of Radiology (Hui Chen, Y.Z., J.L, J.W., C.L., Huafu Chen) and Laboratory Medicine (L.F.), Southwest Hospital, Department of Medical Genetics, College of Basic Medical Science (L.D.), and Department of Biomedical Engineering & Imaging Medicine (Q.W.), Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China; and Department of Biomedical Engineering (B.B.B.), New Jersey Institute of Technology, Newark.
| | - Jian Wang
- From The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation (J.G., B.B.B., X.G., H.Z., L.L., Y.F., S.H., Huafu Chen), School of Medicine (J.G.), and School of Life Science and Technology, Center for Information in Medicine (X.G., H.Z., L.L., Y.F., S.H.), University of Electronic Science and Technology of China, Chengdu; Departments of Radiology (Hui Chen, Y.Z., J.L, J.W., C.L., Huafu Chen) and Laboratory Medicine (L.F.), Southwest Hospital, Department of Medical Genetics, College of Basic Medical Science (L.D.), and Department of Biomedical Engineering & Imaging Medicine (Q.W.), Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China; and Department of Biomedical Engineering (B.B.B.), New Jersey Institute of Technology, Newark.
| | - Chen Liu
- From The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation (J.G., B.B.B., X.G., H.Z., L.L., Y.F., S.H., Huafu Chen), School of Medicine (J.G.), and School of Life Science and Technology, Center for Information in Medicine (X.G., H.Z., L.L., Y.F., S.H.), University of Electronic Science and Technology of China, Chengdu; Departments of Radiology (Hui Chen, Y.Z., J.L, J.W., C.L., Huafu Chen) and Laboratory Medicine (L.F.), Southwest Hospital, Department of Medical Genetics, College of Basic Medical Science (L.D.), and Department of Biomedical Engineering & Imaging Medicine (Q.W.), Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China; and Department of Biomedical Engineering (B.B.B.), New Jersey Institute of Technology, Newark.
| | - Huafu Chen
- From The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation (J.G., B.B.B., X.G., H.Z., L.L., Y.F., S.H., Huafu Chen), School of Medicine (J.G.), and School of Life Science and Technology, Center for Information in Medicine (X.G., H.Z., L.L., Y.F., S.H.), University of Electronic Science and Technology of China, Chengdu; Departments of Radiology (Hui Chen, Y.Z., J.L, J.W., C.L., Huafu Chen) and Laboratory Medicine (L.F.), Southwest Hospital, Department of Medical Genetics, College of Basic Medical Science (L.D.), and Department of Biomedical Engineering & Imaging Medicine (Q.W.), Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China; and Department of Biomedical Engineering (B.B.B.), New Jersey Institute of Technology, Newark.
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18
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Magrinelli F, Latorre A, Balint B, Mackenzie M, Mulroy E, Stamelou M, Tinazzi M, Bhatia KP. Isolated and combined genetic tremor syndromes: a critical appraisal based on the 2018 MDS criteria. Parkinsonism Relat Disord 2020; 77:121-140. [PMID: 32818815 DOI: 10.1016/j.parkreldis.2020.04.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 04/13/2020] [Accepted: 04/18/2020] [Indexed: 12/12/2022]
Abstract
The 2018 consensus statement on the classification of tremors proposes a two-axis categorization scheme based on clinical features and etiology. It also defines "isolated" and "combined" tremor syndromes depending on whether tremor is the sole clinical manifestation or is associated with other neurological or systemic signs. This syndromic approach provides a guide to investigate the underlying etiology of tremors, either genetic or acquired. Several genetic defects have been proven to cause tremor disorders, including autosomal dominant and recessive, X-linked, and mitochondrial diseases, as well as chromosomal abnormalities. Furthermore, some tremor syndromes are recognized in individuals with a positive family history, but their genetic confirmation is pending. Although most genetic tremor disorders show a combined clinical picture, there are some distinctive conditions in which tremor may precede the appearance of other neurological signs by years or remain the prominent manifestation throughout the disease course, previously leading to misdiagnosis as essential tremor (ET). Advances in the knowledge of genetically determined tremors may have been hampered by the inclusion of heterogeneous entities in previous studies on ET. The recent classification of tremors therefore aims to provide more consistent clinical data for deconstructing the genetic basis of tremor syndromes in the next-generation and long-read sequencing era. This review outlines the wide spectrum of tremor disorders with defined or presumed genetic etiology, both isolated and combined, unraveling diagnostic clues of these conditions and focusing mainly on ET-like phenotypes. Furthermore, we suggest a phenotype-to-genotype algorithm to support clinicians in identifying tremor syndromes and guiding genetic investigations.
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Affiliation(s)
- 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.
| | - Bettina Balint
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, United Kingdom; Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany.
| | - Melissa Mackenzie
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, United Kingdom.
| | - Eoin Mulroy
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, United Kingdom.
| | - Maria Stamelou
- Department of Neurology, Attikon University Hospital, Athens, Greece.
| | - Michele Tinazzi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
| | - Kailash P Bhatia
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, United Kingdom.
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19
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Giardina F, Lanza G, Calì F, Ferri R. Late-onset oro-facial dyskinesia in Spinocerebellar Ataxia type 2: a case report. BMC Neurol 2020; 20:156. [PMID: 32340607 PMCID: PMC7184687 DOI: 10.1186/s12883-020-01739-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 04/20/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Genetic familiar causes of oro-facial dyskinesia are usually restricted to Huntington's disease, whereas other causes are often missed or underestimated. Here, we report the case of late-onset oro-facial dyskinesia in an elderly patient with a genetic diagnosis of Spinocerebellar Ataxia type 2 (SCA2). CASE PRESENTATION A 75-year-old man complained of progressive balance difficulty since the age of 60 years, associated with involuntary movements of the mouth and tongue over the last 3 months. No exposure to anti-dopaminergic agents, other neuroleptics, antidepressants, or other drugs was reported. Family history was positive for SCA2 (brother and the son of the brother). At rest, involuntary movements of the mouth and tongue were noted; they appeared partially suppressible and became more evident during stress and voluntary movements. Cognitive examination revealed frontal-executive dysfunction, memory impairment, and attention deficit. Brain magnetic resonance imaging (MRI) disclosed signs of posterior periventricular chronic cerebrovascular disease and a marked ponto-cerebellar atrophy, as confirmed by volumetric MRI analysis. A dopamine transporter imaging scan demonstrated a bilaterally reduced putamen and caudate nucleus uptake. Ataxin-2 (ATXN2) gene analysis revealed a 36 cytosine-adenine-guanine (CAG) repeat expansion, confirming the diagnosis of SCA2. CONCLUSIONS SCA2 should be considered among the possible causes of adult-onset oro-facial dyskinesia, especially when the family history suggests an inherited cerebellar disorder. Additional clinical features, including parkinsonism and motor neuron disease, may represent relevant cues for an early diagnosis and adequate management.
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Affiliation(s)
- Floriana Giardina
- UO Neurologia, Ospedale Santa Maria del Carmine, APSS Trento. Corso Verona, 4, 38068 Rovereto, Italy
| | - Giuseppe Lanza
- grid.8158.40000 0004 1757 1969Department of Surgery and Medical-Surgical Specialties, University of Catania, Via Santa Sofia, 78, 95123 Catania, Italy
- Oasi Research Institute-IRCCS, Via Conte Ruggero, 73, 94018 Troina, Italy
| | - Francesco Calì
- Oasi Research Institute-IRCCS, Via Conte Ruggero, 73, 94018 Troina, Italy
| | - Raffaele Ferri
- Oasi Research Institute-IRCCS, Via Conte Ruggero, 73, 94018 Troina, Italy
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20
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Giardina F, Lanza G, Calì F, Ferri R. Late-onset oro-facial dyskinesia in Spinocerebellar Ataxia type 2: a case report. BMC Neurol 2020. [PMID: 32340607 DOI: 10.1186/s12883-020-01739-8.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Genetic familiar causes of oro-facial dyskinesia are usually restricted to Huntington's disease, whereas other causes are often missed or underestimated. Here, we report the case of late-onset oro-facial dyskinesia in an elderly patient with a genetic diagnosis of Spinocerebellar Ataxia type 2 (SCA2). CASE PRESENTATION A 75-year-old man complained of progressive balance difficulty since the age of 60 years, associated with involuntary movements of the mouth and tongue over the last 3 months. No exposure to anti-dopaminergic agents, other neuroleptics, antidepressants, or other drugs was reported. Family history was positive for SCA2 (brother and the son of the brother). At rest, involuntary movements of the mouth and tongue were noted; they appeared partially suppressible and became more evident during stress and voluntary movements. Cognitive examination revealed frontal-executive dysfunction, memory impairment, and attention deficit. Brain magnetic resonance imaging (MRI) disclosed signs of posterior periventricular chronic cerebrovascular disease and a marked ponto-cerebellar atrophy, as confirmed by volumetric MRI analysis. A dopamine transporter imaging scan demonstrated a bilaterally reduced putamen and caudate nucleus uptake. Ataxin-2 (ATXN2) gene analysis revealed a 36 cytosine-adenine-guanine (CAG) repeat expansion, confirming the diagnosis of SCA2. CONCLUSIONS SCA2 should be considered among the possible causes of adult-onset oro-facial dyskinesia, especially when the family history suggests an inherited cerebellar disorder. Additional clinical features, including parkinsonism and motor neuron disease, may represent relevant cues for an early diagnosis and adequate management.
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Affiliation(s)
- Floriana Giardina
- UO Neurologia, Ospedale Santa Maria del Carmine, APSS Trento. Corso Verona, 4, 38068, Rovereto, Italy
| | - Giuseppe Lanza
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Via Santa Sofia, 78, 95123, Catania, Italy. .,Oasi Research Institute-IRCCS, Via Conte Ruggero, 73, 94018, Troina, Italy.
| | - Francesco Calì
- Oasi Research Institute-IRCCS, Via Conte Ruggero, 73, 94018, Troina, Italy
| | - Raffaele Ferri
- Oasi Research Institute-IRCCS, Via Conte Ruggero, 73, 94018, Troina, Italy
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21
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Gana S, Valente EM. Movement Disorders in Genetic Pediatric Ataxias. Mov Disord Clin Pract 2020; 7:383-393. [PMID: 32373654 DOI: 10.1002/mdc3.12937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/24/2020] [Accepted: 03/08/2020] [Indexed: 11/06/2022] Open
Abstract
Background Genetic pediatric ataxias are heterogeneous rare disorders, mainly inherited as autosomal-recessive traits. Most forms are progressive and lack effective treatment, with relevant socioeconomical impact. Albeit ataxia represents the main clinical feature, the phenotype can be more complex, with additional neurological and nonneurological signs being described in several forms. Methods and Results In this review, we provide an overview of the occurrence and spectrum of movement disorders in the most relevant forms of childhood-onset genetic ataxias. All types of hypokinetic and hyperkinetic movement disorders of variable severity have been reported. Movement disorders occasionally represent the symptom of onset, predating ataxia even of a few years and therefore challenging an early diagnosis. Their pathogenesis still remains poorly defined, as it is not yet clear whether movement disorders may directly relate to the cerebellar pathology or result from an extracerebellar dysfunction, including the basal ganglia. Conclusion Recognition of the complete movement disorder phenotype in genetic pediatric ataxias has important implications for diagnosis, management, and genetic counseling.
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Affiliation(s)
| | - Enza Maria Valente
- IRCCS Mondino Foundation Pavia Italy.,Department of Molecular Medicine University of Pavia Pavia Italy
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22
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Mello NMD, Zonta MB, Teive HAG, Meira AT, Lopes Neto FDN, Silva JTDSND, Camargo CHF, Zeigelboim BS. Assessment of ventilatory function in patients with spinocerebellar ataxia type 2. ARQUIVOS DE NEURO-PSIQUIATRIA 2020; 78:96-102. [PMID: 32022136 DOI: 10.1590/0004-282x20190156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 09/30/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Subclinical ventilatory dysfunction is observed in individuals with spinocerebellar ataxias (SCA). No studies have correlated ventilatory dysfunction to clinical and functional decline in SCA2. OBJECTIVE To evaluate the relationship between the values of peak expiratory flow (PEF), maximum inspiratory pressure (MIP), and presence of respiratory complaints with age, disease duration, age at onset of symptoms, balance scores, independence in basic (ADL) and instrumental (IADL) Activities of Daily Living (ADLs), and severity of ataxia (SARA) in individuals with SCA2. METHODS Cross-sectional study evaluating age, disease duration, age at onset of symptoms, scores in the Berg Balance Scale and in the SARA, Functional Independence Measure and Lawton's scale, values of PEF and MIP, and the presence of respiratory complaints. RESULTS The study included 36 individuals with SCA2, with a mean age of 42.5±2.4 years, disease duration of 7.6±8.2 years, age 33.7±11.5 years at onset of symptoms, and 9.9±10.3 points in the SARA scale. The lowest PEF values correlated with the longer disease duration (p=0.021). The lowest values of PEF and MIP correlated with greater balance impairment (p=0.019 and p=0.045, respectively), increased degree of dependence in the ADL (p=0.006 and p=0.050, respectively) and IADL (p=0.003 and p=0.001, respectively) scales, and highest severity of ataxia (p=0.00 and p=0.017, respectively). Respiratory complaints were observed in 12 (33.3%) individuals and were not related to age, disease duration, age at onset of symptoms, balance, independence, ataxia severity, or PEF and MIP values. CONCLUSION Ventilatory dysfunction, even when asymptomatic, is related to balance impairment, independence, and ataxia severity in individuals with SCA2.
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Affiliation(s)
- Neliana Maria de Mello
- Universidade Federal do Paraná, Hospital de Clínicas, Unidade Multiprofissional, Serviço de Fisioterapia, Curitiba PR, Brazil
| | - Marise Bueno Zonta
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Medicina Interna, Serviço de Neurologia, Setor de Distúrbios do Movimento, Curitiba PR, Brazil
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Medicina Interna, Programa de Pós-Graduação em Medicina Interna (Neurologia), Curitiba PR, Brazil
| | - Hélio Afonso Ghizoni Teive
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Medicina Interna, Serviço de Neurologia, Setor de Distúrbios do Movimento, Curitiba PR, Brazil
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Medicina Interna, Programa de Pós-Graduação em Medicina Interna (Neurologia), Curitiba PR, Brazil
| | - Alex Tiburtino Meira
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Medicina Interna, Serviço de Neurologia, Setor de Distúrbios do Movimento, Curitiba PR, Brazil
| | | | | | - Carlos Henrique Ferreira Camargo
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Medicina Interna, Programa de Pós-Graduação em Medicina Interna (Neurologia), Curitiba PR, Brazil
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23
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Mehta S, Ray S, Aleti S, Lal V. Dystonia and dysphagia in spinocerebellar ataxia 1 portends a severe phenotype. ANNALS OF MOVEMENT DISORDERS 2020. [DOI: 10.4103/aomd.aomd_29_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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24
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Lenka A, Louis ED. Revisiting the Clinical Phenomenology of "Cerebellar Tremor": Beyond the Intention Tremor. THE CEREBELLUM 2019; 18:565-574. [PMID: 30565088 DOI: 10.1007/s12311-018-0994-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Tremor is an involuntary, rhythmic, oscillatory movement of a body part. It is a central feature of a range of diseases resulting from pathological changes in the cerebellum. Interestingly, in modern times, the terms "cerebellar tremor" and "intention tremor" are often used synonymously and interchangeably. However, "cerebellar tremor" (i.e., tremors of cerebellar origin) do not always present exclusively as intention tremor. In this article, we comprehensively revisit the clinical phenomenology of tremors observed in various diseases that are based in the cerebellum. By this, we mean diseases for which the cerebellum and its various connections are often seen as playing a central and defining role. These include spinocerebellar ataxias, essential tremor, orthostatic tremor, dystonia, acute cerebellitis, cerebellar tumors, paraneoplastic cerebellar degeneration, and cerebellar strokes. The theme of this article is to highlight, through published data available in the current literature, that the clinical phenomenology of tremor of cerebellar origin is heterogeneous, and it extends beyond that of intention tremor to include postural tremors, kinetic tremor, rest tremor, and orthostatic tremor. This heterogeneity is consistent with the seminal work of Gordon Holmes, in which he described a variety of tremors aside from intention tremor in the setting of cerebellar lesions. In the end, it would seem that the notion that intention tremor is the sole signature of cerebellar lesions is an over-simplification and is not correct. Future studies are warranted to identify and further characterize the heterogeneity of tremors arising from the various cerebellar etiologies.
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Affiliation(s)
- Abhishek Lenka
- Department of Neurology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Elan D Louis
- Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA. .,Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, USA. .,Department of Neurology, Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, 15 York Street, PO Box 208018, New Haven, CT, 06520-8018, USA.
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25
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Li ST, Zhou Y. Spinocerebellar ataxia type 2 presenting with involuntary movement: a diagnostic dilemma. J Int Med Res 2019; 47:6390-6396. [PMID: 31774014 PMCID: PMC7045683 DOI: 10.1177/0300060519889457] [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] [Indexed: 11/16/2022] Open
Abstract
Spinocerebellar ataxia type 2 (SCA2) is a rare disease characterized by slowly
progressive ataxia, dysarthria, ophthalmoplegia, and slow saccade. SCA2 can
present with a complex combination of hyperkinetic and hypokinetic movement
disorders. Here, we describe a patient with SCA2 that partly mimicked the
clinical manifestations of Huntington’s disease; similar symptoms had previously
occurred in the patient’s family members. The findings in this report indicate
that, when a patient exhibits choreiform movement (i.e., accompanying cerebellar
ataxia), an SCA2-related mutation could be responsible for the onset of disease.
In addition, this knowledge of the potential for extrapyramidal involvement in
such patients is critical for clinicians.
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Affiliation(s)
- Shu-Ting Li
- Department of General Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yang Zhou
- Department of Neurology, Jinhua Hospital, Jinhua, China
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26
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Parkinsonism in neurodegenerative diseases predominantly presenting with ataxia. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2019; 149:277-298. [PMID: 31779816 DOI: 10.1016/bs.irn.2019.10.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The number of molecularly defined degenerative ataxia diseases is rapidly increasing, many of them involving complex multisystemic presentations including parkinsonism. The increasing number of novel ataxia genes -with most of them being ultra-rare - often makes it difficult for clinicians and scientists to identify the molecular diagnosis underlying these ataxia-parkinsonism syndromes. Here we aim to provide an overview on the most frequent diseases and molecular causes underlying ataxia-parkinsonism, focusing both on novel aspects of well-known causes of ataxia-parkinsonism (MSA-C, PSP-C, FXTAS, repeat-expansion spinocerebellar ataxias [SCAs], conventional mutation SCAs) as well as on more recently identified rare genetic causes of ataxia-parkinsonism (AT, POLG, SPG7). We demonstrate that frequency data and phenotype characteristics help to guide diagnostics in patients with unexplained ataxia-parkinsonism, while the newly identified rare genetic causes of ataxia-parkinsonism provide novel insights into molecular key pathways underlying the shared vulnerability of cerebellar and basal ganglia neurons.
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27
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Li Y, Chang Y, Liu X, Li Y, Yan Y. Spinocerebellar ataxia 2 in a family with different phenotypes: Two case reports. Medicine (Baltimore) 2019; 98:e17834. [PMID: 31725623 PMCID: PMC6867747 DOI: 10.1097/md.0000000000017834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Spinocerebellar ataxia 2 (SCA2) is a genetic disease, mainly characterized by ataxia. A number of other neurological symptoms also have been described, such as Parkinsonism, cognitive dysfunction, autonomic dysfunction, even the signs of motor neuron disease and so on. Mostly, In the same family, clinical performance is the same in most cases. Here, we describe a father and his son who suffered from SCA2, but their first manifestations were different. PATIENT CONCERNS The father exhibited progressive bradykinesia and rigidity, which resulted in the dysfunction of walking and caring himself. He hoped to relieve his symptoms by taking medicine. But the son presented with ataxia which was mild that the discomfort did not affect his daily life with none treated. DIAGNOSIS Both of them were given SCA2 tests. Briefly, we designed primers around the CAG trinucleotide, repeated the spinal cerebellar ataxia subtype gene, performed PCR expansion, and then calculated the specific number of repetitions by capillary electrophoresis. Abnormal expansion was detected in them through SCA2 sequencing with different repeat numbers of CAG, and then they were diagnosed with SCA2 sequencing. INTERVENTIONS The father was treated with dopaminergic drugs, but the son was not administered treatment. OUTCOMES The father's symptoms are improved and he can take care of himself. The son has none difficulty in his daily life. LESSONS It is rare that different individuals in the same family with SCA2 have different manifestations. The genetic testing is a crucial method to diagnose the disease of SCA2.
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Affiliation(s)
- Yuanyuan Li
- Department of Neurology, China-Japan Union Hospital of Jilin University, China
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28
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Chen SJ, Lee NC, Chien YH, Hwu WL, Lin CH. Heterogeneous nonataxic phenotypes of spinocerebellar ataxia in a Taiwanese population. Brain Behav 2019; 9:e01414. [PMID: 31523939 PMCID: PMC6790309 DOI: 10.1002/brb3.1414] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 08/10/2019] [Accepted: 08/26/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Spinocerebellar ataxia (SCA) presents with variable clinical presentations in addition to ataxia. The aim of this study was to reappraise the diverse nonataxic clinical characteristics of the five most common SCA subtypes in the Asian population. METHODS The clinical presentations of 90 patients with genetically confirmed SCA1, SCA2, SCA3, SCA6, or SCA17 were assessed retrospectively between November 2008 and September 2018 at a tertiary referral center in Taiwan. RESULTS Parkinsonism was the most common nonataxic phenotype (21.1%), with a greater prevalence than Caucasian and other Asian SCA carriers. Patients with parkinsonism feature had fewer CAG repeats in SCA2 (31.0 ± 4.5 vs. 36.9 ± 6.0, p = .03) and SCA3 (65.6 ± 7.9 vs. 70.0 ± 4.2, p = .02) compared to those with pure ataxia presentation. The average age of symptom onset was significantly higher in the parkinsonism group of SCA2 (51.5 ± 8.9 vs. 35.3 ± 12.6 years, p = .007) than those with pure ataxia. Focal or segmental dystonia was identified in 4.4% of SCA patients (n = 2 each SCA2 and SCA3). Nonmotor symptoms, including impaired cognition (6.1% of SCA2 and 8.3% of SCA3 patients) and depression (9.1% of SCA2 and 8.3% of SCA3 patients), were also common nonataxic features in our SCA patients. CONCLUSIONS Parkinsonism, dystonia, and cognitive-psychiatric symptoms are common features in patients with SCA mutations in our population. Our study identifies a different clinical spectrum of SCA1, SCA2, SCA3, SCA6, and SCA17 compared to Caucasians.
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Affiliation(s)
- Szu-Ju Chen
- Department of Neurology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.,National Taiwan University Hospital Bei-Hu Branch, Taipei, Taiwan
| | - Ni-Chung Lee
- Department of Medical Genetics and Pediatrics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yin-Hsiu Chien
- Department of Medical Genetics and Pediatrics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wuh-Liang Hwu
- Department of Medical Genetics and Pediatrics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chin-Hsien Lin
- Department of Neurology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
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29
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Zanatta A, Camargo CHF, Germiniani FMB, Raskin S, de Souza Crippa AC, Teive HAG. Abnormal Findings in Polysomnographic Recordings of Patients with Spinocerebellar Ataxia Type 2 (SCA2). THE CEREBELLUM 2019; 18:196-202. [PMID: 30264264 DOI: 10.1007/s12311-018-0982-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Spinocerebellar ataxia type 2 (SCA2) is characterized by a progressive cerebellar syndrome, and additionally saccadic slowing, cognitive dysfunction, and sleep disorders. The aim of this study was to assess the frequency of abnormal findings in sleep recordings of patients with SCA2. Seventeen patients with genetically confirmed SCA2 from the Movement Disorders Outpatient group of the Hospital de Clínicas da UFPR were evaluated with a structured medical interview and the Scale for the Assessment and Rating of Ataxia (SARA). Polysomnographic recordings were performed and sleep stages were scored according to standard criteria. There were 10 male subjects and 7 females, aged 24-66 years (mean 47.44). A sex- and age-matched control group of healthy subjects was used for comparison. There was a reduction of rapid eye movement (REM) sleep in 12 (70.58%), increased REM latency in 9 (52.94%), increased obstructive sleep apnea-index in 14 (82.35%), absent REM density (REM density was calculated as the total number of 3-s miniepochs of REM sleep with at least 1 REM per minute) in 13 (76.47%), and markedly reduced REM density in 4 (23.52%). There was an indirect correlation according to the SARA scale and the REM density decrease (r = - 0.6; P = < 0.001); and with a disease progression correlating with a reduction in the REM density (r = - 0.52, P = 0.03). In SCA2, changes occur mainly REM sleep. The absence/decrease of REM sleep density, even in oligosymptomatic patients, and the correlation of this finding with disease time and with the SARA scale were the main findings of the study.
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Affiliation(s)
- Alessandra Zanatta
- Movement Disorders Unit, Neurology Service, Hospital de Clínicas, Federal University of Parana, Rua General Carneiro, 181 - Alto da Glória, Curitiba, 80060-900, Brazil.
| | | | - Francisco Manoel Branco Germiniani
- Movement Disorders Unit, Neurology Service, Hospital de Clínicas, Federal University of Parana, Rua General Carneiro, 181 - Alto da Glória, Curitiba, 80060-900, Brazil
| | - Salmo Raskin
- Advanced Molecular Research Center, Center for Biological and Health Sciences, Catholic University of Parana, Curitiba, Brazil
| | | | - Hélio Afonso Ghizoni Teive
- Movement Disorders Unit, Neurology Service, Hospital de Clínicas, Federal University of Parana, Rua General Carneiro, 181 - Alto da Glória, Curitiba, 80060-900, Brazil
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30
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Latorre A, Del Gamba C, Menozzi E, Balint B, Brugger F, Bhatia KP. Abnormal DaTSCAN and Atypical Parkinsonism in SCA12. Mov Disord Clin Pract 2019; 6:400-402. [PMID: 31286011 DOI: 10.1002/mdc3.12751] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 01/07/2019] [Accepted: 01/27/2019] [Indexed: 01/26/2023] Open
Affiliation(s)
- Anna Latorre
- Department of Clinical and Movement Neurosciences UCL Queen Square Institute of Neurology London United Kingdom.,Department of Human Neurosciences Sapienza University of Rome Rome Italy
| | - Claudia Del Gamba
- Department of Clinical and Movement Neurosciences UCL Queen Square Institute of Neurology London United Kingdom.,Department of Clinical and Experimental Medicine University of Pisa Pisa Italy
| | - Elisa Menozzi
- Department of Clinical and Movement Neurosciences UCL Queen Square Institute of Neurology London United Kingdom.,Department of Biomedical, Metabolic, and Neural Sciences University of Modena and Reggio Emilia Modena Italy
| | - Bettina Balint
- Department of Clinical and Movement Neurosciences UCL Queen Square Institute of Neurology London United Kingdom.,Department of Neurology University Hospital Heidelberg Heidelberg Germany
| | - Florian Brugger
- Department of Neurology Kantonsspital St. Gallen St. Gallen Switzerland
| | - Kailash P Bhatia
- Department of Clinical and Movement Neurosciences UCL Queen Square Institute of Neurology London United Kingdom
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Frederick NM, Shah PV, Didonna A, Langley MR, Kanthasamy AG, Opal P. Loss of the dystonia gene Thap1 leads to transcriptional deficits that converge on common pathogenic pathways in dystonic syndromes. Hum Mol Genet 2019; 28:1343-1356. [PMID: 30590536 DOI: 10.1093/hmg/ddy433] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 11/26/2018] [Accepted: 12/11/2018] [Indexed: 12/15/2022] Open
Abstract
Dystonia is a movement disorder characterized by involuntary and repetitive co-contractions of agonist and antagonist muscles. Dystonia 6 (DYT6) is an autosomal dominant dystonia caused by loss-of-function mutations in the zinc finger transcription factor THAP1. We have generated Thap1 knock-out mice with a view to understanding its transcriptional role. While germ-line deletion of Thap1 is embryonic lethal, mice lacking one Thap1 allele-which in principle should recapitulate the haploinsufficiency of the human syndrome-do not show a discernable phenotype. This is because mice show autoregulation of Thap1 mRNA levels with upregulation at the non-affected locus. We then deleted Thap1 in glial and neuronal precursors using a nestin-conditional approach. Although these mice do not exhibit dystonia, they show pronounced locomotor deficits reflecting derangements in the cerebellar and basal ganglia circuitry. These behavioral features are associated with alterations in the expression of genes involved in nervous system development, synaptic transmission, cytoskeleton, gliosis and dopamine signaling that link DYT6 to other primary and secondary dystonic syndromes.
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Affiliation(s)
| | | | - Alessandro Didonna
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Monica R Langley
- Parkinson Disorders Research Program, Iowa Center for Advanced Neurotoxicology, Department of Biomedical Sciences, Iowa State University, Ames, IA, USA
| | - Anumantha G Kanthasamy
- Parkinson Disorders Research Program, Iowa Center for Advanced Neurotoxicology, Department of Biomedical Sciences, Iowa State University, Ames, IA, USA
| | - Puneet Opal
- Davee Department of Neurology.,Department of Cell and Molecular Biology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Abstract
The spinocerebellar ataxias (SCAs) are a genetically heterogeneous group of autosomal dominantly inherited progressive disorders, the clinical hallmark of which is loss of balance and coordination accompanied by slurred speech; onset is most often in adult life. Genetically, SCAs are grouped as repeat expansion SCAs, such as SCA3/Machado-Joseph disease (MJD), and rare SCAs that are caused by non-repeat mutations, such as SCA5. Most SCA mutations cause prominent damage to cerebellar Purkinje neurons with consecutive cerebellar atrophy, although Purkinje neurons are only mildly affected in some SCAs. Furthermore, other parts of the nervous system, such as the spinal cord, basal ganglia and pontine nuclei in the brainstem, can be involved. As there is currently no treatment to slow or halt SCAs (many SCAs lead to premature death), the clinical care of patients with SCA focuses on managing the symptoms through physiotherapy, occupational therapy and speech therapy. Intense research has greatly expanded our understanding of the pathobiology of many SCAs, revealing that they occur via interrelated mechanisms (including proteotoxicity, RNA toxicity and ion channel dysfunction), and has led to the identification of new targets for treatment development. However, the development of effective therapies is hampered by the heterogeneity of the SCAs; specific therapeutic approaches may be required for each disease.
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Gazulla J, Ferrer I, Izquierdo-Alvarez S, Alvarez S, Sánchez-Alcudia R, Bestué-Cardiel M, Seral M, Benavente I, Sierra-Martínez E, Berciano J. Hereditary primary lateral sclerosis and progressive nonfluent aphasia. J Neurol 2019; 266:1079-1090. [DOI: 10.1007/s00415-019-09235-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 02/01/2019] [Accepted: 02/05/2019] [Indexed: 12/31/2022]
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Stephen CD, Brizzi KT, Bouffard MA, Gomery P, Sullivan SL, Mello J, MacLean J, Schmahmann JD. The Comprehensive Management of Cerebellar Ataxia in Adults. Curr Treat Options Neurol 2019; 21:9. [PMID: 30788613 DOI: 10.1007/s11940-019-0549-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW In this review, we present the multidisciplinary approach to the management of the many neurological, medical, social, and emotional issues facing patients with cerebellar ataxia. RECENT FINDINGS Our holistic approach to treatment, developed over the past 25 years in the Massachusetts General Hospital Ataxia Unit, is centered on the compassionate care of the patient and their family, empowering them through engagement, and including the families as partners in the healing process. We present the management of ataxia in adults, beginning with establishing an accurate diagnosis, followed by treatment of the multiple symptoms seen in cerebellar disorders, with a view to maximizing quality of life and effectively living with the consequences of ataxia. We discuss the importance of a multidisciplinary approach to the management of ataxia, including medical and non-medical management and the evidence base that supports these interventions. We address the pharmacological treatment of ataxia, tremor, and other associated movement disorders; ophthalmological symptoms; bowel, bladder, and sexual symptoms; orthostatic hypotension; psychiatric and cognitive symptoms; neuromodulation, including deep brain stimulation; rehabilitation including physical therapy, occupational therapy and speech and language pathology and, as necessary, involving urology, psychiatry, and pain medicine. We discuss the role of palliative care in late-stage disease. The management of adults with ataxia is complex and a team-based approach is essential.
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Affiliation(s)
- Christopher D Stephen
- Ataxia Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
- Movement Disorders Division, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
- Laboratory for Neuroanatomy and Cerebellar Neurobiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - Kate T Brizzi
- Ataxia Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
- Division of Palliative Care, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Marc A Bouffard
- Ataxia Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
- Division of Advanced General and Autoimmune Neurology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Pablo Gomery
- Department of Urology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Stacey L Sullivan
- Speech Language Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Julie Mello
- Physical Therapy, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Julie MacLean
- Occupational Therapy, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jeremy D Schmahmann
- Ataxia Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
- Laboratory for Neuroanatomy and Cerebellar Neurobiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Cognitive Behavioral Neurology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Rezende Filho FM, Vale TC, Pedroso JL, Braga-Neto P, Barsottini OG. Facial grimacing and clinical correlates in spinocerebellar ataxia type 3. J Neurol Sci 2019; 397:138-140. [PMID: 30616057 DOI: 10.1016/j.jns.2019.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 12/27/2018] [Accepted: 01/01/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Spinocerebellar ataxia type 3 (SCA3), also known as Machado-Joseph disease, is the most common spinocerebellar ataxia (SCA) worldwide. SCA3 presents with cerebellar ataxia in association with pyramidal signs, peripheral amyotrophy, nystagmus, ophthalmoparesis, fasciculations of the face and tongue, dystonia and parkinsonism. Oromandibular dystonia (OMD) with facial grimacing (FG) in SCA3 has seldom been reported in the literature and in series of SCA3 patients. METHODS We evaluated 104 patients with SCA (59 patients with SCA3, 20 with SCA2, 20 with SCA7 and 5 with SCA6) and assessed dystonia frequency and types. RESULTS Thirteen cases of SCA3, one of SCA2 and two of SCA7 had dystonia. OMD in the form of FG was present in seven SCA3 patients (11.9%). Patients with FG were significantly younger, had earlier disease onset and a significantly higher CAG repetition length when compared to the SCA3 sample. Parkinsonism, dysphagia and pyramidal signs were significantly more frequent in the FG group than the non-FG group of the SCA3 sample. CONCLUSION Patients with SCA3 presenting with FG are younger, with earlier disease onset and higher CAG repetition length. They present with parkinsonism, dysphagia and pyramidal signs more frequently than SCA3 patients without FG.
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Affiliation(s)
- Flávio Moura Rezende Filho
- Division of General Neurology and Ataxia Unit, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, Brazil
| | - Thiago Cardoso Vale
- Movement Disorders Unit, Neurology Service, Hospital Universitário, Departamento de Clínica Médica da Universidade Federal de Juiz de Fora (MG), Brazil
| | - José Luiz Pedroso
- Division of General Neurology and Ataxia Unit, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, Brazil.
| | - Pedro Braga-Neto
- Division of Neurology, Department of Clinical Medicine, Universidade Federal do Ceará, Brazil; Center of Health Sciences, Universidade Estadual do Ceará, Brazil
| | - Orlando G Barsottini
- Division of General Neurology and Ataxia Unit, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, Brazil
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Genetic mimics of the non-genetic atypical parkinsonian disorders – the ‘atypical’ atypical. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2019; 149:327-351. [DOI: 10.1016/bs.irn.2019.10.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Han Q, Yang J, Xiong H, Shang H. Voxel-based meta-analysis of gray and white matter volume abnormalities in spinocerebellar ataxia type 2. Brain Behav 2018; 8:e01099. [PMID: 30125476 PMCID: PMC6160648 DOI: 10.1002/brb3.1099] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 07/21/2018] [Accepted: 07/23/2018] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To identify the consistent findings from the whole-brain voxel-based morphometry (VBM) studies on spinocerebellar ataxia type 2 (SCA2). METHODS The whole-brain VBM studies comparing SCA2 patients and healthy controls (HCs) were systematically searched in PubMed, Embase databases from January 2000 to June 2017. The coordinates with significant differences in gray matter (GM) and white matter (WM) between SCA2 patients and HCs were extracted separately from each cluster. A meta-analysis was performed using anisotropic effect size-based signed differential mapping (AES-SDM) software. RESULTS A total of five studies with 65 SCA2 patients and 124 HCs were included in the GM meta-analysis. Four of the five studies with 50 SCA2 patients and 109 HCs were included in the WM meta-analysis. Significant and consistent GM volume reductions were detected in bilateral cerebellar hemispheres, cerebellar vermis, the right fusiform gyrus, the right parahippocampal gyrus, and the right lingual gyrus. The WM volume reductions were observed in bilateral cerebellar hemispheres, cerebellar vermis, middle cerebellar peduncles, pons, and bilateral cortico-spinal projections. The findings of the study remained largely unchanged in jackknife sensitivity analysis. CONCLUSIONS The consistent findings from our meta-analysis showed that GM volume reductions in SCA2 patients were not limited in cerebellum while significant WM volume reductions widely existed in cerebellum and pyramidal system. The findings provide morphological basis for further studies on SCA2.
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Affiliation(s)
- Qing Han
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jing Yang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hai Xiong
- Department of Geriatrics, The Fourth Affiliated Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Huifang Shang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Cheng N, Wied HM, Gaul JJ, Doyle LE, Reich SG. SCA2 presenting as a focal dystonia. JOURNAL OF CLINICAL MOVEMENT DISORDERS 2018; 5:6. [PMID: 30123518 PMCID: PMC6090825 DOI: 10.1186/s40734-018-0073-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 08/03/2018] [Indexed: 11/14/2022]
Abstract
BACKGROUND Spinocerebellar ataxia 2 (SCA2) is an autosomal dominant neurodegenerative disorder caused by CAG repeat expansions in ATXN2 on chromosome 12q24. Patients present with adult-onset progressive gait ataxia, slow saccades, nystagmus, dysarthria and peripheral neuropathy. Dystonia is known to occur as SCA2 advances, but is rarely the presenting symptom. CASE PRESENTATION A 43-year-old right handed woman presented with focal dystonia of the right hand which started two years earlier with difficulty writing. There were only mild cerebellar signs. Her mother was reported to have a progressive gait disorder and we subsequently learned that she had SCA2. A total of 10 maternal family members were similarly affected. Over the course of 10 years, the patient's cerebellar signs progressed only mildly however the dystonia worsened to the extent of inability to use her right hand. Dystonia did not improve significantly with botulinum toxin, levodopa or trihexyphenidyl, but has shown marked improvement since DBS implantation in the GPi. CONCLUSIONS We describe a patient with SCA2 who presented with focal dystonia of the right upper extremity. Subtle cerebellar signs as well as the family history became especially important given the absence of predominant gait ataxia. Our case emphasizes that focal dystonia is not only a feature of SCA2, but can also rarely be the presenting sign as well as the most prominent feature during the disease course.
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Affiliation(s)
- Nan Cheng
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD USA
| | - Heather M. Wied
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA
| | | | - Lauren E. Doyle
- Department of Genetic Counseling, University of North Carolina Greensboro School of Health and Human Sciences, Greensboro, NC USA
| | - Stephen G. Reich
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD USA
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Rossi M, Balint B, Millar Vernetti P, Bhatia KP, Merello M. Genetic Dystonia-ataxia Syndromes: Clinical Spectrum, Diagnostic Approach, and Treatment Options. Mov Disord Clin Pract 2018; 5:373-382. [PMID: 30363394 PMCID: PMC6174447 DOI: 10.1002/mdc3.12635] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 04/20/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Dystonia and ataxia are manifestations of numerous disorders, and indeed, an ever-expanding spectrum of genes causing diseases that encompass dystonia and ataxia are discovered with the advances of genetic techniques. In recent years, a pathophysiological link between both clinical features and the role of the cerebellum in the genesis of dystonia, in some cases, has been proposed. In clinical practice, the genetic diagnosis of dystonia-ataxia syndromes is a major issue for genetic counseling, prognosis and, occasionally, specific treatment. METHODS For this pragmatic and educational review, we conducted a comprehensive and structured literature search in Pubmed, OMIM, and GeneReviews using the key words "dystonia" and "ataxia" to identify those genetic diseases that may combine dystonia with ataxia. RESULTS There are a plethora of genetic diseases causing dystonia and ataxia. We propose a series of clinico-radiological algorithms to guide their differential diagnosis depending on the age of onset, additional neurological or systemic features, and imaging findings. We suggest a sequential diagnostic approach to dystonia-ataxia syndromes. We briefly highlight the pathophysiological links between dystonia and ataxia and conclude with a review of specific treatment implications. CONCLUSIONS The clinical approach presented in this review is intended to improve the diagnostic success of clinicians when faced with patients with dystonia-ataxia syndromes.
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Affiliation(s)
- Malco Rossi
- Movement Disorders Section, Neuroscience DepartmentRaul Carrea Institute for Neurological Research (FLENI)Buenos AiresArgentina
| | - Bettina Balint
- Sobell Department of Motor Neuroscience and Movement Disorders UCL Institute of Neurology, Queen SquareLondonWC1N3BGUK
- Department of NeurologyUniversity HospitalHeidelbergGermany
- Neuroimmunology Group, Nuffield Department of Clinical NeurosciencesJohn Radcliffe HospitalOxfordUK
| | - Patricio Millar Vernetti
- Movement Disorders Section, Neuroscience DepartmentRaul Carrea Institute for Neurological Research (FLENI)Buenos AiresArgentina
| | - Kailash P. Bhatia
- Sobell Department of Motor Neuroscience and Movement Disorders UCL Institute of Neurology, Queen SquareLondonWC1N3BGUK
| | - Marcelo Merello
- Movement Disorders Section, Neuroscience DepartmentRaul Carrea Institute for Neurological Research (FLENI)Buenos AiresArgentina
- Argentine National Scientific and Technological Research Council (CONICET)
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Heidelberg D, Ronsin S, Bonneville F, Hannoun S, Tilikete C, Cotton F. Main inherited neurodegenerative cerebellar ataxias, how to recognize them using magnetic resonance imaging? J Neuroradiol 2018; 45:265-275. [PMID: 29920348 DOI: 10.1016/j.neurad.2018.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 05/09/2018] [Accepted: 05/28/2018] [Indexed: 12/12/2022]
Abstract
Ataxia is a neurodegenerative disease resulting from brainstem, cerebellar, and/or spinocerebellar tracts impairments. Symptoms onset could vary widely from childhood to late-adulthood. Autosomal cerebellar ataxias are considered as one of the most complex group in neurogenetics. In addition to their genetic heterogeneity, there is an important phenotypic variability in the expression of cerebellar impairment, complicating the genetic mutation research. A pattern recognition approach using brain MRI measures of atrophy, hyperintensities and iron-induced hypointensity of the dentate nuclei, could be therefore helpful in guiding genetic research. This review will discuss a pattern recognition approach that, associated with the age at disease onset, and clinical manifestations, may help neuroradiologists differentiate the most frequent profiles of ataxia.
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Affiliation(s)
- D Heidelberg
- Faculty of Medicine, Claude-Bernard Lyon 1 University, 69000 Lyon, France; Service de radiologie and Laboratoire d'anatomie de Rockefeller, centre hospitalier Lyon Sud, hospices civils de Lyon, 69000 Lyon, France
| | - S Ronsin
- Neuro-ophtalmology unit and neurology D, Neurological and Neurosurgical Hospital P. Wertheimer, Hospices Civils de Lyon, 69000 Lyon, France
| | - F Bonneville
- Service de neuroradiologie diagnostique et thérapeutique, Hôpitaux de Toulouse, Hôpital Pierre-Paul-Riquet, 31000 Toulouse, France
| | - S Hannoun
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, 1107, 2020 Beirut, Lebanon
| | - C Tilikete
- Faculty of Medicine, Claude-Bernard Lyon 1 University, 69000 Lyon, France; Neuro-ophtalmology unit and neurology D, Neurological and Neurosurgical Hospital P. Wertheimer, Hospices Civils de Lyon, 69000 Lyon, France; Lyon neuroscience research center, Inserm U1028, CNRS UMR5292, Impact Team, 69000 Lyon, France
| | - F Cotton
- Faculty of Medicine, Claude-Bernard Lyon 1 University, 69000 Lyon, France; Service de radiologie and Laboratoire d'anatomie de Rockefeller, centre hospitalier Lyon Sud, hospices civils de Lyon, 69000 Lyon, France; CREATIS, Inserm U1044/CNRS UMR 5220, 69000 Lyon, France.
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Liu FC, Lin HT, Kuo CF, Hsieh MY, See LC, Yu HP. Familial aggregation of Parkinson's disease and coaggregation with neuropsychiatric diseases: a population-based cohort study. Clin Epidemiol 2018; 10:631-641. [PMID: 29881310 PMCID: PMC5985793 DOI: 10.2147/clep.s164330] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Individuals with a family history of Parkinson's disease (PD) appear to have a higher risk of developing PD and other neuropsychiatric diseases. However, estimates of the relative risks (RRs) of PD and the roles of genetic and environmental factors in PD susceptibility are unclear. The aim of this study was to examine familial aggregation and genetic contributions to PD and the RRs of other neuropsychiatric diseases in relatives of PD patients. Methods In this population-based family cohort study, the records of all individuals actively registered in the Taiwan National Health Insurance Research Database in 2015 were queried (N=24,349,599). In total, 149,187 individuals with a PD-affected parent, 3,698 with an affected offspring, 3,495 with an affected sibling, and 15 with an affected twin were identified. Diagnoses of PD were ascertained between January 1, 1999, and December 31, 2015. The prevalence and RRs of PD and other neuropsychiatric diseases in individuals with first-degree relatives with PD, as well as the contributions of heritability and environmental factors to PD susceptibility were investigated. Results The prevalence of PD was 0.46% in the general population and 0.52% in individuals with first-degree relatives with PD. The RR (95% CI) for PD was 2.20 (1.41-3.45) for siblings, 1.59 (1.47-1.73) for parents, 1.86 (1.63-2.11) for offspring, 63.12 (16.45-242.16) for twins, and 1.46 (1.41-1.52) for spouses. The RR (95% CI) in individuals with first-degree relatives with PD was 1.66 (1.57-1.76) for essential tremor, 1.68 (1.61-1.75) for schizophrenia, and 1.20 (1.12-1.28) for Alzheimer's disease. The estimated contribution to the phenotypic variance of PD was 11.0% for heritability, 9.1% for shared environmental factors, and 79.9% for non-shared environmental factors. Conclusion First-degree relatives of PD patients are more likely to develop PD and other neuropsychiatric diseases. Environmental factors account for a high proportion of the phenotypic variance of PD.
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Affiliation(s)
- Fu-Chao Liu
- Department of Anesthesiology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Huan-Tang Lin
- Department of Anesthesiology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chang-Fu Kuo
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Office for Big Data Research, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Mei-Yun Hsieh
- Office for Big Data Research, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Lai-Chu See
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Public Health, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Biostatistics Core Laboratory, Molecular Medicine Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Huang-Ping Yu
- Department of Anesthesiology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Anesthesiology, Xiamen Changgung Hospital, Xiamen, China
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Abstract
Machado-Joseph disease (MJD) also known as Spinocerebellar ataxia type 3, is a hereditary neurodegenerative disease associated with severe clinical manifestations and premature death. Although rare, it is the most common autosomal dominant spinocerebellar ataxia worldwide and has a distinct geographic distribution, reaching peak prevalence in certain regions of Brazil, Portugal and China. Due to its clinical heterogeneity, it was initially described as several different entities and as had many designations over the last decades. An accurate diagnosis become possible in 1994, after the identification of the MJD1 gene. Among its wide clinical spectrum, progressive cerebellar ataxia is normally present. Other symptoms include pyramidal syndrome, peripheral neuropathy, oculomotor abnormalities, extrapyramidal signs and sleep disorders. On the basis of the presence/absence of important extra-pyramidal signs, and the presence/absence of peripheral signs, five clinical types have been defined. Neuroimaging studies like MRI, DTI and MRS, can be useful as they can characterize structural and functional differences in specific subgroups of patients with MJD. There is no effective treatment for MJD. Symptomatic therapies are used to relieve some of the clinical symptoms and physiotherapy is also helpful in improving quality of live. Several clinical trials have been carried out using different molecules like sulfamethoxazole-trimethoprim, varenicline and lithium carbonate, but the results of these trials were negative or showed little benefit. Future studies sufficiently powered and adequately designed are warranted.
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Dave A, Hawley J. Fragile X–tremor/ataxia syndrome: five areas of new development. FUTURE NEUROLOGY 2017. [DOI: 10.2217/fnl-2017-0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Fragile X–tremor/ataxia syndrome is a relatively newly discovered movement disorder usually affecting patients over the age of 50 who have a FMR1 gene with 55–200 CGG repeats. Patients present with tremor and ataxia and possibly executive dysfunction and peripheral neuropathy. Fragile X–tremor/ataxia syndrome patients have several unique MRI findings including white matter lesions of the middle cerebellar peduncle and splenium of the corpus callosum. The genetics and treatment of this condition are co-developing rapidly as we search for more therapeutic modalities to offer these patients. We will present the latest information available regarding this fascinating syndrome and provide our hypothesis regarding the future focus of research.
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Affiliation(s)
- Ajal Dave
- Department of Neurology, Walter Reed National Military Medical Center, America BLDG 19 4954 North Palmer Rd, Bethesda, MD 20889–5630, USA
| | - Jason Hawley
- Department of Neurology, Walter Reed National Military Medical Center, America BLDG 19 4954 North Palmer Rd, Bethesda, MD 20889–5630, USA
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Schneider SA, Alcalay RN. Neuropathology of genetic synucleinopathies with parkinsonism: Review of the literature. Mov Disord 2017; 32:1504-1523. [PMID: 29124790 PMCID: PMC5726430 DOI: 10.1002/mds.27193] [Citation(s) in RCA: 210] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 08/18/2017] [Accepted: 09/13/2017] [Indexed: 12/27/2022] Open
Abstract
Clinical-pathological studies remain the gold-standard for the diagnosis of Parkinson's disease (PD). However, mounting data from genetic PD autopsies challenge the diagnosis of PD based on Lewy body pathology. Most of the confirmed genetic risks for PD show heterogenous neuropathology, even within kindreds, which may or may not include Lewy body pathology. We review the literature of genetic PD autopsies from cases with molecularly confirmed PD or parkinsonism and summarize main findings on SNCA (n = 25), Parkin (n = 20, 17 bi-allelic and 3 heterozygotes), PINK1 (n = 5, 1 bi-allelic and 4 heterozygotes), DJ-1 (n = 1), LRRK2 (n = 55), GBA (n = 10 Gaucher disease patients with parkinsonism), DNAJC13, GCH1, ATP13A2, PLA2G6 (n = 8 patients, 2 with PD), MPAN (n = 2), FBXO7, RAB39B, and ATXN2 (SCA2), as well as on 22q deletion syndrome (n = 3). Findings from autopsies of heterozygous mutation carriers of genes that are traditionally considered recessively inherited are also discussed. Lewy bodies may be present in syndromes clinically distinctive from PD (eg, MPAN-related neurodegeneration) and absent in patients with clinical PD syndrome (eg, LRRK2-PD or Parkin-PD). Therefore, the authors can conclude that the presence of Lewy bodies are not specific to the diagnosis of PD and that PD can be diagnosed even in the absence of Lewy body pathology. Interventions that reduce alpha-synuclein load may be more justified in SNCA-PD or GBA-PD than in other genetic forms of PD. The number of reported genetic PD autopsies remains small, and there are limited genotype-clinical-pathological-phenotype studies. Therefore, larger series of autopsies from genetic PD patients are required. © 2017 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Susanne A Schneider
- Department of Neurology, Ludwig-Maximilians-University of München, Munich, Germany
| | - Roy N. Alcalay
- Department of Neurology, Columbia University Medical Center, New York, New York
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Kuo PH, Gan SR, Wang J, Lo RY, Figueroa KP, Tomishon D, Pulst SM, Perlman S, Wilmot G, Gomez CM, Schmahmann JD, Paulson H, Shakkottai VG, Ying SH, Zesiewicz T, Bushara K, Geschwind MD, Xia G, Subramony SH, Ashizawa T, Kuo SH. Dystonia and ataxia progression in spinocerebellar ataxias. Parkinsonism Relat Disord 2017; 45:75-80. [PMID: 29089256 DOI: 10.1016/j.parkreldis.2017.10.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 10/03/2017] [Accepted: 10/09/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Dystonia is a common feature in spinocerebellar ataxias (SCAs). Whether the presence of dystonia is associated with different rate of ataxia progression is not known. OBJECTIVES To study clinical characteristics and ataxia progression in SCAs with and without dystonia. METHODS We studied 334 participants with SCA 1, 2, 3 and 6 from the Clinical Research Consortium for Spinocerebellar Ataxias (CRC-SCA) and compared the clinical characteristics of SCAs with and without dystonia. We repeatedly measured ataxia progression by the Scale for Assessment and Rating of Ataxia every 6 months for 2 years. Regression models were employed to study the association between dystonia and ataxia progression after adjusting for age, sex and pathological CAG repeats. We used logistic regression to analyze the impact of different repeat expansion genes on dystonia in SCAs. RESULTS Dystonia was most commonly observed in SCA3, followed by SCA2, SCA1, and SCA6. Dystonia was associated with longer CAG repeats in SCA3. The CAG repeat number in TBP normal alleles appeared to modify the presence of dystonia in SCA1. The presence of dystonia was associated with higher SARA scores in SCA1, 2, and 3. Although relatively rare in SCA6, the presence of dystonia was associated with slower progression of ataxia. CONCLUSIONS The presence of dystonia is associated with greater severity of ataxia in SCA1, 2, and 3, but predictive of a slower progression in SCA6. Complex genetic interactions among repeat expansion genes can lead to diverse clinical symptoms and progression in SCAs.
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Affiliation(s)
- Pei-Hsin Kuo
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA; Department of Neurology, Buddhist Tzu Chi General Hospital, Tzu Chi University, Hualien, Taiwan
| | - Shi-Rui Gan
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA; Department of Neurology, Institute of Neurology, First Affiliated Hospital of Fujian Medical University, Fujian Key Laboratory of Molecular Neurology, Fuzhou, China
| | - Jie Wang
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA; Department of Fundamental and Community Nursing, School of Nursing, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Raymond Y Lo
- Department of Neurology, Buddhist Tzu Chi General Hospital, Tzu Chi University, Hualien, Taiwan
| | - Karla P Figueroa
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Darya Tomishon
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Stefan M Pulst
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Susan Perlman
- Department of Neurology, University of California, Los Angeles, CA, USA
| | - George Wilmot
- Department of Neurology, Emory University, Atlanta, GA, USA
| | | | - Jeremy D Schmahmann
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Henry Paulson
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | | | - Sarah H Ying
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Theresa Zesiewicz
- Department of Neurology, University of South Florida, Tampa, FL, USA
| | - Khalaf Bushara
- Department of Neurology, University of Minnesota, Minneapolis, MN, USA
| | | | - Guangbin Xia
- Department of Neurology, University of New Mexico, Albuquerque, NM, USA
| | - S H Subramony
- Department of Neurology, McKnight Brain Institute, University of Florida, Gainsville, FL, USA
| | | | - Sheng-Han Kuo
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
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Manes M, Alberici A, Di Gregorio E, Boccone L, Premi E, Mitro N, Pasolini MP, Pani C, Paghera B, Perani D, Orsi L, Costanzi C, Ferrero M, Zoppo A, Tempia F, Caruso D, Grassi M, Padovani A, Brusco A, Borroni B. Docosahexaenoic acid is a beneficial replacement treatment for spinocerebellar ataxia 38. Ann Neurol 2017; 82:615-621. [PMID: 28976605 PMCID: PMC5698802 DOI: 10.1002/ana.25059] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 09/17/2017] [Accepted: 09/24/2017] [Indexed: 12/11/2022]
Abstract
Objective Spinocerebellar ataxia 38 (SCA38) is caused by mutations in the ELOVL5 gene, which encodes an elongase involved in the synthesis of polyunsaturated fatty acids, including docosahexaenoic acid (DHA). As a consequence, DHA is significantly reduced in the serum of SCA38 subjects. In the present study, we evaluated the safety of DHA supplementation, its efficacy for clinical symptoms, and changes of brain functional imaging in SCA38 patients. Methods We enrolled 10 SCA38 patients, and carried out a double‐blind randomized placebo‐controlled study for 16 weeks, followed by an open‐label study with overall 40‐week DHA treatment. At baseline and at follow‐up visit, patients underwent standardized clinical assessment, brain 18‐fluorodeoxyglucose positron emission tomography, electroneurography, and ELOVL5 expression analysis. Results After 16 weeks, we showed a significant pre–post clinical improvement in the DHA group versus placebo, using the Scale for the Assessment and Rating of Ataxia (SARA; mean difference [MD] = +2.70, 95% confidence interval [CI] = +0.13 to + 5.27, p = 0.042). At 40‐week treatment, clinical improvement was found significant by both SARA (MD = +2.2, 95% CI = +0.93 to + 3.46, p = 0.008) and International Cooperative Ataxia Rating Scale (MD = +3.8, 95% CI = +1.39 to + 6.41, p = 0.02) scores; clinical data were corroborated by significant improvement of cerebellar hypometabolism (statistical parametric mapping analyses, false discovery rate corrected). We also showed a decreased expression of ELOVL5 in patients’ blood at 40 weeks as compared to baseline. No side effect was recorded. Interpretation DHA supplementation is a safe and effective treatment for SCA38, showing an improvement of clinical symptoms and cerebellar hypometabolism. Ann Neurol 2017;82:615–621
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Affiliation(s)
- Marta Manes
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia
| | - Antonella Alberici
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia
| | - Eleonora Di Gregorio
- Medical Genetics Unit, City of Health and Science, University Hospital, Turin.,Department of Medical Sciences, University of Turin, Turin
| | | | - Enrico Premi
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia
| | - Nico Mitro
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan
| | | | - Claudia Pani
- Microcitemie Regional Hospital, Brotzu Hospital, Cagliari
| | - Barbara Paghera
- Department of Nuclear Medicine, University of Brescia, Brescia
| | - Daniela Perani
- Vita-Salute San Raffaele University, Milan.,Nuclear Medicine Unit, San Raffaele Hospital, Milan.,Division of Neuroscience, San Raffaele Scientific Institute, Milan
| | - Laura Orsi
- Neurologic Division 1, Department of Neuroscience and Mental Health, University Hospital City of Health and Science of Turin, Turin
| | | | - Marta Ferrero
- Department of Medical Sciences, University of Turin, Turin
| | - Adele Zoppo
- Endocrinological Unit, San Carlo Hospital, Paderno Dugnano, Milan, Italy
| | - Filippo Tempia
- Neuroscience Institute Cavalieri Ottolenghi (NICO) and Department of Neuroscience, University of Turin, Turin
| | - Donatella Caruso
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan
| | - Mario Grassi
- Department of Brain and Behavioral Sciences, Medical and Genomic Statistics Unit, University of Pavia, Pavia, Italy
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia
| | - Alfredo Brusco
- Medical Genetics Unit, City of Health and Science, University Hospital, Turin.,Department of Medical Sciences, University of Turin, Turin
| | - Barbara Borroni
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia
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47
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Pedroso JL, Braga-Neto P, Escorcio-Bezerra ML, Abrahão A, de Albuquerque MVC, Filho FMR, de Souza PVS, de Rezende Pinto WBV, Borges FRP, Saraiva-Pereira ML, Jardim LB, Barsottini OGP. Non-motor and Extracerebellar Features in Spinocerebellar Ataxia Type 2. THE CEREBELLUM 2017; 16:34-39. [PMID: 26825292 DOI: 10.1007/s12311-016-0761-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Spinocerebellar ataxia type 2 (SCA2) is an autosomal dominant degenerative disease. Pathological studies have demonstrated not only cerebellar and brainstem atrophy, but substantia nigra, motoneurons, basal ganglia, thalamus, and peripheral nerves involvement. These findings may explain non-motor and extra-cerebellar features in SCA2. We accessed the non-motor symptoms and extra-cerebellar signs in SCA2 patients in order to provide a better understanding on pathophysiological mechanisms and natural history of brain degeneration in the disease. Thirty-three SCA2 patients were evaluated and compared with 26 healthy subjects. We investigated the following variables: sleep disorders, cognitive deficit, olfactory impairment, urinary dysfunction, psychiatric symptoms, cramps, pain, movement disorders, and weight loss. SCA2 had a high frequency of REM sleep behavior disorder (48.48 %, N = 16) as well as excessive daytime sleepiness (42.42 %, N = 14). Chorea was present in 15.15 % (N = 5), dystonia in 27.27 % (N = 9), and parkinsonism in 27.27 % (N = 9). Slow saccadic pursuit was present in 87.87 % (N = 29) and ophtalmoparesis in 78.78 % (N = 26) of patients. Regarding sleep disorders, 18.18 % (N = 6) of patients had restless leg syndrome. Dysphagia was present in 39.39 % (N = 13), weight loss 24.24 % (N = 8), and urinary dysfunction 27.27 % (N = 9). Cramps was present in only 6 % of patients (N = 2). This study highlighted the high frequency of non-motor symptoms and extra-cerebellar signs in SCA2. Our findings demonstrate the widespread of nervous system involvement in SCA2 patients and contribute to better understand the natural history of brain degeneration in this genetic condition.
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Affiliation(s)
- José Luiz Pedroso
- Department of Neurology, Ataxia Unit, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
| | - Pedro Braga-Neto
- Department of Neurology, Ataxia Unit, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Center of Health Sciences, Universidade Estadual do Ceará, CE, Brazil
| | | | - Agessandro Abrahão
- Department of Neurology, Ataxia Unit, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | | | | | | | - Franklin Roberto Pereira Borges
- Department of Neurophysiology and Department of Neurosurgery, Fundação Beneficente, Hospital de Cirurgia, Aracaju, SE, Brazil
| | - Maria Luiza Saraiva-Pereira
- Department of Biochemistry and Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil
| | - Laura Bannach Jardim
- Department of Internal Medicine and Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil
| | - Orlando G P Barsottini
- Department of Neurology, Ataxia Unit, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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48
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Bayati A, Berman T. Localized vs. Systematic Neurodegeneration: A Paradigm Shift in Understanding Neurodegenerative Diseases. Front Syst Neurosci 2017; 11:62. [PMID: 28878634 PMCID: PMC5572257 DOI: 10.3389/fnsys.2017.00062] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 08/07/2017] [Indexed: 12/16/2022] Open
Affiliation(s)
- Armin Bayati
- Department of Neuroscience, University of VictoriaVictoria, BC, Canada
| | - Taryn Berman
- Department of Neuroscience, University of VictoriaVictoria, BC, Canada
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49
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Spinocerebellar ataxia type 6 presenting with parkinsonism, pre-synaptic dopaminergic dysfunction and hyperechogenicity of the substantia nigra. J Neurol Sci 2017; 376:60-62. [DOI: 10.1016/j.jns.2017.02.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 02/08/2017] [Accepted: 02/15/2017] [Indexed: 11/20/2022]
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50
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Nibbeling EAR, Delnooz CCS, de Koning TJ, Sinke RJ, Jinnah HA, Tijssen MAJ, Verbeek DS. Using the shared genetics of dystonia and ataxia to unravel their pathogenesis. Neurosci Biobehav Rev 2017; 75:22-39. [PMID: 28143763 DOI: 10.1016/j.neubiorev.2017.01.033] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 12/09/2016] [Accepted: 01/24/2017] [Indexed: 12/13/2022]
Abstract
In this review we explore the similarities between spinocerebellar ataxias and dystonias, and suggest potentially shared molecular pathways using a gene co-expression network approach. The spinocerebellar ataxias are a group of neurodegenerative disorders characterized by coordination problems caused mainly by atrophy of the cerebellum. The dystonias are another group of neurological movement disorders linked to basal ganglia dysfunction, although evidence is now pointing to cerebellar involvement as well. Our gene co-expression network approach identified 99 shared genes and showed the involvement of two major pathways: synaptic transmission and neurodevelopment. These pathways overlapped in the two disorders, with a large role for GABAergic signaling in both. The overlapping pathways may provide novel targets for disease therapies. We need to prioritize variants obtained by whole exome sequencing in the genes associated with these pathways in the search for new pathogenic variants, which can than be used to help in the genetic counseling of patients and their families.
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Affiliation(s)
- Esther A R Nibbeling
- University of Groningen, University Medical Center Groningen, Department of Genetics, Groningen, The Netherlands
| | - Cathérine C S Delnooz
- University of Groningen, University Medical Center Groningen, Department of Neurology, Groningen, The Netherlands
| | - Tom J de Koning
- University of Groningen, University Medical Center Groningen, Department of Genetics, Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, Department of Neurology, Groningen, The Netherlands
| | - Richard J Sinke
- University of Groningen, University Medical Center Groningen, Department of Genetics, Groningen, The Netherlands
| | - Hyder A Jinnah
- Departments of Neurology, Human Genetics and Pediatrics, Emory Clinic, Atlanta, USA
| | - Marina A J Tijssen
- University of Groningen, University Medical Center Groningen, Department of Neurology, Groningen, The Netherlands
| | - Dineke S Verbeek
- University of Groningen, University Medical Center Groningen, Department of Genetics, Groningen, The Netherlands.
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