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Sinokki A, Säisänen L, Hyppönen J, Silvennoinen K, Kälviäinen R, Mervaala E, Karjalainen PA, Rissanen SM. Detecting negative myoclonus during long-term home measurements using wearables. Clin Neurophysiol 2023; 156:166-174. [PMID: 37952446 DOI: 10.1016/j.clinph.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 08/22/2023] [Accepted: 10/17/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVE The aim of this study was to develop a feasible method for the detection of negative myoclonus (NM) through long-term home measurements in patients with progressive myoclonus epilepsy type 1. METHODS The number and duration of silent periods (SP) associated with NM were detected during a 48 h home recording using wearable surface electromyography (EMG) sensors. RESULTS A newly developed algorithm was able to find short (50-69 ms), intermediate (70-100 ms), and long (101- 500 ms) SPs from EMG data. Negative myoclonus assessed by the algorithm correlated significantly with the video-recorded and physician-evaluated unified myoclonus rating scale (UMRS) scores of NM and action myoclonus. Silent period duration, number, and their combination, correlated strongly and significantly also with the Singer score, which assesses functional status and ambulation. CONCLUSIONS Negative myoclonus can be determined objectively using long-term EMG measurements in home environment. With long-term measurements, we can acquire more reliable quantified information about NM as a symptom, compared to short evaluation at the clinic. SIGNIFICANCE As measured using SPs, NM may be a clinically useful measure for monitoring disease progression or assessing antimyoclonic drug effects objectively.
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Affiliation(s)
- Aku Sinokki
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland.
| | - Laura Säisänen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland; Kuopio Epilepsy Center, Department of Clinical Neurophysiology, Kuopio University Hospital, Full Member of ERN EpiCARE, Kuopio, Finland
| | - Jelena Hyppönen
- Kuopio Epilepsy Center, Department of Clinical Neurophysiology, Kuopio University Hospital, Full Member of ERN EpiCARE, Kuopio, Finland; Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Katri Silvennoinen
- Kuopio Epilepsy Center, Neurocenter, Kuopio University Hospital, Full Member of ERN EpiCARE, Kuopio, Finland; Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Reetta Kälviäinen
- Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland; Kuopio Epilepsy Center, Neurocenter, Kuopio University Hospital, Full Member of ERN EpiCARE, Kuopio, Finland
| | - Esa Mervaala
- Kuopio Epilepsy Center, Department of Clinical Neurophysiology, Kuopio University Hospital, Full Member of ERN EpiCARE, Kuopio, Finland; Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Pasi A Karjalainen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
| | - Saara M Rissanen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland; Adamant Health Ltd, Kuopio, Finland
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Hyppönen J, Paanila V, Äikiä M, Koskenkorva P, Könönen M, Vanninen R, Mervaala E, Kälviäinen R, Hakumäki J. Progressive myoclonic epilepsy type 1 (EPM1) patients present with abnormal 1H MRS brain metabolic profiles associated with cognitive function. Neuroimage Clin 2023; 39:103459. [PMID: 37541097 PMCID: PMC10412857 DOI: 10.1016/j.nicl.2023.103459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/14/2023] [Accepted: 06/20/2023] [Indexed: 08/06/2023]
Abstract
PURPOSE Progressive myoclonic epilepsy, type 1A (EPM1, Unverricht-Lundborg disease), is a rare neurodegenerative autosomal recessive disorder characterized by stimulus-sensitive and action myoclonus and tonic-clonic epileptic seizures. Patients develop neurological symptoms, including ataxia, intention tremor, and dysarthria, over time, with relatively limited and nonspecific MRI atrophy findings. The effects of the disease on brain metabolism are largely unknown. METHOD Eighteen EPM1 patients (9 M, 9F) underwent clinical evaluation and neuropsychological testing, which included the assessment of intellectual ability, verbal memory, and psychomotor and executive functions. Magnetic resonance spectroscopy (MRS) and imaging (MRI) were performed on a 1.5 T MRI system. 2D MRS chemical shift imaging (CSI) maps (TE = 270) were obtained from the following regions of the brain: basal ganglia, thalamus, insula, splenium, and occipital white and gray matter, and N-acetyl-aspartate (NAA)-, choline (Cho)-, and lactate (Lac)-to-creatine (Cr) ratios were analyzed. Ten healthy age-and sex-matched subjects (5M, 5F) were used as controls for MRS. RESULTS We found significant brain metabolic changes involving lactate, NAA, and choline, which are widespread in the basal ganglia, thalamic nuclei, insula, and occipital areas of EPM1 patients. Changes, especially in the right insula, basal ganglia, and thalamus, were associated with intellectual abilities and impairment of the psychomotor and executive functions of EPM1 patients. CONCLUSION Multiple brain metabolic alterations suggest the presence of neurodegeneration associated with EPM1 progression. The changes in metabolite ratios are associated with the neurocognitive dysfunction caused by the disease. However, the role of MRS findings in understanding pathophysiology of EPM1 warrants further studies.
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Affiliation(s)
- Jelena Hyppönen
- Department of Clinical Neurophysiology, Epilepsy Center, Diagnostic Imaging Center, Kuopio University Hospital, Full Member of ERN EpiCARE, Kuopio, Finland; Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Vili Paanila
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; Department of Clinical Radiology, Diagnostic Imaging Center, Kuopio University Hospital, Full Member of ERN EpiCARE, Kuopio, Finland
| | - Marja Äikiä
- Epilepsy Center, Neurocenter, Kuopio University Hospital, Full Member of ERN EpiCARE, Kuopio, Finland
| | - Päivi Koskenkorva
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; Department of Clinical Radiology, Diagnostic Imaging Center, Kuopio University Hospital, Full Member of ERN EpiCARE, Kuopio, Finland
| | - Mervi Könönen
- Department of Clinical Radiology, Diagnostic Imaging Center, Kuopio University Hospital, Full Member of ERN EpiCARE, Kuopio, Finland
| | - Ritva Vanninen
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; Department of Clinical Radiology, Diagnostic Imaging Center, Kuopio University Hospital, Full Member of ERN EpiCARE, Kuopio, Finland
| | - Esa Mervaala
- Department of Clinical Neurophysiology, Epilepsy Center, Diagnostic Imaging Center, Kuopio University Hospital, Full Member of ERN EpiCARE, Kuopio, Finland; Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Reetta Kälviäinen
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; Epilepsy Center, Neurocenter, Kuopio University Hospital, Full Member of ERN EpiCARE, Kuopio, Finland
| | - Juhana Hakumäki
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; Department of Clinical Radiology, Diagnostic Imaging Center, Kuopio University Hospital, Full Member of ERN EpiCARE, Kuopio, Finland.
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3
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Silvennoinen K, Säisänen L, Hyppönen J, Rissanen SM, Karjalainen PA, D'Ambrosio S, Jimenez‐Jimenez D, Zagaglia S, Rothwell JC, Balestrini S, Sisodiya SM, Julkunen P, Mervaala E, Kälviäinen R. Short- and long-interval intracortical inhibition in EPM1 is related to genotype. Epilepsia 2023; 64:208-217. [PMID: 36398398 PMCID: PMC10107775 DOI: 10.1111/epi.17466] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Progressive myoclonic epilepsy type 1 (EPM1) is caused by biallelic alterations in the CSTB gene, most commonly dodecamer repeat expansions. Although transcranial magnetic stimulation (TMS)-induced long-interval intracortical inhibition (LICI) was previously reported to be normal in EPM1, short-interval intracortical inhibition (SICI) was reduced. We explored the association between these measures and the clinical and genetic features in a separate group of patients with EPM1. METHODS TMS combined with electromyography was performed under neuronavigation. LICI was induced with an inter-stimulus interval (ISI) of 100 ms, and SICI with ISIs of 2 and 3 ms, and their means (mSICIs) were expressed as the ratio of conditioned to unconditioned stimuli. LICI and mSICI were compared between patients and controls. Nonparametric correlation was used to study the association between inhibition and parameters of clinical severity, including the Unified Myoclonus Rating Scale (UMRS); among patients with EPM1 due to biallelic expansion repeats, also the association with the number of repeats was assessed. RESULTS The study protocol was completed in 19 patients (15 with biallelic expansion repeats and 4 compound heterozygotes), and 7 healthy, age- and sex-matched control participants. Compared to controls, patients demonstrated significantly less SICI (median mSICI ratio 1.18 vs 0.38; p < .001). Neither LICI nor SICI was associated with parameters of clinical severity. In participants with biallelic repeat expansions, the number of repeats in the more affected allele (greater repeat number [GRN]) correlated with LICI (rho = 0.872; p < .001) and SICI (rho = 0.689; p = .006). SIGNIFICANCE Our results strengthen the finding of deranged γ-aminobutyric acid (GABA)ergic inhibition in EPM1. LICI and SICI may have use as markers of GABAergic impairment in future trials of disease-modifying treatment in this condition. Whether a higher number of expansion repeats leads to greater GABAergic impairment warrants further study.
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Affiliation(s)
- Katri Silvennoinen
- Kuopio Epilepsy Center, NeurocenterMember of ERN EpiCARE, Kuopio University HospitalKuopioFinland
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- Chalfont Centre for EpilepsyUK
| | - Laura Säisänen
- Department of Clinical Neurophysiology, Kuopio Epilepsy Center, NeurocenterMember of ERN EpiCARE, Kuopio University HospitalKuopioFinland
- Department of Applied PhysicsUniversity of Eastern FinlandKuopioFinland
| | - Jelena Hyppönen
- Department of Clinical Neurophysiology, Kuopio Epilepsy Center, NeurocenterMember of ERN EpiCARE, Kuopio University HospitalKuopioFinland
| | - Saara M. Rissanen
- Department of Applied PhysicsUniversity of Eastern FinlandKuopioFinland
| | | | - Sasha D'Ambrosio
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- Dipartimento di Scienze Biomediche e Cliniche "L. Sacco"Università degli Studi di MilanoMilanItaly
| | - Diego Jimenez‐Jimenez
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
| | - Sara Zagaglia
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
| | - John C. Rothwell
- Sobell Department of Motor Neuroscience and Movement DisordersUCL Queen Square Institute of NeurologyLondonUK
| | - Simona Balestrini
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- Chalfont Centre for EpilepsyUK
- Neuroscience DepartmentMember of ERN EpiCARE, Meyer Children HospitalFlorenceItaly
| | - Sanjay M. Sisodiya
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- Chalfont Centre for EpilepsyUK
| | - Petro Julkunen
- Department of Clinical Neurophysiology, Kuopio Epilepsy Center, NeurocenterMember of ERN EpiCARE, Kuopio University HospitalKuopioFinland
- Department of Applied PhysicsUniversity of Eastern FinlandKuopioFinland
| | - Esa Mervaala
- Department of Clinical Neurophysiology, Kuopio Epilepsy Center, NeurocenterMember of ERN EpiCARE, Kuopio University HospitalKuopioFinland
- Institute of Clinical Medicine, School of Medicine, Faculty of Health SciencesUniversity of Eastern FinlandKuopioFinland
| | - Reetta Kälviäinen
- Kuopio Epilepsy Center, NeurocenterMember of ERN EpiCARE, Kuopio University HospitalKuopioFinland
- Institute of Clinical Medicine, School of Medicine, Faculty of Health SciencesUniversity of Eastern FinlandKuopioFinland
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4
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Äikiä M, Hyppönen J, Mervaala E, Kälviäinen R. Cognitive functioning in progressive myoclonus epilepsy type 1 (Unverricht-Lundborg Disease, EPM1). Epilepsy Behav 2021; 122:108157. [PMID: 34171687 DOI: 10.1016/j.yebeh.2021.108157] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of this neuropsychological study of a large cohort of patients with progressive myoclonus epilepsy type 1 (Unverricht-Lundborg disease, EPM1) was to characterize the cognitive function of EPM1 patients and to explore the association between the disability caused by the disease and cognitive performance. METHOD Sixty-eight genetically verified EPM1 patients homozygous for the expansion mutation in the CSTB gene (37 males and 31 females aged 35 ± 11) participated in a neuropsychological assessment of intellectual ability, verbal memory, and executive and psychomotor function. The clinical evaluation comprised administering (and video-recording) the unified myoclonus rating scale (UMRS) to assess the severity of each patient's myoclonus. Forty-six healthy volunteers (19 males and 27 females aged 32 ± 11) served as the control group for the neuropsychological tests. RESULTS The cognitive performance of the EPM1 patient group was impaired. Verbal Intelligence Quotient (VIQ) was below the average range (VIQ < 85) in 49% of the patients; further, Performance Intelligence Quotient (PIQ) was below average in 75% of the patients. The patients performed worse than the controls in both immediate and delayed story recall (p = 0.001); however, in the word list learning task, the patients performed only slightly worse than the controls. The one-hour delayed recall of the learned words was similar in both groups, and the percentage of retained words and story contents did not differ between the patients and controls. The patients were impaired in all of the executive function tests as well as in the psychomotor speed tests (p < 0.001 for all). Also, the patients' simple psychomotor speed in the tapping task was significantly slowed in comparison to controls (p < 0.001). CONCLUSION The patients had impaired performance in the majority of the cognitive measures; they showed the highest level of impairment in all the executive function tests and in the psychomotor speed tests. The measures of these cognitive domains are timed-therefore, it is clear that severe myoclonus limits patients' performance. In contrast, verbal memory, especially delayed recall, was the least affected cognitive domain.
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Affiliation(s)
- Marja Äikiä
- Epilepsy Center, Neurocenter, Kuopio University Hospital, Full Member of the European Reference Network EpiCARE, Kuopio, Finland.
| | - Jelena Hyppönen
- Epilepsy Center, Department of Clinical Neurophysiology, Kuopio University Hospital, Full Member of the European Reference Network EpiCARE, Kuopio, Finland
| | - Esa Mervaala
- Epilepsy Center, Department of Clinical Neurophysiology, Kuopio University Hospital, Full Member of the European Reference Network EpiCARE, Kuopio, Finland; Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Reetta Kälviäinen
- Epilepsy Center, Neurocenter, Kuopio University Hospital, Full Member of the European Reference Network EpiCARE, Kuopio, Finland; Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
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5
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Silvennoinen K, Balestrini S, Rothwell JC, Sisodiya SM. Transcranial magnetic stimulation as a tool to understand genetic conditions associated with epilepsy. Epilepsia 2020; 61:1818-1839. [PMID: 32783192 PMCID: PMC8432162 DOI: 10.1111/epi.16634] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/09/2020] [Accepted: 07/09/2020] [Indexed: 12/30/2022]
Abstract
Advances in genetics may enable a deeper understanding of disease mechanisms and promote a shift to more personalised medicine in the epilepsies. At present, understanding of consequences of genetic variants mainly relies on preclinical functional work; tools for acquiring similar data from the living human brain are needed. Transcranial magnetic stimulation (TMS), in particular paired-pulse TMS protocols which depend on the function of cortical GABAergic interneuron networks, has the potential to become such a tool. For this report, we identified and reviewed 23 publications on TMS studies of cortical excitability and inhibition in 15 different genes or conditions relevant to epilepsy. Reduced short-interval intracortical inhibition (SICI) and reduced cortical silent period (CSP) duration were the most commonly reported findings, suggesting abnormal GABAA - (SICI) or GABAB ergic (CSP) signalling. For several conditions, these findings are plausible based on established evidence of involvement of the GABAergic system; for some others, they may inform future research around such mechanisms. Challenges of TMS include lack of complete understanding of the neural underpinnings of the measures used: hypotheses and analyses should be based on existing clinical and preclinical data. Further pitfalls include gathering sufficient numbers of participants, and the effect of confounding factors, especially medications. TMS-EEG is a unique perturbational technique to study the intrinsic properties of the cortex with excellent temporal resolution; while it has the potential to provide further information of use in interpreting effects of genetic variants, currently the links between measures and neurophysiology are less established. Despite these challenges, TMS is a tool with potential for elucidating the system-level in vivo functional consequences of genetic variants in people carrying genetic changes of interest, providing unique insights.
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Affiliation(s)
- Katri Silvennoinen
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK.,Chalfont Centre for Epilepsy, Chalfont St. Peter, UK
| | - Simona Balestrini
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK.,Chalfont Centre for Epilepsy, Chalfont St. Peter, UK
| | - John C Rothwell
- Sobell Department of Motor Neuroscience and Movement Disorders, Department of UCL Queen Square, Institute of Neurology, London, UK
| | - Sanjay M Sisodiya
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK.,Chalfont Centre for Epilepsy, Chalfont St. Peter, UK
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6
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Di Matteo F, Pipicelli F, Kyrousi C, Tovecci I, Penna E, Crispino M, Chambery A, Russo R, Ayo-Martin AC, Giordano M, Hoffmann A, Ciusani E, Canafoglia L, Götz M, Di Giaimo R, Cappello S. Cystatin B is essential for proliferation and interneuron migration in individuals with EPM1 epilepsy. EMBO Mol Med 2020; 12:e11419. [PMID: 32378798 PMCID: PMC7278547 DOI: 10.15252/emmm.201911419] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 04/01/2020] [Accepted: 04/02/2020] [Indexed: 12/18/2022] Open
Abstract
Progressive myoclonus epilepsy (PME) of Unverricht–Lundborg type (EPM1) is an autosomal recessive neurodegenerative disorder with the highest incidence of PME worldwide. Mutations in the gene encoding cystatin B (CSTB) are the primary genetic cause of EPM1. Here, we investigate the role of CSTB during neurogenesis in vivo in the developing mouse brain and in vitro in human cerebral organoids (hCOs) derived from EPM1 patients. We find that CSTB (but not one of its pathological variants) is secreted into the mouse cerebral spinal fluid and the conditioned media from hCOs. In embryonic mouse brain, we find that functional CSTB influences progenitors’ proliferation and modulates neuronal distribution by attracting interneurons to the site of secretion via cell‐non‐autonomous mechanisms. Similarly, in patient‐derived hCOs, low levels of functional CSTB result in an alteration of progenitor's proliferation, premature differentiation, and changes in interneurons migration. Secretion and extracellular matrix organization are the biological processes particularly affected as suggested by a proteomic analysis in patients’ hCOs. Overall, our study sheds new light on the cellular mechanisms underlying the development of EPM1.
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Affiliation(s)
- Francesco Di Matteo
- Max Planck Institute of Psychiatry, Munich, Germany.,International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany
| | - Fabrizia Pipicelli
- Max Planck Institute of Psychiatry, Munich, Germany.,International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany
| | | | - Isabella Tovecci
- Max Planck Institute of Psychiatry, Munich, Germany.,Department of Biology, University Federico II, Naples, Italy
| | - Eduardo Penna
- Department of Biology, University Federico II, Naples, Italy
| | | | - Angela Chambery
- Department of Environmental, Biological and Pharmaceutical Sciences and Technologies, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Rosita Russo
- Department of Environmental, Biological and Pharmaceutical Sciences and Technologies, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Ane Cristina Ayo-Martin
- Max Planck Institute of Psychiatry, Munich, Germany.,International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany
| | | | | | - Emilio Ciusani
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | | - Magdalena Götz
- Physiological Genomics, Biomedical Center (BMC), Ludwig-Maximilians-Universitaet (LMU), Planegg/Martinsried, Germany.,Helmholtz Center Munich, Biomedical Center (BMC), Institute of Stem Cell Research, Planegg/Martinsried, Germany.,SyNergy Excellence Cluster, Munich, Germany
| | - Rossella Di Giaimo
- Max Planck Institute of Psychiatry, Munich, Germany.,Department of Biology, University Federico II, Naples, Italy
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7
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Rossi Sebastiano D, Visani E, Contarino VE, Panzica F, Duran D, D’Incerti L, Franceschetti S, Canafoglia L. Distortion of the cortical motor map in patients with Unverricht-Lundborg disease: A combined TMS-MRI study. Epilepsy Res 2020; 160:106278. [DOI: 10.1016/j.eplepsyres.2020.106278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 12/30/2019] [Accepted: 01/14/2020] [Indexed: 11/29/2022]
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8
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Julkunen P, Löfberg O, Kallioniemi E, Hyppönen J, Kälviäinen R, Mervaala E. Abnormal motor cortical adaptation to external stimulus in Unverricht-Lundborg disease (progressive myoclonus type 1, EPM1). J Neurophysiol 2018; 120:617-623. [PMID: 29742025 DOI: 10.1152/jn.00063.2018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Unverricht-Lundborg disease (EPM1) is associated with progressive functional and anatomic changes in the thalamus and motor cortex. The neurophysiological mechanisms behind the impaired thalamocortical system were studied through short-term adaptation of the motor cortex to transcranial magnetic stimulation (TMS) via repetition suppression (RS) phenomenon. RS is considered to be related to neural processing of external stimuli. We hypothesized that this neural processing is progressively impaired in EPM1 from adolescence to adulthood. Eight adult patients with EPM1 (age: 40 ± 13 yr), six adolescent patients with EPM1 (age: 16 ± 1 yr), and ten adult controls (age: 35 ± 12 yr) were studied using navigated TMS and RS study protocol including trains of four repeated stimuli with intertrain interval of 20 s and interstimulus interval of 1 s. Changes in RS were investigated from adolescence to adulthood in EPM1 by comparing with adult controls. In controls, the RS was seen as 50-55% reduction in motor response amplitudes to TMS after the first stimulus. RS was mild or missing in EPM1. RS from first to second stimulus within the stimulus trains was significantly stronger in adolescent patients than in adult patients ( P = 0.046). Abnormal RS correlated with the myoclonus severity of the patients. In agreement with our hypothesis, neural processing of external stimuli is progressively impaired in EPM1 possibly due to anatomically impaired thalamocortical system or inhibitory tonus preventing sufficient adaptive reactiveness to stimuli. Our results suggest that RS abnormality might be used as a biomarker in the therapeutic trials for myoclonus. NEW & NOTEWORTHY Unverricht-Lundborg disease (EPM1) is associated with impaired thalamocortical function, which we studied in 8 adult and 6 adolescent patients and in 10 adult controls through repetition suppression (RS) of the motor cortex. We hypothesized that neural processing is progressively impaired in EPM1 from adolescence to adulthood. RS was normal in controls, whereas it was mild or missing in EPM1. Stronger RS was seen in adolescent patients than in adult patients correlating with the myoclonus severity.
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Affiliation(s)
- Petro Julkunen
- Department of Clinical Neurophysiology, Kuopio University Hospital , Kuopio , Finland.,Department of Applied Physics, University of Eastern Finland , Kuopio , Finland
| | - Olli Löfberg
- Department of Clinical Neurophysiology, Kuopio University Hospital , Kuopio , Finland
| | - Elisa Kallioniemi
- Department of Clinical Neurophysiology, Kuopio University Hospital , Kuopio , Finland.,Department of Clinical Radiology, Kuopio University Hospital , Kuopio , Finland
| | - Jelena Hyppönen
- Department of Clinical Neurophysiology, Kuopio University Hospital , Kuopio , Finland
| | - Reetta Kälviäinen
- Department of Neurology, Kuopio Epilepsy Center, Kuopio University Hospital , Kuopio , Finland.,Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland , Kuopio , Finland
| | - Esa Mervaala
- Department of Clinical Neurophysiology, Kuopio University Hospital , Kuopio , Finland.,Department of Clinical Neurophysiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
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9
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Nardone R, Versace V, Höller Y, Sebastianelli L, Brigo F, Lochner P, Golaszewski S, Saltuari L, Trinka E. Transcranial magnetic stimulation in myoclonus of different aetiologies. Brain Res Bull 2018; 140:258-269. [DOI: 10.1016/j.brainresbull.2018.05.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 05/12/2018] [Accepted: 05/18/2018] [Indexed: 12/29/2022]
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10
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Rossi Sebastiano D, Magaudda A, Quartarone A, Brizzi T, Visani E, Capovilla G, Beccaria F, Anversa P, Franceschetti S, Canafoglia L. Effect of repetitive transcranial magnetic stimulation on action myoclonus: A pilot study in patients with EPM1. Epilepsy Behav 2018; 80:33-36. [PMID: 29396360 DOI: 10.1016/j.yebeh.2017.11.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 10/13/2017] [Accepted: 11/26/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The objective of this study was to explore the short-term effects of repetitive transcranial magnetic stimulation (rTMS) on action myoclonus. METHODS Nine patients with Unverricht-Lundborg (EPM1) progressive myoclonus epilepsy type underwent two series of 500 stimuli at 0.3Hz through round coil twice a day for five consecutive days. Clinical and neurophysiological examinations were performed two hours before starting the first rTMS session and two hours after the end of the last rTMS session. RESULTS Eight patients completed the protocol; one discontinued because of a transient increase in spontaneous jerks. The unified myoclonus rating scale indicated a 25% reduction in posttreatment myoclonus with action score associated with an increase in the cortical motor threshold and lengthening of the cortical silent period (CSP). The decrease in the myoclonus with action scores correlated with the prolongation of CSP. CONCLUSIONS Repetitive transcranial magnetic stimulation can be safely used in patients with EPM1, improves action myoclonus, and partially restores deficient cortical inhibition.
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Affiliation(s)
- Davide Rossi Sebastiano
- Neurophysiopathology and Epilepsy Centre Unit, IRCCS Foundation Carlo Besta Neurological Institute, Milan, Italy
| | | | - Angelo Quartarone
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy; IRCCS Centro Neurolesi 'Bonino Pulejo', Messina, Italy
| | - Teresa Brizzi
- Epilepsy Centre, University of Messina, Messina, Italy
| | - Elisa Visani
- Neurophysiopathology and Epilepsy Centre Unit, IRCCS Foundation Carlo Besta Neurological Institute, Milan, Italy
| | - Giuseppe Capovilla
- Epilepsy Centre, Department of Child Neuropsychiatry, C. Poma Hospital, Mantua, Italy
| | - Francesca Beccaria
- Epilepsy Centre, Department of Child Neuropsychiatry, C. Poma Hospital, Mantua, Italy
| | - Paola Anversa
- Neurophysiopathology and Epilepsy Centre Unit, IRCCS Foundation Carlo Besta Neurological Institute, Milan, Italy
| | - Silvana Franceschetti
- Neurophysiopathology and Epilepsy Centre Unit, IRCCS Foundation Carlo Besta Neurological Institute, Milan, Italy
| | - Laura Canafoglia
- Neurophysiopathology and Epilepsy Centre Unit, IRCCS Foundation Carlo Besta Neurological Institute, Milan, Italy.
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Franceschetti S, Canafoglia L, Rotondi F, Visani E, Granvillano A, Panzica F. The network sustaining action myoclonus: a MEG-EMG study in patients with EPM1. BMC Neurol 2016; 16:214. [PMID: 27821136 PMCID: PMC5100097 DOI: 10.1186/s12883-016-0738-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 11/01/2016] [Indexed: 11/12/2022] Open
Abstract
Background To explore the cortical network sustaining action myoclonus and to found markers of the resulting functional impairment, we evaluated the distribution of the cortico-muscular coherence (CMC) and the frequency of coherent cortical oscillations with magnetoencephalography (MEG). All patients had EPM1 (Unverricht-Lundborg) disease known to present with prominent and disabling movement-activated myoclonus. Methods Using autoregressive models, we evaluated CMC on MEG sensors grouped in regions of interests (ROIs) above the main cortical areas. The movement was a repeated sustained isometric extension of the right hand and right foot. We compared the data obtained in 10 EPM1 patients with those obtained in 10 age-matched controls. Results As expected, CMC in beta band was significantly higher in EPM1 patients compared to controls in the ROIs exploring the sensorimotor cortex, but, it was also significantly higher in adjacent ROIs ipsilateral and contralateral to the activated limb. Moreover, the beta-CMC peak occurred at frequencies significantly slower and more stable frequencies in EPM1 patients with respect to controls. The frequency of the beta-CMC peak inversely correlated with the severity of myoclonus. Conclusions the high and spatially extended beta-CMC peaking in a restricted range of low-beta frequencies in EPM1 patients, suggest that action myoclonus may result not only from an enhanced local synchronization but also from a specific oscillatory activity involving an expanded neuronal pool. The significant relationship between beta-CMC peak frequency and the severity of the motor impairment can represent a useful neurophysiological marker for the patients’ evaluation and follow-up.
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Affiliation(s)
- Silvana Franceschetti
- Department of Neurophysiology, Epilepsy Centre, C. Besta Neurological Institute IRCCS Foundation, Via Celoria 11, 20133, Milan, Italy.
| | - Laura Canafoglia
- Department of Neurophysiology, Epilepsy Centre, C. Besta Neurological Institute IRCCS Foundation, Via Celoria 11, 20133, Milan, Italy
| | - Fabio Rotondi
- Department of Neurophysiology, Epilepsy Centre, C. Besta Neurological Institute IRCCS Foundation, Via Celoria 11, 20133, Milan, Italy.,Department of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), University of Genova, Genova, Italy
| | - Elisa Visani
- Department of Neurophysiology, Epilepsy Centre, C. Besta Neurological Institute IRCCS Foundation, Via Celoria 11, 20133, Milan, Italy
| | - Alice Granvillano
- Department of Neurophysiology, Epilepsy Centre, C. Besta Neurological Institute IRCCS Foundation, Via Celoria 11, 20133, Milan, Italy
| | - Ferruccio Panzica
- Department of Neurophysiology, Epilepsy Centre, C. Besta Neurological Institute IRCCS Foundation, Via Celoria 11, 20133, Milan, Italy
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The role of transcranial magnetic stimulation in evaluation of motor cortex excitability in Rett syndrome. Eur J Paediatr Neurol 2016; 20:597-603. [PMID: 27131828 DOI: 10.1016/j.ejpn.2016.03.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 03/16/2016] [Accepted: 03/30/2016] [Indexed: 01/18/2023]
Abstract
UNLABELLED Rett syndrome (RTT) is a frequent neurodevelopmental disorder confirmed by clinical criteria and supported by the methyl-CpG-binding protein 2 gene (MECP2) mutation. A short central motor conduction time (CMCT) was reported in transcranial magnetic stimulation (TMS) studies performed in RTT. This was attributed to hyperexcitability of the motor cortex and/or spinal motor neurons, but was not studied further. AIM We performed TMS in RTT to evaluate motor cortex excitability by determining the cortical motor threshold (CMT) and motor cortex inhibition by the cortical silent period (CSP) besides measuring CMCT. METHODS Single-pulse TMS was performed in 17 Rett patients, diagnosed by clinical criteria and MECP2 mutation testing, and the same number of healthy controls. The outcome measures were compared between RTT groups with different antiepileptic drugs (AED) and those with and without the MECP2 mutation. RESULTS CMCT was shorter, but we found elevated CMT and shorter CSP, which suggests decreased excitatory and inhibitory motor cortical function. The outcome was independent of AED and the presence or absence of the MECP2 mutation. INTERPRETATION Decreased excitatory and inhibitory motor cortical function could explain the short CMCT, with higher stimulus intensities needed to excite pyramidal neurons.
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Manninen O, Puolakkainen T, Lehto J, Harittu E, Kallonen A, Peura M, Laitala-Leinonen T, Kopra O, Kiviranta R, Lehesjoki AE. Impaired osteoclast homeostasis in the cystatin B-deficient mouse model of progressive myoclonus epilepsy. Bone Rep 2015; 3:76-82. [PMID: 28377970 PMCID: PMC5365244 DOI: 10.1016/j.bonr.2015.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 09/19/2015] [Accepted: 10/04/2015] [Indexed: 01/09/2023] Open
Abstract
Progressive myoclonus epilepsy of Unverricht–Lundborg type (EPM1) is an autosomal recessively inherited disorder characterized by incapacitating stimulus-sensitive myoclonus and tonic-clonic epileptic seizures with onset at the age of 6 to 16 years. EPM1 patients also exhibit a range of skeletal changes, e.g., thickened frontal cranial bone, arachnodactyly and scoliosis. Mutations in the gene encoding cystatin B (CSTB) underlie EPM1. CSTB is an inhibitor of cysteine cathepsins, including cathepsin K, a key enzyme in bone resorption by osteoclasts. CSTB has previously been shown to protect osteoclasts from experimentally induced apoptosis and to modulate bone resorption in vitro. Nevertheless, its physiological function in bone and the cause of the bone changes in patients remain unknown. Here we used the CSTB-deficient mouse (Cstb−/−) model of EPM1 to evaluate the contribution of defective CSTB protein function on bone pathology and osteoclast differentiation and function. Micro-computed tomography of hind limbs revealed thicker trabeculae and elevated bone mineral density in the trabecular bone of Cstb−/− mice. Histology from Cstb−/− mouse bones showed lower osteoclast count and thinner growth plates in long bones. Bone marrow-derived osteoclast cultures revealed lower osteoclast number and size in the Cstb−/− group. Cstb−/− osteoclasts formed less and smaller resorption pits in an in vitro assay. This impaired resorptive capacity was likely due to a decrease in osteoclast numbers and size. These data imply that the skeletal changes in Cstb−/− mice and in EPM1 patients are a result of CSTB deficiency leading to impaired osteoclast formation and consequently compromised resorptive capacity. These results suggest that the role of CSTB in osteoclast homeostasis and modulation of bone metabolism extends beyond cathepsin K regulation. μCT reveals changes in trabecular bone of the Cstb−/− mouse model of EPM1, compatible with findings in human patients. Bone histology in Cstb−/− mice shows lower osteoclast number and thinner growth plates in long bones. Cultured osteoclasts of Cstb−/− mice show decreased size and number of mature osteoclasts with impaired bone resorption. Impaired osteoclast formation and resorption are likely to underlie the bone phenotype associated with CSTB deficiency.
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Affiliation(s)
- Otto Manninen
- Folkhälsan Institute of Genetics, 00290 Helsinki, Finland; Research Program's Unit, Molecular Neurology, University of Helsinki, 00014 Helsinki, Finland; Neuroscience Center, University of Helsinki, 00014 Helsinki, Finland
| | | | - Jemina Lehto
- Department of Medicine, University of Turku, 20520 Turku, Finland
| | - Elina Harittu
- Department of Anatomy, University of Turku, 20520 Turku, Finland
| | - Aki Kallonen
- Department of Physics, University of Helsinki, 00014 Helsinki, Finland
| | - Marko Peura
- Department of Physics, University of Helsinki, 00014 Helsinki, Finland
| | | | - Outi Kopra
- Folkhälsan Institute of Genetics, 00290 Helsinki, Finland; Research Program's Unit, Molecular Neurology, University of Helsinki, 00014 Helsinki, Finland; Neuroscience Center, University of Helsinki, 00014 Helsinki, Finland
| | - Riku Kiviranta
- Department of Physics, University of Helsinki, 00014 Helsinki, Finland
| | - Anna-Elina Lehesjoki
- Folkhälsan Institute of Genetics, 00290 Helsinki, Finland; Research Program's Unit, Molecular Neurology, University of Helsinki, 00014 Helsinki, Finland; Neuroscience Center, University of Helsinki, 00014 Helsinki, Finland
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Reduced cortical activation in inferior frontal junction in Unverricht–Lundborg disease (EPM1) – A motor fMRI study. Epilepsy Res 2015; 111:78-84. [DOI: 10.1016/j.eplepsyres.2015.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 01/13/2015] [Accepted: 01/19/2015] [Indexed: 11/23/2022]
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Kimiskidis VK, Valentin A, Kälviäinen R. Transcranial magnetic stimulation for the diagnosis and treatment of epilepsy. Curr Opin Neurol 2014; 27:236-41. [DOI: 10.1097/wco.0000000000000071] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Progressive volume loss and white matter degeneration in cstb-deficient mice: a diffusion tensor and longitudinal volumetry MRI study. PLoS One 2014; 9:e90709. [PMID: 24603771 PMCID: PMC3948351 DOI: 10.1371/journal.pone.0090709] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 02/03/2014] [Indexed: 11/19/2022] Open
Abstract
Unverricht-Lundborg type progressive myoclonus epilepsy (EPM1, OMIM 254800) is an autosomal recessive disorder characterized by onset at the age of 6 to 16 years, incapacitating stimulus-sensitive myoclonus and tonic-clonic epileptic seizures. It is caused by mutations in the gene encoding cystatin B. Previously, widespread white matter changes and atrophy has been detected both in adult EPM1 patients and in 6-month-old cystatin B-deficient mice, a mouse model for the EPM1 disease. In order to elucidate the spatiotemporal dynamics of the brain atrophy and white matter changes in EPM1, we conducted longitudinal in vivo magnetic resonance imaging and ex vivo diffusion tensor imaging accompanied with tract-based spatial statistics analysis to compare volumetric changes and fractional anisotropy in the brains of 1 to 6 months of age cystatin B-deficient and control mice. The results reveal progressive but non-uniform volume loss of the cystatin B-deficient mouse brains, indicating that different neuronal populations possess distinct sensitivity to the damage caused by cystatin B deficiency. The diffusion tensor imaging data reveal early and progressive white matter alterations in cystatin B-deficient mice affecting all major tracts. The results also indicate that the white matter damage in the cystatin B-deficient brain is most likely secondary to glial activation and neurodegenerative events rather than a primary result of CSTB deficiency. The data also show that diffusion tensor imaging combined with TBSS analysis provides a feasible approach not only to follow white matter damage in neurodegenerative mouse models but also to detect fractional anisotropy changes related to normal white matter maturation and reorganisation.
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