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Mukherjee A, Pandey S. Tremor in Spinocerebellar Ataxia: A Scoping Review. Tremor Other Hyperkinet Mov (N Y) 2024; 14:31. [PMID: 38911333 PMCID: PMC11192095 DOI: 10.5334/tohm.911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 06/14/2024] [Indexed: 06/25/2024] Open
Abstract
Background Spinocerebellar ataxia (SCA) denotes an expanding list of autosomal dominant cerebellar ataxias. Although tremor is an important aspect of the clinical spectrum of the SCAs, its prevalence, phenomenology, and pathophysiology are unknown. Objectives This review aims to describe the various types of tremors seen in the different SCAs, with a discussion on the pathophysiology of the tremors, and the possible treatment modalities. Methods The authors conducted a literature search on PubMed using search terms including tremor and the various SCAs. Relevant articles were included in the review after excluding duplicate publications. Results While action (postural and intention) tremors are most frequently associated with SCA, rest and other rare tremors have also been documented. The prevalence and types of tremors vary among the different SCAs. SCA12, common in certain ethnic populations, presents a unique situation, where the tremor is typically the principal manifestation. Clinical manifestations of SCAs may be confused with essential tremor or Parkinson's disease. The pathophysiology of tremors in SCAs predominantly involves the cerebellum and its networks, especially the cerebello-thalamo-cortical circuit. Additionally, connections with the basal ganglia, and striatal dopaminergic dysfunction may have a role. Medical management of tremor is usually guided by the phenomenology and associated clinical features. Deep brain stimulation surgery may be helpful in treatment-resistant tremors. Conclusions Tremor is an elemental component of SCAs, with diverse phenomenology, and emphasizes the role of the cerebellum in tremor. Further studies will be useful to delineate the clinical, pathophysiological, and therapeutic aspects of tremor in SCAs.
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Affiliation(s)
- Adreesh Mukherjee
- Department of Neurology and Stroke Medicine, Amrita Hospital, Mata Amritanandamayi Marg Sector 88, Faridabad, Delhi National Capital Region, India
| | - Sanjay Pandey
- Department of Neurology and Stroke Medicine, Amrita Hospital, Mata Amritanandamayi Marg Sector 88, Faridabad, Delhi National Capital Region, India
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2
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Quintas S, Sanles‐Falagan R, Berbís MÁ. I 123-FP-CIT (DaTSCAN) SPECT beyond the Most Common Causes of Parkinsonism: A Systematic Review. Mov Disord Clin Pract 2024; 11:613-625. [PMID: 38693679 PMCID: PMC11145110 DOI: 10.1002/mdc3.14055] [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: 11/14/2023] [Revised: 01/23/2024] [Accepted: 03/30/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND As the diagnosis of Parkinson's disease (PD) is fundamentally clinical, the usefulness of ioflupane (123I) single-photon emission computed tomography (SPECT) or DaTSCAN as a diagnostic tool has been a matter of debate for years. The performance of DaTSCAN is generally recommended in the follow-up of patients with a clinically uncertain diagnosis, especially in those with a suspected essential tremor, drug-induced parkinsonism, or vascular parkinsonism. However, there is a dearth of DaTSCAN findings regarding neurodegenerative parkinsonisms besides PD and atypical parkinsonisms. To date, a specific nigrostriatal dopamine uptake pattern that would help differentiate PD from the most frequent atypical parkinsonisms is yet to be described. This fact is further complicated by the possible visualization of abnormalities in the uptake pattern in patients with rarer neurodegenerative parkinsonisms. OBJECTIVES We aimed to summarize the current literature regarding DaTSCAN findings in patients with rare neurodegenerative parkinsonisms. METHODS The PubMed database was systematically screened for studies in English or Spanish up to October 15, 2023, using search terms "DaTSCAN", "ioflupane", "DaT-SPECT", "123I-FP-CIT SPECT", "dopamine transporter imaging", and "[123I] FP-CIT SPECT". Duplicated publications and studies regarding PD, atypical parkinsonisms, dystonia-parkinsonism, essential tremor, and parkinsonism due to non-degenerative causes were excluded. RESULTS The obtained results were reviewed and summarized, including DaTSCAN findings in fragile X-associated tremor/ataxia syndrome, prion diseases, Huntington's disease, spinocerebellar ataxia, hereditary spastic paraparesis, metabolic disorders, and other diseases (anti-IgLON5 disease, ring chromosome 20 syndrome, chorea-acanthocytosis, and neuronal ceroid lipofuscinosis). CONCLUSIONS This review highlights the need to determine in the future the utility and cost-effectiveness of DaTSCAN, both as a diagnostic and a prognostic tool, in patients with parkinsonian symptoms in rare neurodegenerative diseases.
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Affiliation(s)
- Sonia Quintas
- Department of NeurologyLa Princesa University HospitalMadridSpain
| | | | - M. Álvaro Berbís
- Department of RadiologyHT Médica, San Juan de Dios HospitalCórdobaSpain
- Faculty of MedicineAutonomous University of MadridMadridSpain
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3
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Zheng Z, Zhu Z, Pu J, Zhou C, Cao L, Lv D, Lu J, Zhao G, Chen Y, Tian J, Yin X, Zhang B, Yan Y, Zhao G. Early-onset familial essential tremor is associated with nucleotide expansions of spinocerebellar ataxia in China. Mol Biol Rep 2024; 51:113. [PMID: 38227102 DOI: 10.1007/s11033-023-09023-x] [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: 09/24/2023] [Accepted: 10/23/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Essential tremor (ET) is a neurological disease characterized by action tremor in upper arms. Although its high heritability and prevalence worldwide, its etiology and association with other diseases are still unknown. METHOD We investigated 10 common spinocerebellar ataxias (SCAs), including SCA1, SCA2, SCA3, SCA6, SCA7, SCA8, SCA12, SCA17, SCA36, dentatorubral-pallidoluysian atrophy (DRPLA) in 92 early-onset familial ET pedigrees in China collected from 2016 to 2022. RESULT We found one SCA12 proband carried 51 CAG repeats within PPP2R2B gene and one SCA3 proband with intermediate CAG repeats (55) with ATXN3 gene. The other 90 ET probands all had normal repeat expansions. CONCLUSION Tremor can be the initial phenotype of certain SCA. For early-onset, familial ET patients, careful physical examinations are needed before genetic SCA screening.
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Affiliation(s)
- Zhilin Zheng
- Department of Neurology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Zeyu Zhu
- Department of Neurology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Jiali Pu
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Chen Zhou
- Department of Neurology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Lanxiao Cao
- Department of Neurology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Dayao Lv
- Department of Neurology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Jinyu Lu
- Department of Neurology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Gaohua Zhao
- Department of Neurology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Yanxing Chen
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jun Tian
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xinzhen Yin
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Baorong Zhang
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
| | - Yaping Yan
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
| | - Guohua Zhao
- Department of Neurology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, China.
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
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Oliveira JBL, Martinez ARM, França MC. Pharmacotherapy for the management of the symptoms of Machado-Joseph Disease. Expert Opin Pharmacother 2022; 23:1687-1694. [PMID: 36254604 DOI: 10.1080/14656566.2022.2135432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Machado-Joseph disease or spinocerebellar ataxia type 3 (SCA3/MJD) is the leading cause of autosomal dominant ataxia worldwide. This is a slowly progressive, but very disabling disorder. Ataxia is the main clinical feature, but additional motor and non-motor manifestations may be found. Many of these manifestations are amenable to pharmacological treatments, which may impact the quality of life of affected subjects. AREAS COVERED Authors review available literature on both disease-modifying and symptomatic pharmacological therapies for SCA3/MJD. Discussion is stratified into motor (ataxic and non-ataxic syndromes) and non-motor manifestations. Ongoing clinical trials and future perspectives are also discussed in the manuscript. EXPERT OPINION Symptomatic treatment is the mainstay of clinical care and should be tailored for each patient with SCA3/MJD. Management of ataxia is still a challenging task, but relief (at least partial) of dystonia, pain/cramps, fatigue, and sleep disorders is an achievable goal for many patients. Even though there are no disease-modifying treatments so far, recent advances in understanding the biology of disease and international collaborations of clinical researchers are now paving the way for a new era where more clinical trials will be available for this devastating disorder.
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Affiliation(s)
| | - Alberto R M Martinez
- Department of Neurology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
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Li J, Peng Y, Tang J, Li M, Zhu M, Zhou M, Fang P, Hong D. Autophagic vacuolar myopathy involving the phenotype of spinocerebellar ataxia type 3. Neuropathology 2022; 43:135-142. [PMID: 37005010 DOI: 10.1111/neup.12860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/29/2022] [Accepted: 07/27/2022] [Indexed: 11/26/2022]
Abstract
Spinocerebellar ataxia type 3 (SCA3) is a form of autosomal dominant cerebellar ataxia with a wide range of clinical manifestations, including ataxia and pyramidal and extrapyramidal signs. A few SCA3 patients have been noticed to be predisposed to the development of inclusion body myositis. It is still unknown whether muscle can be primarily involved in the pathogenesis of SCA3. This study reported an SCA3 family in which the index patient initially presented with parkinsonism, sensory ataxia, and distal myopathy but the absence of cerebellar and pyramidal symptoms. The clinical and electrophysiological studies implied a possible combination of distal myopathy and sensory-motor neuropathy or neuronopathy. MRI muscle showed selective fat infiltration and absence of denervated edema-like changes, indicating the distal muscle weakness had a myopathic origin. Muscle pathology showed the myopathic involvement, besides neurogenic involvement, characterized by chronic myopathic changes with multiple autophagic vacuoles. Genetic screening revealed expanded CAG of 61 repeats in the ATXN3 gene, which showed co-segregation in the family. Besides the neurogenic origin, the myopathic origin may be partly attributed to the limb weakness of SCA3 patients, which expands the spectrum of the clinical manifestation of SCA3.
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Affiliation(s)
- Jingjing Li
- Department of Neurology The First Affiliated Hospital of Nanchang University Nanchang China
| | - Yun Peng
- Department of Neurology The First Affiliated Hospital of Nanchang University Nanchang China
- Department of Medical Genetics The First Affiliated Hospital of Nanchang University Nanchang China
| | - Jincai Tang
- Department of Neurology The First Affiliated Hospital of Nanchang University Nanchang China
| | - Menghua Li
- Department of Neurology The First Affiliated Hospital of Nanchang University Nanchang China
| | - Min Zhu
- Department of Neurology The First Affiliated Hospital of Nanchang University Nanchang China
- Department of Medical Genetics The First Affiliated Hospital of Nanchang University Nanchang China
| | - Meihong Zhou
- Department of Neurology The First Affiliated Hospital of Nanchang University Nanchang China
| | - Pu Fang
- Department of Neurology The First Affiliated Hospital of Nanchang University Nanchang China
| | - Daojun Hong
- Department of Neurology The First Affiliated Hospital of Nanchang University Nanchang China
- Department of Medical Genetics The First Affiliated Hospital of Nanchang University Nanchang China
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6
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Movement disorders and neuropathies: overlaps and mimics in clinical practice. J Neurol 2022; 269:4646-4662. [PMID: 35657406 DOI: 10.1007/s00415-022-11200-0] [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: 05/13/2022] [Accepted: 05/16/2022] [Indexed: 10/18/2022]
Abstract
Movement disorders as well as peripheral neuropathies are extremely frequent in the general population; therefore, it is not uncommon to encounter patients with both these conditions. Often, the coexistence is coincidental, due to the high incidence of common causes of peripheral neuropathy, such as diabetes and other age-related disorders, as well as of Parkinson disease (PD), which has a typical late onset. Nonetheless, there is broad evidence that PD patients may commonly develop a sensory and/or autonomic polyneuropathy, triggered by intrinsic and/or extrinsic mechanisms. Similarly, some peripheral neuropathies may develop some movement disorders in the long run, such as tremor, and rarely dystonia and myoclonus, suggesting that central mechanisms may ensue in the pathogenesis of these diseases. Although rare, several acquired or hereditary causes may be responsible for the combination of movement and peripheral nerve disorders as a unique entity, some of which are potentially treatable, including paraneoplastic, autoimmune and nutritional aetiologies. Finally, genetic causes should be pursued in case of positive family history, young onset or multisystemic involvement, and examined for neuroacanthocytosis, spinocerebellar ataxias, mitochondrial disorders and less common causes of adult-onset cerebellar ataxias and spastic paraparesis. Deep phenotyping in terms of neurological and general examination, as well as laboratory tests, neuroimaging, neurophysiology, and next-generation genetic analysis, may guide the clinician toward the correct diagnosis and management.
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Louis ED, Faust PL. Essential Tremor Within the Broader Context of Other Forms of Cerebellar Degeneration. THE CEREBELLUM 2021; 19:879-896. [PMID: 32666285 DOI: 10.1007/s12311-020-01160-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Essential tremor (ET) has recently been reconceptualized by many as a degenerative disease of the cerebellum. Until now, though, there has been no attempt to frame it within the context of these diseases. Here, we compare the clinical and postmortem features of ET with other cerebellar degenerations, thereby placing it within the broader context of these diseases. Action tremor is the hallmark feature of ET. Although often underreported in the spinocerebellar ataxias (SCAs), action tremors occur, and it is noteworthy that in SCA12 and 15, they are highly prevalent, often severe, and can be the earliest disease manifestation, resulting in an initial diagnosis of ET in many cases. Intention tremor, sometimes referred to as "cerebellar tremor," is a common feature of ET and many SCAs. Other features of cerebellar dysfunction, gait ataxia and eye motion abnormalities, are seen to a mild degree in ET and more markedly in SCAs. Several SCAs (e.g., SCA5, 6, 14, and 15), like ET, follow a milder and more protracted disease course. In ET, numerous postmortem changes have been localized to the cerebellum and are largely confined to the cerebellar cortex, preserving the cerebellar nuclei. Purkinje cell loss is modest. Similarly, in SCA3, 12, and 15, Purkinje cell loss is limited, and in SCA12 and 15, there is preservation of cerebellar nuclei and relative sparing of other central nervous system regions. Both clinically and pathologically, there are numerous similarities and intersection points between ET and other disorders of cerebellar degeneration.
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Affiliation(s)
- Elan D Louis
- Department of Neurology and Therapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Phyllis L Faust
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center and the New York Presbyterian Hospital, New York, NY, USA
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Thompson R, Bhatti DE, Hellman A, Doss SJ, Malgireddy K, Shou J, Srikanth-Mysore C, Bendi S, Bertoni JM, Torres-Russotto D. Ataxia Prevalence in Primary Orthostatic Tremor. Tremor Other Hyperkinet Mov (N Y) 2020; 10:54. [PMID: 33362948 PMCID: PMC7747757 DOI: 10.5334/tohm.570] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 11/24/2020] [Indexed: 12/15/2022] Open
Abstract
Background The exact pathophysiology of primary Orthostatic Tremor (OT) is unknown. A central oscillator is assumed, and previous imaging studies show involvement of cerebellar pathways. However, the presence of ataxia on clinical exam is disputed. We set out to study ataxia in OT prospectively. Methods EMG-confirmed primary OT subjects and spousal controls received a neurological exam with additional semiquantitative evaluations of ataxia as part of a multinational, prospective study. These included detailed limb coordination (DLC), detailed stance and gait evaluation (DS), and the Brief Ataxia Rating Scale (BARS). Intra- and inter-rater reliability were assessed and satisfactory. Results 34 OT subjects (mean age = 67 years, 88% female) and 21 controls (mean age = 66 years, 65% male) were enrolled. Average disease duration was 18 years (range 4-44). BARS items were abnormal in 88% of OT patients. The OT subjects were more likely to have appendicular and truncal ataxia with significant differences in DLC, DS and BARS. Ocular ataxia and dysarthria were not statistically different between the groups. Discussion Mild-to-moderate ataxia could be more common in OT than previously thought. This is supportive of cerebellar involvement in the pathophysiology of OT. We discuss possible implications for clinical care and future research. Highlights Previous studies of Primary Orthostatic Tremor (OT) have proposed pathophysiologic involvement of the cerebellar pathways.However, presence of ataxia has not been systematically studied in OT.This is a prospective comprehensive ataxia assessment in OT compared to controls. Mild-to-moderate appendiculo-truncal ataxia was found to be common in OT.
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Affiliation(s)
- Rebecca Thompson
- University of Nebraska Medical Center, Department of Neurological Sciences, Nebraska Medical Center, Omaha, NE, US
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, US
| | - Danish E. Bhatti
- University of Nebraska Medical Center, Department of Neurological Sciences, Nebraska Medical Center, Omaha, NE, US
| | - Amy Hellman
- University of Nebraska Medical Center, Department of Neurological Sciences, Nebraska Medical Center, Omaha, NE, US
| | - Sarah J. Doss
- University of Nebraska Medical Center, Department of Neurological Sciences, Nebraska Medical Center, Omaha, NE, US
| | - Kalyan Malgireddy
- University of Nebraska Medical Center, Department of Neurological Sciences, Nebraska Medical Center, Omaha, NE, US
| | - James Shou
- University of Nebraska Medical Center, Department of Neurological Sciences, Nebraska Medical Center, Omaha, NE, US
| | - Channaiah Srikanth-Mysore
- University of Nebraska Medical Center, Department of Neurological Sciences, Nebraska Medical Center, Omaha, NE, US
| | - Sunil Bendi
- University of Nebraska Medical Center, Department of Neurological Sciences, Nebraska Medical Center, Omaha, NE, US
| | - John M. Bertoni
- University of Nebraska Medical Center, Department of Neurological Sciences, Nebraska Medical Center, Omaha, NE, US
| | - Diego Torres-Russotto
- University of Nebraska Medical Center, Department of Neurological Sciences, Nebraska Medical Center, Omaha, NE, US
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3-Hz Postural Tremor in MSA-C and SCA: Revisiting an Old but Underestimated Cerebellar Sign by Posturography. THE CEREBELLUM 2020; 20:246-253. [PMID: 33164129 DOI: 10.1007/s12311-020-01209-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/26/2020] [Indexed: 10/23/2022]
Abstract
The aim of this study is to evaluate the prevalence and electrophysiological features of 3-Hz postural tremor in multiple system atrophy-cerebellar type and spinocerebellar ataxia. A static posturography examination was administered to 37 persons with spinocerebellar ataxia, 58 others with the cerebellar type of multiple system atrophy, and 53 healthy controls. During the sensory organization tests of 5 multiple system atrophy patients, surface electromyograms were recorded from bilateral tibialis anterior and medial gastrocnemius muscles. The patients with multiple system atrophy had, on average, significantly higher scores on the International Cooperative Ataxia Rating Scale and significantly greater prevalence of cross sign. Almost 80% of them fell during the posturography testing compared with two-thirds of the spinocerebellar ataxia patients. Twenty-seven percent of the spinocerebellar ataxia patients and 82.8% of those with multiple system atrophy displayed postural tremor with a frequency of approximately 3 Hz. The tremor's frequency tended to be lower in the spinocerebellar ataxia patients. The surface electromyography revealed highly coherent tremor activity at about 3 Hz in the patients' bilateral tibialis anterior and alternating firing in the bilateral antagonist muscles. Combining cross sign with a subject's static score of the International Cooperative Ataxia Rating Scale and occurrence of the tremor produced an indicator able to differentiate the two conditions with a sensitivity of 87.9% and a specificity of 89.2%. The area under the receiver operating characteristics curve for the indicator was 0.942. Three-hertz postural tremor is relatively characteristic of cerebellar type of multiple system atrophy and appears at an early stage of the disease. Identification of the tremor by posturography will facilitate its diagnosis.
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Gan SR, Figueroa KP, Xu HL, Perlman S, Wilmot G, Gomez CM, Schmahmann J, Paulson H, Shakkottai VG, Ying SH, Zesiewicz T, Bushara K, Geschwind MD, Xia G, Subramony SH, Rosenthal L, Ashizawa T, Pulst SM, Wang N, Kuo SH. The impact of ethnicity on the clinical presentations of spinocerebellar ataxia type 3. Parkinsonism Relat Disord 2020; 72:37-43. [PMID: 32105964 DOI: 10.1016/j.parkreldis.2020.02.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 02/14/2020] [Accepted: 02/14/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND For a variety of sporadic neurodegenerative diseases such as Alzheimer's disease, Parkinson's disease and amyotrophic lateral sclerosis, it is well-established that ethnicity does affect the disease phenotypes. However, how ethnicity contributes to the clinical symptoms and disease progressions in monogenetic disorders, such as spinocerebellar ataxia type 3 (SCA3), remains less studied. METHODS We used multivariable linear and logistical regression models in 257 molecularly-confirmed SCA3 patients (66 Caucasians, 43 African Americans, and 148 Asians [composed of 131 Chinese and 17 Asian Americans]) to explore the influence of ethnicity on age at onset (AAO), ataxia severity, and non-ataxia symptoms (i.e. depression, tremor, and dystonia). RESULTS We found that Asians had significantly later AAO, compared to Caucasians (β = 4.75, p = 0.000) and to African Americans (β = 6.64, p = 0.000) after adjusting for the pathological CAG repeat numbers in ATXN3. African Americans exhibited the most severe ataxia as compared to Caucasians (β = 3.81, p = 0.004) and Asians (β = 4.39, p = 0.001) after taking into consideration of the pathological CAG repeat numbers in ATXN3 and disease duration. Caucasians had a higher prevalence of depression than African Americans (β = 1.23, p = 0.040). Ethnicity had no influence on tremor or dystonia. CONCLUSIONS Ethnicity plays an important role in clinical presentations of SCA3 patients, which could merit further clinical studies and public health consideration. These results highlight the role of ethnicity in monogenetic, neurodegenerative disorders.
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Affiliation(s)
- Shi-Rui Gan
- Department of Neurology and Institute of Neurology, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Karla P Figueroa
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Hao-Ling Xu
- Department of Neurology and Institute of Neurology, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Susan Perlman
- Department of Neurology, University of California, Los Angeles, CA, USA
| | - George Wilmot
- Department of Neurology, Emory University, Atlanta, GA, USA
| | | | - Jeremy 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, School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - S H Subramony
- Department of Neurology and McKnight Brain Institute, University of Florida, Gainesville, FL, USA
| | - Liana Rosenthal
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Stefan M Pulst
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Ning Wang
- Department of Neurology and Institute of Neurology, First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
| | - Sheng-Han Kuo
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
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11
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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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12
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Hassan A, Caviness J. Slow Orthostatic Tremor: Review of the Current Evidence. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2019; 9:tre-09-721. [PMID: 31832265 PMCID: PMC6886496 DOI: 10.7916/tohm.v0.721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 10/07/2019] [Indexed: 12/01/2022]
Abstract
Background Orthostatic tremor (OT) is defined as tremor in the legs and trunk evoked during standing. While the classical description is tremor of ≥13 Hz, slower frequencies are recognized. There is disagreement as to whether the latter represents a slow variant of classical OT, or different tremor disorder(s) given frequent coexistent neurological disease. Methods A systematic literature search of PubMed was performed in February 2019 for “slow orthostatic tremor” and related terms which generated 573 abstracts, of which 61 were included. Results Between 1970 and 2019, there were 70 cases of electrophysiologically confirmed slow OT. Two-thirds were female, of mean age 60 years (range 26–86), and mean disease duration 6 years (range 0–32). One-third of cases were isolated, and two-thirds had a coexistent disorder(s), including parkinsonism (30%), ataxia (12%), and dystonia (10%). Postural arm tremor was present in 34%. Median tremor frequency was 6–7 Hz (range 3–12). Tremor bursts ranged from 50 to 150 ms duration, and were alternating or synchronous in antagonistic and/or analogous muscles. Low and high coherences were reported. Five cases (7%) had coexistent classical OT. Clonazepam was the most effective medication across all frequencies, and levodopa was effective for 4–7 Hz OT with coexistent parkinsonism. Two cases resolved with the treatment of Graves’ disease. Electrophysiology and imaging predominantly support a central tremor generator. Discussion While multiple lines of evidence separate slow OT from classical OT, clinical and electrophysiological overlap may occur. Primary and secondary causes are identified, similar to classical OT. Further exploration to clarify these slow OT subtypes, clinically and neurophysiologically, is proposed.
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Affiliation(s)
- Anhar Hassan
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - John Caviness
- Department of Neurology, Mayo Clinic, Scottsdale, AZ, USA
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Wu S, Tan KJ, Govindarajan LN, Stewart JC, Gu L, Ho JWH, Katarya M, Wong BH, Tan EK, Li D, Claridge-Chang A, Libedinsky C, Cheng L, Aw SS. Fully automated leg tracking of Drosophila neurodegeneration models reveals distinct conserved movement signatures. PLoS Biol 2019; 17:e3000346. [PMID: 31246996 PMCID: PMC6619818 DOI: 10.1371/journal.pbio.3000346] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 07/10/2019] [Accepted: 06/14/2019] [Indexed: 11/19/2022] Open
Abstract
Some neurodegenerative diseases, like Parkinsons Disease (PD) and Spinocerebellar ataxia 3 (SCA3), are associated with distinct, altered gait and tremor movements that are reflective of the underlying disease etiology. Drosophila melanogaster models of neurodegeneration have illuminated our understanding of the molecular mechanisms of disease. However, it is unknown whether specific gait and tremor dysfunctions also occur in fly disease mutants. To answer this question, we developed a machine-learning image-analysis program, Feature Learning-based LImb segmentation and Tracking (FLLIT), that automatically tracks leg claw positions of freely moving flies recorded on high-speed video, producing a series of gait measurements. Notably, unlike other machine-learning methods, FLLIT generates its own training sets and does not require user-annotated images for learning. Using FLLIT, we carried out high-throughput and high-resolution analysis of gait and tremor features in Drosophila neurodegeneration mutants for the first time. We found that fly models of PD and SCA3 exhibited markedly different walking gait and tremor signatures, which recapitulated characteristics of the respective human diseases. Selective expression of mutant SCA3 in dopaminergic neurons led to a gait signature that more closely resembled those of PD flies. This suggests that the behavioral phenotype depends on the neurons affected rather than the specific nature of the mutation. Different mutations produced tremors in distinct leg pairs, indicating that different motor circuits were affected. Using this approach, fly models can be used to dissect the neurogenetic mechanisms that underlie movement disorders. This study uses automated leg tracking to characterise gait and tremor features in fruit fly models of Parkinson’s disease and spinocerebellar ataxia 3, finding movement features that resemble characteristics of the respective human diseases.
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Affiliation(s)
- Shuang Wu
- Bioinformatics Institute, Agency for Science, Technology and Research, Singapore
| | - Kah Junn Tan
- Institute of Molecular and Cell Biology, Agency for Science, Technology and Research, Singapore
| | | | - James Charles Stewart
- Institute of Molecular and Cell Biology, Agency for Science, Technology and Research, Singapore
- Duke-NUS Graduate Medical School, Neuroscience and Behavioural Disorders, Singapore
| | - Lin Gu
- Bioinformatics Institute, Agency for Science, Technology and Research, Singapore
| | - Joses Wei Hao Ho
- Institute of Molecular and Cell Biology, Agency for Science, Technology and Research, Singapore
- Duke-NUS Graduate Medical School, Neuroscience and Behavioural Disorders, Singapore
| | - Malvika Katarya
- Institute of Molecular and Cell Biology, Agency for Science, Technology and Research, Singapore
| | - Boon Hui Wong
- National University of Singapore, Department of Biological Sciences, Singapore
| | - Eng-King Tan
- National Neuroscience Institute, Singapore General Hospital, Singapore
| | - Daiqin Li
- National University of Singapore, Department of Biological Sciences, Singapore
| | - Adam Claridge-Chang
- Institute of Molecular and Cell Biology, Agency for Science, Technology and Research, Singapore
- Duke-NUS Graduate Medical School, Neuroscience and Behavioural Disorders, Singapore
| | - Camilo Libedinsky
- Institute of Molecular and Cell Biology, Agency for Science, Technology and Research, Singapore
- Singapore Institute for Neurotechnology (SiNAPSE), Singapore
- National University of Singapore, Department of Psychology, Singapore
| | - Li Cheng
- Bioinformatics Institute, Agency for Science, Technology and Research, Singapore
- Department of Electrical and Computer Engineering, University of Alberta, Edmonton, Alberta, Canada
- * E-mail: (SA); (CL)
| | - Sherry Shiying Aw
- Institute of Molecular and Cell Biology, Agency for Science, Technology and Research, Singapore
- * E-mail: (SA); (CL)
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Shirai S, Yabe I, Naganuma R, Sato C, Takahashi I, Matsushima M, Kano T, Sasaki H. Tremor during orthostatism as the initial symptom of Machado–Joseph disease. Clin Neurol Neurosurg 2018; 173:173-175. [DOI: 10.1016/j.clineuro.2018.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 07/13/2018] [Accepted: 08/04/2018] [Indexed: 11/26/2022]
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15
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Miura M, Numasawa Y, Takahisa M, Ozaki K, Irioka T, Nishida Y, Ishibashi S, Yokota T. Levodopa-responsive truncal tremor in a patient with spinocerebellar ataxia type 3. J Neurol Sci 2018; 392:32-33. [PMID: 30097150 DOI: 10.1016/j.jns.2018.06.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 06/26/2018] [Accepted: 06/27/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Motoki Miura
- Department of Neurology and Neurological Science, Tokyo Medical and Dental University, Japan
| | - Yoshiyuki Numasawa
- Department of Neurology and Neurological Science, Tokyo Medical and Dental University, Japan.
| | - Mikami Takahisa
- Department of Neurology and Neurological Science, Tokyo Medical and Dental University, Japan
| | - Kokoro Ozaki
- Department of Neurology and Neurological Science, Tokyo Medical and Dental University, Japan
| | - Takashi Irioka
- Department of Neurology, Yokosuka Kyosai Hospital, Japan
| | - Yoichiro Nishida
- Department of Neurology and Neurological Science, Tokyo Medical and Dental University, Japan
| | - Satoru Ishibashi
- Department of Neurology and Neurological Science, Tokyo Medical and Dental University, Japan
| | - Takanori Yokota
- Department of Neurology and Neurological Science, Tokyo Medical and Dental University, Japan
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16
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Gan SR, Wang J, Figueroa KP, Pulst SM, Tomishon D, Lee D, Perlman S, Wilmot G, Gomez CM, Schmahmann J, Paulson H, Shakkottai VG, Ying SH, Zesiewicz T, Bushara K, Geschwind MD, Xia G, Subramony SH, Ashizawa T, Kuo SH. Postural Tremor and Ataxia Progression in Spinocerebellar Ataxias. Tremor Other Hyperkinet Mov (N Y) 2017; 7:492. [PMID: 29057148 PMCID: PMC5647398 DOI: 10.7916/d8gm8krh] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 09/07/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Postural tremor can sometimes occur in spinocerebellar ataxias (SCAs). However, the prevalence and clinical characteristics of postural tremor in SCAs are poorly understood, and whether SCA patients with postural tremor have different ataxia progression is not known. METHODS We studied postural tremor in 315 patients with SCA1, 2, 3, and 6 recruited from the Clinical Research Consortium for Spinocerebellar Ataxias (CRC-SCA), which consists of 12 participating centers in the United States, and we evaluated ataxia progression in these patients from January 2010 to August 2012. RESULTS Among 315 SCA patients, postural tremor was most common in SCA2 patients (SCA1, 5.8%; SCA2, 27.5%; SCA3, 12.4%; SCA6, 16.9%; p = 0.007). SCA3 patients with postural tremor had longer CAG repeat expansions than SCA3 patients without postural tremor (73.67 ± 3.12 vs. 70.42 ± 3.96, p = 0.003). Interestingly, SCA1 and SCA6 patients with postural tremor had a slower rate of ataxia progression (SCA1, β = -0.91, p < 0.001; SCA6, β = -1.28, p = 0.025), while SCA2 patients with postural tremor had a faster rate of ataxia progression (β = 1.54, p = 0.034). We also found that the presence of postural tremor in SCA2 patients could be influenced by repeat expansions of ATXN1 (β = -1.53, p = 0.037) and ATXN3 (β = 0.57, p = 0.018), whereas postural tremor in SCA3 was associated with repeat lengths in TBP (β = 0.63, p = 0.041) and PPP2R2B (β = -0.40, p = 0.032). DISCUSSION Postural tremor could be a clinical feature of SCAs, and the presence of postural tremor could be associated with different rates of ataxia progression. Genetic interactions between ataxia genes might influence the brain circuitry and thus affect the clinical presentation of postural tremor.
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Affiliation(s)
- Shi-Rui Gan
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Neurology and Institute of Neurology, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Jie Wang
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Basic and Community Nursing, School of Nursing, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Karla P. Figueroa
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Stefan M. Pulst
- 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
| | - Danielle Lee
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Susan Perlman
- Department of Neurology, University of California, Los Angeles, CA, USA
| | - George Wilmot
- Department of Neurology, Emory University, Atlanta, GA, USA
| | | | - Jeremy 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, School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - S. H. Subramony
- Department of Neurology, School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | | | - Sheng-Han Kuo
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Altered striatal endocannabinoid signaling in a transgenic mouse model of spinocerebellar ataxia type-3. PLoS One 2017; 12:e0176521. [PMID: 28448548 PMCID: PMC5407801 DOI: 10.1371/journal.pone.0176521] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 04/12/2017] [Indexed: 12/16/2022] Open
Abstract
Spinocerebellar ataxia type-3 (SCA-3) is the most prevalent autosomal dominant inherited ataxia. We recently found that the endocannabinoid system is altered in the post-mortem cerebellum of SCA-3 patients, and similar results were also found in the cerebellar and brainstem nuclei of a SCA-3 transgenic mouse model. Given that the neuropathology of SCA-3 is not restricted to these two brain regions but rather, it is also evident in other structures (e.g., the basal ganglia), we studied the possible changes to endocannabinoid signaling in the striatum of these transgenic mice. SCA-3 mutant mice suffer defects in motor coordination, balance and they have an abnormal gait, reflecting a cerebellar/brainstem neuropathology. However, they also show dystonia-like behavior (limb clasping) that may be related to the malfunction/deterioration of specific neurons in the striatum. Indeed, we found a loss of striatal projecting neurons in SCA-3 mutant mice, accompanied by a reduction in glial glutamate transporters that could potentially aggravate excitotoxic damage. In terms of endocannabinoid signaling, no changes in CB2 receptors were evident, yet an important reduction in CB1 receptors was detected by qPCR and immunostaining. The reduction in CB1 receptors was presumed to occur in striatal afferent and efferent neurons, also potentially aggravating excitotoxicity. We also measured the endocannabinoid lipids in the striatum and despite a marked increase in the FAAH enzyme in this area, no overall changes in these lipids were found. Collectively, these studies confirm that the striatal endocannabinoid system is altered in SCA-3 mutant mice, adding to the equivalent changes found in other strongly affected CNS structures in this type of ataxia (i.e.: the cerebellum and brainstem). These data open the way to search for drugs that might correct these changes.
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18
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Erro R, Bhatia KP, Cordivari C. Shaking on Standing: A Critical Review. Mov Disord Clin Pract 2014; 1:173-179. [PMID: 30363785 DOI: 10.1002/mdc3.12053] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Revised: 04/19/2014] [Accepted: 04/24/2014] [Indexed: 11/06/2022] Open
Abstract
Orthostatic tremor is a rare condition, though its exact prevalence is unknown, which is clinically characterized by a feeling of unsteadiness or being about to fall on standing and which disappears on walking, sitting, or lying down. It is generally accepted that classic orthostatic tremor manifests with a high-frequency tremor (>13 Hz) of the legs when standing. However, a number of patients initially reported as orthostatic tremor did not actually have such electrophysiological features. It is our experience that there is a clinical spectrum of different conditions presenting as shaking on standing, and this highlights the importance of the electrophysiology to aid the differential diagnosis of these disorders. Here, we provide a critical review of the clinical spectrum of shaking on standing, along with demonstrative electrophysiological recordings of some of these conditions.
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Affiliation(s)
- Roberto Erro
- Sobell Department of Motor Neuroscience and Movement Disorders UCL Institute of Neurology London United Kingdom.,Dipartimento di Scienze Neurologiche e del Movimento Università di Verona Verona Italy.,Department of Clinical Neurophysiology National Hospital for Neurology and Neurosurgery, Queen Square London United Kingdom
| | - Kailash P Bhatia
- Sobell Department of Motor Neuroscience and Movement Disorders UCL Institute of Neurology London United Kingdom
| | - Carla Cordivari
- Department of Clinical Neurophysiology National Hospital for Neurology and Neurosurgery, Queen Square London United Kingdom
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19
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Rossi M, Perez-Lloret S, Cerquetti D, Merello M. Movement Disorders in Autosomal Dominant Cerebellar Ataxias: A Systematic Review. Mov Disord Clin Pract 2014; 1:154-160. [PMID: 30363920 DOI: 10.1002/mdc3.12042] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 04/23/2014] [Accepted: 04/27/2014] [Indexed: 11/06/2022] Open
Abstract
Autosomal dominant cerebellar ataxias (ADCAs) are clinically heterogeneous disorders classified according to genetic subtype and collectively known as SCAs. In a few SCAs, movement disorders can be the most frequent extracerebellar sign. The aim of this article is to perform a systematic review of movement disorders frequency and characteristics in ADCAs. This work consisted of a structured search of electronic databases up to January 2013. Publications containing descriptions of ADCA clinical features written in several languages were selected initially based on title and abstract screening, followed by full-text reading of potentially relevant publications. Clinical findings and demographic data on genetically confirmed patients were extracted. Analysis of individual patient data from subjects with movement disorders was performed using the chi-square test and logistic regression. One thousand and sixty-six publications reviewing 12,151 patients from 30 different SCAs were analyzed. Individual data were available from 755 patients with at least one type of movement disorder during overall disease course. Of 422 patients in whom onset symptom data were available, one third referred a movement disorder as the initial symptom. During overall disease course, parkinsonism was common in many SCA subtypes, frequently described in the absence of ataxia and characterized as responding to dopaminergic medications. Motor complications developed occasionally in some patients as did nigrostriatal imaging alterations. Other frequent features were dystonia, chorea, and myoclonus. Rare conditions, such as akathisia, paroxysmal nonkinesigenic dyskinesia, or stiff person-like syndrome, were also reported. ADCA descriptions included a full range of movement disorders. Aside from postural or intention tremor, dopamine-responsive parkinsonism and dystonia were the most common.
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Affiliation(s)
- Malco Rossi
- Movement Disorders Section, Neuroscience Department Raul Carrea Institute for Neurological Research (FLENI) Buenos Aires Argentina
| | - Santiago Perez-Lloret
- Clinical Pharmacology and Epidemiology Laboratory Pontifical Catholic University of Argentina Buenos Aires Argentina.,Argentine National Scientific and Technological Research Council (CONICET) Buenos Aires Argentina
| | - Daniel Cerquetti
- Movement Disorders Section, Neuroscience Department Raul Carrea Institute for Neurological Research (FLENI) Buenos Aires Argentina
| | - Marcelo Merello
- Movement Disorders Section, Neuroscience Department Raul Carrea Institute for Neurological Research (FLENI) Buenos Aires Argentina.,Argentine National Scientific and Technological Research Council (CONICET) Buenos Aires Argentina
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20
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Apartis E, Jedynak CP. Tremori. Neurologia 2014. [DOI: 10.1016/s1634-7072(14)66663-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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21
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Jhunjhunwala K, Netravathi M, Purushottam M, Jain S, Pal PK. Profile of extrapyramidal manifestations in 85 patients with spinocerebellar ataxia type 1, 2 and 3. J Clin Neurosci 2013; 21:1002-6. [PMID: 24602359 DOI: 10.1016/j.jocn.2013.10.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 10/01/2013] [Accepted: 10/05/2013] [Indexed: 12/01/2022]
Abstract
This study aimed to determine the prevalence and type of extrapyramidal signs (EPS) in spinocerebellar ataxia (SCA) type 1, 2 and 3. Eighty-five patients with genetically confirmed SCA (SCA1=40, SCA2=28, SCA3=17) were evaluated for the prevalence and types of EPS. Forty-one SCA patients (48.2%) had one or more types of EPS. The prevalence of EPS was 60.7% in SCA2, 52.9% in SCA3, and 37.5% in SCA1. Among SCA2 patients, bradykinesia was the most frequent (35.3%), followed by reduced facial expression, postural tremor and dystonia (29.4% each), rest tremor, titubation and rigidity (23.5% each), and lip/jaw tremor and chorea (11.8% each). In SCA3 the common EPS were bradykinesia (44.4%), staring look, postural tremor and dystonia (33.3% each), and reduced facial expression and rigidity (22.2% each). In SCA1, staring look was the most common (53.3%), followed by dystonia and bradykinesia (33.3% each), and postural tremor (26.7%). In all three groups, there was no significant difference in the mean length of repeat of the abnormal allele between those with and without EPS. To conclude bradykinesia, staring look, dystonia and postural tremor were the most frequent EPS observed in SCA. In SCA1, these signs were seen more often in younger patients with early onset of symptoms.
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Affiliation(s)
- Ketan Jhunjhunwala
- Department of Neurology, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore 560029, Karnataka, India
| | - M Netravathi
- Department of Neurology, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore 560029, Karnataka, India
| | - Meera Purushottam
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bangalore, Karnataka, India
| | - Sanjeev Jain
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bangalore, Karnataka, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore 560029, Karnataka, India.
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22
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Bettencourt C, Lima M. “Mimicking” capacity of spinocerebellar ataxia type 3: The details matter. J Neurol Sci 2013; 326:120-1; author reply 122. [DOI: 10.1016/j.jns.2013.01.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 01/15/2013] [Indexed: 01/28/2023]
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