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Tahedl M, Tan EL, Kleinerova J, Delaney S, Hengeveld JC, Doherty MA, Mclaughlin RL, Pradat PF, Raoul C, Ango F, Hardiman O, Chang KM, Lope J, Bede P. Progressive Cerebrocerebellar Uncoupling in Sporadic and Genetic Forms of Amyotrophic Lateral Sclerosis. Neurology 2024; 103:e209623. [PMID: 38900989 DOI: 10.1212/wnl.0000000000209623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Amyotrophic lateral sclerosis (ALS) is predominantly associated with motor cortex, corticospinal tract (CST), brainstem, and spinal cord degeneration, and cerebellar involvement is much less well characterized. However, some of the cardinal clinical features of ALS, such as dysarthria, dysphagia, gait impairment, falls, and impaired dexterity, are believed to be exacerbated by coexisting cerebellar pathology. Cerebellar pathology may also contribute to cognitive, behavioral, and pseudobulbar manifestations. Our objective was to systematically assess both intracerebellar pathology and cerebrocerebellar connectivity alterations in a genetically stratified cohort of ALS. METHODS A prospective, multimodal neuroimaging study was conducted to evaluate the longitudinal evolution of intracerebellar pathology and cerebrocerebellar connectivity, using structural and functional measures. RESULTS A total of 113 healthy controls and 212 genetically stratified individuals with ALS were included: (1) C9orf72 hexanucleotide carriers ("C9POS"), (2) sporadic patients who tested negative for ALS-associated genetic variants, and (3) intermediate-length CAG trinucleotide carriers in ATXN2 ("ATXN2"). Flocculonodular lobule (padj = 0.014, 95% CI -5.06e-5 to -3.98e-6) and crura (padj = 0.031, 95% CI -1.63e-3 to -5.55e-5) volume reductions were detected at baseline in sporadic patients. Cerebellofrontal and cerebelloparietal structural connectivity impairment was observed in both C9POS and sporadic patients at baseline, and both projections deteriorated further over time in sporadic patients (padj = 0.003, t(249) = 3.04 and padj = 0.05, t(249) = 1.93). Functional cerebelloparietal uncoupling was evident in sporadic patients at baseline (padj = 0.004, 95% CI -0.19 to -0.03). ATXN2 patients exhibited decreased cerebello-occipital functional connectivity at baseline (padj = 0.004, 95% CI -0.63 to -0.06), progressive cerebellotemporal functional disconnection (padj = 0.025, t(199) = -2.26), and progressive flocculonodular lobule degeneration (padj = 0.017, t(249) = -2.24). C9POS patients showed progressive ventral dentate atrophy (padj = 0.007, t(249) = -2.75). The CSTs (padj < 0.001, 95% CI 4.89e-5 to 1.14e-4) and transcallosal interhemispheric fibers (padj < 0.001, 95% CI 5.21e-5 to 1.31e-4) were affected at baseline in C9POS and exhibited rapid degeneration over the 4 time points. The rate of decline in CST and corpus callosum integrity was faster than the rate of cerebrocerebellar disconnection (padj = 0.001, t(190) = 6.93). DISCUSSION ALS is associated with accruing intracerebellar disease burden as well as progressive corticocerebellar uncoupling. Contrary to previous suggestions, we have not detected evidence of compensatory structural or functional changes in response to supratentorial degeneration. The contribution of cerebellar disease burden to dysarthria, dysphagia, gait impairment, pseudobulbar affect, and cognitive deficits should be carefully considered in clinical assessments, monitoring, and multidisciplinary interventions.
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Affiliation(s)
- Marlene Tahedl
- From the Computational Neuroimaging Group (CNG) (M.T., E.L.T., J.K., S.D., O.H., K.M.C., J.L., P.B.), School of Medicine, Trinity College Dublin; Department of Neurology (S.D., P.B.), St James's Hospital, Dublin; Smurfit Institute of Genetics (J.C.H., M.A.D., R.L.M.), Trinity College Dublin, Ireland; Department of Neurology (P.-F.P.), Pitié-Salpêtrière University Hospital, Paris; The Neuroscience Institute of Montpellier (INM) (C.R., F.A.), INSERM, CNRS; and ALS Centre (C.R.), University of Montpellier, CHU Montpellier, France
| | - Ee Ling Tan
- From the Computational Neuroimaging Group (CNG) (M.T., E.L.T., J.K., S.D., O.H., K.M.C., J.L., P.B.), School of Medicine, Trinity College Dublin; Department of Neurology (S.D., P.B.), St James's Hospital, Dublin; Smurfit Institute of Genetics (J.C.H., M.A.D., R.L.M.), Trinity College Dublin, Ireland; Department of Neurology (P.-F.P.), Pitié-Salpêtrière University Hospital, Paris; The Neuroscience Institute of Montpellier (INM) (C.R., F.A.), INSERM, CNRS; and ALS Centre (C.R.), University of Montpellier, CHU Montpellier, France
| | - Jana Kleinerova
- From the Computational Neuroimaging Group (CNG) (M.T., E.L.T., J.K., S.D., O.H., K.M.C., J.L., P.B.), School of Medicine, Trinity College Dublin; Department of Neurology (S.D., P.B.), St James's Hospital, Dublin; Smurfit Institute of Genetics (J.C.H., M.A.D., R.L.M.), Trinity College Dublin, Ireland; Department of Neurology (P.-F.P.), Pitié-Salpêtrière University Hospital, Paris; The Neuroscience Institute of Montpellier (INM) (C.R., F.A.), INSERM, CNRS; and ALS Centre (C.R.), University of Montpellier, CHU Montpellier, France
| | - Siobhan Delaney
- From the Computational Neuroimaging Group (CNG) (M.T., E.L.T., J.K., S.D., O.H., K.M.C., J.L., P.B.), School of Medicine, Trinity College Dublin; Department of Neurology (S.D., P.B.), St James's Hospital, Dublin; Smurfit Institute of Genetics (J.C.H., M.A.D., R.L.M.), Trinity College Dublin, Ireland; Department of Neurology (P.-F.P.), Pitié-Salpêtrière University Hospital, Paris; The Neuroscience Institute of Montpellier (INM) (C.R., F.A.), INSERM, CNRS; and ALS Centre (C.R.), University of Montpellier, CHU Montpellier, France
| | - Jennifer C Hengeveld
- From the Computational Neuroimaging Group (CNG) (M.T., E.L.T., J.K., S.D., O.H., K.M.C., J.L., P.B.), School of Medicine, Trinity College Dublin; Department of Neurology (S.D., P.B.), St James's Hospital, Dublin; Smurfit Institute of Genetics (J.C.H., M.A.D., R.L.M.), Trinity College Dublin, Ireland; Department of Neurology (P.-F.P.), Pitié-Salpêtrière University Hospital, Paris; The Neuroscience Institute of Montpellier (INM) (C.R., F.A.), INSERM, CNRS; and ALS Centre (C.R.), University of Montpellier, CHU Montpellier, France
| | - Mark A Doherty
- From the Computational Neuroimaging Group (CNG) (M.T., E.L.T., J.K., S.D., O.H., K.M.C., J.L., P.B.), School of Medicine, Trinity College Dublin; Department of Neurology (S.D., P.B.), St James's Hospital, Dublin; Smurfit Institute of Genetics (J.C.H., M.A.D., R.L.M.), Trinity College Dublin, Ireland; Department of Neurology (P.-F.P.), Pitié-Salpêtrière University Hospital, Paris; The Neuroscience Institute of Montpellier (INM) (C.R., F.A.), INSERM, CNRS; and ALS Centre (C.R.), University of Montpellier, CHU Montpellier, France
| | - Russell L Mclaughlin
- From the Computational Neuroimaging Group (CNG) (M.T., E.L.T., J.K., S.D., O.H., K.M.C., J.L., P.B.), School of Medicine, Trinity College Dublin; Department of Neurology (S.D., P.B.), St James's Hospital, Dublin; Smurfit Institute of Genetics (J.C.H., M.A.D., R.L.M.), Trinity College Dublin, Ireland; Department of Neurology (P.-F.P.), Pitié-Salpêtrière University Hospital, Paris; The Neuroscience Institute of Montpellier (INM) (C.R., F.A.), INSERM, CNRS; and ALS Centre (C.R.), University of Montpellier, CHU Montpellier, France
| | - Pierre-Francois Pradat
- From the Computational Neuroimaging Group (CNG) (M.T., E.L.T., J.K., S.D., O.H., K.M.C., J.L., P.B.), School of Medicine, Trinity College Dublin; Department of Neurology (S.D., P.B.), St James's Hospital, Dublin; Smurfit Institute of Genetics (J.C.H., M.A.D., R.L.M.), Trinity College Dublin, Ireland; Department of Neurology (P.-F.P.), Pitié-Salpêtrière University Hospital, Paris; The Neuroscience Institute of Montpellier (INM) (C.R., F.A.), INSERM, CNRS; and ALS Centre (C.R.), University of Montpellier, CHU Montpellier, France
| | - Cédric Raoul
- From the Computational Neuroimaging Group (CNG) (M.T., E.L.T., J.K., S.D., O.H., K.M.C., J.L., P.B.), School of Medicine, Trinity College Dublin; Department of Neurology (S.D., P.B.), St James's Hospital, Dublin; Smurfit Institute of Genetics (J.C.H., M.A.D., R.L.M.), Trinity College Dublin, Ireland; Department of Neurology (P.-F.P.), Pitié-Salpêtrière University Hospital, Paris; The Neuroscience Institute of Montpellier (INM) (C.R., F.A.), INSERM, CNRS; and ALS Centre (C.R.), University of Montpellier, CHU Montpellier, France
| | - Fabrice Ango
- From the Computational Neuroimaging Group (CNG) (M.T., E.L.T., J.K., S.D., O.H., K.M.C., J.L., P.B.), School of Medicine, Trinity College Dublin; Department of Neurology (S.D., P.B.), St James's Hospital, Dublin; Smurfit Institute of Genetics (J.C.H., M.A.D., R.L.M.), Trinity College Dublin, Ireland; Department of Neurology (P.-F.P.), Pitié-Salpêtrière University Hospital, Paris; The Neuroscience Institute of Montpellier (INM) (C.R., F.A.), INSERM, CNRS; and ALS Centre (C.R.), University of Montpellier, CHU Montpellier, France
| | - Orla Hardiman
- From the Computational Neuroimaging Group (CNG) (M.T., E.L.T., J.K., S.D., O.H., K.M.C., J.L., P.B.), School of Medicine, Trinity College Dublin; Department of Neurology (S.D., P.B.), St James's Hospital, Dublin; Smurfit Institute of Genetics (J.C.H., M.A.D., R.L.M.), Trinity College Dublin, Ireland; Department of Neurology (P.-F.P.), Pitié-Salpêtrière University Hospital, Paris; The Neuroscience Institute of Montpellier (INM) (C.R., F.A.), INSERM, CNRS; and ALS Centre (C.R.), University of Montpellier, CHU Montpellier, France
| | - Kai Ming Chang
- From the Computational Neuroimaging Group (CNG) (M.T., E.L.T., J.K., S.D., O.H., K.M.C., J.L., P.B.), School of Medicine, Trinity College Dublin; Department of Neurology (S.D., P.B.), St James's Hospital, Dublin; Smurfit Institute of Genetics (J.C.H., M.A.D., R.L.M.), Trinity College Dublin, Ireland; Department of Neurology (P.-F.P.), Pitié-Salpêtrière University Hospital, Paris; The Neuroscience Institute of Montpellier (INM) (C.R., F.A.), INSERM, CNRS; and ALS Centre (C.R.), University of Montpellier, CHU Montpellier, France
| | - Jasmin Lope
- From the Computational Neuroimaging Group (CNG) (M.T., E.L.T., J.K., S.D., O.H., K.M.C., J.L., P.B.), School of Medicine, Trinity College Dublin; Department of Neurology (S.D., P.B.), St James's Hospital, Dublin; Smurfit Institute of Genetics (J.C.H., M.A.D., R.L.M.), Trinity College Dublin, Ireland; Department of Neurology (P.-F.P.), Pitié-Salpêtrière University Hospital, Paris; The Neuroscience Institute of Montpellier (INM) (C.R., F.A.), INSERM, CNRS; and ALS Centre (C.R.), University of Montpellier, CHU Montpellier, France
| | - Peter Bede
- From the Computational Neuroimaging Group (CNG) (M.T., E.L.T., J.K., S.D., O.H., K.M.C., J.L., P.B.), School of Medicine, Trinity College Dublin; Department of Neurology (S.D., P.B.), St James's Hospital, Dublin; Smurfit Institute of Genetics (J.C.H., M.A.D., R.L.M.), Trinity College Dublin, Ireland; Department of Neurology (P.-F.P.), Pitié-Salpêtrière University Hospital, Paris; The Neuroscience Institute of Montpellier (INM) (C.R., F.A.), INSERM, CNRS; and ALS Centre (C.R.), University of Montpellier, CHU Montpellier, France
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Mishra I, Feng B, Basu B, Brown AM, Kim LH, Lin T, Raza MA, Moore A, Hahn A, Bailey S, Sharp A, Bournat JC, Poulton C, Kim B, Langsner A, Sathyanesan A, Sillitoe RV, He Y, Chopra AR. The cerebellum modulates thirst. Nat Neurosci 2024:10.1038/s41593-024-01700-9. [PMID: 38987435 DOI: 10.1038/s41593-024-01700-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 06/07/2024] [Indexed: 07/12/2024]
Abstract
The cerebellum, a phylogenetically ancient brain region, has long been considered strictly a motor control structure. Recent studies have implicated the cerebellum in cognition, sensation, emotion and autonomic function, making it an important target for further investigation. Here, we show that cerebellar Purkinje neurons in mice are activated by the hormone asprosin, leading to enhanced thirst, and that optogenetic or chemogenetic activation of Purkinje neurons induces rapid manifestation of water drinking. Purkinje neuron-specific asprosin receptor (Ptprd) deletion results in reduced water intake without affecting food intake and abolishes asprosin's dipsogenic effect. Purkinje neuron-mediated motor learning and coordination were unaffected by these manipulations, indicating independent control of two divergent functions by Purkinje neurons. Our results show that the cerebellum is a thirst-modulating brain area and that asprosin-Ptprd signaling may be a potential therapeutic target for the management of thirst disorders.
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Affiliation(s)
- Ila Mishra
- Harrington Discovery Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Bing Feng
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA
| | - Bijoya Basu
- Department of Genetics and Genome Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Amanda M Brown
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA
- Jan and Dan Duncan Neurological Research Institute at Texas Children's Hospital, Houston, TX, USA
| | - Linda H Kim
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA
- Jan and Dan Duncan Neurological Research Institute at Texas Children's Hospital, Houston, TX, USA
| | - Tao Lin
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA
- Jan and Dan Duncan Neurological Research Institute at Texas Children's Hospital, Houston, TX, USA
| | - Mir Abbas Raza
- Department of Biology, College of Arts & Sciences, University of Dayton, Dayton, OH, USA
| | - Amelia Moore
- Department of Biology, College of Arts & Sciences, University of Dayton, Dayton, OH, USA
| | - Abigayle Hahn
- Department of Biology, College of Arts & Sciences, University of Dayton, Dayton, OH, USA
| | - Samantha Bailey
- Department of Biology, College of Arts & Sciences, University of Dayton, Dayton, OH, USA
| | - Alaina Sharp
- Department of Biology, College of Arts & Sciences, University of Dayton, Dayton, OH, USA
| | - Juan C Bournat
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA
| | - Claire Poulton
- Harrington Discovery Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Brian Kim
- Department of Genetics and Genome Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Amos Langsner
- Harrington Discovery Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Aaron Sathyanesan
- Department of Biology, College of Arts & Sciences, University of Dayton, Dayton, OH, USA
- Department of Electrical & Computer Engineering, School of Engineering, University of Dayton, Dayton, OH, USA
| | - Roy V Sillitoe
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA
- Jan and Dan Duncan Neurological Research Institute at Texas Children's Hospital, Houston, TX, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
- Development, Disease Models & Therapeutics Graduate Program, Baylor College of Medicine, Houston, TX, USA
| | - Yanlin He
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA.
| | - Atul R Chopra
- Harrington Discovery Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
- Department of Genetics and Genome Sciences, Case Western Reserve University, Cleveland, OH, USA.
- Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
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3
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Sasegbon A, Cheng I, Labeit B, Lapa S, Rommel N, Hamdy S. New and Evolving Treatments for Neurologic Dysphagia. Drugs 2024:10.1007/s40265-024-02064-x. [PMID: 38954267 DOI: 10.1007/s40265-024-02064-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2024] [Indexed: 07/04/2024]
Abstract
Despite swallowing being a frequently performed daily function, it is highly complex. For a safe swallow to occur, muscles within the head, neck, and thorax need to contract in a concerted pattern, controlled by several swallowing centers at multiple levels of the central nervous system, including the midbrain, cerebral cortex, and cerebellum in addition to five cranial nerves. Dysphagia, or difficulty swallowing, is caused by a long list of pathologic processes and diseases, which can interfere with various stages along the swallowing sensorimotor pathway. When present, dysphagia leads to increased mortality, morbidity, hospital length of stay, and reduced quality of life. Current dysphagia management approaches, such as altering the texture and consistency of foods and fluids and teaching patients rehabilitative exercises, have been broadly unchanged for many years and, in the case of texture modification, are of uncertain effectiveness. However, evidence is emerging in support of new medication-based and neuromodulatory treatment approaches. Regarding medication-based therapies, most research has focused on capsaicinoids, which studies have shown are able to improve swallowing in patients with post-stroke dysphagia. Separately, albeit convergently, in the field of neuromodulation, there is a growing and positive evidential base behind three non-invasive brain stimulation techniques: repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (TDCS), and pharyngeal electrical stimulation (PES). Should some or all of these emerging therapies fulfill their promise, dysphagia-related patient outcomes may be improved. This paper describes the current state of our understanding regarding new medication and neuromodulation-based neurogenic oropharyngeal dysphagia treatments.
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Affiliation(s)
- Ayodele Sasegbon
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, School of Medical Sciences, Centre for Gastrointestinal Sciences, University of Manchester, Manchester, UK
| | - Ivy Cheng
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, School of Medical Sciences, Centre for Gastrointestinal Sciences, University of Manchester, Manchester, UK
- Academic Unit of Human Communication, Learning, and Development, Faculty of Education, The University of Hong Kong, Hong Kong, China
- Institute for Biomagnetism and Biosignal Analysis, University of Münster, Münster, Germany
- Universitätsklinikum Münster, Münster, Germany
| | - Bendix Labeit
- Department of Neurology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Sriramya Lapa
- Department of Neurology, Goethe University and University Hospital, Frankfurt, Germany
| | - Nathalie Rommel
- Deglutology, Experimental Otorhinolaryngology, Department of Neurosciences, University of Leuven, Leuven, Belgium
- Department of Gastroenterology, Neurogastroenterology and Motility, University Hospitals Leuven, Leuven, Belgium
| | - Shaheen Hamdy
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, School of Medical Sciences, Centre for Gastrointestinal Sciences, University of Manchester, Manchester, UK.
- Centre for Gastrointestinal Sciences, Salford Royal Foundation Trust, University of Manchester, Clinical Sciences Building, Manchester, Eccles Old Road, Salford, M6 8HD, UK.
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Li K, Fu C, Xie Z, Zhang J, Zhang C, Li R, Gao C, Wang J, Xue C, Zhang Y, Deng W. The impact of physical therapy on dysphagia in neurological diseases: a review. Front Hum Neurosci 2024; 18:1404398. [PMID: 38903410 PMCID: PMC11187312 DOI: 10.3389/fnhum.2024.1404398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 05/28/2024] [Indexed: 06/22/2024] Open
Abstract
A neurogenic dysphagia is dysphagia caused by problems with the central and peripheral nervous systems, is particularly prevalent in conditions such as Parkinson's disease and stroke. It significantly impacts the quality of life for affected individuals and causes additional burdens, such as malnutrition, aspiration pneumonia, asphyxia, or even death from choking due to improper eating. Physical therapy offers a non-invasive treatment with high efficacy and low cost. Evidence supporting the use of physical therapy in dysphagia treatment is increasing, including techniques such as neuromuscular electrical stimulation, sensory stimulation, transcranial direct current stimulation, and repetitive transcranial magnetic stimulation. While initial studies have shown promising results, the effectiveness of specific treatment regimens still requires further validation. At present, there is a lack of scientific evidence to guide patient selection, develop appropriate treatment regimens, and accurately evaluate treatment outcomes. Therefore, the primary objectives of this review are to review the results of existing research, summarize the application of physical therapy in dysphagia management, we also discussed the mechanisms and treatments of physical therapy for neurogenic dysphagia.
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Affiliation(s)
- Kun Li
- Shandong Daizhuang Hospital, Jining, China
| | - Cuiyuan Fu
- Shandong Daizhuang Hospital, Jining, China
| | - Zhen Xie
- Shandong Daizhuang Hospital, Jining, China
| | - Jiajia Zhang
- Department of Psychology, Xinxiang Medical University, Xinxiang, China
| | | | - Rui Li
- Shandong Daizhuang Hospital, Jining, China
| | | | | | - Chuang Xue
- Affiliated Mental Health Center and Hangzhou Seventh People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | | | - Wei Deng
- Affiliated Mental Health Center and Hangzhou Seventh People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Liangzhu Laboratory, MOE Frontier Science Center for Brain Science and Brain-machine Integration, State Key Laboratory of Brain-Machine Intelligence, Zhejiang University, Hangzhou, China
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Kleinerova J, Tahedl M, Tan EL, Delaney S, Hengeveld JC, Doherty MA, McLaughlin RL, Hardiman O, Chang KM, Finegan E, Bede P. Supra- and infra-tentorial degeneration patterns in primary lateral sclerosis: a multimodal longitudinal neuroradiology study. J Neurol 2024; 271:3239-3255. [PMID: 38438819 PMCID: PMC11136747 DOI: 10.1007/s00415-024-12261-z] [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: 12/21/2023] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND Primary lateral sclerosis (PLS) is traditionally solely associated with progressive upper motor neuron dysfunction manifesting in limb spasticity, gait impairment, bulbar symptoms and pseudobulbar affect. Recent studies have described frontotemporal dysfunction in some patients resulting in cognitive manifestations. Cerebellar pathology is much less well characterised despite sporadic reports of cerebellar disease. METHODS A multi-timepoint, longitudinal neuroimaging study was conducted to characterise the evolution of both intra-cerebellar disease burden and cerebro-cerebellar connectivity. The volumes of deep cerebellar nuclei, cerebellar cortical volumes, cerebro-cerebellar structural and functional connectivity were assessed longitudinally in a cohort of 43 individuals with PLS. RESULTS Cerebello-frontal, -temporal, -parietal, -occipital and cerebello-thalamic structural disconnection was detected at baseline based on radial diffusivity (RD) and cerebello-frontal decoupling was also evident based on fractional anisotropy (FA) alterations. Functional connectivity changes were also detected in cerebello-frontal, parietal and occipital projections. Volume reductions were identified in the vermis, anterior lobe, posterior lobe, and crura. Among the deep cerebellar nuclei, the dorsal dentate was atrophic. Longitudinal follow-up did not capture statistically significant progressive changes. Significant primary motor cortex atrophy and inter-hemispheric transcallosal degeneration were also captured. CONCLUSIONS PLS is not only associated with upper motor neuron dysfunction, but cerebellar cortical volume loss and deep cerebellar nuclear atrophy can also be readily detected. In addition to intra-cerebellar disease burden, cerebro-cerebellar connectivity alterations also take place. Our data add to the evolving evidence of widespread neurodegeneration in PLS beyond the primary motor regions. Cerebellar dysfunction in PLS is likely to exacerbate bulbar, gait and dexterity impairment and contribute to pseudobulbar affect.
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Affiliation(s)
- Jana Kleinerova
- Computational Neuroimaging Group (CNG), School of Medicine, Trinity College Dublin, Dublin 2, Ireland
| | - Marlene Tahedl
- Computational Neuroimaging Group (CNG), School of Medicine, Trinity College Dublin, Dublin 2, Ireland
| | - Ee Ling Tan
- Computational Neuroimaging Group (CNG), School of Medicine, Trinity College Dublin, Dublin 2, Ireland
| | - Siobhan Delaney
- Computational Neuroimaging Group (CNG), School of Medicine, Trinity College Dublin, Dublin 2, Ireland
- Department of Neurology, St James's Hospital, Dublin, Ireland
| | | | - Mark A Doherty
- Smurfit Institute of Genetics, Trinity College Dublin, Dublin, Ireland
| | | | - Orla Hardiman
- Computational Neuroimaging Group (CNG), School of Medicine, Trinity College Dublin, Dublin 2, Ireland
| | - Kai Ming Chang
- Computational Neuroimaging Group (CNG), School of Medicine, Trinity College Dublin, Dublin 2, Ireland
| | - Eoin Finegan
- Computational Neuroimaging Group (CNG), School of Medicine, Trinity College Dublin, Dublin 2, Ireland
| | - Peter Bede
- Computational Neuroimaging Group (CNG), School of Medicine, Trinity College Dublin, Dublin 2, Ireland.
- Department of Neurology, St James's Hospital, Dublin, Ireland.
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Schaefer JH, Luft F, Seiler A, Harborth E, Kaffenberger S, Polkowski C, Foerch C, Lapa S. Prevalence, recovery and phenotype of dysphagia in patients with ischaemic cerebellar stroke. Eur J Neurol 2024:e16303. [PMID: 38634169 DOI: 10.1111/ene.16303] [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: 02/06/2024] [Revised: 03/26/2024] [Accepted: 03/29/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND AND PURPOSE Swallowing is a complex task, moderated by a sophisticated bilateral network including multiple supratentorial regions, the brainstem and the cerebellum. To date, conflicting data exist about whether focal lesions to the cerebellum are associated with dysphagia. Therefore, the aim of the study was to evaluate dysphagia prevalence, recovery and dysphagia pattern in patients with ischaemic cerebellar stroke. METHODS A retrospective analysis of patients consecutively admitted to an academic stroke centre with ischaemic stroke found only in the cerebellum was performed. The presence of dysphagia was the primary end-point and was assessed by a speech-language pathologist, according to defined criteria. Dysphagia pattern was evaluated by analysing the videos of the flexible endoscopic evaluation of swallowing. Brain imaging was used to identify lesion size and location associated with dysphagia. RESULTS Between January 2016 and December 2021, 102 patients (35.3% female) with a mean age of 52.8 ± 17.3 years were included. Thirteen (12.7%) patients presented with dysphagia. The most frequently observed flexible endoscopic evaluation of swallowing phenotype was premature spillage (n = 7; 58.3%), whilst significant residues or aspiration did not occur. One patient died (7.7%); the other patients showed improvement of dysphagia and one patient (7.7%) was discharged with dietary restrictions. CONCLUSIONS Although the involvement of the cerebellum in deglutition has become increasingly evident, isolated lesions to the cerebellum are less likely to cause clinically relevant and persisting dysphagia compared to other brain regions. The observed dysphagia pattern shows a lack of coordination and control, resulting in premature spillage or fragmented bolus transfer in some patients.
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Affiliation(s)
- Jan Hendrik Schaefer
- Department of Neurology, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
| | - Felix Luft
- Department of Neurology, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
| | - Alexander Seiler
- Department of Neurology, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
- Department of Neurology, University Hospital of Schleswig Holstein, Kiel, Germany
| | - Elena Harborth
- Department of Neurology, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
| | - Sara Kaffenberger
- Department of Communication Disorders, University of Canterbury, Christchurch, New Zealand
| | - Christoph Polkowski
- Institute of Neuroradiology, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
| | - Christian Foerch
- Department of Neurology, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
- Department of Neurology, RKH Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Sriramya Lapa
- Department of Neurology, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
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7
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Sasegbon A, Cheng I, Hamdy S. The neurorehabilitation of post-stroke dysphagia: Physiology and pathophysiology. J Physiol 2024. [PMID: 38517302 DOI: 10.1113/jp285564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 02/29/2024] [Indexed: 03/23/2024] Open
Abstract
Swallowing is a complex process involving the precise contractions of numerous muscles of the head and neck, which act to process and shepherd ingested material from the oral cavity to its eventual destination, the stomach. Over the past five decades, information from animal and human studies has laid bare the complex network of neurones in the brainstem, cortex and cerebellum that are responsible for orchestrating each normal swallow. Amidst this complexity, problems can and often do occur that result in dysphagia, defined as impaired or disordered swallowing. Dysphagia is common, arising from multiple varied disease processes that can affect any of the neuromuscular structures involved in swallowing. Post-stroke dysphagia (PSD) remains the most prevalent and most commonly studied form of dysphagia and, as such, provides an important disease model to assess dysphagia physiology and pathophysiology. In this review, we explore the complex neuroanatomical processes that occur during normal swallowing and PSD. This includes how strokes cause dysphagia, the mechanisms through which natural neuroplastic recovery occurs, current treatments for patients with persistent dysphagia and emerging neuromodulatory treatments.
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Affiliation(s)
- Ayodele Sasegbon
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Centre for Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, Salford Royal Foundation Trust, University of Manchester, Manchester, UK
| | - Ivy Cheng
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Centre for Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, Salford Royal Foundation Trust, University of Manchester, Manchester, UK
- Academic Unit of Human Communication, Learning, and Development, Faculty of Education, The University of Hong Kong, Hong Kong, China
- Institute for Biomagnetism and Biosignalanalysis, University of Münster, Münster, Germany
| | - Shaheen Hamdy
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Centre for Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, Salford Royal Foundation Trust, University of Manchester, Manchester, UK
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8
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Jaarsma D, Birkisdóttir MB, van Vossen R, Oomen DWGD, Akhiyat O, Vermeij WP, Koekkoek SKE, De Zeeuw CI, Bosman LWJ. Different Purkinje cell pathologies cause specific patterns of progressive gait ataxia in mice. Neurobiol Dis 2024; 192:106422. [PMID: 38286390 DOI: 10.1016/j.nbd.2024.106422] [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: 09/19/2023] [Revised: 01/24/2024] [Accepted: 01/24/2024] [Indexed: 01/31/2024] Open
Abstract
Gait ataxia is one of the most common and impactful consequences of cerebellar dysfunction. Purkinje cells, the sole output neurons of the cerebellar cortex, are often involved in the underlying pathology, but their specific functions during locomotor control in health and disease remain obfuscated. We aimed to describe the effect of gradual adult-onset Purkinje cell degeneration on gaiting patterns in mice, and to determine whether two different mechanisms that both lead to Purkinje cell degeneration cause different patterns in the development of gait ataxia. Using the ErasmusLadder together with a newly developed limb detection algorithm and machine learning-based classification, we subjected mice to a challenging locomotor task with detailed analysis of single limb parameters, intralimb coordination and whole-body movement. We tested two Purkinje cell-specific mouse models, one involving stochastic cell death due to impaired DNA repair mechanisms (Pcp2-Ercc1-/-), the other carrying the mutation that causes spinocerebellar ataxia type 1 (Pcp2-ATXN1[82Q]). Both mouse models showed progressive gaiting deficits, but the sequence with which gaiting parameters deteriorated was different between mouse lines. Our longitudinal approach revealed that gradual loss of Purkinje cell function can lead to a complex pattern of loss of function over time, and that this pattern depends on the specifics of the pathological mechanisms involved. We hypothesize that this variability will also be present in disease progression in patients, and that our findings will facilitate the study of therapeutic interventions in mice, as subtle changes in locomotor abilities can be quantified by our methods.
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Affiliation(s)
- Dick Jaarsma
- Department of Neuroscience, Erasmus MC, 3015 CA, Rotterdam, the Netherlands.
| | - Maria B Birkisdóttir
- Department of Neuroscience, Erasmus MC, 3015 CA, Rotterdam, the Netherlands; Princess Máxima Center for Pediatric Oncology, 3584 CS, Utrecht, the Netherlands
| | - Randy van Vossen
- Department of Neuroscience, Erasmus MC, 3015 CA, Rotterdam, the Netherlands
| | - Demi W G D Oomen
- Department of Neuroscience, Erasmus MC, 3015 CA, Rotterdam, the Netherlands
| | - Oussama Akhiyat
- Department of Neuroscience, Erasmus MC, 3015 CA, Rotterdam, the Netherlands
| | - Wilbert P Vermeij
- Princess Máxima Center for Pediatric Oncology, 3584 CS, Utrecht, the Netherlands; Oncode Institute, 3521 AL, Utrecht, the Netherlands
| | | | - Chris I De Zeeuw
- Department of Neuroscience, Erasmus MC, 3015 CA, Rotterdam, the Netherlands; Netherlands Institute for Neuroscience, Royal Dutch Academy of Arts & Science, 1105 BA, Amsterdam, the Netherlands
| | - Laurens W J Bosman
- Department of Neuroscience, Erasmus MC, 3015 CA, Rotterdam, the Netherlands.
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9
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Hajipour M, Sobhani-Rad D, Zainaee S, Farzadfar MT, Khaniki SH. Dysphagia following cerebellar stroke: analyzing the contribution of the cerebellum to swallowing function. Front Neurol 2023; 14:1276243. [PMID: 38033782 PMCID: PMC10687548 DOI: 10.3389/fneur.2023.1276243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/31/2023] [Indexed: 12/02/2023] Open
Abstract
Swallowing is essential for human health, and the cerebellum is crucial for motor movement regulation. Cerebellar strokes may cause dysphagia, but their exact effects remain unexplored in swallowing function. Therefore, the aim of this study was to analyze the precise clinical characteristics of the oral and pharyngeal phases of swallowing after cerebellar stroke and to critically discuss the cerebellum's contribution to swallowing. The study involved 34 participants with cerebellar strokes, gathered through convenience sampling. Neurologists diagnosed isolated strokes, and a speech and language pathologist examined swallowing ability using the Mann Assessment of Swallowing Ability. The study found that 52.9% of people experienced dysphagia after a cerebellar stroke. Dysphagia was significantly associated with a higher risk of aspiration. Age was also significantly correlated with dysphagia. No significant correlation was found between swallowing ability and sex. In conclusion, this study suggests isolated cerebellar stroke can adversely affect the motor and non-motor aspects of swallowing and cause severe dysphagia and aspiration risk. Thus, early diagnosis and timely management of dysphagia following a cerebellar stroke can help prevent serious consequences.
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Affiliation(s)
- Masoume Hajipour
- Department of Speech Therapy, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Davood Sobhani-Rad
- Department of Speech Therapy, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Shahryar Zainaee
- Department of Communication Sciences and Disorders, College of Health and Human Services, Bowling Green State University, Bowling Green, OH, United States
| | | | - Saeedeh Hajebi Khaniki
- Department of Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
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10
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Santos SVP, Araújo BCL, Sordi C, Cesar CPHAR, de Andrade DDCM, Batista TSC, Schneiberg S. Swallowing capacity and gravity of the laryngotracheal aspiration risk in atypical cerebellar stroke: case report. Codas 2023; 35:e20210220. [PMID: 37909490 PMCID: PMC10688292 DOI: 10.1590/2317-1782/20232021220pt] [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: 09/16/2021] [Accepted: 09/04/2022] [Indexed: 11/03/2023] Open
Abstract
This case report aimed to evaluate the swallowing capacity and the severity of the risk of laryngotracheal aspiration of a 52-year-old female patient with atypical and rare stroke, with major injury in the cerebellar pathway. In order to measure swallowing capacity and risk of aspiration a routine clinical assessment used in the speech therapy clinic was performed and two valid clinical tests were used: Massey Bedside Swallowing Screen (MBSS) and Gugging Swallowing Screen (GUSS). After evaluation with the clinical tests, it was observed that the patient had reduced swallowing capacity, performance characterized as pathological, 100% dysfunction in the water swallowing test (MBSS), presence of choking, coughing, change in vocal quality and anterior escape. In the assessment of risk of aspiration with the GUSS, the patient presented moderate dysphagia and risk of laryngotracheal aspiration.This case report demonstrated that moderate dysphagia is found in a stroke patient with lesions that affect the cerebellum. Standardized and validated clinical tests such as GUSS and MBSS should also be used to assess the risk of dysphagia after stroke at ambulatory care.
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Affiliation(s)
- Sara Virgínia Paiva Santos
- Programa de Pós-graduação de Ciências Aplicadas a Saúde - PPGCAS, Universidade Federal de Sergipe - UFS - Lagarto (SE), Brasil.
| | - Brenda Carla Lima Araújo
- Departamento de Fonoaudiologia, Universidade Federal de Sergipe - UFS - São Cristóvão (SE), Brasil.
| | - Claudia Sordi
- Departamento de Fonoaudiologia, Universidade Federal de Sergipe - UFS - Lagarto (SE), Brasil.
| | | | | | | | - Sheila Schneiberg
- Programa de Pós-graduação de Ciências Aplicadas a Saúde - PPGCAS, Universidade Federal de Sergipe - UFS - Lagarto (SE), Brasil.
- Departamento de Fisioterapia, Universidade Federal de Sergipe - UFS - Lagarto (SE), Brasil.
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11
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Iosif CI, Bashir ZI, Apps R, Pickford J. Cerebellar Prediction and Feeding Behaviour. CEREBELLUM (LONDON, ENGLAND) 2023; 22:1002-1019. [PMID: 36121552 PMCID: PMC10485105 DOI: 10.1007/s12311-022-01476-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/01/2022] [Indexed: 06/15/2023]
Abstract
Given the importance of the cerebellum in controlling movements, it might be expected that its main role in eating would be the control of motor elements such as chewing and swallowing. Whilst such functions are clearly important, there is more to eating than these actions, and more to the cerebellum than motor control. This review will present evidence that the cerebellum contributes to homeostatic, motor, rewarding and affective aspects of food consumption.Prediction and feedback underlie many elements of eating, as food consumption is influenced by expectation. For example, circadian clocks cause hunger in anticipation of a meal, and food consumption causes feedback signals which induce satiety. Similarly, the sight and smell of food generate an expectation of what that food will taste like, and its actual taste will generate an internal reward value which will be compared to that expectation. Cerebellar learning is widely thought to involve feed-forward predictions to compare expected outcomes to sensory feedback. We therefore propose that the overarching role of the cerebellum in eating is to respond to prediction errors arising across the homeostatic, motor, cognitive, and affective domains.
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Affiliation(s)
- Cristiana I Iosif
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Biomedical Sciences Building, University Walk, Bristol, BS8 1TD, UK.
| | - Zafar I Bashir
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Biomedical Sciences Building, University Walk, Bristol, BS8 1TD, UK
| | - Richard Apps
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Biomedical Sciences Building, University Walk, Bristol, BS8 1TD, UK
| | - Jasmine Pickford
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Biomedical Sciences Building, University Walk, Bristol, BS8 1TD, UK
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12
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Rajagopalan V, Pioro EP. Graph network measures reveal distinct white matter abnormalities in motor and extra-motor brain regions of two UMN-predominant ALS subtypes. J Neurol Sci 2023; 452:120765. [PMID: 37672915 DOI: 10.1016/j.jns.2023.120765] [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: 05/09/2023] [Revised: 08/04/2023] [Accepted: 08/08/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Routine clinical magnetic resonance imaging (MRI) shows bilateral corticospinal tract (CST) hyperintensity in some patients with upper motor neuron (UMN)-predominant ALS (ALS-CST+) but not in others (ALS-CST-). Although, similar in their UMN features, the ALS-CST+ patient group is significantly younger in age, has faster disease progression and shorter survival than the ALS-CST- patient group. Reasons for the differences are unclear. METHOD In order to evaluate more objective MRI measures of these ALS subgroups, we used diffusion tensor images (DTI) obtained using single shot echo planar imaging sequence from 1.5 T Siemens MRI Scanner. We performed an exploratory whole brain white matter (WM) network analysis using graph theory approach on 45 ALS patients (ALS-CST+) (n = 21), and (ALS-CST-) (n = 24) and neurological controls (n = 14). RESULTS Significant (p < 0.05) differences in nodal degree measure between ALS patients and controls were observed in motor and extra motor regions, supplementary motor area, subcortical WM regions, cerebellum and vermis. Importantly, WM network abnormalities were significantly (p < 0.05) different between ALS-CST+ and ALS-CST- subgroups. Compared to neurologic controls, both ALS subgroups showed hubs in the right superior occipital gyrus and cuneus as well as significantly (p < 0.05) reduced small worldness supportive of WM network damage. CONCLUSIONS Significant differences between ALS-CST+ and ALS-CST- subgroups of WM network abnormalities, age of onset, symptom duration prior to MRI, and progression rate suggest these patients represent distinct clinical phenotypes and possibly pathophysiologic mechanisms of ALS.
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Affiliation(s)
- Venkateswaran Rajagopalan
- Department of Electrical and Electronics Engineering, Birla Institute of Technology and Science Pilani, Hyderabad Campus, Hyderabad 500078, India
| | - Erik P Pioro
- Neuromuscular Center, Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH 44195, USA; Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
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13
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Cheng I, Sasegbon A, Hamdy S. Evaluating the Therapeutic Application of Neuromodulation in the Human Swallowing System. Dysphagia 2023; 38:1005-1024. [PMID: 36239821 PMCID: PMC10326109 DOI: 10.1007/s00455-022-10528-z] [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: 06/07/2022] [Accepted: 09/30/2022] [Indexed: 11/03/2022]
Abstract
In the last two decades, the focus of neurogenic dysphagia management has moved from passive compensatory strategies to evidence-based rehabilitative approaches. Advances in technology have enabled the development of novel treatment approaches such as neuromodulation techniques, which target the promotion of neurological reorganization for functional recovery of swallowing. Given the rapid pace of development in the field, this review aims to summarize the current findings on the effects of neuromodulation techniques on the human swallowing system and evaluate their therapeutic potential for neurogenic dysphagia. Implications for future clinical research and practical considerations for using neuromodulation in clinical practice will also be discussed.
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Affiliation(s)
- Ivy Cheng
- Centre for Gastrointestinal Sciences, Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Ayodele Sasegbon
- Centre for Gastrointestinal Sciences, Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Shaheen Hamdy
- Centre for Gastrointestinal Sciences, Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
- Centre for Gastrointestinal Sciences, University of Manchester, Clinical Sciences Building, Salford Royal Foundation Trust, Eccles Old Road, Salford, M6 8HD, UK.
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14
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Dai M, Qiao J, Shi Z, Wei X, Chen H, Shen L, Wen H, Dou Z. Effect of cerebellar transcranial magnetic stimulation with double-cone coil on dysphagia after subacute infratentorial stroke: A randomized, single-blinded, controlled trial. Brain Stimul 2023; 16:1012-1020. [PMID: 37301470 DOI: 10.1016/j.brs.2023.05.023] [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: 02/14/2023] [Revised: 05/13/2023] [Accepted: 05/28/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND A 10-Hz cerebellar repetitive transcranial magnetic stimulation (rTMS) could increase corticobulbar tract excitability in healthy individuals. However, its clinical efficacy for poststroke dysphagia (PSD) remains unclear. OBJECTIVE To investigate the effectiveness of 10-Hz cerebellar rTMS in PSD patients with infratentorial stroke (IS). METHODS In this single-blinded, randomized controlled trial, 42 PSD patients with subacute IS were allocated to three groups: bilateral cerebellar rTMS (biCRB-rTMS), unilateral cerebellar rTMS (uniCRB-rTMS), or sham-rTMS. The stimulation parameters were 5 trains of 50 stimuli at 10 Hz with an interval of 10 s at 90% of the thenar resting motor threshold (RMT). The Functional Oral Intake Scale (FOIS) was assessed at T0 (baseline), T1 (day 0 after intervention), and T2 (day 14 after intervention), whereas the Dysphagia Outcome and Severity Scale (DOSS), Penetration Aspiration Scale (PAS), and neurophysiological parameters were evaluated at T0 and T1. RESULTS Significant time and intervention interaction effects were observed for the FOIS score (F = 3.045, p = 0.022). The changes in the FOIS scores at T1 and T2 were both significantly higher in the biCRB-rTMS group than in the sham-rTMS group (p < 0.05). The uniCRB-rTMS and biCRB-rTMS groups demonstrated greater changes in the DOSS and PAS at T1, compared with the sham-rTMS group (p < 0.05). Bilateral corticobulbar tract excitability partly increased in the biCRB-rTMS and uniCRB-rTMS groups at T1, compared with T0. The percent changes in corticobulbar tract excitability parameters at T1 showed no difference among three groups. CONCLUSIONS A 10-Hz bilateral cerebellar rTMS is a promising, noninvasive treatment for subacute infratentorial PSD.
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Affiliation(s)
- Meng Dai
- Third affiliate hospital of sun Yat-sen university, 600 Tianhe Road, Guangzhou, Guangdong Province, 510630, People's Republic of China
| | - Jia Qiao
- Third affiliate hospital of sun Yat-sen university, 600 Tianhe Road, Guangzhou, Guangdong Province, 510630, People's Republic of China
| | - Zhonghui Shi
- Third affiliate hospital of sun Yat-sen university, 600 Tianhe Road, Guangzhou, Guangdong Province, 510630, People's Republic of China
| | - Xiaomei Wei
- Third affiliate hospital of sun Yat-sen university, 600 Tianhe Road, Guangzhou, Guangdong Province, 510630, People's Republic of China
| | - Huayu Chen
- Third affiliate hospital of sun Yat-sen university, 600 Tianhe Road, Guangzhou, Guangdong Province, 510630, People's Republic of China
| | - Luxi Shen
- Third affiliate hospital of sun Yat-sen university, 600 Tianhe Road, Guangzhou, Guangdong Province, 510630, People's Republic of China
| | - Hongmei Wen
- Third affiliate hospital of sun Yat-sen university, 600 Tianhe Road, Guangzhou, Guangdong Province, 510630, People's Republic of China.
| | - Zulin Dou
- Third affiliate hospital of sun Yat-sen university, 600 Tianhe Road, Guangzhou, Guangdong Province, 510630, People's Republic of China.
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15
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Huang L, Wang Y, Sun J, Zhu L, Liu J, Wu Y, Shan C, Yan J, Wan P. Incidence and Risk Factors for Dysphagia Following Cerebellar Stroke: a Retrospective Cohort Study. CEREBELLUM (LONDON, ENGLAND) 2023:10.1007/s12311-023-01564-y. [PMID: 37204664 DOI: 10.1007/s12311-023-01564-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 04/26/2023] [Indexed: 05/20/2023]
Abstract
The cerebellum is known to play a supportive role in swallowing-related functions; however, wide discrepancies about the incidence rate of swallowing disorders following cerebellar strokes exist within the literature. This study aimed to investigate the incidence rate of dysphagia and the factors which may affect the presence of dysphagia and clinical recovery in individuals diagnosed with cerebellar stroke. A retrospective chart audit of 1651 post-stroke patients (1049 males and 602 females) admitted with a cerebellar stroke to a comprehensive tertiary hospital in China was conducted. Data on demographics, medical, along with swallowing function assessment were collected. Differences between dysphagic and non-dysphagic groups were evaluated using t-tests and Pearson's chi-square test. Univariate logistic regression analysis was performed to establish factors associated with the presence of dysphagia. A total of 11.45% of participants were identified with dysphagia during inpatient admission. Individuals with mixed types of stroke, multiple lesions in the cerebellum, and ages older than 85 years old were more likely to develop dysphagia. Moreover, the prognosis of dysphagia following a cerebellar stroke was associated with lesions in different parts of the cerebellum. The cumulative recovery rates from the best to worse were the right hemisphere group, the cerebellum vermis or peduncle group, and both the hemisphere group and the left hemisphere group, respectively.
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Affiliation(s)
- Li Huang
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, 110 Ganhe Road, Hongkou District, Shanghai, 200437, China
- Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong New District, Shanghai, 201203, China
| | - Yunlu Wang
- Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong New District, Shanghai, 201203, China
| | - Jikang Sun
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, 110 Ganhe Road, Hongkou District, Shanghai, 200437, China
| | - Lequn Zhu
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, 110 Ganhe Road, Hongkou District, Shanghai, 200437, China
| | - Jimin Liu
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, 110 Ganhe Road, Hongkou District, Shanghai, 200437, China
| | - Yuwei Wu
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, 110 Ganhe Road, Hongkou District, Shanghai, 200437, China
| | - Chunlei Shan
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, 110 Ganhe Road, Hongkou District, Shanghai, 200437, China
- Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong New District, Shanghai, 201203, China
| | - Juntao Yan
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, 110 Ganhe Road, Hongkou District, Shanghai, 200437, China
- Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong New District, Shanghai, 201203, China
| | - Ping Wan
- Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong New District, Shanghai, 201203, China.
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Wagner V, Knudsen MS, Curtis DJ, Riberholt CG. Use of the EXOPULSE Mollii for severe ataxia in an adult male 4 months after cardiac arrest. BMJ Case Rep 2023; 16:e249574. [PMID: 36963762 PMCID: PMC10040057 DOI: 10.1136/bcr-2022-249574] [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] [Indexed: 03/26/2023] Open
Abstract
The EXOPULSE Mollii is designed to reduce spasticity through low-current electrical stimulation of major muscle groups. The effect on severe cerebellar ataxia has not been investigated. This case describes the use of the EXOPULSE Mollii in an adult male with severe cerebellar ataxia 4 months after cardiac arrest and ischaemic stroke. The patient used the suit in 15 of 19 possible sessions (78.9%). He improved in the sit-to-stand test, arm function test and 10 m walking test. He described improved visual focus, ability to speak and swallow. Improvements were maintained for 1 week after the last session. The EXOPULSE Mollii is relevant to consider in the early stages of inpatient rehabilitation for patients with severe ataxia, but further research is warranted.
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Affiliation(s)
- Vibeke Wagner
- Department of Neurorehabilitation TBI Unit, Rigshospitalet, Hvidovre, Denmark
| | | | - Derek John Curtis
- Child and Youth Administration, City of Copenhagen, Copenhagen, Denmark
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Campbell KS, Keller P, Golovko SA, Seeger D, Golovko MY, Kerby JL. Connecting the Pipes: Agricultural Tile Drains and Elevated Imidacloprid Brain Concentrations in Juvenile Northern Leopard Frogs ( Rana pipiens). ENVIRONMENTAL SCIENCE & TECHNOLOGY 2023; 57:2758-2767. [PMID: 36753680 DOI: 10.1021/acs.est.2c06527] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Neonicotinoids are neurotoxic insecticides and are often released into nearby wetlands via subsurface tile drains and can negatively impact nontarget organisms, such as amphibians. Previous studies have indicated that imidacloprid, a commonly used neonicotinoid, can cross the amphibian blood-brain barrier under laboratory conditions; however, little is known about the impact of low concentrations in a field-based setting. Here, we report aqueous pesticide concentrations at wetland production areas that were either connected or not connected to agricultural tile drains, quantified imidacloprid and its break down products in juvenile amphibian brains and livers, and investigated the relationship between imidacloprid brain concentration and brain size. Imidacloprid concentrations in brain and water samples were nearly 2.5 and 5 times higher at tile wetlands (brain = 4.12 ± 1.92 pg/mg protein; water = 0.032 ± 0.045 μg/L) compared to reference wetlands, respectively. Tile wetland amphibians also had shorter cerebellums (0.013 ± 0.001 mm), depicting a negative relationship between imidacloprid brain concentration and cerebellum length. The metabolite, desnitro-imidacloprid, had liver concentrations that were 2 times higher at tile wetlands (2 ± 0.3 μg/g). Our results demonstrate that imidacloprid can cross the amphibian blood-brain barrier under ecological conditions and may alter brain dimensions and provide insight into the metabolism of imidacloprid in amphibians.
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Affiliation(s)
- Kaitlyn S Campbell
- Department of Biology, University of South Dakota, Vermillion, South Dakota 57069, United States
| | - Peyton Keller
- Department of Biology, University of South Dakota, Vermillion, South Dakota 57069, United States
| | - Svetlana A Golovko
- Department of Biomedical Sciences, School of Medicine and Health Sciences, University of North Dakota, Grand Forks, North Dakota 58203, United States
| | - Drew Seeger
- Department of Biomedical Sciences, School of Medicine and Health Sciences, University of North Dakota, Grand Forks, North Dakota 58203, United States
| | - Mikhail Y Golovko
- Department of Biomedical Sciences, School of Medicine and Health Sciences, University of North Dakota, Grand Forks, North Dakota 58203, United States
| | - Jacob L Kerby
- Department of Biology, University of South Dakota, Vermillion, South Dakota 57069, United States
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Yang CW, Chen RD, Feng MT, Zhang MZ, Liu W, Liu XC, Wang DC. The therapeutic effect of capsaicin on oropharyngeal dysphagia: A systematic review and meta-analysis. Front Aging Neurosci 2022; 14:931016. [PMID: 36425319 PMCID: PMC9679510 DOI: 10.3389/fnagi.2022.931016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 10/17/2022] [Indexed: 10/28/2023] Open
Abstract
OBJECTIVES Capsaicin is a specific agonist of TRPV1 (multimodal sensory receptor), which improves oropharyngeal dysphagia by increasing sensory input from the oropharynx and hypopharynx and by increasing repetitive stimulation of the cerebral cortex. The aim of this systematic review was to evaluate the therapeutic effect of capsaicin on swallowing disorders in stroke patients and the elderly. METHOD We searched Medline, Embase, PubMed, and Cochrane Library databases. We used the Mesh terms search database to screen all clinical trials that complied with the inclusion criteria. Studies were subjected to literature screening, quality assessment, and data extraction to remove studies that did not meet the inclusion criteria. After literature screening, quality assessment, and data extraction, a systematic review and meta-analysis of the included study were performed. RESULTS This systematic review and meta-analysis were prospectively registered on PROSPERO under registration number CRD42022313958. Five high-quality randomized controlled trials were ultimately included. The results of our meta-analysis showed a more significant reduction in swallowing function score change in the capsaicin group compared to the control group [SMD = -1.30, 95% CI: (-2.35, -0.25), P = 0.01] and on the Water swallowing test the improvement was significantly higher in the capsaicin group [RR = 2.46, 95% CI: (1.73, 3.50), P < 0.0001]. CONCLUSIONS Although the results of our meta-analysis showed that capsaicin improved swallowing function, most studies had an unclear bias and included few studies. More studies are needed to support this in the future. SYSTEMATIC REVIEW REGISTRATION www.crd.york.ac.uk/prospero/display_record.php?RecordID=304061, identifier: 304061.
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Affiliation(s)
- Cong-wen Yang
- Department of Neurosurgery, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Ru-dong Chen
- Department of Spinal Surgery, Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Meng-ting Feng
- Department of Pediatrics, Jilin University, Changchun, China
| | | | - Wei Liu
- Department of Neurosurgery, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Xu-chang Liu
- Department of Spinal Surgery, Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Da-chuan Wang
- Department of Spinal Surgery, Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
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Neural Correlates of Oral Stereognosis—An fMRI Study. Dysphagia 2022; 38:923-932. [PMID: 36087119 PMCID: PMC10182931 DOI: 10.1007/s00455-022-10517-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 08/26/2022] [Indexed: 11/03/2022]
Abstract
AbstractOral stereognosis is the ability to recognize, discriminate and localize a bolus in the oral cavity. Clinical observation indicates deficits in oral stereognosis in patients with vascular or neurodegenerative diseases particularly affecting the parietal lobes. However, the precise neural representation of oral stereognosis remains unclear whereas the neural network of manual stereognosis has already been identified. We hypothesize that oral and manual stereognosis share common neuronal substrates whilst also showing somatotopic distribution. Functional magnetic resonance images (fMRI; Siemens Prisma 3 T) from 20 healthy right-handed participants (11 female; mean age 25.7 years) using a cross-modal task of oral and manual spatial object manipulation were acquired. Data were analyzed using FSL software using a block design and standard analytical and statistical procedures. A conjunction analysis targeted the common neuronal substrate for stereognosis. Activations associated with manual and oral stereognosis were found in partially overlapping fronto-parietal networks in a somatotopic fashion, where oral stereognosis is located caudally from manual stereognosis. A significant overlap was seen in the left anterior intraparietal sulcus. Additionally, cerebellar activations were shown particularly for the oral condition. Spatial arrangement of shaped boli in the oral cavity is associated with neuronal activity in fronto-parietal networks and the cerebellum. These findings have significant implications for clinical diagnostics and management of patients with lesions or atrophy in parietal lobule (e.g. Alzheimer’s disease, stroke). More studies are required to investigate the clinical effect of damage to these areas, such as loss of oral stereognosis or an impaired oral phase.
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Forstenpointner J, Maallo AMS, Elman I, Holmes S, Freeman R, Baron R, Borsook D. The Solitary Nucleus Connectivity to Key Autonomic Regions in Humans MRI and Literature based Considerations. Eur J Neurosci 2022; 56:3938-3966. [PMID: 35545280 DOI: 10.1111/ejn.15691] [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: 10/13/2021] [Revised: 05/04/2022] [Accepted: 05/05/2022] [Indexed: 11/03/2022]
Abstract
The nucleus tractus solitarius (NTS), is a key brainstem structure relaying interoceptive peripheral information to the interrelated brain centers for eliciting rapid autonomic responses and for shaping longer-term neuroendocrine and motor patterns. Structural and functional NTS' connectivity has been extensively investigated in laboratory animals. But there is limited information about NTS' connectome in humans. Using MRI, we examined diffusion and resting state data from 20 healthy participants in the Human Connectome Project. The regions within the brainstem (n=8), subcortical (n=6), cerebellar (n=2) and cortical (n=5) parts of the brain were selected via a systematic review of the literature and their white matter NTS connections were evaluated via probabilistic tractography along with functional and directional (i.e., Granger-causality) analyses. The underlying study confirms previous results from animal models and provides novel aspects on NTS integration in humans. Two key findings can be summarized: (i) the NTS predominantly processes afferent input and (ii) a lateralization towards a predominantly left-sided NTS processing. Our results lay the foundations for future investigations into the NTS' tripartite role comprised of interoreceptors' input integration, the resultant neurochemical outflow and cognitive/affective processing. The implications of these data add to the understanding of NTS' role in specific aspects of autonomic functions.
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Affiliation(s)
- Julia Forstenpointner
- Center for Pain and the Brain, Boston Children's Hospital, Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA, USA.,Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Anne Margarette S Maallo
- Center for Pain and the Brain, Boston Children's Hospital, Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA, USA
| | - Igor Elman
- Center for Pain and the Brain, Boston Children's Hospital, Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA, USA.,Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA
| | - Scott Holmes
- Center for Pain and the Brain, Boston Children's Hospital, Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA, USA
| | - Roy Freeman
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ralf Baron
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - David Borsook
- Center for Pain and the Brain, Boston Children's Hospital, Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA, USA.,Department of Radiology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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21
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Bede P, Chipika RH, Christidi F, Hengeveld JC, Karavasilis E, Argyropoulos GD, Lope J, Li Hi Shing S, Velonakis G, Dupuis L, Doherty MA, Vajda A, McLaughlin RL, Hardiman O. Genotype-associated cerebellar profiles in ALS: focal cerebellar pathology and cerebro-cerebellar connectivity alterations. J Neurol Neurosurg Psychiatry 2021; 92:1197-1205. [PMID: 34168085 PMCID: PMC8522463 DOI: 10.1136/jnnp-2021-326854] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/02/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Cerebellar disease burden and cerebro-cerebellar connectivity alterations are poorly characterised in amyotrophic lateral sclerosis (ALS) despite the likely contribution of cerebellar pathology to the clinical heterogeneity of the condition. METHODS A prospective imaging study has been undertaken with 271 participants to systematically evaluate cerebellar grey and white matter alterations, cerebellar peduncle integrity and cerebro-cerebellar connectivity in ALS. Participants were stratified into four groups: (1) patients testing positive for GGGGCC repeat expansions in C9orf72, (2) patients carrying an intermediate-length repeat expansion in ATXN2, (3) patients without established ALS-associated mutations and (4) healthy controls. Additionally, the cerebellar profile of a single patient with ALS who had an ATXN2 allele length of 62 was evaluated. Cortical thickness, grey matter and white matter volumes were calculated in each cerebellar lobule complemented by morphometric analyses to characterise genotype-associated atrophy patterns. A Bayesian segmentation algorithm was used for superior cerebellar peduncle volumetry. White matter diffusivity parameters were appraised both within the cerebellum and in the cerebellar peduncles. Cerebro-cerebellar connectivity was assessed using deterministic tractography. RESULTS Cerebellar pathology was confined to lobules I-V of the anterior lobe in patients with sporadic ALS in contrast to the considerable posterior lobe and vermis disease burden identified in C9orf72 mutation carriers. Patients with intermediate ATXN2 expansions did not exhibit significant cerebellar pathology. CONCLUSIONS Focal rather than global cerebellar degeneration characterises ALS. Pathognomonic ALS symptoms which are typically attributed to other anatomical regions, such as dysarthria, dysphagia, pseudobulbar affect, eye movement abnormalities and cognitive deficits, may be modulated, exacerbated or partially driven by cerebellar changes in ALS.
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Affiliation(s)
- Peter Bede
- Computational Neuroimaging Group, Trinity College Dublin, Dublin, Ireland
| | | | - Foteini Christidi
- Computational Neuroimaging Group, Trinity College Dublin, Dublin, Ireland
- National and Kapodistrian University of Athens, Athens, Greece
| | | | | | | | - Jasmin Lope
- Computational Neuroimaging Group, Trinity College Dublin, Dublin, Ireland
| | - Stacey Li Hi Shing
- Computational Neuroimaging Group, Trinity College Dublin, Dublin, Ireland
| | | | - Léonie Dupuis
- Smurfit Institute of Genetics, Trinity College Dublin, Dublin, Ireland
- University of Central Florida College of Medicine, Orlando, Florida, USA
| | - Mark A Doherty
- Smurfit Institute of Genetics, Trinity College Dublin, Dublin, Ireland
| | - Alice Vajda
- Smurfit Institute of Genetics, Trinity College Dublin, Dublin, Ireland
| | | | - Orla Hardiman
- Computational Neuroimaging Group, Trinity College Dublin, Dublin, Ireland
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