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Wei JS, Hu X, Xia L, Shang J, Han Q, Zhang DY. Evaluation of the effect of botulinum toxin A on the physical and mental health of patients with hemifacial spasm. Neurologia 2024; 39:540-548. [PMID: 39232591 DOI: 10.1016/j.nrleng.2024.07.001] [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: 08/24/2021] [Accepted: 11/23/2021] [Indexed: 09/06/2024] Open
Abstract
BACKGROUND Hemifacial spasm (HFS) is a debilitating disease characterized by involuntary tonic and clonic contractions of muscles innervated by the facial nerve. Botulinum toxin A (BTX-A) is the first-line option and the most effective medical treatment for HFS. The objective of this study was to evaluate the effect of BTX-A therapy on the physical and mental health of HFS patients. METHODS Participants included 65 HFS patients and 65 matched healthy controls in the study. Cornell Medical Index (CMI) self-assessment questionnaire was used to detect the psychological health of all participants. Local injection of BTX-A was applied, and the Cohen hierarchical criteria were employed to stratify the degree of spasticity, further evaluating the efficacy of BTX-A before and two months after treatment in HFS patients. The HFS patients at two months post-treatment were re-evaluated by CMI self-assessment questionnaire, and the evaluated factors of these patients were compared with those of patients before treatment. RESULTS The scores of somatization, depression, anxiety, inadaptation, sensitivity, anger, tension, M-R, and total scores in the HFS group were significantly higher than those in the control group (all P<0.05). Two months post-treatment, among 65 HFS patients who received with BTX-A treatment, 42 (64.6%) were completely relieved, 16 (24.6%) were significantly relieved, 7 (10.8%) were partially relieved, and 0 (0%) cases were invalid, and the total effective rate was 89.2%. Two months after BTX-A treatment, the scores of somatization, tension, anxiety, depression, sensitivity, M-R and total scores of patients with HFS were lower than those before treatment (all P<0.05). CONCLUSIONS Patients with HFS are often accompanied by somatization, anger, inadaptation, sensitivity, anxiety, depression, and tension. BTX-A can not only alleviate the symptoms of HFS, but also improve the somatization, tension, anxiety, depression, and sensitivity.
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Affiliation(s)
- J S Wei
- Department of Neurology, Hongze Huaian District People's Hospital, Huaian 223100, China
| | - X Hu
- Department of Neurology, The Second People's Hospital of Huai'an, The Affiliated Huai'an Hospital of Xuzhou Medical University, Huai'an 223002, China
| | - L Xia
- Department of Neurology, Huai'an First People's Hospital, the Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian 223300, China
| | - J Shang
- Department of Neurology, Huai'an First People's Hospital, the Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian 223300, China
| | - Q Han
- Department of Neurology, Huai'an First People's Hospital, the Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian 223300, China.
| | - D Y Zhang
- Department of Radiology, Huai'an First People's Hospital, the Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian 223300, China.
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Manes JL, Bullock L, Meier AM, Turner RS, Richardson RM, Guenther FH. A neurocomputational view of the effects of Parkinson's disease on speech production. Front Hum Neurosci 2024; 18:1383714. [PMID: 38812472 PMCID: PMC11133703 DOI: 10.3389/fnhum.2024.1383714] [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: 02/07/2024] [Accepted: 04/23/2024] [Indexed: 05/31/2024] Open
Abstract
The purpose of this article is to review the scientific literature concerning speech in Parkinson's disease (PD) with reference to the DIVA/GODIVA neurocomputational modeling framework. Within this theoretical view, the basal ganglia (BG) contribute to several different aspects of speech motor learning and execution. First, the BG are posited to play a role in the initiation and scaling of speech movements. Within the DIVA/GODIVA framework, initiation and scaling are carried out by initiation map nodes in the supplementary motor area acting in concert with the BG. Reduced support of the initiation map from the BG in PD would result in reduced movement intensity as well as susceptibility to early termination of movement. A second proposed role concerns the learning of common speech sequences, such as phoneme sequences comprising words; this view receives support from the animal literature as well as studies identifying speech sequence learning deficits in PD. Third, the BG may play a role in the temporary buffering and sequencing of longer speech utterances such as phrases during conversational speech. Although the literature does not support a critical role for the BG in representing sequence order (since incorrectly ordered speech is not characteristic of PD), the BG are posited to contribute to the scaling of individual movements in the sequence, including increasing movement intensity for emphatic stress on key words. Therapeutic interventions for PD have inconsistent effects on speech. In contrast to dopaminergic treatments, which typically either leave speech unchanged or lead to minor improvements, deep brain stimulation (DBS) can degrade speech in some cases and improve it in others. However, cases of degradation may be due to unintended stimulation of efferent motor projections to the speech articulators. Findings of spared speech after bilateral pallidotomy appear to indicate that any role played by the BG in adult speech must be supplementary rather than mandatory, with the sequential order of well-learned sequences apparently represented elsewhere (e.g., in cortico-cortical projections).
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Affiliation(s)
- Jordan L. Manes
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, MA, United States
- Department of Communicative Disorders and Sciences, University at Buffalo, Buffalo, NY, United States
| | - Latané Bullock
- Program in Speech and Hearing Bioscience and Technology, Division of Medical Sciences, Harvard Medical School, Boston, MA, United States
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Andrew M. Meier
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, MA, United States
| | - Robert S. Turner
- Department of Neurobiology, University of Pittsburgh, Pittsburgh, PA, United States
- Aligning Science Across Parkinson’s (ASAP) Collaborative Research Network, Chevy Chase, MD, United States
| | - R. Mark Richardson
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Frank H. Guenther
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, MA, United States
- Department of Biomedical Engineering, Boston University, Boston, MA, United States
- Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA, United States
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Passarotto E, Doll-Lee J, Altenmüller E, Lee A. Practice behaviors as trigger factor for the onset of Musicians' Dystonia. J Neural Transm (Vienna) 2023; 130:1561-1569. [PMID: 37633870 PMCID: PMC10682052 DOI: 10.1007/s00702-023-02689-4] [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: 07/28/2023] [Accepted: 08/18/2023] [Indexed: 08/28/2023]
Abstract
Musician's Dystonia (MD) is a task-specific movement disorder that results in an involuntary cramping of muscles involved in playing an instrument such as the upper limbs or the embouchure. It is usually painless and occurs in general only at the instrument. The pathophysiology of MD is not completely understood. The present study aimed at assessing differences in practice behaviors between pianists affected by MD and Healthy Controls (HC) in the years preceding the onset of the disease. Thus, we investigated to what extent practice quantity can be considered a trigger of Musicians' Dystonia. The results showed that despite comparable practice behaviors in childhood, MD pianists incremented the amount of daily practice to a greater extent than their healthy colleagues, especially in the second and in the third decade of life. Thus, subsequent logistic regression analysis showed that high amounts of daily practice might significantly increase the risk of developing MD. Furthermore, gender-related differences in practice behaviors across groups were identified, indicating that male pianists from the MD group might not have practiced significantly more than HC male pianists before the onset of the disease. To the authors' knowledge, these are the first empirical evidence of the role of dysfunctional practice behaviors in triggering MD, which has clinical and educational implications.
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Affiliation(s)
- Edoardo Passarotto
- Institute of Music Physiology and Musicians' Medicine, University of Music, Drama and Media Hannover, Hannover, Germany
| | - Johanna Doll-Lee
- Department of Neurology, Hannover Medical School, Hannover, Germany.
| | - Eckart Altenmüller
- Institute of Music Physiology and Musicians' Medicine, University of Music, Drama and Media Hannover, Hannover, Germany
| | - André Lee
- Institute of Music Physiology and Musicians' Medicine, University of Music, Drama and Media Hannover, Hannover, Germany
- Department of Neurology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
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4
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Kaji R. A look at the future-new BoNTs and delivery systems in development: What it could mean in the clinic. Toxicon 2023; 234:107264. [PMID: 37657515 DOI: 10.1016/j.toxicon.2023.107264] [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: 05/05/2023] [Revised: 08/07/2023] [Accepted: 08/22/2023] [Indexed: 09/03/2023]
Abstract
Despite the expanding clinical utility of botulinum neurotoxins, there remain problems to be solved for attaining the best outcome. The efficacy and safety need to be reconsidered for commercially available preparations all derived from subtype A1 or B1. Emerging new toxins include A2 or A6 subtypes or engineered toxins with less spread, more potency, longer durations of action, less antigenicity and better safety profile than currently used preparations. Non-toxic BoNTs with a few amino acid replacements of the light chain (LC) may have a role as a drug-delivery system if the toxicity is abolished entirely. At present, efficacy of these BoNTs in animal botulism was demonstrated.
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Affiliation(s)
- Ryuji Kaji
- Tokushima University, Department of Clinical Neuroscience, 2-50-1 Kuramoto-cho, Tokushima, 770-8503, Japan.
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5
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Nelkenstock R, Iltis PW, Voit D, Frahm J, Passarotto E, Altenmüller E. Movement patterns in tuba playing: comparison of an embouchure dystonia case with healthy professional tuba players using real-time MRI imaging. Front Neurol 2023; 14:1106217. [PMID: 37234782 PMCID: PMC10206072 DOI: 10.3389/fneur.2023.1106217] [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: 11/23/2022] [Accepted: 04/07/2023] [Indexed: 05/28/2023] Open
Abstract
Introduction Musculoskeletal problems in professional brass musicians are very common and often involve the muscles of the embouchure. In rare cases, embouchure dystonia (EmD), a task-specific movement disorder with a wide symptomatic and phenotypic variability, occurs. Following trumpeters and horn players, professional tuba players with and without EmD have now been studied using the latest real-time MRI technology to better understand the underlying pathophysiology. Materials and methods In the present study, the tongue movement patterns of 11 healthy professional artists and one subject suffering from EmD were compared. The tongue position in the anterior, intermediary and posterior oral cavity were converted into pixel positions based on seven previously generated profile lines, using the established software MATLAB. These data allow a structured comparison of tongue movement patterns between the patient and the healthy subjects, as well as between individual exercises. The main focus of the analysis was on an ascending 7-note harmonic series performed in different playing techniques (slurred, tongued, tenuto and staccato). Results Playing the ascending harmonics, a noticeable ascending tongue movement could be observed in the anterior part of the oral cavity in healthy tubists. In the posterior region, there was a slight decrease in oral cavity space. In the EmD patient, hardly any movement was observed at the tongue apex, but in the middle and posterior regions of the oral cavity there was an increase in size the higher the tone became. These distinct differences are relevant for the characterization and a better understanding of the clinical presentation of EmD. Concerning different playing techniques, it was apparent, that notes played slurred or staccato resulted in a larger oral cavity when compared to notes played tongued or tenuto, respectively. Conclusion By using real-time MRI videos, the tongue movements of tuba players can be clearly observed and analyzed. The differences between healthy and diseased tuba players demonstrate the great effects of movement disorders in a small area of the tongue. In order to better understand the compensation of this motor control dysfunction, further studies should investigate further parameters of tone production in all brass players with a larger number of EmD patients additional to the observed movement patterns.
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Affiliation(s)
- Robert Nelkenstock
- Institut für Musikphysiologie und Musikermedizin, Hochschule für Musik, Theater und Medien, Hannover, Germany
| | - Peter W. Iltis
- Department of Kinesiology, Gordon College, Wenham, MA, United States
| | - Dirk Voit
- Biomedizinische NMR, Max-Planck-Institut für Multidisziplinäre Naturwissenschaften, Göttingen, Germany
| | - Jens Frahm
- Biomedizinische NMR, Max-Planck-Institut für Multidisziplinäre Naturwissenschaften, Göttingen, Germany
| | - Edoardo Passarotto
- Institut für Musikphysiologie und Musikermedizin, Hochschule für Musik, Theater und Medien, Hannover, Germany
| | - Eckart Altenmüller
- Institut für Musikphysiologie und Musikermedizin, Hochschule für Musik, Theater und Medien, Hannover, Germany
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The epidemiology of dystonia: the Hannover epidemiology study. J Neurol 2022; 269:6483-6493. [PMID: 35948800 PMCID: PMC9618521 DOI: 10.1007/s00415-022-11310-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/22/2022] [Accepted: 07/23/2022] [Indexed: 12/03/2022]
Abstract
The prevalence of dystonia has been studied since the 1980s. Due to different methodologies and due to varying degrees of awareness, resulting figures have been extremely different. We wanted to determine the prevalence of dystonia according to its current definition, using quality-approved registries and based on its relevance for patients, their therapy and the health care system. We applied a service-based chart review design with the City of Hannover as reference area and a population of 525,731. Barrier-free comprehensive dystonia treatment in few highly specialised centres for the last 30 years should have generated maximal dystonia awareness, a minimum of unreported cases and a high degree of data homogeneity. Prevalence [n/1mio] and relative frequency is 601.1 (100%) for all forms of dystonia, 251.1 (42%) for cervical dystonia, 87.5 (15%) for blepharospasm, 55.2 (9%) for writer’s cramp, 38.0 (6%) for tardive dystonia, 32.3 (5%) for musician’s dystonia, 28.5 (5%) for psychogenic dystonia, 26.6 (4%) for generalised dystonia, 24.7 (4%) for spasmodic dysphonia, 20.9 (3%) for segmental dystonia, 15.2 (3%) for arm dystonia and 13.3 (2%) for oromandibular dystonia. Leg dystonia, hemidystonia and complex regional pain syndrome-associated dystonia are very rare. Compared to previous meta-analytical data, primary or isolated dystonia is 3.3 times more frequent in our study. When all forms of dystonia including psychogenic, generalised, tardive and other symptomatic dystonias are considered, our dystonia prevalence is 3.7 times higher than believed before. The real prevalence is likely to be even higher. Having based our study on treatment necessity, our data will allow better allocation of resources for comprehensive dystonia treatment.
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Dressler D, Johnson EA. Botulinum toxin therapy: past, present and future developments. J Neural Transm (Vienna) 2022; 129:829-833. [PMID: 35396965 PMCID: PMC9188496 DOI: 10.1007/s00702-022-02494-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 03/23/2022] [Indexed: 12/17/2022]
Abstract
Although botulinum toxin (BT) is now being used in a large number of different indications in numerous medical specialties, there is still dynamic and rapid development. Treatment algorithms were improved by the introduction of BT short-interval therapy, BT high-dose therapy and improved dosing guidelines. Ultrasound guidance may be helpful in special situations. New indication areas including depression and inflammatory processes are being explored. Drug development projects are mainly focusing on onabotulinumtoxinA analogues, some are addressing liquid preparations and modifications of BT's duration of action. Recombinant BT may simplify production processes. Cell-based assays for potency measurement will soon be required by registration authorities. Treatment algorithms will be further refined and indications will be expanded. New indication areas are still uncertain. BT type A will remain the drug substance of choice. Removal of complexing proteins seems logical. Whether there is a need for BT drugs with modified duration of action and for liquid preparations, is unclear. Bringing BT therapy to those who need it, is the biggest challenge. Current high-price business models need to be changed, either by employing a biosimilar registration approach or by referring to companies from countries where business models are based on different cost structures.
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Affiliation(s)
- Dirk Dressler
- Movement Disorders Section, Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Eric A Johnson
- Botulinum Toxins Laboratory, Department of Bacteriology, University of Wisconsin, Madison, WI, USA
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8
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Wei J, Hu X, Xia L, Shang J, Han Q, Zhang D. Evaluation of the effect of botulinum toxin A on the physical and mental health of patients with hemifacial spasm. Neurologia 2022. [DOI: 10.1016/j.nrl.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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9
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Real-World Dosing of OnabotulinumtoxinA and IncobotulinumtoxinA for Cervical Dystonia and Blepharospasm: Results from TRUDOSE and TRUDOSE II. Toxins (Basel) 2021; 13:toxins13070488. [PMID: 34357959 PMCID: PMC8310174 DOI: 10.3390/toxins13070488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 07/02/2021] [Accepted: 07/04/2021] [Indexed: 11/17/2022] Open
Abstract
The real-world use of onabotulinumtoxinA and incobotulinumtoxinA for cervical dystonia and blepharospasm treatment was assessed in two separate retrospective studies using identical protocols (TRUDOSE and TRUDOSE II). The studies were conducted in Mexico, Norway, and United Kingdom and designed to evaluate dose utilization of the two botulinum toxins in clinical practice. Eighty-three patients treated with both onabotulinumtoxinA and incobotulinumtoxinA for ≥2 years for each botulinum toxin were included, (52, cervical dystonia; 31, blepharospasm). All patients switched from onabotulinumtoxinA to incobotulinumtoxinA for administrative/financial reasons. A range of dose ratios (incobotulinumtoxinA to onabotulinumtoxinA) was reported; with the majority of dose ratios being >1. The mean dose ratio was >1 regardless of the study site or underlying clinical condition. The inter-injection interval was significantly longer for onabotulinumtoxinA versus incobotulinumtoxinA when assessed for all patients (15.5 vs. 14.3 weeks; p = 0.006), resulting in fewer onabotulinumtoxinA treatments over the study time period. Consistent with product labeling, no single fixed-dose ratio exists between incobotulinumtoxinA and onabotulinumtoxinA. The dosage of each should be individualized based on patient needs and used as per product labeling. These real-world utilization data may have pharmacoeconomic implications.
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10
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Poydasheva AG, Semenova OV, Suponeva NA, Timerbaeva SL, Piradov MA. [Issues of diagnostic and therapeutic use of transcranial magnetic stimulation in patients with writing cramp]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 120:49-56. [PMID: 33459541 DOI: 10.17116/jnevro202012012149] [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: 11/18/2022]
Abstract
OBJECTIVE To study diagnostic and therapeutic values of transcranial magnetic stimulation (TMS) in writing cramp (WC). MATERIAL AND METHODS Twelve right-handed patients with WC were enrolled in the study. All patients underwent low-frequency repetitive TMS (rTMS) of the premotor cortex of contralateral to affected hand hemisphere. The clinical efficacy was assessed using the Writer's Cramp Rating Scale (WCRS) and the Medical Outcomes Study-Short Form (MOS-SF-36). Before and after last rTMS session, motor mapping of Abductor pollicis brevis muscle (APB) was performed using navigated TMS (nTMS). Localization, area, and amplitude-weighted area of the APB muscle cortical representations were compared with the healthy controls. After the rTMS course, the dynamics of the studied parameters was assessed. RESULTS Ten sessions of low-frequency rTMS of premotor cortex reduced the severity of WS clinical symptoms with a duration of effect of at least 1 month (p<0.05). There was no statistically significant difference between the area and the weighted area of cortical muscle representations between patients and healthy controls or in patients before and after rTMS. When assessing the localization of cortical muscle representations, two trends were noted: in 4 patients, the localization remained stable, with a shift in the center of gravity of less than 4 mm; in the other 8 patients, a shift in the center of mass of more than 5 mm was noted. No significant correlation between the stability of the cortical muscle representations (the magnitude of the shift in the center of gravity) and the improvement on the WCRS were found. CONCLUSION The low-frequency rTMS of the premotor cortex of the contralateral to affected hand hemisphere can be used as an adjuvant therapy for WC. The TMS-motor mapping study did not show its diagnostic value.
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Affiliation(s)
| | - O V Semenova
- Vorokhobov City Clinical Hospital No. 67, Moscow, Russia
| | | | | | - M A Piradov
- Research Center of Neurology, Moscow, Russia
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Latorre A, Cocco A, Bhatia KP, Erro R, Antelmi E, Conte A, Rothwell JC, Rocchi L. Defective Somatosensory Inhibition and Plasticity Are Not Required to Develop Dystonia. Mov Disord 2020; 36:1015-1021. [PMID: 33332649 DOI: 10.1002/mds.28427] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/21/2020] [Accepted: 11/18/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Dystonia may have different neuroanatomical substrates and pathophysiology. This is supported by studies on the motor system showing, for instance, that plasticity is abnormal in idiopathic dystonia, but not in dystonia secondary to basal ganglia lesions. OBJECTIVE The aim of this study was to test whether somatosensory inhibition and plasticity abnormalities reported in patients with idiopathic dystonia also occur in patients with dystonia caused by basal ganglia damage. METHODS Ten patients with acquired dystonia as a result of basal ganglia lesions and 12 healthy control subjects were recruited. They underwent electrophysiological testing at baseline and after a single 45-minute session of high-frequency repetitive somatosensory stimulation. Electrophysiological testing consisted of somatosensory temporal discrimination, somatosensory-evoked potentials (including measurement of early and late high-frequency oscillations and the spatial inhibition ratio of N20/25 and P14 components), the recovery cycle of paired-pulse somatosensory-evoked potentials, and primary motor cortex short-interval intracortical inhibition. RESULTS Unlike previous reports of patients with idiopathic dystonia, patients with acquired dystonia did not differ from healthy control subjects in any of the electrophysiological measures either before or after high-frequency repetitive somatosensory stimulation, except for short-interval intracortical inhibition, which was reduced at baseline in patients compared to control subjects. CONCLUSIONS The data show that reduced somatosensory inhibition and enhanced cortical plasticity are not required for the clinical expression of dystonia, and that the abnormalities reported in idiopathic dystonia are not necessarily linked to basal ganglia damage. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Anna Latorre
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Antoniangela Cocco
- Department of Neurology, IRCCS Humanitas Research Hospital, Milan, Italy.,Department of Neuroscience, Catholic University, Milan, Italy
| | - Kailash P Bhatia
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Roberto Erro
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy
| | - Elena Antelmi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Antonella Conte
- Department of Human Neurosciences, Sapienza, University of Rome, Rome, Italy.,IRCCS Neuromed, Pozzilli, Italy
| | - John C Rothwell
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Lorenzo Rocchi
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, United Kingdom
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12
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Dressler D, Adib Saberi F, Rosales RL. Botulinum toxin therapy of dystonia. J Neural Transm (Vienna) 2020; 128:531-537. [PMID: 33125571 PMCID: PMC8099791 DOI: 10.1007/s00702-020-02266-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/09/2020] [Indexed: 01/13/2023]
Abstract
Botulinum toxin (BT) is used to treat a large number of muscle hyperactivity syndromes. Its use in dystonia, however, is still one of the most important indications for BT therapy. When BT is injected into dystonic muscles, it produces a peripheral paresis which is localised, well controllable and follows a distinct and predictable time course of around 3 months. Adverse effects are always transient and usually mild, long-term application is safe. With this profile BT can be used to treat cranial dystonia, cervical dystonia and limb dystonia including writer's and musician's cramps. The recent introduction of BT high dose therapy also allows to treat more wide-spread dystonia including segmental and generalised dystonia. BT can easily be combined with other anti-dystonic treatments such as deep brain stimulation and intrathecal baclofen application. Best treatment results are obtained when BT therapy is integrated in the multimodal and long-term 'multilayer concept of treatment of dystonia'. The biggest challenge for the future will be to deliver state of the art BT therapy to all dystonia patients in need, regardless of whether they live in developed countries or beyond.
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Affiliation(s)
- Dirk Dressler
- Movement Disorders Section, Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Fereshte Adib Saberi
- Movement Disorders Section, Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Raymond L Rosales
- Department of Neurology and Psychiatry, Neuroscience Institute, University of Santo Tomas Hospital, Manila, Philippines
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13
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Pan S, Zhu C. Atypical pantothenate kinase-associated neurodegeneration with PANK2 mutations : clinical description and a review of the literature. Neurocase 2020; 26:175-182. [PMID: 32310012 DOI: 10.1080/13554794.2020.1752739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Panthothenate kinase-associated neurodegeneration (PKAN) is arare neurodegeneration caused by mutations in the pantothenate kinase (PANK2) gene, which is located on chromosome 20p13. These mutations result in iron accumulation in the brain basal ganglia leading to parkinsonism, dysarthria, spasticity, cognitive impairment, and retinopathy. Herein, we report acase of adult-onset PKAN who presented with young-onset action tremor, bradykinesia, dysarthria, and bilateral interossei atrophy. Neuroimaging demonstrated "eye-of-the-tiger signs". Through analyzing PANK2 gene, PANK2 NM_153638:c.1133A>G (p.Asp378 Gly) and PANK2 NM_153638:c.1502 T > A (p.lle501Asn), were detected. In addition, we reviewed the clinical and genetic features and therapeutic strategies for patients with PKAN.
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Affiliation(s)
- Si Pan
- Department of Neurology Intervention, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou University , Zhengzhou, Henan, China
| | - Chenkai Zhu
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou University , Zhengzhou, Henan, China
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de Oliveira Souza C, Goulardins J, Coelho DB, Casagrande S, Conti J, Limongi JCP, Barbosa ER, Monte-Silva K, Tanaka C. Non-invasive brain stimulation and kinesiotherapy for treatment of focal dystonia: Instrumental analysis of three cases. J Clin Neurosci 2020; 76:208-210. [PMID: 32284289 DOI: 10.1016/j.jocn.2020.04.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 04/04/2020] [Indexed: 12/31/2022]
Abstract
Dystonia is a disabling movement disorder characterized by co-contraction of antagonist and agonist muscles, leading to abnormal sustained postures and impaired motor control. Cervical Dystonia (CD) and Hand Focal Dystonia (HFD) have been the most common forms of focal dystonia (FD). Do Non-Invasive Brain Neuromodulation (NIBS) such as Transcranial Direct Current Stimulation (tDCS) and repetitive Transcranial Magnetic Stimulation (rTMS) modulate the excitability of the connections between the motor cortical areas and may represent a therapeutic alternative for focal dystonia? Herein, we reported three cases of focal dystonia, two of them with cervical dystonia (CD) and one with hand focal dystonia (HFD), treated with NIBS combined to kinesiotherapy. The patients were daily submitted to 15 sessions of NIBS combined simultaneously with kinesiotherapy. CD patients were treated with tDCS (2 mA, 20 min, over the primary motor cortex), and HFD patient with rTMS (1 Hz, 1200 pulses, 80% of resting motor threshold, over the premotor cortex). For the CD patient's assessment, the Modified Toronto Scale for Cervical Dystonia Assessment (MTS), quiet balance test, and visual postural assessment were applied to observe the therapeutic effects. Quality handwriting analysis, tremor acceleration amplitudes, and the Wrinter's Cramp Rating Scale (WCRS) were used to assess the NIBS effect on HFD symptoms. Patients were evaluated before (pretest), immediately after (posttest), and three months after treatment (retention). NIBS associated with kinesiotherapy produced a long-term improvement of dystonia symptoms in all three patients. rTMS and tDCS associated with kinesiotherapy showed to be useful and safe to relief the dystonia symptoms in individuals with different types of focal dystonia with distinct functional disorders. SIGNIFICANCE: The combined use of these intervention strategies seems to optimize and anticipate satisfactory clinical results in these neurological conditions, characterized by its difficult clinical management.
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Affiliation(s)
- Carolina de Oliveira Souza
- Ambulatório de Neuromodulação da Divisão de Fisioterapia do Instituto Central do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Brazil; Department of Neurology, Hospital das Clínicas, School of Medicine, University of São Paulo, Brazil
| | - Juliana Goulardins
- Ambulatório de Neuromodulação da Divisão de Fisioterapia do Instituto Central do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Brazil; Universidade Nove de Julho, Brazil
| | | | - Sara Casagrande
- Department of Neurology, Hospital das Clínicas, School of Medicine, University of São Paulo, Brazil
| | - Juliana Conti
- Department of Neurology, Hospital das Clínicas, School of Medicine, University of São Paulo, Brazil
| | | | - Egberto Reis Barbosa
- Department of Neurology, Hospital das Clínicas, School of Medicine, University of São Paulo, Brazil
| | - Katia Monte-Silva
- Applied Neuroscience Laboratory, Department of Physical Therapy, Federal University of Pernambuco, Brazil
| | - Clarice Tanaka
- Ambulatório de Neuromodulação da Divisão de Fisioterapia do Instituto Central do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Brazil; Physical Therapy Department, School of Medicine, University of São Paulo, Brazil
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15
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Drexel SC, Klietz M, Kollewe K, Paracka L, Kutschenko A, Kopp B, Lange F, Wegner F, Dressler D. Caregiver burden and health-related quality of life in idiopathic dystonia patients under botulinum toxin treatment: a cross-sectional study. J Neural Transm (Vienna) 2020; 127:61-70. [PMID: 31802240 PMCID: PMC6942568 DOI: 10.1007/s00702-019-02109-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 11/25/2019] [Indexed: 12/12/2022]
Abstract
Dystonia is a chronic movement disorder that is associated with a reduction in health-related quality of life (HR-QoL) and restriction of activities of daily living. Botulinum neurotoxin (BT) improves disease-specific HR-QoL by reducing abnormal movements, postures, and pain. We examined the burden of the corresponding primary caregiver as a potential important factor for disease management and HR-QoL of dystonia patients under treatment with BT. 114 patients with focal, segmental, or generalized dystonia were recruited, together with 93 corresponding caregivers, whose burden was investigated using the Caregiver Burden Inventory. In addition, all participants were assessed for cognitive impairment, depression, anxiety, alexithymia, and HR-QoL. Only a small proportion of caregivers suffered from caregiver burden. Despite BT therapy, patients' HR-QoL was decreased compared to the age-matched general German population. Psychological symptoms, notably anxiety, and depression correlated significantly with reduced HR-QoL. Our data imply that caregiver burden emerged to be an issue in subgroups of dystonia patients. Furthermore, HR-QoL of dystonia patients is reduced even under optimized BT treatment in a specialized center.
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Affiliation(s)
- S C Drexel
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - M Klietz
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - K Kollewe
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - L Paracka
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - A Kutschenko
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - B Kopp
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - F Lange
- Behavioral Engineering Research Group, KU Leuven, Naamsestraat 69, 3000, Leuven, Belgium
| | - F Wegner
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - D Dressler
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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16
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Poydasheva AG, Semenova OV, Suponeva NA, Timerbaeva SL, Piradov MA. [Diagnostic and therapeutic issues of using transcranial magnetic stimulation in patients with writer's cramp]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:22-29. [PMID: 31793539 DOI: 10.17116/jnevro201911910122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To assess diagnostic and therapeutic values of transcranial magnetic stimulation (TMS) in patients with writer's cramp (WC). MATERIAL AND METHODS Twelve right-handed patients with WC were enrolled in the study. All patients underwent low-frequency repetitive TMS (rTMS) over the premotor cortex of the hemisphere contralateral to the affected hand. The clinical efficacy was assessed using the Writer's Cramp Rating Scale (WCRS) and the Medical Outcomes Study-Short Form (MOS-SF-36). Before and after the last rTMS session, motor mapping of abductor pollicis brevis muscle (APB) was performed using navigated TMS (nTMS). Localization, area, and amplitude-weighted area of the APB muscle cortical representations were compared with the healthy controls. The dynamics of the mentioned above parameters after the rTMS course was assessed. RESULTS Ten sessions of low-frequency rTMS over premotor cortex reduced the severity of WC clinical symptoms, with a duration of effect of at least 1 month (p<0.05). There was no significant difference between the area and the weighted area of cortical muscle representations between patients and healthy controls or in patients before and after rTMS. When assessing the localization of cortical muscle representations, two trends were noted: in 4 patients, the localization remained stable, with a shift in the center of gravity of less than 4 mm; in the other 8 patients, a shift in the center of gravity of more than 5 mm was noted. No significant correlations between the stability of the cortical muscle representations (the magnitude of the shift in the center of gravity) and the improvement on the WCRS scale were found. CONCLUSION The low-frequency rTMS over the premotor cortex of the hemisphere contralateral to the affected hand can be used as an adjuvant therapy for WC. The TMS-motor mapping study did not show its diagnostic value.
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Affiliation(s)
| | - O V Semenova
- Vorokhobov City Clinical Hospital #67, Moscow, Russia
| | | | - S L Timerbaeva
- Federal State Hospital for Treatment and Rehabilitation, Moscow, Russia
| | - M A Piradov
- Research Center of Neurology, Moscow, Russia
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17
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Abstract
Botulinum toxin (BT) has changed from a deadly poison to a novel therapeutic principle for a large number of disorders in many medical areas.BT drugs are special in many ways: they are biologicals, their active ingredient BT is not patentable, their spectrum of clinical applications is extremely broad, their dose range is enormous, their mode of action is local and their life cycles are special.This review covers BT's therapeutic mode of action, time course of action, target tissues, pharmacological profile, adverse effects, interactions, potency labelling and antigenicity as well as BT's therapeutic preparations.
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Abstract
INTRODUCTION Dystonia is a clinically heterogeneous group of hyperkinetic movement disorders. Recent advances have provided a better understanding of these conditions with significant clinical impact. SOURCES OF DATA Peer reviewed journals and reviews. PubMed.gov. AREAS OF AGREEMENT A recent consensus classification, including the assessment of phenomenology and identification of the dystonia syndromes, has provided a helpful tool for the clinical assessment. New forms of monogenic dystonia have been recently identified. AREAS OF CONTROVERSY Despite recent advances in the understanding of dystonia, treatment remains symptomatic in most patients. GROWING POINTS Recent advances in genetics have provided a better understanding of the potential pathogenic mechanisms involved in dystonia. Deep brain stimulation has shown to improve focal and combined forms of dystonia and its indications are constantly expanding. AREAS TIMELY FOR DEVELOPING RESEARCH Growing understanding of the disease mechanisms involved will allow the development of targeted and disease-modifying therapies in the future.
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Affiliation(s)
- Eduardo De Pablo-Fernandez
- Reta Lila Weston Institute of Neurological Studies, UCL institute of Neurology, 1 Wakefield Street, WC1N 1PJ London, UK.,Queen Square Brain Bank for Neurological Disorders, UCL Institute of Neurology, 1 Wakefield Street, WC1N 1PJ London, UK
| | - Thomas T Warner
- Reta Lila Weston Institute of Neurological Studies, UCL institute of Neurology, 1 Wakefield Street, WC1N 1PJ London, UK.,Queen Square Brain Bank for Neurological Disorders, UCL Institute of Neurology, 1 Wakefield Street, WC1N 1PJ London, UK
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19
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Pirio Richardson S, Wegele AR, Skipper B, Deligtisch A, Jinnah HA. Dystonia treatment: Patterns of medication use in an international cohort. Neurology 2017; 88:543-550. [PMID: 28077492 DOI: 10.1212/wnl.0000000000003596] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 11/08/2016] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE To determine the frequency of medication use in patients with dystonia enrolled in an international biorepository study. METHODS In a cross-sectional analysis, we included 2,026 participants enrolled at 37 sites in the United States, Canada, Europe, and Australia through Project 1 of the Dystonia Coalition, an international biorepository study. The primary aim was to assess the frequency of medication classes recommended for treating patients with dystonia, and the secondary aim was to compare characteristics (disease type, age, sex, duration of disease, comorbid conditions, severity). RESULTS Querying the database for the presence of any medication for dystonia used (includes both injectable and oral therapy), we found 73% using medications (n = 1,488) and 27% using no dystonia medications (n = 538). Furthermore, 61% of the total sample used botulinum toxin (BoNT) therapy alone or in combination. Differences were found in medication use patterns by dystonia type, with the lowest oral medication use in focal dystonia and highest use in generalized dystonia; by region, with highest BoNT therapy rate reported in Italy and the lowest in the Northeast region of the United States; and by focal dystonia subtype, with highest BoNT therapy alone in blepharospasm and spasmodic dysphonia (49%) and lowest in other cranial dystonia (32%). CONCLUSIONS The majority of patients with dystonia enrolled in the Dystonia Coalition Project 1 were using medications to treat their dystonia. Overall, a complex picture of medication use patterns emerged, with factors such as region, disease duration, type of dystonia, disease severity, and psychiatric comorbidities all playing a significant role.
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Affiliation(s)
- Sarah Pirio Richardson
- From the Departments of Neurology (S.P.R., A.R.W., A.D.) and Family and Community Medicine (B.S.), University of New Mexico Health Sciences Center, Albuquerque; and Departments of Neurology, Human Genetics, and Pediatrics (H.A.J.), Emory University School of Medicine, Atlanta, GA.
| | - Ashley R Wegele
- From the Departments of Neurology (S.P.R., A.R.W., A.D.) and Family and Community Medicine (B.S.), University of New Mexico Health Sciences Center, Albuquerque; and Departments of Neurology, Human Genetics, and Pediatrics (H.A.J.), Emory University School of Medicine, Atlanta, GA
| | - Betty Skipper
- From the Departments of Neurology (S.P.R., A.R.W., A.D.) and Family and Community Medicine (B.S.), University of New Mexico Health Sciences Center, Albuquerque; and Departments of Neurology, Human Genetics, and Pediatrics (H.A.J.), Emory University School of Medicine, Atlanta, GA
| | - Amanda Deligtisch
- From the Departments of Neurology (S.P.R., A.R.W., A.D.) and Family and Community Medicine (B.S.), University of New Mexico Health Sciences Center, Albuquerque; and Departments of Neurology, Human Genetics, and Pediatrics (H.A.J.), Emory University School of Medicine, Atlanta, GA
| | - H A Jinnah
- From the Departments of Neurology (S.P.R., A.R.W., A.D.) and Family and Community Medicine (B.S.), University of New Mexico Health Sciences Center, Albuquerque; and Departments of Neurology, Human Genetics, and Pediatrics (H.A.J.), Emory University School of Medicine, Atlanta, GA
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20
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Termsarasab P, Thammongkolchai T, Frucht SJ. Medical treatment of dystonia. JOURNAL OF CLINICAL MOVEMENT DISORDERS 2016; 3:19. [PMID: 28031858 PMCID: PMC5168853 DOI: 10.1186/s40734-016-0047-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 11/08/2016] [Indexed: 11/25/2022]
Abstract
Therapeutic strategies in dystonia have evolved considerably in the past few decades. Three major treatment modalities include oral medications, botulinum toxin injections and surgical therapies, particularly deep brain stimulation. Although there has been a tremendous interest in the later two modalities, there are relatively few recent reviews of oral treatment. We review the medical treatment of dystonia, focusing on three major neurotransmitter systems: cholinergic, GABAergic and dopaminergic. We also provide a practical guide to medication selection, therapeutic strategy and unmet needs.
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Affiliation(s)
- Pichet Termsarasab
- Movement Disorder Division, Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, USA
| | | | - Steven J. Frucht
- Movement Disorder Division, Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, USA
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21
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Affiliation(s)
- Dirk Dressler
- Movement Disorders Section, Department of Neurology, Hannover Medical School, Hannover, Germany
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22
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Sandhu H, Bernstein CJ, Davies G, Tang NKY, Belhag M, Tingle A, Field M, Foss J, Lindahl A, Underwood M, Ellard DR. Combined cognitive-behavioural and mindfulness programme for people living with dystonia: a proof-of-concept study. BMJ Open 2016; 6:e011495. [PMID: 27496234 PMCID: PMC4985914 DOI: 10.1136/bmjopen-2016-011495] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES To design and test the delivery of an intervention targeting the non-motor symptoms of dystonia and pilot key health and well-being questionnaires in this population. DESIGN A proof-of-concept study to test the delivery, acceptability, relevance, structure and content for a 3-day group residential programme for the management of dystonia. SETTING Participants were recruited from a single botulinum toxin clinic. The intervention was delivered in the community. PARTICIPANTS 14 participants consented to take part (2 withdrew prior to the starting of intervention). The average age was 60 years (range 44-77), 8 of whom were female. After drop-out, 9 participants completed the 3-day programme. INTERVENTION A 3-day group residential programme. PRIMARY AND SECONDARY OUTCOME MEASURES Process evaluation and interviews were carried out before and after the intervention to explore participant's views and expectations, as well as experiences of the intervention. Select questionnaires were completed at baseline, 1-month and 3-month follow-up. RESULTS Although participants were not sure what to expect from the programme, they found it informative and for many this together with being in a group with other people with dystonia legitimised their condition. Mindfulness was accepted and adopted as a coping strategy. This was reflected in the 1-month follow-up. CONCLUSIONS We successfully delivered a 3-day residential programme to help those living with dystonia manage their condition. Further improvements are suggested. The quantitative outcome measures were acceptable to this group of patients with dystonia.
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Affiliation(s)
- H Sandhu
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - C J Bernstein
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - G Davies
- University of Southampton, Southampton, UK
| | - N K Y Tang
- Department of Psychology, University of Warwick, Coventry, UK
| | - M Belhag
- Department of Neurology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - A Tingle
- The Dystonia Society (West Midlands Group), West Midlands, UK
| | - M Field
- The Dystonia Society (West Midlands Group), West Midlands, UK
| | - J Foss
- Department of Computer Science, University of Warwick, Coventry, UK
| | - A Lindahl
- Department of Neurology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - M Underwood
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - D R Ellard
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
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