1
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Reyes-Lopez M, Vaca-Palomares I, Dávila-Ortiz de Montellano DJ, White BJ, Brien DC, Coe BC, Munoz DP, Fernandez-Ruiz J. Saccades, pupil response and blink abnormalities in Huntington's disease patients during free viewing. Clin Neurophysiol 2024; 165:117-124. [PMID: 39013355 DOI: 10.1016/j.clinph.2024.06.012] [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: 01/26/2024] [Revised: 05/16/2024] [Accepted: 06/18/2024] [Indexed: 07/18/2024]
Abstract
OBJECTIVE Video-based eye tracking was used to investigate saccade, pupil, and blink abnormalities among patients with Huntington's disease (HD) who watched sequences of short videos. HD, an autosomal dominant neurodegenerative disorder resulting from a CAG mutation on chromosome 4, produces motor and cognitive impairments including slow or irregular eye movements, which have been studied using structured tasks. METHODS To explore how HD affects eye movements under instruction free conditions, we assessed 22 HD patients and their age matched controls in a 10-minute video-based free viewing task. RESULTS Patients with HD experienced a significant reduction in saccade exploration rate following video clip transitions, an increase in pupil reactions to luminance changes after clip transitions, and a significant higher blink rate throughout the task compared to the control group. CONCLUSIONS These results show that HD has a significant impact on how patients visually explore and respond to their environment under unconstrained and ecologically natural conditions. SIGNIFICANCE Eye tracking in HD patients revealed saccadic, pupil, and blink abnormalities in early HD patients, suggestive of brain circuitry abnormalities that probably involve brain stem deficits. Further research should explore the impact of these changes on the quality of life of the patients affected by the disease.
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Affiliation(s)
- Mariana Reyes-Lopez
- Ciencias Cognitivas y del Comportamiento, Facultad de Psicología, Universidad Nacional Autónoma de México, CDMX, Mexico
| | - Israel Vaca-Palomares
- Ciencias Cognitivas y del Comportamiento, Facultad de Psicología, Universidad Nacional Autónoma de México, CDMX, Mexico
| | | | - Brian J White
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - Donald C Brien
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - Brian C Coe
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - Douglas P Munoz
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - Juan Fernandez-Ruiz
- Instituto de Neuroetología, Universidad Veracruzana, Xalapa, Mexico; Departamento de Fisiología, Facultad de Medicina, Universidad Nacional Autónoma de México, CDMX, Mexico.
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2
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Chan JL, Sarna JR. Distinguishing Tics Secondary To Juvenile Huntington's Disease From A Primary Tic Disorder. Can J Neurol Sci 2024; 51:474-476. [PMID: 37203796 DOI: 10.1017/cjn.2023.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Affiliation(s)
- Jason L Chan
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Justyna R Sarna
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
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3
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Oosterloo M, Touze A, Byrne LM, Achenbach J, Aksoy H, Coleman A, Lammert D, Nance M, Nopoulos P, Reilmann R, Saft C, Santini H, Squitieri F, Tabrizi S, Burgunder JM, Quarrell O. Clinical Review of Juvenile Huntington's Disease. J Huntingtons Dis 2024; 13:149-161. [PMID: 38669553 PMCID: PMC11307030 DOI: 10.3233/jhd-231523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2024] [Indexed: 04/28/2024]
Abstract
Juvenile Huntington's disease (JHD) is rare. In the first decade of life speech difficulties, rigidity, and dystonia are common clinical motor symptoms, whereas onset in the second decade motor symptoms may sometimes resemble adult-onset Huntington's disease (AOHD). Cognitive decline is mostly detected by declining school performances. Behavioral symptoms in general do not differ from AOHD but may be confused with autism spectrum disorder or attention deficit hyperactivity disorder and lead to misdiagnosis and/or diagnostic delay. JHD specific features are epilepsy, ataxia, spasticity, pain, itching, and possibly liver steatosis. Disease progression of JHD is faster compared to AOHD and the disease duration is shorter, particularly in case of higher CAG repeat lengths. The diagnosis is based on clinical judgement in combination with a positive family history and/or DNA analysis after careful consideration. Repeat length in JHD is usually > 55 and caused by anticipation, usually via paternal transmission. There are no pharmacological and multidisciplinary guidelines for JHD treatment. Future perspectives for earlier diagnosis are better diagnostic markers such as qualitative MRI and neurofilament light in serum.
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Affiliation(s)
- Mayke Oosterloo
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Alexiane Touze
- Department of Neurodegenerative Disease, UCL Huntington’s Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Lauren M. Byrne
- Department of Neurodegenerative Disease, UCL Huntington’s Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Jannis Achenbach
- Department of Neurology, Huntington Centre NRW, Ruhr-University Bochum, St. Josef-Hospital, Bochum, Germany
| | - Hande Aksoy
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Annabelle Coleman
- Department of Neurodegenerative Disease, UCL Huntington’s Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Dawn Lammert
- Department of Neurology, Division of Child Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Martha Nance
- Struthers Parkinson’s Center, Minneapolis, MN, USA
| | - Peggy Nopoulos
- Departments of Psychiatry, Pediatrics, & Neurology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Ralf Reilmann
- George-Huntington-Institute & Department of Radiology, University of Muenster, Muenster, Germany
- Department for Neurodegeneration, Hertie Institute for Clinical, Brain Research, University of Tuebingen, Tuebingen, Germany
| | - Carsten Saft
- Department of Neurology, Huntington Centre NRW, Ruhr-University Bochum, St. Josef-Hospital, Bochum, Germany
| | | | - Ferdinando Squitieri
- Centre for Rare Neurological Diseases (CMRN), Italian League for Research on Huntington (LIRH) Foundation, Rome, Italy
- Huntington and Rare Diseases Unit, IRCCS Casa Sollievo Della Sofferenza Research Hospital, San Giovanni Rotondo, Italy
| | - Sarah Tabrizi
- Department of Neurodegenerative Disease, UCL Huntington’s Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Jean-Marc Burgunder
- Neurozentrum Siloah and Department of Neurology, Swiss HD Center, University of Bern, Bern, Switzerland
| | - Oliver Quarrell
- Department of Clinical Genetics, Sheffield Children’s Hospital, Sheffield, UK
- Department of Neurosciences University of Sheffield, Sheffield, UK
| | - on behalf of the Pediatric Huntington Disease Working Group of the European Huntington Disease Network
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Department of Neurodegenerative Disease, UCL Huntington’s Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
- Department of Neurology, Huntington Centre NRW, Ruhr-University Bochum, St. Josef-Hospital, Bochum, Germany
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Neurology, Division of Child Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Struthers Parkinson’s Center, Minneapolis, MN, USA
- Departments of Psychiatry, Pediatrics, & Neurology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
- George-Huntington-Institute & Department of Radiology, University of Muenster, Muenster, Germany
- Department for Neurodegeneration, Hertie Institute for Clinical, Brain Research, University of Tuebingen, Tuebingen, Germany
- Huntington’s Disease Association, England and Wales
- Centre for Rare Neurological Diseases (CMRN), Italian League for Research on Huntington (LIRH) Foundation, Rome, Italy
- Huntington and Rare Diseases Unit, IRCCS Casa Sollievo Della Sofferenza Research Hospital, San Giovanni Rotondo, Italy
- Neurozentrum Siloah and Department of Neurology, Swiss HD Center, University of Bern, Bern, Switzerland
- Department of Clinical Genetics, Sheffield Children’s Hospital, Sheffield, UK
- Department of Neurosciences University of Sheffield, Sheffield, UK
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4
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Wilson D, Hallett M, Anderson T. An Eye on Movement Disorders. Mov Disord Clin Pract 2021; 8:1168-1180. [PMID: 34765682 DOI: 10.1002/mdc3.13317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/28/2021] [Accepted: 07/20/2021] [Indexed: 02/06/2023] Open
Abstract
Eye disorders spanning a range of ocular tissue are common in patients with movement disorders. Highlighting these ocular manifestations will benefit patients and may even aid in diagnosis. In this educational review we outline the anatomy and function of the ocular tissues with a focus on the tissues most affected in movement disorders. We review the movement disorders associated with ocular pathology and where possible explore the underlying cellular basis thought to be driving the pathology and provide a brief overview of ophthalmic investigations available to the neurologist. This review does not cover intracranial primary visual pathways, higher visual function, or the ocular motor system.
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Affiliation(s)
- Duncan Wilson
- Department of Neurology Christchurch Hospital Christchurch New Zealand.,New Zealand Brain Research Institute Christchurch New Zealand
| | - Mark Hallett
- Human Motor Control Section, NINDS, NIH Bethesda Maryland USA
| | - Tim Anderson
- Department of Neurology Christchurch Hospital Christchurch New Zealand.,New Zealand Brain Research Institute Christchurch New Zealand.,Department of Medicine Otago University Dunedin New Zealand
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5
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Medarametla S, Boraiah N, Raju S. A Curious Case of Excessive Winking. Mov Disord Clin Pract 2021; 8:947-949. [PMID: 34405103 DOI: 10.1002/mdc3.13254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 05/06/2021] [Accepted: 05/08/2021] [Indexed: 11/11/2022] Open
Affiliation(s)
- Soumya Medarametla
- Anu Institute of Neuro and Cardiac Sciences Vijayawada India.,Department of Neurology Vydehi Institute of Medical Sciences & Research Centre Bangalore India
| | - Nataraju Boraiah
- Department of Neurology Vydehi Institute of Medical Sciences & Research Centre Bangalore India
| | - Srinivas Raju
- Department of Neurology Vydehi Institute of Medical Sciences & Research Centre Bangalore India.,Department of Neurology Bangalore Baptist Hospital Bangalore India.,Department of Neurology Columbia Asia Hebbal Bangalore India
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6
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Baizabal-Carvallo JF, Cardoso F. Chorea in children: etiology, diagnostic approach and management. J Neural Transm (Vienna) 2020; 127:1323-1342. [DOI: 10.1007/s00702-020-02238-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/01/2020] [Indexed: 01/07/2023]
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7
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Moser AD, Epping E, Espe-Pfeifer P, Martin E, Zhorne L, Mathews K, Nance M, Hudgell D, Quarrell O, Nopoulos P. A survey-based study identifies common but unrecognized symptoms in a large series of juvenile Huntington's disease. Neurodegener Dis Manag 2017; 7:307-315. [PMID: 29043929 DOI: 10.2217/nmt-2017-0019] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
AIM The symptoms of Huntington's disease are well known, yet the symptoms of juvenile Huntington's disease (JHD) are less established due to its rarity. The study examined a cluster of symptoms considered to be common, but under-recognized in JHD: pain, itching, sleeping difficulties, psychosis and tics. MATERIALS & METHODS A symptom survey was constructed using the online tool Qualtrics and dispersed to JHD caregivers through websites. RESULTS A total of 33 surveys were completed. Disrupted sleep was the most prevalent symptom (87%), followed by tics (78%), pain (69%), itching (60%) and psychosis (39%). CONCLUSION Despite limitations, the study supports that there are symptoms in the JHD population that are not considered classic, however, are common and significant for patients and caregivers.
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Affiliation(s)
- Amelia D Moser
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Eric Epping
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Patricia Espe-Pfeifer
- Departments of Psychiatry & Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Erin Martin
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Leah Zhorne
- Departments of Pediatrics & Neurology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Katherine Mathews
- Departments of Pediatrics & Neurology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Martha Nance
- Struthers Parkinson's Center, Minneapolis, MN, USA
| | | | - Oliver Quarrell
- Department of Clinical Genetics, Sheffield Children's Hospital, Sheffield, UK
| | - Peg Nopoulos
- Departments of Psychiatry, Pediatrics, & Neurology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
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8
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Cui SS, Ren RJ, Wang Y, Wang G, Chen SD. Tics as an initial manifestation of juvenile Huntington's disease: case report and literature review. BMC Neurol 2017; 17:152. [PMID: 28789621 PMCID: PMC5549341 DOI: 10.1186/s12883-017-0923-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 07/14/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Huntington's disease (HD) is an autosomal dominant disorder, typically characterized by chorea due to a trinucleotide repeat expansion in the HTT gene, although the clinical manifestations of patients with juvenile HD (JHD) are atypical. CASE PRESENTATION A 17-year-old boy with initial presentation of tics attended our clinic and his DNA analysis demonstrated mutation in the HTT gene (49 CAG repeats). After treatment, his symptoms improved. Furthermore, we performed literature review through searching the databases and summarized clinical features in 33 JHD patients. CONCLUSION The most prevalent symptoms are ataxia, and two cases reported that tics as initial and prominent manifestation in JHD. Among them, 88% patients carried CAG repeats beyond 60 and most of them have family history. This case here illustrates the variable range of clinical symptoms of JHD and the necessity of testing for the HD mutation in young patients with tics with symptoms unable to be explained by Tourette's syndrome (TS).
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Affiliation(s)
- Shi-Shuang Cui
- Department of Neurology & Neuroscience Institute, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Ru-Jing Ren
- Department of Neurology & Neuroscience Institute, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Ying Wang
- Department of Neurology & Neuroscience Institute, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
| | - Gang Wang
- Department of Neurology & Neuroscience Institute, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
| | - Sheng-Di Chen
- Department of Neurology & Neuroscience Institute, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
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9
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Hamedani AG, Gold DR. Eyelid Dysfunction in Neurodegenerative, Neurogenetic, and Neurometabolic Disease. Front Neurol 2017; 8:329. [PMID: 28769865 PMCID: PMC5513921 DOI: 10.3389/fneur.2017.00329] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 06/23/2017] [Indexed: 12/18/2022] Open
Abstract
Eye movement abnormalities are among the earliest clinical manifestations of inherited and acquired neurodegenerative diseases and play an integral role in their diagnosis. Eyelid movement is neuroanatomically linked to eye movement, and thus eyelid dysfunction can also be a distinguishing feature of neurodegenerative disease and complements eye movement abnormalities in helping us to understand their pathophysiology. In this review, we summarize the various eyelid abnormalities that can occur in neurodegenerative, neurogenetic, and neurometabolic diseases. We discuss eyelid disorders, such as ptosis, eyelid retraction, abnormal spontaneous and reflexive blinking, blepharospasm, and eyelid apraxia in the context of the neuroanatomic pathways that are affected. We also review the literature regarding the prevalence of eyelid abnormalities in different neurologic diseases as well as treatment strategies (Table 1).
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Affiliation(s)
- Ali G Hamedani
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Daniel R Gold
- Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, United States.,Department of Ophthalmology, Johns Hopkins Hospital, Baltimore, MD, United States.,Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, United States.,Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, MD, United States
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10
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The Complexity of Clinical Huntington's Disease: Developments in Molecular Genetics, Neuropathology and Neuroimaging Biomarkers. ADVANCES IN NEUROBIOLOGY 2017; 15:129-161. [PMID: 28674980 DOI: 10.1007/978-3-319-57193-5_5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Huntington's disease (HD) is an autosomal dominant neurodegenerative disorder characterised by extensive neuronal loss in the striatum and cerebral cortex, and a triad of clinical symptoms affecting motor, cognitive/behavioural and mood functioning. The mutation causing HD is an expansion of a CAG tract in exon 1 of the HTT gene. This chapter provides a multifaceted overview of the clinical complexity of HD. We explore recent directions in molecular genetics including the identification of loci that are genetic modifiers of HD that could potentially reveal therapeutic targets beyond the HTT gene transcript and protein. The variability of clinical symptomatology in HD is considered alongside recent findings of variability in cellular and neurochemical changes in the striatum and cerebral cortex in human brain. We review evidence from structural neuroimaging methods of progressive changes of striatum, cerebral cortex and white matter in pre-symptomatic and symptomatic HD, with a particular focus on the potential identification of neuroimaging biomarkers that could be used to test promising disease-specific and modifying treatments. Finally we provide an overview of completed clinical trials in HD and future therapeutic developments.
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11
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Santarcangelo EL, Briscese L, Capitani S, Orsini P, Varanini M, Rossi B, Carboncini MC. Blink reflex in subjects with different hypnotizability: New findings for an old debate. Physiol Behav 2016; 163:288-293. [DOI: 10.1016/j.physbeh.2016.05.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 05/11/2016] [Accepted: 05/12/2016] [Indexed: 12/26/2022]
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12
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Spontaneous eye blink rate as predictor of dopamine-related cognitive function-A review. Neurosci Biobehav Rev 2016; 71:58-82. [PMID: 27555290 DOI: 10.1016/j.neubiorev.2016.08.020] [Citation(s) in RCA: 150] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 07/29/2016] [Accepted: 08/16/2016] [Indexed: 12/18/2022]
Abstract
An extensive body of research suggests the spontaneous eye blink rate (EBR) is a non-invasive indirect marker of central dopamine (DA) function, with higher EBR predicting higher DA function. In the present review we provide a comprehensive overview of this literature. We broadly divide the available research in studies that aim to disentangle the dopaminergic underpinnings of EBR, investigate its utility in diagnosis of DA-related disorders and responsivity to drug treatment, and, lastly, investigate EBR as predictor of individual differences in DA-related cognitive performance. We conclude (i) EBR can reflect both DA receptor subtype D1 and D2 activity, although baseline EBR might be most strongly related to the latter, (ii) EBR can predict hypo- and hyperdopaminergic activity as well as normalization of this activity following treatment, and (iii) EBR can reliably predict individual differences in performance on many cognitive tasks, in particular those related to reward-driven behavior and cognitive flexibility. In sum, this review establishes EBR as a useful predictor of DA in a wide variety of contexts.
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13
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Jiang H, Sun YM, Hao Y, Yan YP, Chen K, Xin SH, Tang YP, Li XH, Jun T, Chen YY, Liu ZJ, Wang CR, Li H, Pei Z, Shang HF, Zhang BR, Gu WH, Wu ZY, Tang BS, Burgunder JM. Huntingtin gene CAG repeat numbers in Chinese patients with Huntington's disease and controls. Eur J Neurol 2014; 21:637-42. [PMID: 24471773 DOI: 10.1111/ene.12366] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Accepted: 12/17/2013] [Indexed: 02/05/2023]
Affiliation(s)
- H. Jiang
- Department of Neurology; Xiangya Hospital; Central South University; Changsha China
- Key Laboratory of Hunan Province in Neurodegenerative Disorders; State Key Laboratory of Medical Genetics of China; Central South University; Changsha China
| | - Y. M. Sun
- Department of Neurology; Institute of Neurology; Huashan Hospital; Shanghai Medical College; Fudan University; Shanghai China
| | - Y. Hao
- Department of Neurology; China−Japan Friendship Hospital; Beijing China
| | - Y. P. Yan
- Department of Neurology; Second Affiliated Hospital; College of Medicine; Zhejiang University; Hangzhou China
| | - K. Chen
- Department of Neurology; West China Hospital; Sichuan University; Chengdu China
| | - S. H. Xin
- First Affiliated Hospital of Sun Yat-Sen University; Guangzhou China
| | - Y. P. Tang
- Department of Medical Genetics; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | - X. H. Li
- First Affiliated Hospital of Sun Yat-Sen University; Guangzhou China
| | - T. Jun
- Department of Neurology; Second Affiliated Hospital; College of Medicine; Zhejiang University; Hangzhou China
| | - Y. Y. Chen
- Department of Neurology; China−Japan Friendship Hospital; Beijing China
| | - Z. J. Liu
- Department of Neurology; Institute of Neurology; Huashan Hospital; Shanghai Medical College; Fudan University; Shanghai China
| | - C. R. Wang
- Department of Neurology; Xiangya Hospital; Central South University; Changsha China
| | - H. Li
- Department of Medical Genetics; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | - Z. Pei
- First Affiliated Hospital of Sun Yat-Sen University; Guangzhou China
| | - H. F. Shang
- Department of Neurology; West China Hospital; Sichuan University; Chengdu China
| | - B. R. Zhang
- Department of Neurology; Second Affiliated Hospital; College of Medicine; Zhejiang University; Hangzhou China
| | - W. H. Gu
- Department of Neurology; China−Japan Friendship Hospital; Beijing China
| | - Z. Y. Wu
- Department of Neurology; Institute of Neurology; Huashan Hospital; Shanghai Medical College; Fudan University; Shanghai China
| | - B. S. Tang
- Department of Neurology; Xiangya Hospital; Central South University; Changsha China
| | - J.-M. Burgunder
- Department of Neurology; Xiangya Hospital; Central South University; Changsha China
- Department of Neurology; West China Hospital; Sichuan University; Chengdu China
- First Affiliated Hospital of Sun Yat-Sen University; Guangzhou China
- Swiss Huntington's Disease Centre; Department of Neurology; University of Bern; NeuroBu Clinics; Bern Switzerland
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14
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Liu ZJ, Sun YM, Ni W, Dong Y, Shi SS, Wu ZY. Clinical features of Chinese patients with Huntington's disease carrying CAG repeats beyond 60 within HTT gene. Clin Genet 2013; 85:189-93. [PMID: 23398026 DOI: 10.1111/cge.12120] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 02/05/2013] [Accepted: 02/05/2013] [Indexed: 11/28/2022]
Abstract
Patients with Huntington's disease (HD) carrying CAG repeats beyond 60 are less frequently seen and clinical features of them have been rarely reported. We identified four unrelated patients carrying CAG repeats beyond 60 (84.0 ± 13.76, ranging from 74 to 104) from 119 Chinese HD patients via direct sequencing. These four were all early onset with a mean age at presenting symptom of 9.8 ± 1.71 years. Paternal transmission was found in three of them and the fourth was apparently sporadic. In addition, they had atypical onset symptoms including epilepsy, intellectual decline, tics and walking instability, which might lead the clinicians to make the wrong diagnosis in the early stage of disease. Our work explores clinical features of Chinese HD patients with an expanded CAG repeat over 60 and may help the clinicians make a correct diagnosis in the early stage of disease.
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Affiliation(s)
- Z-J Liu
- Department of Neurology and Institute of Neurology, Huashan Hospital, Institutes of Brain Science and State Key Laboratory of Medical Neurobiology, Shanghai Medical College, Fudan University, Shanghai, China ; Department of Neurology and Institute of Neurology, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
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15
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Allen NM, McKeon A, O'Rourke DJ, O'Meara A, King MD. Excessive blinking and ataxia in a child with occult neuroblastoma and voltage-gated potassium channel antibodies. Pediatrics 2012; 129:e1348-52. [PMID: 22529275 DOI: 10.1542/peds.2011-2690] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
A previously healthy 9-year-old girl presented with a 10-day history of slowly progressive unsteadiness, slurred speech, and behavior change. On examination there was cerebellar ataxia and dysarthria, excessive blinking, subtle perioral myoclonus, and labile mood. The finding of oligoclonal bands in the cerebrospinal fluid prompted paraneoplastic serological evaluation and search for an occult neural crest tumor. Antineuronal nuclear autoantibody type 1 (anti-Hu) and voltage-gated potassium channel complex antibodies were detected in serum. Metaiodobenzylguanidine scan and computed tomography scan of the abdomen showed a localized abdominal mass in the region of the porta hepatis. A diagnosis of occult neuroblastoma was made. Resection of the stage 1 neuroblastoma and treatment with pulsed corticosteroids resulted in resolution of all symptoms and signs. Excessive blinking has rarely been described with neuroblastoma, and, when it is not an isolated finding, it may be a useful clue to this paraneoplastic syndrome. Although voltage-gated potassium channel complex autoimmunity has not been described previously in the setting of neuroblastoma, it is associated with a spectrum of paraneoplastic neurologic manifestations in adults, including peripheral nerve hyperexcitability disorders.
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Affiliation(s)
- Nicholas M Allen
- Department of Pediatric Neurology, Children's University Hospital, Dublin 1, Ireland.
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16
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Reflexive and volitional saccades: biomarkers of Huntington disease severity and progression. J Neurol Sci 2011; 313:35-41. [PMID: 22018763 DOI: 10.1016/j.jns.2011.09.035] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Accepted: 09/27/2011] [Indexed: 11/21/2022]
Abstract
BACKGROUND Huntington disease (HD) is a genetic, neurodegenerative disorder characterized by chorea, behavioral co-morbidities, cognitive deficits, and eye movement abnormalities. We sought to evaluate whether reflexive and voluntary orienting prove useful as biomarkers of disease severity in HD. METHODS Eleven HD subjects were evaluated with the motor subscale of the Unified Huntington Disease Rating Scale (UHDRS) and the Montreal Cognitive Assessment. Using an infrared eye tracker, we also measured latency and error rates of horizontal and vertical saccades using prosaccade and antisaccade eye movement tasks. We calculated simple and age-controlled correlations between eye movement and clinical parameters. RESULTS Prosaccade latency correlated with total chorea score. HD patients with greater clinical severity were significantly slower in the prosaccade task. Antisaccade error rate also correlated with UHDRS motor score and total chorea score. HD patients with greater clinical severity as measured by either measure made significantly more errors in the antisaccade task. All these correlations remained significant even when age was taken into account. CONCLUSIONS The results of the present age-controlled study show for the first time that both reflexive and voluntary eye motor control in HD patients decrease with increase in disease severity suggesting declines in both motor and cognitive function. Thus, relatively simple eye movement parameters (latency and error rate) obtained from simple tasks (prosaccade and antisaccade) may serve as quantitative biomarkers of sub-cortical and cortical disease severity in HD and could aid in predicting onset, distinguishing subtypes, or evaluating disease progression and novel therapies.
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Nicolas G, Devys D, Goldenberg A, Maltête D, Hervé C, Hannequin D, Guyant-Maréchal L. Juvenile Huntington disease in an 18-month-old boy revealed by global developmental delay and reduced cerebellar volume. Am J Med Genet A 2011; 155A:815-8. [DOI: 10.1002/ajmg.a.33911] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Accepted: 12/29/2010] [Indexed: 11/11/2022]
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