1
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Garcia-Guaqueta DP, Botha H, Utianski RL, Duffy JR, Clark HM, Goodrich AW, Pham NTT, Machulda MM, Baker M, Rademakers R, Whitwell JL, Josephs KA. Progression to corticobasal syndrome: a longitudinal study of patients with nonfluent primary progressive aphasia and primary progressive apraxia of speech. J Neurol 2024; 271:4168-4179. [PMID: 38583104 PMCID: PMC11233233 DOI: 10.1007/s00415-024-12344-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND AND OBJECTIVES Nonfluent variant primary progressive aphasia (nfvPPA) and primary progressive apraxia of speech (PPAOS) can be precursors to corticobasal syndrome (CBS). Details on their progression remain unclear. We aimed to examine the clinical and neuroimaging evolution of nfvPPA and PPAOS into CBS. METHODS We conducted a retrospective longitudinal study in 140 nfvPPA or PPAOS patients and applied the consensus criteria for possible and probable CBS for every visit, evaluating limb rigidity, akinesia, limb dystonia, myoclonus, ideomotor apraxia, alien limb phenomenon, and nonverbal oral apraxia (NVOA). Given the association of NVOA with AOS, we also modified the CBS criteria by excluding NVOA and assigned every patient to either a progressors or non-progressors group. We evaluated the frequency of every CBS feature by year from disease onset, and assessed gray and white matter volume loss using SPM12. RESULTS Asymmetric akinesia, NVOA, and limb apraxia were the most common CBS features that developed; while limb dystonia, myoclonus, and alien limb were rare. Eighty-two patients progressed to possible CBS; only four to probable CBS. nfvPPA and PPAOS had a similar proportion of progressors, although nfvPPA progressed to CBS earlier (p-value = 0.046), driven by an early appearance of limb apraxia (p-value = 0.0041). The non-progressors and progressors both showed premotor/motor cortex involvement at baseline, with spread into prefrontal cortex over time. DISCUSSION An important proportion of patients with nfvPPA and PPAOS progress to possible CBS, while they rarely develop features of probable CBS even after long follow-up.
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Affiliation(s)
- Danna P Garcia-Guaqueta
- Department of Neurology, Behavioral Neurology & Movement Disorders, Mayo Clinic, College of Medicine and Science, Rochester, MN, 55905, USA
| | - Hugo Botha
- Department of Neurology, Behavioral Neurology & Movement Disorders, Mayo Clinic, College of Medicine and Science, Rochester, MN, 55905, USA
| | - Rene L Utianski
- Department of Neurology, Behavioral Neurology & Movement Disorders, Mayo Clinic, College of Medicine and Science, Rochester, MN, 55905, USA
| | - Joseph R Duffy
- Department of Neurology, Behavioral Neurology & Movement Disorders, Mayo Clinic, College of Medicine and Science, Rochester, MN, 55905, USA
| | - Heather M Clark
- Department of Neurology, Behavioral Neurology & Movement Disorders, Mayo Clinic, College of Medicine and Science, Rochester, MN, 55905, USA
| | - Austin W Goodrich
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, 55905, USA
| | | | - Mary M Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Matt Baker
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | - Rosa Rademakers
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
- VIB Center for Molecular Neurology, University of Antwerp, Antwerp, Belgium
| | | | - Keith A Josephs
- Department of Neurology, Behavioral Neurology & Movement Disorders, Mayo Clinic, College of Medicine and Science, Rochester, MN, 55905, USA.
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2
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Uzan GS, Günay Ç, Kurul SH, Yiş U. Double Trouble: A Case of DYT-TOR1A Diagnosed in the Postoperative Period. Ann Indian Acad Neurol 2023; 26:578-580. [PMID: 37970319 PMCID: PMC10645274 DOI: 10.4103/aian.aian_39_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/24/2023] [Accepted: 03/01/2023] [Indexed: 11/17/2023] Open
Affiliation(s)
- Gamze Sarıkaya Uzan
- Department of Pediatrics, Division of Child Neurology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Çağatay Günay
- Department of Pediatrics, Division of Child Neurology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Semra Hız Kurul
- Department of Pediatrics, Division of Child Neurology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Uluç Yiş
- Department of Pediatrics, Division of Child Neurology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
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3
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Corp DT, Morrison-Ham J, Jinnah HA, Joutsa J. The functional anatomy of dystonia: Recent developments. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2023; 169:105-136. [PMID: 37482390 DOI: 10.1016/bs.irn.2023.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
While dystonia has traditionally been viewed as a disorder of the basal ganglia, the involvement of other key brain structures is now accepted. However, just what these structures are remains to be defined. Neuroimaging has been an especially valuable tool in dystonia, yet traditional cross-sectional designs have not been able to separate causal from compensatory brain activity. Therefore, this chapter discusses recent studies using causal brain lesions, and animal models, to converge upon the brain regions responsible for dystonia with increasing precision. This evidence strongly implicates the basal ganglia, thalamus, brainstem, cerebellum, and somatosensory cortex, yet shows that different types of dystonia involve different nodes of this brain network. Nearly all of these nodes fall within the recently identified two-way networks connecting the basal ganglia and cerebellum, suggesting dysfunction of these specific pathways. Localisation of the functional anatomy of dystonia has strong implications for targeted treatment options, such as deep brain stimulation, and non-invasive brain stimulation.
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Affiliation(s)
- Daniel T Corp
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Australia; Center for Brain Circuit Therapeutics, Brigham and Women's Hospital, Boston, MA, United States.
| | - Jordan Morrison-Ham
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Australia
| | - H A Jinnah
- Departments of Neurology, Human Genetics, and Pediatrics, Atlanta, GA, United States
| | - Juho Joutsa
- Center for Brain Circuit Therapeutics, Brigham and Women's Hospital, Boston, MA, United States; Turku Brain and Mind Center, Clinical Neurosciences, University of Turku, Turku, Finland; Turku PET Centre, Neurocenter, Turku University Hospital, Turku, Finland
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4
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Manzo N, Ginatempo F, Belvisi D, Defazio G, Conte A, Deriu F, Berardelli A. Pathophysiological mechanisms of oromandibular dystonia. Clin Neurophysiol 2021; 134:73-80. [PMID: 34979293 DOI: 10.1016/j.clinph.2021.11.075] [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: 08/28/2021] [Revised: 11/03/2021] [Accepted: 11/28/2021] [Indexed: 11/03/2022]
Abstract
Oromandibular dystonia (OMD) is a rare form of focal idiopathic dystonia. OMD was clinically identified at the beginning of the 20th century, and the main clinical features have been progressively described over the years. However, OMD has several peculiarities that still remain unexplained, including the high rate of oral trauma, which is often related to the onset of motor symptoms. The purpose of this paper was to formulate a hypothesis regarding the pathophysiology of OMD, starting from the neuroanatomical basis of the masticatory and facial systems and highlighting the features that differentiate this condition from other forms of focal idiopathic dystonia. We provide a brief review of the clinical and etiological features of OMD as well as neurophysiological and neuroimaging findings obtained from studies in patients with OMD. We discuss possible pathophysiological mechanisms underlying OMD and suggest that abnormalities in sensory input processing may play a prominent role in OMD pathophysiology, possibly triggering a cascade of events that results in sensorimotor cortex network dysfunction. Finally, we identify open questions that future studies should address, including the effect of abnormal sensory input processing and oral trauma on the peculiar neurophysiological abnormalities observed in OMD.
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Affiliation(s)
| | | | - Daniele Belvisi
- IRCCS NEUROMED, Via Atinense, 18, 86077 Pozzilli, IS, Italy; Department of Human Neurosciences, Sapienza, University of Rome, Viale Dell' Università 30, 00185 Rome, Italy
| | - Giovanni Defazio
- Movement Disorders Center, Department of Neurology, University of Cagliari, SS 554 km 4.500, 09042 Cagliari, Italy
| | - Antonella Conte
- IRCCS NEUROMED, Via Atinense, 18, 86077 Pozzilli, IS, Italy; Department of Human Neurosciences, Sapienza, University of Rome, Viale Dell' Università 30, 00185 Rome, Italy
| | - Franca Deriu
- Department of Biomedical Sciences, University of Sassari, Viale S. Pietro, 43c, 07100 Sassari, Italy; Unit of Endocrinology, Nutritional and Metabolic Disorders, AOU Sassari, 07100 Sassari, Italy
| | - Alfredo Berardelli
- IRCCS NEUROMED, Via Atinense, 18, 86077 Pozzilli, IS, Italy; Department of Human Neurosciences, Sapienza, University of Rome, Viale Dell' Università 30, 00185 Rome, Italy.
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5
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Neuropathology of blepharospasm. Exp Neurol 2021; 346:113855. [PMID: 34464652 DOI: 10.1016/j.expneurol.2021.113855] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/18/2021] [Accepted: 08/27/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The dystonias are a group of disorders characterized by excessive muscle contractions leading to abnormal repetitive movements or postures. In blepharospasm, the face is affected, leading to excessive eye blinking and spasms of muscles around the eyes. The pathogenesis of blepharospasm is not well understood, but several imaging studies have implied subtle structural defects in several brain regions, including the cerebellum. OBJECTIVE To delineate cerebellar pathology in brains collected at autopsy from 7 human subjects with blepharospasm and 9 matched controls. METHODS Sections from 3 cerebellar regions were sampled and processed using Nissl and silver impregnation stains. Purkinje neurons were the focus of the evaluation, along with as several other subtle pathological features of cerebellar dysfunction such as Purkinje neuron axonal swellings (torpedo bodies), proliferation of basket cell processes around Purkinje neurons (hairy baskets), empty baskets (missing Purkinje neurons), and displacement of cell soma from their usual location (ectopic Purkinje neurons). RESULTS The results revealed a significant reduction in Purkinje neuron and torpedo body density, but no changes in any of the other measures. CONCLUSIONS These findings demonstrate subtle neuropathological changes similar to those reported for subjects with cervical dystonia. These findings may underly some of the subtle imaging changes reported for blepharospasm.
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6
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Defazio G, Ercoli T, Erro R, Pellicciari R, Mascia MM, Fabbrini G, Albanese A, Lalli S, Eleopra R, Barone P, Marchese R, Ceravolo R, Scaglione C, Liguori R, Esposito M, Bentivoglio AR, Bertolasi L, Altavista MC, Bono F, Pisani A, Girlanda P, Berardelli A, Cimino P, Ferrazzano G, Devigili G, Scannapieco S, Di Biasio F, Mazzucchi S, Habetswallner F, Petracca M, Zivelonghi C, Polidori L, Manzo L, Di Lazzaro G, Terranova C, Cotelli MS, Castagna A, Minafra B, Misceo S, Magistrelli L, Zibetti M, Cossu G, Coletti Moja M. Idiopathic
Non‐task‐Specific
Upper Limb Dystonia, a Neglected Form of Dystonia. Mov Disord 2020; 35:2038-2045. [DOI: 10.1002/mds.28199] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/30/2020] [Accepted: 06/17/2020] [Indexed: 12/16/2022] Open
Affiliation(s)
- Giovanni Defazio
- Department of Medical Science and Public Health Institute of Neurology, University of Cagliari Cagliari Italy
| | - Tommaso Ercoli
- Department of Medical Science and Public Health Institute of Neurology, University of Cagliari Cagliari Italy
| | - Roberto Erro
- Department of Medicine Surgery and Dentistry "Scuola Medica Salernitana," University of Salerno Baronissi (SA) Italy
| | - Roberta Pellicciari
- Department of Basic Science, Neuroscience and Sense Organs Aldo Moro University of Bari Bari Italy
| | - Marcello Mario Mascia
- Department of Medical Science and Public Health Institute of Neurology, University of Cagliari Cagliari Italy
| | - Giovanni Fabbrini
- Department of Human Neurosciences Sapienza University of Rome Rome Italy
- IRCSS Neuromed Pozzili Italy
| | - Alberto Albanese
- Department of Neurology IRCCS Istituto Clinico Humanitas Rozzano, Milan Italy
| | - Stefania Lalli
- Department of Neurology IRCCS Istituto Clinico Humanitas Rozzano, Milan Italy
| | | | - Paolo Barone
- Department of Medicine Surgery and Dentistry "Scuola Medica Salernitana," University of Salerno Baronissi (SA) Italy
| | | | - Roberto Ceravolo
- Department of Clinical and Experimental Medicine University of Pisa Pisa Italy
| | - Cesa Scaglione
- IRCCS ‐ Institute of Neurological Sciences Bologna Italy
| | - Rocco Liguori
- IRCCS ‐ Institute of Neurological Sciences Bologna Italy
| | | | - Anna Rita Bentivoglio
- Gemelli University Hospital ‐ IRCCS Rome Italy
- Institute of Neurology, Università Cattolica del Sacro Cuore Rome Italy
| | | | | | - Francesco Bono
- Center for Botulinum Toxin Therapy, Neurologic Unit Mater Domini University Hospital Catanzaro Italy
| | - Antonio Pisani
- Department of Systems Medicine University of Rome Tor Vergata Rome Italy
| | - Paolo Girlanda
- Department of Clinical and Experimental Medicine University of Messina Messina Italy
| | - Alfredo Berardelli
- Department of Human Neurosciences Sapienza University of Rome Rome Italy
- IRCSS Neuromed Pozzili Italy
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7
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Does the network model fits neurophysiological abnormalities in blepharospasm? Neurol Sci 2020; 41:2067-2079. [DOI: 10.1007/s10072-020-04347-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 03/16/2020] [Indexed: 10/24/2022]
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8
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Conte A, Defazio G, Mascia M, Belvisi D, Pantano P, Berardelli A. Advances in the pathophysiology of adult-onset focal dystonias: recent neurophysiological and neuroimaging evidence. F1000Res 2020; 9. [PMID: 32047617 PMCID: PMC6993830 DOI: 10.12688/f1000research.21029.2] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2020] [Indexed: 12/28/2022] Open
Abstract
Focal dystonia is a movement disorder characterized by involuntary muscle contractions that determine abnormal postures. The traditional hypothesis that the pathophysiology of focal dystonia entails a single structural dysfunction (i.e. basal ganglia) has recently come under scrutiny. The proposed network disorder model implies that focal dystonias arise from aberrant communication between various brain areas. Based on findings from animal studies, the role of the cerebellum has attracted increased interest in the last few years. Moreover, it has been increasingly reported that focal dystonias also include nonmotor disturbances, including sensory processing abnormalities, which have begun to attract attention. Current evidence from neurophysiological and neuroimaging investigations suggests that cerebellar involvement in the network and mechanisms underlying sensory abnormalities may have a role in determining the clinical heterogeneity of focal dystonias.
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Affiliation(s)
- Antonella Conte
- Department of Human Neurosciences, Sapienza, University of Rome, Rome, Italy.,IRCCS Neuromed, Pozzilli (IS), Italy
| | - Giovanni Defazio
- Department of Medical Sciences and Public Health, Neurology Unit, University of Cagliari and AOU Cagliari, Monserrato, Cagliari, Italy
| | - Marcello Mascia
- Department of Medical Sciences and Public Health, Neurology Unit, University of Cagliari and AOU Cagliari, Monserrato, Cagliari, Italy
| | | | - Patrizia Pantano
- Department of Human Neurosciences, Sapienza, University of Rome, Rome, Italy.,IRCCS Neuromed, Pozzilli (IS), Italy
| | - Alfredo Berardelli
- Department of Human Neurosciences, Sapienza, University of Rome, Rome, Italy.,IRCCS Neuromed, Pozzilli (IS), Italy
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9
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Forman CR, Svane C, Kruuse C, Gracies JM, Nielsen JB, Lorentzen J. Sustained involuntary muscle activity in cerebral palsy and stroke: same symptom, diverse mechanisms. Brain Commun 2019; 1:fcz037. [PMID: 33033798 PMCID: PMC7531180 DOI: 10.1093/braincomms/fcz037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 10/24/2019] [Accepted: 10/28/2019] [Indexed: 12/12/2022] Open
Abstract
Individuals with lesions of central motor pathways frequently suffer from sustained
involuntary muscle activity. This symptom shares clinical characteristics with dystonia
but is observable in individuals classified as spastic. The term spastic dystonia has been
introduced, although the underlying mechanisms of involuntary activity are not clarified
and vary between individuals depending on the disorder. This study aimed to investigate
the nature and pathophysiology of sustained involuntary muscle activity in adults with
cerebral palsy and stroke. Seventeen adults with cerebral palsy (Gross Motor Function
Classification System I–V), 8 adults with chronic stroke and 14 control individuals
participated in the study. All individuals with cerebral palsy or stroke showed increased
resistance to passive movement with Modified Ashworth Scale >1. Two-minute surface EMG
recordings were obtained from the biceps muscle during attempted rest in three positions
of the elbow joint; a maximally flexed position, a 90-degree position and a maximally
extended position. Cross-correlation analysis of sustained involuntary muscle activity
from individuals with cerebral palsy and stroke, and recordings of voluntary isometric
contractions from control individuals were performed to examine common synaptic drive. In
total, 13 out of 17 individuals with cerebral palsy and all 8 individuals with stroke
contained sustained involuntary muscle activity. In individuals with cerebral palsy, the
level of muscle activity was not affected by the joint position. In individuals with
stroke, the level of muscle activity significantly (P < 0.05)
increased from the flexed position to the 90 degree and extended position. Cumulant
density function indicated significant short-term synchronization of motor unit activities
in all recordings. All groups exhibited significant coherence in the alpha (6–15 Hz), beta
(16–35 Hz) and early gamma band (36–60 Hz). The cerebral palsy group had lower alpha band
coherence estimates, but higher gamma band coherence estimates compared with the stroke
group. Individuals with increased resistance to passive movement due to cerebral palsy or
stroke frequently suffer sustained involuntary muscle activity, which cannot exclusively
be described by spasticity. The sustained involuntary muscle activity in both groups
originated from a common synaptic input to the motor neuron pool, but the generating
mechanisms could differ between groups. In cerebral palsy it seemed to originate more from
central mechanisms, whereas peripheral mechanisms likely play a larger role in stroke. The
sustained involuntary muscle activity should not be treated simply like the spinal stretch
reflex mediated symptom of spasticity and should not either be treated identically in both
groups.
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Affiliation(s)
| | - Christian Svane
- Department of Neuroscience, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Christina Kruuse
- Department of Neurology, Neurovascular Research Unit, Herlev Gentofte Hospital, 2730 Herlev Gentofte, Denmark
| | - Jean-Michel Gracies
- EA 7377 BIOTN, Université Paris-Est Creteil, Hospital Albert Chenevier-Henri Mondor, Service de Rééducation Neurolocomotrice, APHP, Créteil, France
| | - Jens Bo Nielsen
- Department of Neuroscience, University of Copenhagen, 2200 Copenhagen, Denmark.,Elsass Institute, 2830 Charlottenlund, Denmark
| | - Jakob Lorentzen
- Department of Neuroscience, University of Copenhagen, 2200 Copenhagen, Denmark.,Elsass Institute, 2830 Charlottenlund, Denmark
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10
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Conte A, Rocchi L, Latorre A, Belvisi D, Rothwell JC, Berardelli A. Ten‐Year Reflections on the Neurophysiological Abnormalities of Focal Dystonias in Humans. Mov Disord 2019; 34:1616-1628. [DOI: 10.1002/mds.27859] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 08/20/2019] [Accepted: 08/23/2019] [Indexed: 12/12/2022] Open
Affiliation(s)
- Antonella Conte
- Department of Human Neurosciences Sapienza, University of Rome Rome Italy
- IRCCS Neuromed Pozzilli (IS) Italy
| | - Lorenzo Rocchi
- Department of Clinical and Movement Neurosciences UCL Queen Square Institute of Neurology London UK
| | - Anna Latorre
- Department of Human Neurosciences Sapienza, University of Rome Rome Italy
- Department of Clinical and Movement Neurosciences UCL Queen Square Institute of Neurology London UK
| | | | - John C. Rothwell
- Department of Clinical and Movement Neurosciences UCL Queen Square Institute of Neurology London UK
| | - Alfredo Berardelli
- Department of Human Neurosciences Sapienza, University of Rome Rome Italy
- IRCCS Neuromed Pozzilli (IS) Italy
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11
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Sul B, Kim JS, Hong BY, Lim SH. The effect of dopamine for focal hand dystonia after stroke. Neurol Sci 2019; 40:1301-1302. [DOI: 10.1007/s10072-019-3705-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 01/04/2019] [Indexed: 10/27/2022]
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Abstract
Dystonias are characterized by involuntary muscle contractions, twisting movements, abnormal postures, and often tremor in various body regions. However, in the last decade several studies have demonstrated that dystonias are also characterized by sensory abnormalities. While botulinum toxin is the gold standard therapy for focal dystonia, exactly how it improves this disorder is not entirely understood. Neurophysiological studies in animals and humans have clearly demonstrated that botulinum toxin improves dystonic motor manifestations by inducing chemodenervation, therefore weakening the injected muscles. In addition, neurophysiological and neuroimaging evidence also suggests that botulinum toxin modulates the activity of various neural structures in the CNS distant from the injected site, particularly cortical motor and sensory areas. Concordantly, recent studies have shown that in patients with focal dystonias botulinum toxin ameliorates sensory disturbances, including reduced spatial discrimination acuity and pain. Overall, these observations suggest that in these patients botulinum toxin-induced effects encompass complex mechanisms beyond chemodenervation of the injected muscles.
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Affiliation(s)
- Alfredo Berardelli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.
- IRCCS Neuromed, Pozzilli, IS, Italy.
| | - Antonella Conte
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli, IS, Italy
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13
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Iacono D, Lee P, Hallett M, Perl D. Possible Post-Traumatic Focal Dystonia Associated with Tau Pathology Localized to Putamen-Globus Pallidus. Mov Disord Clin Pract 2018; 5:492-498. [PMID: 30637269 DOI: 10.1002/mdc3.12626] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 03/28/2018] [Accepted: 04/05/2018] [Indexed: 11/07/2022] Open
Abstract
Background Dystonia is often associated with damage to basal ganglia (BG), but neuropathological assessments of these cases are infrequent. Methods A brain was assessed with possible post-traumatic focal dystonia that appeared after an accident occurred during childhood. Results Tau pathology was found within putamen and globus pallidus of the right hemisphere, and chronic traumatic encephalopathy (CTE) was observed in the cortex of the left hemisphere. No diffuse axonal injury (DAI), β-amyloid, ubiquitin, p62, or pTDP43 pathology was found. Conclusions Post-traumatic dystonia could be associated with post-traumatic tau pathology formation. However, more cases are necessary to establish causality. The tau lesions found in the BG of this patient did not fit within CTE criteria. We hypothesize that due to the anatomo-histological characteristics of the BG, tau pathology associated with brain traumas produce histopathological patterns different from sulcal-tau pathology, which is the only tau pathology distribution currently accepted as pathognomonic of CTE.
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Affiliation(s)
- Diego Iacono
- Brain Tissue Repository & Neuropathology Core, Center for Neuroscience and Regenerative Medicine (CNRM) Uniformed Services University (USU) Bethesda MD.,Department of Neurology, F. Edward Hébert School of Medicine Uniformed Services University (USU) Bethesda MD.,Department of Pathology, F. Edward Hébert School of Medicine Uniformed Services University (USU) Bethesda MD.,The Henry M. Jackson Foundation for the Advancement of Military Medicine (HJF) Bethesda MD.,Complex Neurodegenerative Disorders, Motor Neuron Disorders Unit, National Institute of Neurological Disorders and Stroke, NINDS NIH Bethesda MD
| | - Patricia Lee
- Brain Tissue Repository & Neuropathology Core, Center for Neuroscience and Regenerative Medicine (CNRM) Uniformed Services University (USU) Bethesda MD.,The Henry M. Jackson Foundation for the Advancement of Military Medicine (HJF) Bethesda MD
| | - Mark Hallett
- Human Motor Control Section, Medical Neurology Branch, NINDS NIH Bethesda MD
| | - Daniel Perl
- Brain Tissue Repository & Neuropathology Core, Center for Neuroscience and Regenerative Medicine (CNRM) Uniformed Services University (USU) Bethesda MD.,Department of Pathology, F. Edward Hébert School of Medicine Uniformed Services University (USU) Bethesda MD
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14
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15
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Abstract
Dystonia is a heterogeneous disorder characterized by involuntary muscle contractions, twisting movements, and abnormal postures in various body regions. It is widely accepted that the basal ganglia are involved in the pathogenesis of dystonia. A growing body of evidence, however, is challenging the traditional view and suggest that the cerebellum may also play a role in dystonia. Studies on animals indicate that experimental manipulations of the cerebellum lead to dystonic-like movements. Several clinical observations, including those from secondary dystonia cases as well as neurophysiologic and neuroimaging studies in human patients, provide further evidence in humans of a possible relationship between cerebellar abnormalities and dystonia. Claryfing the role of the cerebellum in dystonia is an important step towards providing alternative treatments based on noninvasive brain stimulation techniques.
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Affiliation(s)
- Matteo Bologna
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy; Neuromed Institute IRCCS, Pozzilli, Italy
| | - Alfredo Berardelli
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy; Neuromed Institute IRCCS, Pozzilli, Italy.
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16
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Jinnah HA, Hess EJ. Evolving concepts in the pathogenesis of dystonia. Parkinsonism Relat Disord 2018; 46 Suppl 1:S62-S65. [PMID: 28784298 PMCID: PMC5696051 DOI: 10.1016/j.parkreldis.2017.08.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 07/26/2017] [Accepted: 08/01/2017] [Indexed: 01/01/2023]
Abstract
INTRODUCTION The dystonias are a group of disorders defined by over-contraction of muscles leading to abnormal movements and postures. In recent years, enormous advances have been made in elucidating the neurobiological mechanisms responsible for many types of dystonia. METHODS A literature review was conducted focusing on evolving concepts in dystonia genetics, anatomy and physiology. RESULTS The list of genes related to dystonia has grown from a relatively small number to more than 100. Concepts regarding the neuroanatomical basis for dystonia have evolved from a relatively narrow focus on dysfunction of the basal ganglia to a broader motor network model in which the basal ganglia, cerebellum, cerebral cortex, and other brain regions play a key role. Physiologically, our understanding of the core abnormalities has matured; and numerous changes in neural signaling have been revealed in the basal ganglia, cerebellum and cortex. CONCLUSION Although the dystonias share certain clinical aspects such as over-contraction of muscles leading to abnormal movements and postures, they actually comprise a very clinically and etiologically heterogeneous group of disorders. Understanding their neurobiological basis is important for devising rational therapies appropriately targeted for specific subgroups of patients.
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Affiliation(s)
- H A Jinnah
- Departments of Neurology, Human Genetics and Pediatrics, Emory University, Atlanta, GA, USA.
| | - Ellen J Hess
- Department of Pharmacology and Neurology, Emory University, Atlanta, GA, USA
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Jinnah HA, Neychev V, Hess EJ. The Anatomical Basis for Dystonia: The Motor Network Model. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2017; 7:506. [PMID: 29123945 PMCID: PMC5673689 DOI: 10.7916/d8v69x3s] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 09/25/2017] [Indexed: 01/27/2023]
Abstract
Background The dystonias include a clinically and etiologically very diverse group of disorders. There are both degenerative and non-degenerative subtypes resulting from genetic or acquired causes. Traditionally, all dystonias have been viewed as disorders of the basal ganglia. However, there has been increasing appreciation for involvement of other brain regions including the cerebellum, thalamus, midbrain, and cortex. Much of the early evidence for these other brain regions has come from studies of animals, but multiple recent studies have been done with humans, in an effort to confirm or refute involvement of these other regions. The purpose of this article is to review the new evidence from animals and humans regarding the motor network model, and to address the issues important to translational neuroscience. Methods The English literature was reviewed for articles relating to the neuroanatomical basis for various types of dystonia in both animals and humans. Results There is evidence from both animals and humans that multiple brain regions play an important role in various types of dystonia. The most direct evidence for specific brain regions comes from animal studies using pharmacological, lesion, or genetic methods. In these studies, experimental manipulations of specific brain regions provide direct evidence for involvement of the basal ganglia, cerebellum, thalamus and other regions. Additional evidence also comes from human studies using neuropathological, neuroimaging, non-invasive brain stimulation, and surgical interventions. In these studies, the evidence is less conclusive, because discriminating the regions that cause dystonia from those that reflect secondary responses to abnormal movements is more challenging. Discussion Overall, the evidence from both animals and humans suggests that different regions may play important roles in different subtypes of dystonia. The evidence so far provides strong support for the motor network model. There are obvious challenges, but also advantages, of attempting to translate knowledge gained from animals into a more complete understanding of human dystonia and novel therapeutic strategies.
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Affiliation(s)
- H A Jinnah
- Departments of Neurology, Human Genetics and Pediatrics, Emory University, Atlanta, GA, USA
| | - Vladimir Neychev
- Department of Surgery, University Multiprofile Hospital for Active Treatment "Alexandrovska", Medical University of Sofia, Sofia, Bulgaria
| | - Ellen J Hess
- Departments of Pharmacology and Neurology, Emory University, Atlanta, GA, USA
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Bologna M, Berardelli A. Cerebellum: An explanation for dystonia? CEREBELLUM & ATAXIAS 2017; 4:6. [PMID: 28515949 PMCID: PMC5429509 DOI: 10.1186/s40673-017-0064-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 04/28/2017] [Indexed: 11/29/2022]
Abstract
Dystonia is a movement disorder that is characterized by involuntary muscle contractions, abnormal movements and postures, as well as by non-motor symptoms, and is due to abnormalities in different brain areas. In this article, we focus on the growing number of experimental studies aimed at explaining the pathophysiological role of the cerebellum in dystonia. Lastly, we highlight gaps in current knowledge and issues that future research studies should focus on as well as some of the potential applications of this research avenue. Clarifying the pathophysiological role of cerebellum in dystonia is an important concern given the increasing availability of invasive and non-invasive stimulation techniques and their potential therapeutic role in this condition.
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Affiliation(s)
- Matteo Bologna
- Department of Neurology and Psychiatry and Neuromed Institute, Sapienza University of Rome, Viale dell'Università, 30, 00185 Rome, Italy.,Neuromed Institute IRCCS, Pozzilli, IS Italy
| | - Alfredo Berardelli
- Department of Neurology and Psychiatry and Neuromed Institute, Sapienza University of Rome, Viale dell'Università, 30, 00185 Rome, Italy.,Neuromed Institute IRCCS, Pozzilli, IS Italy
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