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Seemann J, Daghsen L, Cazier M, Lamy JC, Welter ML, Giese MA, Synofzik M, Durr A, Ilg W, Coarelli G. Digital Gait Measures Capture 1-Year Progression in Early-Stage Spinocerebellar Ataxia Type 2. Mov Disord 2024; 39:788-797. [PMID: 38419144 DOI: 10.1002/mds.29757] [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: 10/12/2023] [Revised: 01/29/2024] [Accepted: 02/02/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND With disease-modifying drugs in reach for cerebellar ataxias, fine-grained digital health measures are highly warranted to complement clinical and patient-reported outcome measures in upcoming treatment trials and treatment monitoring. These measures need to demonstrate sensitivity to capture change, in particular in the early stages of the disease. OBJECTIVE Our aim is to unravel gait measures sensitive to longitudinal change in the-particularly trial-relevant-early stage of spinocerebellar ataxia type 2 (SCA2). METHODS We performed a multicenter longitudinal study with combined cross-sectional and 1-year interval longitudinal analysis in early-stage SCA2 participants (n = 23, including nine pre-ataxic expansion carriers; median, ATXN2 CAG repeat expansion 38 ± 2; median, Scale for the Assessment and Rating of Ataxia [SARA] score 4.8 ± 4.3). Gait was assessed using three wearable motion sensors during a 2-minute walk, with analyses focused on gait measures of spatio-temporal variability that have shown sensitivity to ataxia severity (eg, lateral step deviation). RESULTS We found significant changes for gait measures between baseline and 1-year follow-up with large effect sizes (lateral step deviation P = 0.0001, effect size rprb = 0.78), whereas the SARA score showed no change (P = 0.67). Sample size estimation indicates a required cohort size of n = 43 to detect a 50% reduction in natural progression. Test-retest reliability and minimal detectable change analysis confirm the accuracy of detecting 50% of the identified 1-year change. CONCLUSIONS Gait measures assessed by wearable sensors can capture natural progression in early-stage SCA2 within just 1 year-in contrast to a clinical ataxia outcome. Lateral step deviation represents a promising outcome measure for upcoming multicenter interventional trials, particularly in the early stages of cerebellar ataxia. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Jens Seemann
- Section Computational Sensomotorics, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- Centre for Integrative Neuroscience (CIN), Tübingen, Germany
| | - Lina Daghsen
- Sorbonne Université, Paris Brain Institute-ICM, Inserm, CNRS, AP-HP, Paris, France
| | - Matthieu Cazier
- Sorbonne Université, Paris Brain Institute-ICM, Inserm, CNRS, AP-HP, Paris, France
| | - Jean-Charles Lamy
- Sorbonne Université, Paris Brain Institute-ICM, Inserm, CNRS, AP-HP, Paris, France
| | - Marie-Laure Welter
- Sorbonne Université, Paris Brain Institute-ICM, Inserm, CNRS, AP-HP, Paris, France
| | - Martin A Giese
- Section Computational Sensomotorics, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- Centre for Integrative Neuroscience (CIN), Tübingen, Germany
| | - Matthis Synofzik
- Division Translational Genomics of Neurodegenerative Diseases, Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Alexandra Durr
- Sorbonne Université, Paris Brain Institute-ICM, Inserm, CNRS, AP-HP, Paris, France
| | - Winfried Ilg
- Section Computational Sensomotorics, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- Centre for Integrative Neuroscience (CIN), Tübingen, Germany
| | - Giulia Coarelli
- Sorbonne Université, Paris Brain Institute-ICM, Inserm, CNRS, AP-HP, Paris, France
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2
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van Prooije T, Knuijt S, Oostveen J, Kapteijns K, Vogel AP, van de Warrenburg B. Perceptual and Acoustic Analysis of Speech in Spinocerebellar ataxia Type 1. CEREBELLUM (LONDON, ENGLAND) 2024; 23:112-120. [PMID: 36633828 PMCID: PMC10864471 DOI: 10.1007/s12311-023-01513-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/07/2023] [Indexed: 01/13/2023]
Abstract
This study characterizes the speech phenotype of spinocerebellar ataxia type 1 (SCA1) using both perceptual and objective acoustic analysis of speech in a cohort of SCA1 patients. Twenty-seven symptomatic SCA1 patients in various disease stages (SARA score range: 3-32 points) and 18 sex and age matched healthy controls underwent a clinical assessment addressing ataxia severity, non-ataxia signs, cognitive functioning, and speech. Speech samples were perceptually rated by trained speech therapists, and acoustic metrics representing speech timing, vocal control, and voice quality were extracted. Perceptual analysis revealed reduced intelligibility and naturalness in speech samples of SCA1 patients. Acoustically, SCA1 patients presented with slower speech rate and diadochokinetic rate as well as longer syllable duration compared to healthy controls. No distinct abnormalities in voice quality in the acoustic analysis were detected at group level. Both the affected perceptual and acoustic variables correlated with ataxia severity. Longitudinal assessment of speech is needed to place changes in speech in the context of disease progression and potential response to treatment.
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Affiliation(s)
- Teije van Prooije
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Simone Knuijt
- Department of Rehabilitation, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Judith Oostveen
- Department of Rehabilitation, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Kirsten Kapteijns
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Adam P Vogel
- Centre for Neuroscience of Speech, The University of Melbourne, Melbourne, Australia
- Translational Genomics of Neurodegenerative Diseases, Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen, Tubingen, Germany
- Redenlab Inc., Melbourne, Australia
| | - Bart van de Warrenburg
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands.
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3
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Suginoma H, Owada R, Katano-Toki A, Mori A, Fujioka J, Nakamura K. Non-fibril form but not fibril form of human islet amyloid polypeptide 8-20 changes brain functions in mice. PLoS One 2024; 19:e0296750. [PMID: 38181010 PMCID: PMC10769099 DOI: 10.1371/journal.pone.0296750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 12/19/2023] [Indexed: 01/07/2024] Open
Abstract
Whether fibril formation increases or decreases cytotoxicity remains unclear. Aggregation of human islet amyloid polypeptide (hIAPP), a pivotal regulator of glucose homeostasis, impairs the function and viability of pancreatic β cells. Evidence suggests that low-order oligomers of hIAPP are more toxic to β cells than fibril. However, it remains unclear whether non-fibril form of hIAPP specifically alters brain functions. This study produced fibril and non-fibril forms from a single hIAPP 8-20 peptide. The non-fibril form-injected mice showed changes in spontaneous motor activities, preference for location in the open field and social behavior. In contrast, the fibril-injected mice showed no changes in these behavioral tests. In line with the behavioral changes, the non-fibril form led to impaired neurite outgrowth of cultured neuron-like cells and the loss of neurons in the mouse hippocampus. These findings suggest that non-fibril form but not fibril form of hIAPP changes brain functions.
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Affiliation(s)
- Hinaho Suginoma
- Department of Laboratory Sciences, Gunma University Graduate School of Health Sciences, Maebashi, Gunma, Japan
| | - Ryuji Owada
- Department of Laboratory Sciences, Gunma University Graduate School of Health Sciences, Maebashi, Gunma, Japan
| | - Akiko Katano-Toki
- Department of Laboratory Sciences, Gunma University Graduate School of Health Sciences, Maebashi, Gunma, Japan
| | - Ayaka Mori
- Department of Laboratory Sciences, Gunma University Graduate School of Health Sciences, Maebashi, Gunma, Japan
| | - Jun Fujioka
- Department of Chemistry, Faculty of Science Division I, Tokyo University of Science, Shinjuku-ku, Tokyo, Japan
| | - Kazuhiro Nakamura
- Department of Laboratory Sciences, Gunma University Graduate School of Health Sciences, Maebashi, Gunma, Japan
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4
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Potashman MH, Mize ML, Beiner MW, Pierce S, Coric V, Schmahmann JD. Ataxia Rating Scales Reflect Patient Experience: an Examination of the Relationship Between Clinician Assessments of Cerebellar Ataxia and Patient-Reported Outcomes. CEREBELLUM (LONDON, ENGLAND) 2023; 22:1257-1273. [PMID: 36495470 PMCID: PMC10657309 DOI: 10.1007/s12311-022-01494-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/02/2022] [Indexed: 12/14/2022]
Abstract
Ataxia rating scales are observer administered clinical outcome assessments (COAs) of the cerebellar motor syndrome. It is not known whether these COAs mirror patient experience of their disease. Here we test the hypothesis that ataxia COAs are related to and reflect patient reported symptoms and impact of illness. A concept library of symptoms and activities impacted by ataxia was created by reviewing (a) concept elicitation data from surveys completed by 147 ataxia patients and 80 family members and (b) cognitive debrief data from focus groups of 17 ataxia patients used to develop the Patient Reported Outcome Measure of Ataxia. These findings were mapped across the items on 4 clinical measures of ataxia (SARA, BARS, ICARS and FARS). Symptoms reported most commonly related to balance, gait or walking, speech, tremor and involuntary movements, and vision impairment. Symptoms reported less frequently related to hand coordination, loss of muscle control, dizziness and vertigo, muscle discomfort or pain, swallowing, and incontinence. There was a mosaic mapping of items in the observer-derived ataxia COAs with the subjective reports by ataxia patients/families of the relevance of these items to their daily lives. Most COA item mapped onto multiple real-life manifestations; and most of the real-life impact of disease mapped onto multiple COA items. The 4 common ataxia COAs reflect patient reported symptoms and impact of illness. These results validate the relevance of the COAs to patients' lives and underscore the inadvisability of singling out any one COA item to represent the totality of the patient experience.
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Affiliation(s)
| | - Miranda L Mize
- Ataxia Center, Cognitive Behavioral Neurology Unit, Laboratory for Neuroanatomy and Cerebellar Neurobiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, 100 Cambridge Street, Suite 2000, Boston, MA, 02114, USA
| | | | - Samantha Pierce
- Ataxia Center, Cognitive Behavioral Neurology Unit, Laboratory for Neuroanatomy and Cerebellar Neurobiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Jeremy D Schmahmann
- Ataxia Center, Cognitive Behavioral Neurology Unit, Laboratory for Neuroanatomy and Cerebellar Neurobiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
- Department of Neurology, Massachusetts General Hospital, 100 Cambridge Street, Suite 2000, Boston, MA, 02114, USA.
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5
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Ilg W, Milne S, Schmitz-Hübsch T, Alcock L, Beichert L, Bertini E, Mohamed Ibrahim N, Dawes H, Gomez CM, Hanagasi H, Kinnunen KM, Minnerop M, Németh AH, Newman J, Ng YS, Rentz C, Samanci B, Shah VV, Summa S, Vasco G, McNames J, Horak FB. Quantitative Gait and Balance Outcomes for Ataxia Trials: Consensus Recommendations by the Ataxia Global Initiative Working Group on Digital-Motor Biomarkers. CEREBELLUM (LONDON, ENGLAND) 2023:10.1007/s12311-023-01625-2. [PMID: 37955812 DOI: 10.1007/s12311-023-01625-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/20/2023] [Indexed: 11/14/2023]
Abstract
With disease-modifying drugs on the horizon for degenerative ataxias, ecologically valid, finely granulated, digital health measures are highly warranted to augment clinical and patient-reported outcome measures. Gait and balance disturbances most often present as the first signs of degenerative cerebellar ataxia and are the most reported disabling features in disease progression. Thus, digital gait and balance measures constitute promising and relevant performance outcomes for clinical trials.This narrative review with embedded consensus will describe evidence for the sensitivity of digital gait and balance measures for evaluating ataxia severity and progression, propose a consensus protocol for establishing gait and balance metrics in natural history studies and clinical trials, and discuss relevant issues for their use as performance outcomes.
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Affiliation(s)
- Winfried Ilg
- Section Computational Sensomotorics, Hertie Institute for Clinical Brain Research, Otfried-Müller-Straße 25, 72076, Tübingen, Germany.
- Centre for Integrative Neuroscience (CIN), Tübingen, Germany.
| | - Sarah Milne
- Bruce Lefroy Centre for Genetic Health Research, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, Melbourne University, Melbourne, VIC, Australia
- Physiotherapy Department, Monash Health, Clayton, VIC, Australia
- School of Primary and Allied Health Care, Monash University, Frankston, VIC, Australia
| | - Tanja Schmitz-Hübsch
- Experimental and Clinical Research Center, a cooperation of Max-Delbrueck Center for Molecular Medicine and Charité, Universitätsmedizin Berlin, Berlin, Germany
- Neuroscience Clinical Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Lisa Alcock
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne, UK
| | - Lukas Beichert
- Department of Neurodegenerative Diseases and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Enrico Bertini
- Research Unit of Neuromuscular and Neurodegenerative Disorders, Bambino Gesu' Children's Research Hospital, IRCCS, Rome, Italy
| | | | - Helen Dawes
- NIHR Exeter BRC, College of Medicine and Health, University of Exeter, Exeter, UK
| | | | - Hasmet Hanagasi
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | | | - Martina Minnerop
- Institute of Neuroscience and Medicine (INM-1)), Research Centre Juelich, Juelich, Germany
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty & University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Department of Neurology, Center for Movement Disorders and Neuromodulation, Medical Faculty & University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Andrea H Németh
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Jane Newman
- NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne, UK
- Wellcome Centre for Mitochondrial Research, Newcastle University, Newcastle upon Tyne, UK
| | - Yi Shiau Ng
- Wellcome Centre for Mitochondrial Research, Newcastle University, Newcastle upon Tyne, UK
| | - Clara Rentz
- Institute of Neuroscience and Medicine (INM-1)), Research Centre Juelich, Juelich, Germany
| | - Bedia Samanci
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Vrutangkumar V Shah
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
- APDM Precision Motion, Clario, Portland, OR, USA
| | - Susanna Summa
- Movement Analysis and Robotics Laboratory (MARLab), Neurorehabilitation Unit, Neurological Science and Neurorehabilitation Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Gessica Vasco
- Movement Analysis and Robotics Laboratory (MARLab), Neurorehabilitation Unit, Neurological Science and Neurorehabilitation Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - James McNames
- APDM Precision Motion, Clario, Portland, OR, USA
- Department of Electrical and Computer Engineering, Portland State University, Portland, OR, USA
| | - Fay B Horak
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
- APDM Precision Motion, Clario, Portland, OR, USA
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6
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Elyoseph Z, Geisinger D, Zaltzman R, Hartman TG, Gordon CR, Mintz M. The overarching effects of vestibular deficit: Imbalance, anxiety, and spatial disorientation. J Neurol Sci 2023; 451:120723. [PMID: 37393737 DOI: 10.1016/j.jns.2023.120723] [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: 01/17/2023] [Revised: 06/19/2023] [Accepted: 06/24/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Comorbid Balance, Anxiety, and Spatial symptoms are observed in neurodevelopmental disorders and aging. Each of these symptoms was studied separately in association with vestibular hypofunction. We aimed to investigate whether such a diffuse range of symptoms has common vestibular pathophysiology. Specifically, we tested whether this Triad of dysfunctions is associated with central or peripheral vestibular hypofunction. We also assessed the possible contribution of semicircular canals (SCCs) vs. saccular function. METHODS We tested patients with Peripheral bilateral and unilateral Vestibular Hypofunction (PVH), Machado Joseph Disease (MJD) with cerebellar and central bilateral vestibular hypofunction, and healthy controls. SCCs and sacculi functioning were evaluated by the video Head Impulse Test (vHIT) and cervical Vestibular Evoked Myogenic Potentials (cVEMP), respectively. Balance was assessed by the Activities-specific Balance Confidence scale (ABC), anxiety by the Hamilton Anxiety Rating Scale (HAM-A), and spatial orientation by the Object Perspective Taking test (OPT-t). RESULTS PVH patients with vestibular SCCs and saccular hypofunction presented the Triad of symptoms, imbalance, anxiety, and spatial disorientation. MJD patients with SCCs-related vestibular hypofunction but preserved saccular-related vestibular function presented with a partial profile of imbalance and spatial disorientation. CONCLUSIONS The present study provides evidence that peripheral vestibular hypofunction is associated with the Triad of dysfunctions, i.e., imbalance, anxiety, and spatial disorientation. The combination of SCCs and saccular hypofunction seems to contribute to the emergence of the Triad of symptoms.
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Affiliation(s)
- Zohar Elyoseph
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel; The Center for Psychobiological Research, Department of Educational Psychology and Educational Counseling, Max Stern Yezreel Valley College, Jezreel Valley, Israel.
| | - Dario Geisinger
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roy Zaltzman
- Department of Neurology, Meir Medical Center, Kfar Saba, Israel
| | - Tamar G Hartman
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Carlos R Gordon
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Neurology, Meir Medical Center, Kfar Saba, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Matti Mintz
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
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7
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Tezenas du Montcel S, Petit E, Olubajo T, Faber J, Lallemant-Dudek P, Bushara K, Perlman S, Subramony SH, Morgan D, Jackman B, Figueroa KP, Pulst SM, Fauret-Amsellem AL, Dufke C, Paulson HL, Öz G, Klockgether T, Durr A, Ashizawa T. Baseline Clinical and Blood Biomarkers in Patients With Preataxic and Early-Stage Disease Spinocerebellar Ataxia 1 and 3. Neurology 2023; 100:e1836-e1848. [PMID: 36797067 PMCID: PMC10136009 DOI: 10.1212/wnl.0000000000207088] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 01/06/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND AND OBJECTIVES In spinocerebellar ataxia, ataxia onset can be preceded by mild clinical manifestation, cerebellar and/or brainstem alterations, or biomarker modifications. READISCA is a prospective, longitudinal observational study of patients with spinocerebellar ataxia type 1 (SCA1) and 3 (SCA3) to provide essential markers for therapeutic interventions. We looked for clinical, imaging, or biological markers that are present at an early stage of the disease. METHODS We enrolled carriers of a pathologic ATXN1 or ATXN3 expansion and controls from 18 US and 2 European ataxia referral centers. Clinical, cognitive, quantitative motor, neuropsychological measures and plasma neurofilament light chain (NfL) measurements were compared between expansion carriers with and without ataxia and controls. RESULTS We enrolled 200 participants: 45 carriers of a pathologic ATXN1 expansion (31 patients with ataxia [median Scale for the Assessment and Rating of Ataxia: 9; 7-10] and 14 expansion carriers without ataxia [1; 0-2]) and 116 carriers of a pathologic ATXN3 expansion (80 patients with ataxia [7; 6-9] and 36 expansion carriers without ataxia [1; 0-2]). In addition, we enrolled 39 controls who did not carry a pathologic expansion in ATXN1 or ATXN3. Plasma NfL levels were significantly higher in expansion carriers without ataxia than controls, despite similar mean age (controls: 5.7 pg/mL, SCA1: 18.0 pg/mL [p < 0.0001], SCA3: 19.8 pg/mL [p < 0.0001]). Expansion carriers without ataxia differed from controls by significantly more upper motor signs (SCA1 p = 0.0003, SCA3 p = 0.003) and by the presence of sensor impairment and diplopia in SCA3 (p = 0.0448 and 0.0445, respectively). Functional scales, fatigue and depression scores, swallowing difficulties, and cognitive impairment were worse in expansion carriers with ataxia than those without ataxia. Ataxic SCA3 participants showed extrapyramidal signs, urinary dysfunction, and lower motor neuron signs significantly more often than expansion carriers without ataxia. DISCUSSION READISCA showed the feasibility of harmonized data acquisition in a multinational network. NfL alterations, early sensory ataxia, and corticospinal signs were quantifiable between preataxic participants and controls. Patients with ataxia differed in many parameters from controls and expansion carriers without ataxia, with a graded increase of abnormal measures from control to preataxic to ataxic cohorts. TRIAL REGISTRATION INFORMATION ClinicalTrials.gov NCT03487367.
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Affiliation(s)
- Sophie Tezenas du Montcel
- From the Sorbonne Universite (S.T.d.M., E.P., P.L.-D., A.D.), Paris Brain Institute, Inserm, INRIA, CNRS, APHP, France; The Houston Methodist Research Institute (T.O., T.A.), TX; Department of Neurology (J.F., T.K.), University Hospital of Bonn; German Center for Neurodegenerative Diseases (DZNE) (J.F., T.K.), Bonn, Germany; Department of Neurology (K.B.), University of Minnesota, Minneapolis; University of California, Los Angeles (S.P.); Norman Fixel Center for Neurological Disorders (S.H.S.), College of Medicine, University of Florida, Gainesville; Department of Translational Neuroscience (D.M., B.J.), Michigan State University, Grand Rapids; Department of Neurology (H.L.P.), University of Michigan, Ann Arbor; and Center for Magnetic Resonance Research (G.Ö.), Department of Radiology, University of Minnesota, Minneapolis.
| | - Emilien Petit
- From the Sorbonne Universite (S.T.d.M., E.P., P.L.-D., A.D.), Paris Brain Institute, Inserm, INRIA, CNRS, APHP, France; The Houston Methodist Research Institute (T.O., T.A.), TX; Department of Neurology (J.F., T.K.), University Hospital of Bonn; German Center for Neurodegenerative Diseases (DZNE) (J.F., T.K.), Bonn, Germany; Department of Neurology (K.B.), University of Minnesota, Minneapolis; University of California, Los Angeles (S.P.); Norman Fixel Center for Neurological Disorders (S.H.S.), College of Medicine, University of Florida, Gainesville; Department of Translational Neuroscience (D.M., B.J.), Michigan State University, Grand Rapids; Department of Neurology (H.L.P.), University of Michigan, Ann Arbor; and Center for Magnetic Resonance Research (G.Ö.), Department of Radiology, University of Minnesota, Minneapolis
| | - Titilayo Olubajo
- From the Sorbonne Universite (S.T.d.M., E.P., P.L.-D., A.D.), Paris Brain Institute, Inserm, INRIA, CNRS, APHP, France; The Houston Methodist Research Institute (T.O., T.A.), TX; Department of Neurology (J.F., T.K.), University Hospital of Bonn; German Center for Neurodegenerative Diseases (DZNE) (J.F., T.K.), Bonn, Germany; Department of Neurology (K.B.), University of Minnesota, Minneapolis; University of California, Los Angeles (S.P.); Norman Fixel Center for Neurological Disorders (S.H.S.), College of Medicine, University of Florida, Gainesville; Department of Translational Neuroscience (D.M., B.J.), Michigan State University, Grand Rapids; Department of Neurology (H.L.P.), University of Michigan, Ann Arbor; and Center for Magnetic Resonance Research (G.Ö.), Department of Radiology, University of Minnesota, Minneapolis
| | - Jennifer Faber
- From the Sorbonne Universite (S.T.d.M., E.P., P.L.-D., A.D.), Paris Brain Institute, Inserm, INRIA, CNRS, APHP, France; The Houston Methodist Research Institute (T.O., T.A.), TX; Department of Neurology (J.F., T.K.), University Hospital of Bonn; German Center for Neurodegenerative Diseases (DZNE) (J.F., T.K.), Bonn, Germany; Department of Neurology (K.B.), University of Minnesota, Minneapolis; University of California, Los Angeles (S.P.); Norman Fixel Center for Neurological Disorders (S.H.S.), College of Medicine, University of Florida, Gainesville; Department of Translational Neuroscience (D.M., B.J.), Michigan State University, Grand Rapids; Department of Neurology (H.L.P.), University of Michigan, Ann Arbor; and Center for Magnetic Resonance Research (G.Ö.), Department of Radiology, University of Minnesota, Minneapolis
| | - Pauline Lallemant-Dudek
- From the Sorbonne Universite (S.T.d.M., E.P., P.L.-D., A.D.), Paris Brain Institute, Inserm, INRIA, CNRS, APHP, France; The Houston Methodist Research Institute (T.O., T.A.), TX; Department of Neurology (J.F., T.K.), University Hospital of Bonn; German Center for Neurodegenerative Diseases (DZNE) (J.F., T.K.), Bonn, Germany; Department of Neurology (K.B.), University of Minnesota, Minneapolis; University of California, Los Angeles (S.P.); Norman Fixel Center for Neurological Disorders (S.H.S.), College of Medicine, University of Florida, Gainesville; Department of Translational Neuroscience (D.M., B.J.), Michigan State University, Grand Rapids; Department of Neurology (H.L.P.), University of Michigan, Ann Arbor; and Center for Magnetic Resonance Research (G.Ö.), Department of Radiology, University of Minnesota, Minneapolis
| | - Khalaf Bushara
- From the Sorbonne Universite (S.T.d.M., E.P., P.L.-D., A.D.), Paris Brain Institute, Inserm, INRIA, CNRS, APHP, France; The Houston Methodist Research Institute (T.O., T.A.), TX; Department of Neurology (J.F., T.K.), University Hospital of Bonn; German Center for Neurodegenerative Diseases (DZNE) (J.F., T.K.), Bonn, Germany; Department of Neurology (K.B.), University of Minnesota, Minneapolis; University of California, Los Angeles (S.P.); Norman Fixel Center for Neurological Disorders (S.H.S.), College of Medicine, University of Florida, Gainesville; Department of Translational Neuroscience (D.M., B.J.), Michigan State University, Grand Rapids; Department of Neurology (H.L.P.), University of Michigan, Ann Arbor; and Center for Magnetic Resonance Research (G.Ö.), Department of Radiology, University of Minnesota, Minneapolis
| | - Susan Perlman
- From the Sorbonne Universite (S.T.d.M., E.P., P.L.-D., A.D.), Paris Brain Institute, Inserm, INRIA, CNRS, APHP, France; The Houston Methodist Research Institute (T.O., T.A.), TX; Department of Neurology (J.F., T.K.), University Hospital of Bonn; German Center for Neurodegenerative Diseases (DZNE) (J.F., T.K.), Bonn, Germany; Department of Neurology (K.B.), University of Minnesota, Minneapolis; University of California, Los Angeles (S.P.); Norman Fixel Center for Neurological Disorders (S.H.S.), College of Medicine, University of Florida, Gainesville; Department of Translational Neuroscience (D.M., B.J.), Michigan State University, Grand Rapids; Department of Neurology (H.L.P.), University of Michigan, Ann Arbor; and Center for Magnetic Resonance Research (G.Ö.), Department of Radiology, University of Minnesota, Minneapolis
| | - Sub H Subramony
- From the Sorbonne Universite (S.T.d.M., E.P., P.L.-D., A.D.), Paris Brain Institute, Inserm, INRIA, CNRS, APHP, France; The Houston Methodist Research Institute (T.O., T.A.), TX; Department of Neurology (J.F., T.K.), University Hospital of Bonn; German Center for Neurodegenerative Diseases (DZNE) (J.F., T.K.), Bonn, Germany; Department of Neurology (K.B.), University of Minnesota, Minneapolis; University of California, Los Angeles (S.P.); Norman Fixel Center for Neurological Disorders (S.H.S.), College of Medicine, University of Florida, Gainesville; Department of Translational Neuroscience (D.M., B.J.), Michigan State University, Grand Rapids; Department of Neurology (H.L.P.), University of Michigan, Ann Arbor; and Center for Magnetic Resonance Research (G.Ö.), Department of Radiology, University of Minnesota, Minneapolis
| | - David Morgan
- From the Sorbonne Universite (S.T.d.M., E.P., P.L.-D., A.D.), Paris Brain Institute, Inserm, INRIA, CNRS, APHP, France; The Houston Methodist Research Institute (T.O., T.A.), TX; Department of Neurology (J.F., T.K.), University Hospital of Bonn; German Center for Neurodegenerative Diseases (DZNE) (J.F., T.K.), Bonn, Germany; Department of Neurology (K.B.), University of Minnesota, Minneapolis; University of California, Los Angeles (S.P.); Norman Fixel Center for Neurological Disorders (S.H.S.), College of Medicine, University of Florida, Gainesville; Department of Translational Neuroscience (D.M., B.J.), Michigan State University, Grand Rapids; Department of Neurology (H.L.P.), University of Michigan, Ann Arbor; and Center for Magnetic Resonance Research (G.Ö.), Department of Radiology, University of Minnesota, Minneapolis
| | - Brianna Jackman
- From the Sorbonne Universite (S.T.d.M., E.P., P.L.-D., A.D.), Paris Brain Institute, Inserm, INRIA, CNRS, APHP, France; The Houston Methodist Research Institute (T.O., T.A.), TX; Department of Neurology (J.F., T.K.), University Hospital of Bonn; German Center for Neurodegenerative Diseases (DZNE) (J.F., T.K.), Bonn, Germany; Department of Neurology (K.B.), University of Minnesota, Minneapolis; University of California, Los Angeles (S.P.); Norman Fixel Center for Neurological Disorders (S.H.S.), College of Medicine, University of Florida, Gainesville; Department of Translational Neuroscience (D.M., B.J.), Michigan State University, Grand Rapids; Department of Neurology (H.L.P.), University of Michigan, Ann Arbor; and Center for Magnetic Resonance Research (G.Ö.), Department of Radiology, University of Minnesota, Minneapolis
| | | | | | | | | | - Henry Lauris Paulson
- From the Sorbonne Universite (S.T.d.M., E.P., P.L.-D., A.D.), Paris Brain Institute, Inserm, INRIA, CNRS, APHP, France; The Houston Methodist Research Institute (T.O., T.A.), TX; Department of Neurology (J.F., T.K.), University Hospital of Bonn; German Center for Neurodegenerative Diseases (DZNE) (J.F., T.K.), Bonn, Germany; Department of Neurology (K.B.), University of Minnesota, Minneapolis; University of California, Los Angeles (S.P.); Norman Fixel Center for Neurological Disorders (S.H.S.), College of Medicine, University of Florida, Gainesville; Department of Translational Neuroscience (D.M., B.J.), Michigan State University, Grand Rapids; Department of Neurology (H.L.P.), University of Michigan, Ann Arbor; and Center for Magnetic Resonance Research (G.Ö.), Department of Radiology, University of Minnesota, Minneapolis
| | - Gülin Öz
- From the Sorbonne Universite (S.T.d.M., E.P., P.L.-D., A.D.), Paris Brain Institute, Inserm, INRIA, CNRS, APHP, France; The Houston Methodist Research Institute (T.O., T.A.), TX; Department of Neurology (J.F., T.K.), University Hospital of Bonn; German Center for Neurodegenerative Diseases (DZNE) (J.F., T.K.), Bonn, Germany; Department of Neurology (K.B.), University of Minnesota, Minneapolis; University of California, Los Angeles (S.P.); Norman Fixel Center for Neurological Disorders (S.H.S.), College of Medicine, University of Florida, Gainesville; Department of Translational Neuroscience (D.M., B.J.), Michigan State University, Grand Rapids; Department of Neurology (H.L.P.), University of Michigan, Ann Arbor; and Center for Magnetic Resonance Research (G.Ö.), Department of Radiology, University of Minnesota, Minneapolis
| | - Thomas Klockgether
- From the Sorbonne Universite (S.T.d.M., E.P., P.L.-D., A.D.), Paris Brain Institute, Inserm, INRIA, CNRS, APHP, France; The Houston Methodist Research Institute (T.O., T.A.), TX; Department of Neurology (J.F., T.K.), University Hospital of Bonn; German Center for Neurodegenerative Diseases (DZNE) (J.F., T.K.), Bonn, Germany; Department of Neurology (K.B.), University of Minnesota, Minneapolis; University of California, Los Angeles (S.P.); Norman Fixel Center for Neurological Disorders (S.H.S.), College of Medicine, University of Florida, Gainesville; Department of Translational Neuroscience (D.M., B.J.), Michigan State University, Grand Rapids; Department of Neurology (H.L.P.), University of Michigan, Ann Arbor; and Center for Magnetic Resonance Research (G.Ö.), Department of Radiology, University of Minnesota, Minneapolis
| | - Alexandra Durr
- From the Sorbonne Universite (S.T.d.M., E.P., P.L.-D., A.D.), Paris Brain Institute, Inserm, INRIA, CNRS, APHP, France; The Houston Methodist Research Institute (T.O., T.A.), TX; Department of Neurology (J.F., T.K.), University Hospital of Bonn; German Center for Neurodegenerative Diseases (DZNE) (J.F., T.K.), Bonn, Germany; Department of Neurology (K.B.), University of Minnesota, Minneapolis; University of California, Los Angeles (S.P.); Norman Fixel Center for Neurological Disorders (S.H.S.), College of Medicine, University of Florida, Gainesville; Department of Translational Neuroscience (D.M., B.J.), Michigan State University, Grand Rapids; Department of Neurology (H.L.P.), University of Michigan, Ann Arbor; and Center for Magnetic Resonance Research (G.Ö.), Department of Radiology, University of Minnesota, Minneapolis
| | - Tetsuo Ashizawa
- From the Sorbonne Universite (S.T.d.M., E.P., P.L.-D., A.D.), Paris Brain Institute, Inserm, INRIA, CNRS, APHP, France; The Houston Methodist Research Institute (T.O., T.A.), TX; Department of Neurology (J.F., T.K.), University Hospital of Bonn; German Center for Neurodegenerative Diseases (DZNE) (J.F., T.K.), Bonn, Germany; Department of Neurology (K.B.), University of Minnesota, Minneapolis; University of California, Los Angeles (S.P.); Norman Fixel Center for Neurological Disorders (S.H.S.), College of Medicine, University of Florida, Gainesville; Department of Translational Neuroscience (D.M., B.J.), Michigan State University, Grand Rapids; Department of Neurology (H.L.P.), University of Michigan, Ann Arbor; and Center for Magnetic Resonance Research (G.Ö.), Department of Radiology, University of Minnesota, Minneapolis
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8
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Lin CYR, Kuo SH. Ataxias: Hereditary, Acquired, and Reversible Etiologies. Semin Neurol 2023; 43:48-64. [PMID: 36828010 DOI: 10.1055/s-0043-1763511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
A variety of etiologies can cause cerebellar dysfunction, leading to ataxia symptoms. Therefore, the accurate diagnosis of the cause for cerebellar ataxia can be challenging. A step-wise investigation will reveal underlying causes, including nutritional, toxin, immune-mediated, genetic, and degenerative disorders. Recent advances in genetics have identified new genes for both autosomal dominant and autosomal recessive ataxias, and new therapies are on the horizon for targeting specific biological pathways. New diagnostic criteria for degenerative ataxias have been proposed, specifically for multiple system atrophy, which will have a broad impact on the future clinical research in ataxia. In this article, we aim to provide a review focus on symptoms, laboratory testing, neuroimaging, and genetic testing for the diagnosis of cerebellar ataxia causes, with a special emphasis on recent advances. Strategies for the management of cerebellar ataxia is also discussed.
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Affiliation(s)
- Chi-Ying R Lin
- Department of Neurology, Parkinson's Disease Center and Movement Disorders Clinic, Baylor College of Medicine, Houston, Texas.,Department of Neurology, Alzheimer's Disease and Memory Disorders Center, Baylor College of Medicine, Houston, Texas
| | - Sheng-Han Kuo
- Department of Neurology, College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York.,Initiative for Columbia Ataxia and Tremor, Columbia University Irving Medical Center, New York, New York
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9
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Ataxia in Neurometabolic Disorders. Metabolites 2022; 13:metabo13010047. [PMID: 36676973 PMCID: PMC9866741 DOI: 10.3390/metabo13010047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/19/2022] [Accepted: 12/19/2022] [Indexed: 12/29/2022] Open
Abstract
Ataxia is a movement disorder that manifests during the execution of purposeful movements. It results from damage to the structures of the cerebellum and its connections or the posterior cords of the spinal cord. It should be noted that, in addition to occurring as part of many diseases, pediatric ataxia is a common symptom in neurometabolic diseases. To date, there are more than 150 inherited metabolic disorders that can manifest as ataxia in children. Neuroimaging studies (magnetic resonance imaging of the head and spinal cord) are essential in the diagnosis of ataxia, and genetic studies are performed when metabolic diseases are suspected. It is important to remember that most of these disorders are progressive if left untreated. Therefore, it is crucial to include neurometabolic disorders in the differential diagnosis of ataxia, so that an early diagnosis can be made. Initiating prompt treatment influences positive neurodevelopmental outcomes.
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10
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Luttik K, Olmos V, Owens A, Khan A, Yun J, Driessen T, Lim J. Identifying Disease Signatures in the Spinocerebellar Ataxia Type 1 Mouse Cortex. Cells 2022; 11:2632. [PMID: 36078042 PMCID: PMC9454518 DOI: 10.3390/cells11172632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/18/2022] [Accepted: 08/23/2022] [Indexed: 11/16/2022] Open
Abstract
The neurodegenerative disease spinocerebellar ataxia type 1 (SCA1) is known to lead to the progressive degeneration of specific neuronal populations, including cerebellar Purkinje cells (PCs), brainstem cranial nerve nuclei and inferior olive nuclei, and spinocerebellar tracts. The disease-causing protein ataxin-1 is fairly ubiquitously expressed throughout the brain and spinal cord, but most studies have primarily focused on the role of ataxin-1 in the cerebellum and brainstem. Therefore, the functions of ataxin-1 and the effects of SCA1 mutations in other brain regions including the cortex are not well-known. Here, we characterized pathology in the motor cortex of a SCA1 mouse model and performed RNA sequencing in this brain region to investigate the impact of mutant ataxin-1 towards transcriptomic alterations. We identified progressive cortical pathology and significant transcriptomic changes in the motor cortex of a SCA1 mouse model. We also identified progressive, region-specific, colocalization of p62 protein with mutant ataxin-1 aggregates in broad brain regions, but not the cerebellum or brainstem. A cross-regional comparison of the SCA1 cortical and cerebellar transcriptomic changes identified both common and unique gene expression changes between the two regions, including shared synaptic dysfunction and region-specific kinase regulation. These findings suggest that the cortex is progressively impacted via both shared and region-specific mechanisms in SCA1.
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Affiliation(s)
- Kimberly Luttik
- Interdepartmental Neuroscience Program, Yale School of Medicine, New Haven, CT 06510, USA
- Department of Neuroscience, Yale School of Medicine, New Haven, CT 06510, USA
| | - Victor Olmos
- Department of Genetics, Yale School of Medicine, New Haven, CT 06510, USA
| | - Ashley Owens
- Interdepartmental Neuroscience Program, Yale School of Medicine, New Haven, CT 06510, USA
- Department of Neuroscience, Yale School of Medicine, New Haven, CT 06510, USA
| | | | - Joy Yun
- Yale College, New Haven, CT 06510, USA
| | - Terri Driessen
- Department of Genetics, Yale School of Medicine, New Haven, CT 06510, USA
| | - Janghoo Lim
- Interdepartmental Neuroscience Program, Yale School of Medicine, New Haven, CT 06510, USA
- Department of Neuroscience, Yale School of Medicine, New Haven, CT 06510, USA
- Department of Genetics, Yale School of Medicine, New Haven, CT 06510, USA
- Program in Cellular Neuroscience, Neurodegeneration and Repair, Yale School of Medicine, New Haven, CT 06510, USA
- Yale Stem Cell Center, Yale School of Medicine, New Haven, CT 06510, USA
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11
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Radmard S, Zesiewicz TA, Kuo SH. Evaluation of Cerebellar Ataxic Patients. Neurol Clin 2022; 41:21-44. [DOI: 10.1016/j.ncl.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Olmos V, Gogia N, Luttik K, Haidery F, Lim J. The extra-cerebellar effects of spinocerebellar ataxia type 1 (SCA1): looking beyond the cerebellum. Cell Mol Life Sci 2022; 79:404. [PMID: 35802260 PMCID: PMC9993484 DOI: 10.1007/s00018-022-04419-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/07/2022] [Accepted: 06/08/2022] [Indexed: 12/28/2022]
Abstract
Spinocerebellar ataxia type 1 (SCA1) is one of nine polyglutamine (polyQ) diseases and is characterized as an adult late-onset, progressive, dominantly inherited genetic disease. SCA1 is caused by an increase in the number of CAG repeats in the ATXN1 gene leading to an expanded polyQ tract in the ATAXIN-1 protein. ATAXIN-1 is broadly expressed throughout the brain. However, until recently, SCA1 research has primarily centered on the cerebellum, given the characteristic cerebellar Purkinje cell loss observed in patients, as well as the progressive motor deficits, including gait and limb incoordination, that SCA1 patients present with. There are, however, also other symptoms such as respiratory problems, cognitive defects and memory impairment, anxiety, and depression observed in SCA1 patients and mouse models, which indicate that there are extra-cerebellar effects of SCA1 that cannot be explained solely through changes in the cerebellar region of the brain alone. The existing gap between human and mouse model studies of extra-cerebellar regions in SCA1 makes it difficult to answer many important questions in the field. This review will cover both the cerebellar and extra-cerebellar effects of SCA1 and highlight the need for further investigations into the impact of mutant ATXN1 expression in these regions. This review will also discuss implications of extra-cerebellar effects not only for SCA1 but other neurodegenerative diseases showing diverse pathology as well.
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Affiliation(s)
- Victor Olmos
- Department of Genetics, Yale School of Medicine, 295 Congress Avenue, BCMM 154E, New Haven, CT, 06510, USA
| | - Neha Gogia
- Department of Genetics, Yale School of Medicine, 295 Congress Avenue, BCMM 154E, New Haven, CT, 06510, USA
| | - Kimberly Luttik
- Interdepartmental Neuroscience Program, Yale School of Medicine, 295 Congress Avenue, BCMM 154E, New Haven, CT, 06510, USA
- Department of Neuroscience, Yale School of Medicine, 295 Congress Avenue, BCMM 154E, New Haven, CT, 06510, USA
| | | | - Janghoo Lim
- Department of Genetics, Yale School of Medicine, 295 Congress Avenue, BCMM 154E, New Haven, CT, 06510, USA.
- Interdepartmental Neuroscience Program, Yale School of Medicine, 295 Congress Avenue, BCMM 154E, New Haven, CT, 06510, USA.
- Department of Neuroscience, Yale School of Medicine, 295 Congress Avenue, BCMM 154E, New Haven, CT, 06510, USA.
- Program in Cellular Neuroscience, Neurodegeneration and Repair, Yale School of Medicine, 295 Congress Avenue, BCMM 154E, New Haven, CT, 06510, USA.
- Yale Stem Cell Center, Yale School of Medicine, 295 Congress Avenue, BCMM 154E, New Haven, CT, 06510, USA.
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13
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Altered retinal structure and function in Spinocerebellar ataxia type 3. Neurobiol Dis 2022; 170:105774. [DOI: 10.1016/j.nbd.2022.105774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 01/13/2023] Open
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14
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Cabaraux P, Agrawal SK, Cai H, Calabro RS, Casali C, Damm L, Doss S, Habas C, Horn AKE, Ilg W, Louis ED, Mitoma H, Monaco V, Petracca M, Ranavolo A, Rao AK, Ruggieri S, Schirinzi T, Serrao M, Summa S, Strupp M, Surgent O, Synofzik M, Tao S, Terasi H, Torres-Russotto D, Travers B, Roper JA, Manto M. Consensus Paper: Ataxic Gait. CEREBELLUM (LONDON, ENGLAND) 2022; 22:394-430. [PMID: 35414041 DOI: 10.1007/s12311-022-01373-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/20/2022] [Indexed: 12/19/2022]
Abstract
The aim of this consensus paper is to discuss the roles of the cerebellum in human gait, as well as its assessment and therapy. Cerebellar vermis is critical for postural control. The cerebellum ensures the mapping of sensory information into temporally relevant motor commands. Mental imagery of gait involves intrinsically connected fronto-parietal networks comprising the cerebellum. Muscular activities in cerebellar patients show impaired timing of discharges, affecting the patterning of the synergies subserving locomotion. Ataxia of stance/gait is amongst the first cerebellar deficits in cerebellar disorders such as degenerative ataxias and is a disabling symptom with a high risk of falls. Prolonged discharges and increased muscle coactivation may be related to compensatory mechanisms and enhanced body sway, respectively. Essential tremor is frequently associated with mild gait ataxia. There is growing evidence for an important role of the cerebellar cortex in the pathogenesis of essential tremor. In multiple sclerosis, balance and gait are affected due to cerebellar and spinal cord involvement, as a result of disseminated demyelination and neurodegeneration impairing proprioception. In orthostatic tremor, patients often show mild-to-moderate limb and gait ataxia. The tremor generator is likely located in the posterior fossa. Tandem gait is impaired in the early stages of cerebellar disorders and may be particularly useful in the evaluation of pre-ataxic stages of progressive ataxias. Impaired inter-joint coordination and enhanced variability of gait temporal and kinetic parameters can be grasped by wearable devices such as accelerometers. Kinect is a promising low cost technology to obtain reliable measurements and remote assessments of gait. Deep learning methods are being developed in order to help clinicians in the diagnosis and decision-making process. Locomotor adaptation is impaired in cerebellar patients. Coordinative training aims to improve the coordinative strategy and foot placements across strides, cerebellar patients benefiting from intense rehabilitation therapies. Robotic training is a promising approach to complement conventional rehabilitation and neuromodulation of the cerebellum. Wearable dynamic orthoses represent a potential aid to assist gait. The panel of experts agree that the understanding of the cerebellar contribution to gait control will lead to a better management of cerebellar ataxias in general and will likely contribute to use gait parameters as robust biomarkers of future clinical trials.
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Affiliation(s)
- Pierre Cabaraux
- Unité Des Ataxies Cérébelleuses, Department of Neurology, CHU de Charleroi, Charleroi, Belgium.
| | | | - Huaying Cai
- Department of Neurology, Neuroscience Center, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, China
| | | | - Carlo Casali
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome Sapienza, Latina, Italy
| | - Loic Damm
- EuroMov Digital Health in Motion, Univ Montpellier, IMT Mines Ales, Montpellier, France
| | - Sarah Doss
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, USA
| | - Christophe Habas
- Université Versailles Saint-Quentin, Versailles, France.,Service de NeuroImagerie, Centre Hospitalier National des 15-20, Paris, France
| | - Anja K E Horn
- Institute of Anatomy and Cell Biology I, Ludwig Maximilians-University Munich, Munich, Germany
| | - Winfried Ilg
- Section Computational Sensomotorics, Hertie Institute for Clinical Brain Research, University Tübingen, Tübingen, Germany
| | - Elan D Louis
- Department of Neurology, University of Texas Southwestern, Dallas, TX, USA
| | - Hiroshi Mitoma
- Department of Medical Education, Tokyo Medical University, Tokyo, Japan
| | - Vito Monaco
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Maria Petracca
- Department of Human Neurosciences, University of Rome Sapienza, Rome, Italy
| | - Alberto Ranavolo
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone, Rome, Italy
| | - Ashwini K Rao
- Department of Rehabilitation & Regenerative Medicine (Programs in Physical Therapy), Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Serena Ruggieri
- Department of Human Neurosciences, University of Rome Sapienza, Rome, Italy.,Neuroimmunology Unit, IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Tommaso Schirinzi
- Department of Systems Medicine, University of Roma Tor Vergata, Rome, Italy
| | - Mariano Serrao
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome Sapienza, Latina, Italy.,Movement Analysis LAB, Policlinico Italia, Rome, Italy
| | - Susanna Summa
- MARlab, Neuroscience and Neurorehabilitation Department, Bambino Gesù Children's Hospital - IRCCS, Rome, Italy
| | - Michael Strupp
- Department of Neurology and German Center for Vertigo and Balance Disorders, Hospital of the Ludwig Maximilians-University Munich, Munich, Germany
| | - Olivia Surgent
- Neuroscience Training Program and Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Matthis Synofzik
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research and Centre of Neurology, Tübingen, Germany
| | - Shuai Tao
- Dalian Key Laboratory of Smart Medical and Health, Dalian University, Dalian, 116622, China
| | - Hiroo Terasi
- Department of Neurology, Tokyo Medical University, Tokyo, Japan
| | - Diego Torres-Russotto
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, USA
| | - Brittany Travers
- Department of Kinesiology and Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Jaimie A Roper
- School of Kinesiology, Auburn University, Auburn, AL, USA
| | - Mario Manto
- Unité Des Ataxies Cérébelleuses, Department of Neurology, CHU de Charleroi, Charleroi, Belgium.,Service Des Neurosciences, University of Mons, UMons, Mons, Belgium
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15
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Liu XH, Wang ZY, Li Y, Xu HL, Sikandar A, Ni J, Gan SR. Impaired Lower Limb Proprioception in Spinocerebellar Ataxia Type 3 and Its Affected Factors. Front Neurol 2022; 13:833908. [PMID: 35185776 PMCID: PMC8847775 DOI: 10.3389/fneur.2022.833908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 01/11/2022] [Indexed: 11/21/2022] Open
Abstract
Background Spinocerebellar ataxia type 3 (SCA3) is one of the most common hereditary neurodegenerative diseases. Postural control dysfunction is the main symptom of SCA3, and the proprioceptive system is a critical sensory component of postural control. Accordingly, proprioception quantification assessment is necessary in monitoring the progression of SCA3. Objective We aimed to quantitatively assess lower limb proprioception and investigate the relationship between proprioception and clinical characteristics in patients with SCA3. Methods A total of 80 patients with SCA3 and 62 health controls were recruited, and their lower limb proprioception was measured using the Pro-kin system. Clinical characteristics of the SCA3 patients were collected. Multivariable linear regression was used to investigate potential affected factors for lower limb proprioception. Results We found that the patients with SCA3 experience poorer lower limb proprioception characterized by significant impairment in the average trace error (ATE) and time to carry out the test time execution (TTE) compared to controls (P < 0.05). Moreover, there were significant differences in TTE between the right and left lower limbs (P < 0.05) of the patients. Regression analyses revealed that increasing age at onset (AAO) predicts poorer lower limb proprioception for both ATE (β = 2.006, P = 0.027) and TTE (β = 1.712, P = 0.043) and increasing disease duration predicts poorer lower limb proprioception for ATE (β = 0.874, P = 0.044). AAO (β = 0.328, P = 0.019) along with the expanded alleles (β = 0.565, P = 0.000) could affect the severity of ataxia. By contrast, ATE (β = 0.036, P = 0.800) and TTE (β = −0.025, P = 0.862) showed no significant predictors. Conclusions Lower limb proprioception in patients with SCA3 is significantly impaired when compared to healthy controls. Increasing AAO and disease duration are related to impaired lower limb proprioception.
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Affiliation(s)
- Xia-Hua Liu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Zhi-Yong Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- *Correspondence: Zhi-Yong Wang
| | - Ying Li
- The Third Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Hao-Ling Xu
- Department of Neurology, Institute of Neurology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Arif Sikandar
- Department of Neurology, Institute of Neurology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Jun Ni
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Shi-Rui Gan
- Department of Neurology, Institute of Neurology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
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16
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Zonta MB, Teive HAG, Camargo CHF, Meira AT, Lopes Neto FDN, Tensini FS, Braga CB, Ashizawa T, Munhoz RP. Comparing loss of balance and functional capacity among patients with SCA2, SCA3 and SCA10. Clin Neurol Neurosurg 2022; 214:107150. [PMID: 35123369 DOI: 10.1016/j.clineuro.2022.107150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/19/2022] [Accepted: 01/21/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Spinocerebellar ataxia (SCA) presents different rates of functional decline depending on the type of ataxia. OBJECTIVE To compare the progression of disability, imbalance and severity of ataxia in patients with the three most common types of SCA in southern Brazil. METHODS 126 patients (31-SCA2, 58-SCA3 and 37-SCA10) were stratified into four groups based on disease duration. Progression rates were calculated in each group for ataxia severity (SARA), functioning (FIM-ADL and Lawton-IADL), and balance (Berg Balance Scale). RESULTS Differences across groups in terms of disease severity revealed a linear pattern of decline in SCA3, with a faster rate over time (p = 0.039) compared to SCA2 and SCA10. The pattern was nonlinear for SCA2 and SCA10, with a twofold faster rate in patients with up to seven years of disease compared to all other periods in SCA10 (p < 0.001) and to the longer follow up period in SCA2 (p = 0.049). Differences across groups regarding worsening of balance scores was significantly faster in SCA3 compared to SCA10 (p = 0.028) and SCA2 (p = 0.028). The rate of loss of independence of ADLs tended to diminish over time in the three types of ataxia and was faster in SCA3. Similarly, the rate for loss of independence (IADLs) was faster in SCA3 compared to SCA2 (p = 0.057) and significantly faster compared to SCA10 (p = 0.028). CONCLUSION The present findings suggest that the progression of the disease (severity/functioning/balance) varies according to the SCA subtype and the period in disease course. Progression is more linear and aggressive in patients with SCA3.
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Affiliation(s)
- Marise Bueno Zonta
- Movement Disorder Unit, Neurology Service, Department of Internal Medicine, Hospital de Clínicas, Federal University of Paraná, Rua General Carneiro 181, 4th Floor, Alto da Glória, Curitiba, PR 80060-900, Brazil; Neurological Disease Group, Graduate Program in Internal Medicine, Department of Internal Medicine, Hospital de Clínicas, Federal University of Paraná, Rua General Carneiro 181, 11th Floor, Alto da Glória, Curitiba, PR 80060-900, Brazil.
| | - Hélio A G Teive
- Movement Disorder Unit, Neurology Service, Department of Internal Medicine, Hospital de Clínicas, Federal University of Paraná, Rua General Carneiro 181, 4th Floor, Alto da Glória, Curitiba, PR 80060-900, Brazil; Neurological Disease Group, Graduate Program in Internal Medicine, Department of Internal Medicine, Hospital de Clínicas, Federal University of Paraná, Rua General Carneiro 181, 11th Floor, Alto da Glória, Curitiba, PR 80060-900, Brazil.
| | - Carlos Henrique F Camargo
- Neurological Disease Group, Graduate Program in Internal Medicine, Department of Internal Medicine, Hospital de Clínicas, Federal University of Paraná, Rua General Carneiro 181, 11th Floor, Alto da Glória, Curitiba, PR 80060-900, Brazil.
| | - Alex T Meira
- Movement Disorder Unit, Neurology Service, Department of Internal Medicine, Hospital de Clínicas, Federal University of Paraná, Rua General Carneiro 181, 4th Floor, Alto da Glória, Curitiba, PR 80060-900, Brazil.
| | - Francisco Diego Negrão Lopes Neto
- Statistics Service, Hospital de Clínicas, Federal University of Paraná, Rua General Carneiro 181, 2th Floor, Alto da Glória, Curitiba, PR 80060-900, Brazil.
| | - Fernando Spina Tensini
- Movement Disorder Unit, Neurology Service, Department of Internal Medicine, Hospital de Clínicas, Federal University of Paraná, Rua General Carneiro 181, 4th Floor, Alto da Glória, Curitiba, PR 80060-900, Brazil.
| | - Cláudia Bonfim Braga
- Movement Disorder Unit, Neurology Service, Department of Internal Medicine, Hospital de Clínicas, Federal University of Paraná, Rua General Carneiro 181, 4th Floor, Alto da Glória, Curitiba, PR 80060-900, Brazil.
| | - Tetsuo Ashizawa
- Department of Neurology, Houston Methodist Research Institute, Stanley H. Appel Department of Neurology, 6560 Fannin St. ScurlockTower, 8thFloor, Houston, TX 77030, USA.
| | - Renato P Munhoz
- University of Toronto, Toronto Western Hospital, Movement Disorders Centre, 399 Bathurst St, McLaughlin Pavilion - 7th Fl, Toronto, ON M5T 2S8, Canada.
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17
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Zhou H, Nguyen H, Enriquez A, Morsy L, Curtis M, Piser T, Kenney C, Stephen CD, Gupta AS, Schmahmann JD, Vaziri A. Assessment of gait and balance impairment in people with spinocerebellar ataxia using wearable sensors. Neurol Sci 2021; 43:2589-2599. [PMID: 34664180 DOI: 10.1007/s10072-021-05657-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 10/05/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To explore the use of wearable sensors for objective measurement of motor impairment in spinocerebellar ataxia (SCA) patients during clinical assessments of gait and balance. METHODS In total, 14 patients with genetically confirmed SCA (mean age 61.6 ± 8.6 years) and 4 healthy controls (mean age 49.0 ± 16.4 years) were recruited through the Massachusetts General Hospital (MGH) Ataxia Center. Participants donned seven inertial sensors while performing two independent trials of gait and balance assessments from the Scale for the Assessment and Rating of Ataxia (SARA) and Brief Ataxia Rating Scale (BARS2). Univariate analysis was used to identify sensor-derived metrics from wearable sensors that discriminate motor function between the SCA and control groups. Multivariate linear regression models were used to estimate the subjective in-person SARA/BARS2 ratings. Spearman correlation coefficients were used to evaluate the performance of the model. RESULTS Stride length variability, stride duration, cadence, stance phase, pelvis sway, and turn duration were different between SCA and controls (p < 0.05). Similarly, sway and sway velocity of the ankle, hip, and center of mass differentiated SCA and controls (p < 0.05). Using these features, linear regression models showed moderate-to-strong correlation with clinical scores from the in-person rater during SARA assessments of gait (r = 0.73, p = 0.003) and stance (r = 0.90, p < 0.001) and the BARS2 gait assessment (r = 0.74, p = 0.003). CONCLUSION This study demonstrates that sensor-derived metrics can potentially be used to estimate the level of motor impairment in patient with SCA quickly and objectively. Thus, digital biomarkers from wearable sensors have the potential to be an integral tool for SCA clinical trials and care.
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Affiliation(s)
- He Zhou
- BioSensics LLC, Newton, MA, USA
| | | | | | | | | | | | | | - Christopher D Stephen
- Ataxia Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Anoopum S Gupta
- Ataxia Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Jeremy D Schmahmann
- Ataxia Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
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18
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Detection of ataxia in low disability MS patients by hybrid convolutional neural networks based on images of plantar pressure distribution. Mult Scler Relat Disord 2021; 56:103261. [PMID: 34555759 DOI: 10.1016/j.msard.2021.103261] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/25/2021] [Accepted: 09/09/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND This study aimed to detect ataxia in patients with multiple sclerosis (PwMS) with a deep learning-based approach based on images showing plantar pressure distribution of the patients. The secondary aim of the study was to investigate an alternative and objective method in the early diagnosis of ataxia in these patients. METHODS A total of 105 images showing plantar pressure distribution of 43 ataxic PwMS and 62 healthy individuals were analyzed. The images were resized for the models including VGG16, VGG19, ResNet, DenseNet, MobileNet, NasNetMobile, and NasNetLarge. Feature vectors were extracted from the resized images and then classified using Support Vector Machines (SVM), K-Nearest Neighbors (K-NN), and Artificial Neural Network (ANN). A 10-fold cross-validation was applied to increase the validity of the classifiers. RESULTS The VGG19-SVM hybrid model showed the highest accuracy, sensitivity, and specificity values (89.23%, 89.65%, and 88.88%, respectively). CONCLUSION The proposed method provided an automatic decision support system for detecting ataxia based on images showing plantar pressure distribution in patients with PwMS. The performance of the proposed method indicated that this method can be applied in clinical practice to establish a rapid diagnosis of ataxia that is asymptomatic or difficult to detect clinically and that it can be recommended as a useful aid for the physician in clinical practice.
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19
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Kim M, Ahn JH, Mun JK, Choi EH, Kim JS, Youn J, Cho JW. Extracerebellar Signs and Symptoms in 117 Korean Patients with Early-Stage Spinocerebellar Ataxia. J Clin Neurol 2021; 17:242-248. [PMID: 33835745 PMCID: PMC8053557 DOI: 10.3988/jcn.2021.17.2.242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 11/18/2020] [Accepted: 11/18/2020] [Indexed: 01/07/2023] Open
Abstract
Background and Purpose Spinocerebellar ataxias (SCAs) are the most common form of hereditary ataxias. Extracerebellar signs have been well described and are helpful in differentiating the SCA subtypes. However, there are few reports on the early-stage extracerebellar signs in various SCA subtypes. This study explored the clinical and magnetic resonance imaging (MRI) characteristics of early-stage SCAs in the Korean population. Methods We retrospectively reviewed the medical records of genetically confirmed SCA patients with a disease duration of <5 years. Data on baseline characteristics, extracerebellar signs, and initial MRI findings were organized based on SCA subtypes. Results This study included 117 SCA patients with a median age at onset of 40.6 years. The family history was positive in 71.8% of the patients, and the median disease duration and the score on the Scale for the Assessment and Rating of Ataxia at the initial visit were 2.6 years and 5.0, respectively. SCA3 was the most prevalent subtype, and oculomotor abnormalities were the most frequent extracerebellar signs in early-stage SCAs. Saccadic slowing was characteristic of SCA2 and SCA7, and gaze-evoked nystagmus was prominent in SCA6. Parkinsonism was relatively frequent in SCA8 and SCA3. Decreased visual acuity was specific for SCA7. Dementia was not an early manifestation of SCAs. Brain MRI revealed a pattern of pontocerebellar atrophy in SCA2 and SCA7, while SCA6 demonstrated only cerebellar cortical atrophy. Conclusions SCA patients exhibited diverse extracerebellar signs even in the early stage. Specific extracerebellar signs were characteristic of specific subtypes, which could facilitate differential diagnoses of early-stage SCAs.
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Affiliation(s)
- Minkyeong Kim
- Department of Neurology, Gyeongsang National University Hospital, Jinju, Korea
| | - Jong Hyeon Ahn
- Department of Neurology, Samsung Medical Center, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea
| | - Jun Kyu Mun
- Department of Neurology, Samsung Medical Center, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea
| | - Eun Hyeok Choi
- Department of Neurology, Samsung Medical Center, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea
| | - Ji Sun Kim
- Department of Neurology, Samsung Medical Center, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea
| | - Jinyoung Youn
- Department of Neurology, Samsung Medical Center, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea.,Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Whan Cho
- Department of Neurology, Samsung Medical Center, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea.,Sungkyunkwan University School of Medicine, Seoul, Korea.
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20
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Chen ML, Lin CC, Rosenthal LS, Opal P, Kuo SH. Rating scales and biomarkers for CAG-repeat spinocerebellar ataxias: Implications for therapy development. J Neurol Sci 2021; 424:117417. [PMID: 33836316 DOI: 10.1016/j.jns.2021.117417] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/26/2021] [Accepted: 03/23/2021] [Indexed: 01/18/2023]
Abstract
Spinocerebellar ataxias (SCAs) are a group of dominantly-inherited cerebellar ataxias, among which CAG expansion-related SCAs are most common. These diseases have very high penetrance with defined disease progression, and emerging therapies are being developed to provide either symptomatic or disease-modifying benefits. In clinical trial design, it is crucial to incorporate biomarkers to test target engagement or track disease progression in response to therapies, especially in rare diseases such as SCAs. In this article, we review the available rating scales and recent advances of biomarkers in CAG-repeat SCAs. We divided biomarkers into neuroimaging, body fluid, and physiological studies. Understanding the utility of each biomarker will facilitate the design of robust clinical trials to advance therapies for SCAs.
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Affiliation(s)
- Meng-Ling Chen
- Department of Neurology, Columbia University, New York, NY, USA; Initiative for Columbia Ataxia and Tremor, Columbia University, New York, NY, USA
| | - Chih-Chun Lin
- Department of Neurology, Columbia University, New York, NY, USA; Initiative for Columbia Ataxia and Tremor, Columbia University, New York, NY, USA
| | - Liana S Rosenthal
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Puneet Opal
- Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Department of Cellular and Molecular Biology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Sheng-Han Kuo
- Department of Neurology, Columbia University, New York, NY, USA; Initiative for Columbia Ataxia and Tremor, Columbia University, New York, NY, USA.
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21
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White JJ, Bosman LWJ, Blot FGC, Osório C, Kuppens BW, Krijnen WHJJ, Andriessen C, De Zeeuw CI, Jaarsma D, Schonewille M. Region-specific preservation of Purkinje cell morphology and motor behavior in the ATXN1[82Q] mouse model of spinocerebellar ataxia 1. Brain Pathol 2021; 31:e12946. [PMID: 33724582 PMCID: PMC8412070 DOI: 10.1111/bpa.12946] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 01/27/2021] [Accepted: 02/16/2021] [Indexed: 01/09/2023] Open
Abstract
Purkinje cells are the primary processing units of the cerebellar cortex and display molecular heterogeneity that aligns with differences in physiological properties, projection patterns, and susceptibility to disease. In particular, multiple mouse models that feature Purkinje cell degeneration are characterized by incomplete and patterned Purkinje cell degeneration, suggestive of relative sparing of Purkinje cell subpopulations, such as those expressing Aldolase C/zebrinII (AldoC) or residing in the vestibulo‐cerebellum. Here, we investigated a well‐characterized Purkinje cell‐specific mouse model for spinocerebellar ataxia type 1 (SCA1) that expresses human ATXN1 with a polyQ expansion (82Q). Our pathological analysis confirms previous findings that Purkinje cells of the vestibulo‐cerebellum, i.e., the flocculonodular lobes, and crus I are relatively spared from key pathological hallmarks: somatodendritic atrophy, and the appearance of p62/SQSTM1‐positive inclusions. However, immunohistological analysis of transgene expression revealed that spared Purkinje cells do not express mutant ATXN1 protein, indicating the sparing of Purkinje cells can be explained by an absence of transgene expression. Additionally, we found that Purkinje cells in other cerebellar lobules that typically express AldoC, not only display severe pathology but also show loss of AldoC expression. The relatively preserved flocculonodular lobes and crus I showed a substantial fraction of Purkinje cells that expressed the mutant protein and displayed pathology as well as loss of AldoC expression. Despite considerable pathology in these lobules, behavioral analyses demonstrated a relative sparing of related functions, suggestive of sufficient functional cerebellar reserve. Together, the data indicate that mutant ATXN1 affects both AldoC‐positive and AldoC‐negative Purkinje cells and disrupts normal parasagittal AldoC expression in Purkinje cells. Our results show that, in a mouse model otherwise characterized by widespread Purkinje cell degeneration, sparing of specific subpopulations is sufficient to maintain normal performance of specific behaviors within the context of the functional, modular map of the cerebellum.
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Affiliation(s)
- Joshua J White
- Department of Neuroscience, Erasmus MC, Rotterdam, Netherlands
| | | | | | - Catarina Osório
- Department of Neuroscience, Erasmus MC, Rotterdam, Netherlands
| | - Bram W Kuppens
- Department of Neuroscience, Erasmus MC, Rotterdam, Netherlands
| | | | | | - Chris I De Zeeuw
- Department of Neuroscience, Erasmus MC, Rotterdam, Netherlands.,Netherlands Institute for Neuroscience, Royal Academy of Arts and Sciences, Amsterdam, Netherlands
| | - Dick Jaarsma
- Department of Neuroscience, Erasmus MC, Rotterdam, Netherlands
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22
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Abstract
Spinocerebellar ataxia type 1 (SCA1) is a fatal neurodegenerative disease caused by abnormal expansion of glutamine-encoding CAG repeats in the Ataxin-1 (ATXN1) gene. SCA1 is characterized by progressive motor deficits, cognitive decline, and mood changes including anxiety and depression, with longer number of repeats correlating with worse disease outcomes. While mouse models have been very useful in understanding etiology of ataxia and cognitive decline, our understanding of mood symptoms in SCA1 has lagged. It remains unclear whether anxiety or depression stem from an underlying brain pathology or as a consequence of living with an untreatable and lethal disease. To increase our understanding of the etiology of SCA1 mood alterations, we used the elevated-plus maze, sucrose preference and forced swim tests to assess mood in four different mouse lines. We found that SCA1 knock-in mice exhibit increased anxiety that correlated with the length of CAG repeats, supporting the idea that underlying brain pathology contributes to SCA1-like anxiety. Additionally, our results support the concept that increased anxiety is caused by non-cerebellar pathology, as Purkinje cell specific SCA1 transgenic mice exhibit decreased anxiety-like behavior. Regarding the molecular mechanism, partial loss of ATXN1 may play a role in anxiety, based on our results for Atxn1 haploinsufficient and null mice.
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23
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Measurements of Hand Function in Degenerative Cerebellar Disease: A Case-Control Pilot Study. Am J Phys Med Rehabil 2020; 99:795-800. [PMID: 32167956 DOI: 10.1097/phm.0000000000001411] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The aim of the study was to determine the association of Nine Hole Peg Test, Box and Block Test, Jebsen-Taylor Hand Function Test, and kinematic measures of a simple reaching task with ataxia severity in adults with degenerative cerebellar disease. DESIGN Fourteen adults with cerebellar degeneration were recruited, and ataxia severity was determined using the Scale for the Assessment and Rating of Ataxia. The median Scale for the Assessment and Rating of Ataxia score was used to divide participants into less and more severe ataxia groups. The two groups' average scores on the hand function tests were compared, and correlation of each test with ataxia severity was determined. RESULTS The Nine Hole Peg Test, Box and Block Test, and Jebsen-Taylor Hand Function Test all differentiated between less and more severe ataxia groups, and the Nine Hole Peg Test performed with the participant's dominant hand had the highest correlation with ataxia severity (rs = 0.92, P < 0.01). Although accuracy, precision, and number of submovements were statistically different between healthy individuals and the more ataxic participant group, most kinematic measures were not significantly different between the less and more severe ataxic groups. CONCLUSION Overall, our results indicate that all three clinical tests correlate with ataxia severity. Larger future studies should examine the reliability and validity of these hand function measures in adults with degenerative cerebellar disease.
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24
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Du YC, Dong Y, Cheng HL, Li QF, Yang L, Shao YR, Ma Y, Ni W, Gan SR, Wu ZY. Genotype-phenotype correlation in 667 Chinese families with spinocerebellar ataxia type 3. Parkinsonism Relat Disord 2020; 78:116-121. [DOI: 10.1016/j.parkreldis.2020.07.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 07/17/2020] [Accepted: 07/24/2020] [Indexed: 10/23/2022]
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25
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Liu XH, Li Y, Xu HL, Sikandar A, Lin WH, Li GH, Li XF, Alimu A, Yu SB, Ye XH, Wang N, Ni J, Chen WJ, Gan SR. Quantitative assessment of postural instability in spinocerebellar ataxia type 3 patients. Ann Clin Transl Neurol 2020; 7:1360-1370. [PMID: 32638517 PMCID: PMC7448197 DOI: 10.1002/acn3.51124] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/05/2020] [Accepted: 06/15/2020] [Indexed: 12/17/2022] Open
Abstract
Objective Spinocerebellar ataxia type 3 (SCA3) is one of the most common hereditary neurodegenerative diseases, with balance instability as main symptom. Balance quantification is crucial for evaluating the efficacy of therapeutic interventions. However, balance evaluation in SCA3 is often subject to bias. Here, we aimed to quantitatively evaluate postural instability and investigate the relationship between postural instability and clinical characteristics in SCA3 patients. Methods Sixty‐two SCA3 patients and 62 normal controls were recruited, and their postural balance was measured using a posturographic platform. Principal component analysis was performed as data reduction to identify postural instability factors. Multivariable linear regression was used to investigate potential risk factors for postural instability and to explore whether postural instability predicts the severity and progression of ataxia in SCA3 patients. Results We found SCA3 patients experience postural instability characterized by significant impairment in static and dynamic stability. The condition without visual feedback was the most sensitive measure in differentiating SCA3 from controls. Regression analyses revealed that ataxia severity predicted both static (P = 0.014) and dynamic stability (P = 0.001). Likewise, along with expanded CAG repeats (P < 0.001), both static (P < 0.001) and dynamic stability (P < 0.001) predicted ataxia severity, but not ataxia progression. Interpretation Our findings demonstrate the validity of using the Pro‐kin system for assessing postural instability in SCA3 patients. This type of quantitative assessment of balance dysfunction can contribute to clinical trials and balance rehabilitation in SCA3 patients.
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Affiliation(s)
- Xia-Hua Liu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Ying Li
- Fujian Medical University, Fuzhou, China
| | - Hao-Ling Xu
- Department of Neurology and Institute of Neurology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Arif Sikandar
- Department of Neurology and Institute of Neurology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Wei-Hong Lin
- Department of Neurology and Institute of Neurology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Gui-He Li
- Fujian Medical University, Fuzhou, China
| | | | | | | | | | - Ning Wang
- Department of Neurology and Institute of Neurology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, China
| | - Jun Ni
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Wan-Jin Chen
- Department of Neurology and Institute of Neurology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, China
| | - Shi-Rui Gan
- Department of Neurology and Institute of Neurology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, China
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26
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Abstract
PURPOSE OF REVIEW This article reviews the symptoms, laboratory and neuroimaging diagnostic tests, genetics, and management of cerebellar ataxia. RECENT FINDINGS Recent advances in genetics have led to the identification of novel genetic causes for ataxia and a more comprehensive understanding of the biological pathways critical for normal cerebellar function. When these molecular pathways become dysfunctional, patients develop cerebellar ataxia. In addition, several ongoing clinical trials for Friedreich ataxia and spinocerebellar ataxia will likely result in novel symptomatic and disease-modifying therapies for ataxia. Antisense oligonucleotides for spinocerebellar ataxias associated with CAG repeat expansions might be a promising therapeutic strategy. SUMMARY Cerebellar ataxias include heterogeneous disorders affecting cerebellar function, leading to ataxic symptoms. Step-by-step diagnostic workups with genetic investigations are likely to reveal the underlying causes of ataxia. Some disease-specific therapies for ataxia exist, such as vitamin E for ataxia with vitamin E deficiency and thiamine for Wernicke encephalopathy, highlighting the importance of recognizing these forms of ataxia. Finally, genetic diagnosis for patients with ataxia will accelerate clinical trials for disease-modifying therapy and will have prognostic value and implications for family planning for these patients.
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Differential value of brain magnetic resonance imaging in multiple system atrophy cerebellar phenotype and spinocerebellar ataxias. Sci Rep 2019; 9:17329. [PMID: 31758059 PMCID: PMC6874541 DOI: 10.1038/s41598-019-53980-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 11/05/2019] [Indexed: 02/08/2023] Open
Abstract
Clinically differentiating multiple system atrophy cerebellar (MSA-C) phenotype and spinocerebellar ataxias (SCAs) is challenging especially in the early stage. We assessed diagnostic value of brain magnetic resonance imaging (MRI) in differentiating MSA-C and SCAs based at different disease stages (<3, 3–7, and >7 years of disease duration). Overall, 186 patients with probable MSA-C and 117 with genetically confirmed SCAs were included. Hot cross bun (HCB) signs and middle cerebellar peduncle (MCP) hyperintensities were exclusively prevalent in MSA-C compared to SCAs at <3 years (HCB, 44.6% versus 0.9%; MCP hyperintensities, 38.3% versus 0.9%, respectively). Sensitivity, specificity, and positive predictive value (PPV) for HCB signs to differentiate MSA-C from SCAs were 45%, 99%, and 99% and those for MCP hyperintensities were 68%, 99%, and 99%, respectively; considering both HCB signs and MCP hyperintensities, specificity and PPV were 100%. However, the differential value of MRI signs decreased over time. MCP widths were smaller and showed more significant decrease in MSA-C than in SCAs. In conclusion, pontine and MCP changes were exclusively prominent in early stage MSA-C rather than in SCAs. Therefore, we should consider disease duration when interpreting pontine and MCP changes in brain MRIs, which will help better differentiate MSA-C and SCAs.
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28
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Egorova PA, Bezprozvanny IB. Molecular Mechanisms and Therapeutics for Spinocerebellar Ataxia Type 2. Neurotherapeutics 2019; 16:1050-1073. [PMID: 31435879 PMCID: PMC6985344 DOI: 10.1007/s13311-019-00777-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The effective therapeutic treatment and the disease-modifying therapy for spinocerebellar ataxia type 2 (SCA2) (a progressive hereditary disease caused by an expansion of polyglutamine in the ataxin-2 protein) is not available yet. At present, only symptomatic treatment and methods of palliative care are prescribed to the patients. Many attempts were made to study the physiological, molecular, and biochemical changes in SCA2 patients and in a variety of the model systems to find new therapeutic targets for SCA2 treatment. A better understanding of the uncovered molecular mechanisms of the disease allowed the scientific community to develop strategies of potential therapy and helped to create some promising therapeutic approaches for SCA2 treatment. Recent progress in this field will be discussed in this review article.
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Affiliation(s)
- Polina A Egorova
- Laboratory of Molecular Neurodegeneration, Peter the Great St.Petersburg Polytechnic University, St. Petersburg, 195251, Russia
| | - Ilya B Bezprozvanny
- Laboratory of Molecular Neurodegeneration, Peter the Great St.Petersburg Polytechnic University, St. Petersburg, 195251, Russia.
- Department of Physiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, ND12.200, Dallas, Texas, 75390, USA.
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Xu HL, Su QN, Shang XJ, Sikandar A, Lin MT, Wang N, Lin H, Gan SR. The influence of initial symptoms on phenotypes in spinocerebellar ataxia type 3. Mol Genet Genomic Med 2019; 7:e00719. [PMID: 31124318 PMCID: PMC6625145 DOI: 10.1002/mgg3.719] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 04/15/2019] [Accepted: 04/15/2019] [Indexed: 12/13/2022] Open
Abstract
Background Spinocerebellar ataxia type 3 (SCA3) is a rare, inherited form of ataxia that leads to progressive neurodegeneration. The initial symptoms could affect clinical phenotypes in neurodegenerative diseases, such as Parkinson's disease and amyotrophic lateral sclerosis. However, the contribution of initial symptoms to the phenotypes of SCA3 has been scarcely investigated. Methods In the present study, 143 SCA3 patients from China were recruited and divided into two groups of gait‐onset and non‐gait‐onset. For determining the influences of initial symptoms on age at onset (AAO), the severity and progression of ataxia, and the possible factors affecting the initial symptoms, multivariable linear regression, and multivariate logistic regression were performed. Results We found that the frequency of gait‐onset was 87.41%, and the frequency of non‐gait‐onset was 12.59% (diplopia: 7.69%, dysarthria: 4.20%, dystonia: 0.70%). Compared to the non‐gait‐onset group, the gait‐onset group had significantly more severe ataxia (p = 0.046), while the initial symptoms had no effect on AAO (p = 0.109) and progression of ataxia (p = 0.265). We failed to find the existence of any factors affecting initial symptoms. Conclusion These findings collectively suggested that initial symptoms influenced phenotypes in SCA3 and that neurodegeneration in different parts of brain may induce different disease severity in SCA3. To investigate the contribution of initial symptoms to the phenotypes of spinocerebellar ataxia type 3 (SCA3), 143 SCA3 patients from China were recruited and divided into two groups of gait‐onset and non‐gait‐onset. We found that compared to the group of non‐gait‐onset, the group of gait‐onset had significantly more severe ataxia. Our finding suggested that initial symptoms influenced phenotypes in SCA3 and that neurodegeneration in different parts of brain may induce different severity in SCA3.
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Affiliation(s)
- Hao-Ling Xu
- Department of Neurology and Institute of Neurology, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Qiu-Ni Su
- Department of Laboratory Medicine, The 1st Affiliated Hospital of Xiamen University, Xiamen, China
| | - Xian-Jin Shang
- Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, China
| | - Arif Sikandar
- Department of Neurology and Institute of Neurology, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Min-Ting Lin
- Department of Neurology and Institute of Neurology, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Ning Wang
- Department of Neurology and Institute of Neurology, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Hong Lin
- Department of Neurology and Institute of Neurology, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Shi-Rui Gan
- Department of Neurology and Institute of Neurology, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
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30
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Wang P, Chen Z, Peng Y, Cao L, Li X, Wang C, Yang H, Peng H, Shi Y, Zhou X, Li T, Feng L, Wu C, Qiu R, Xia K, Tang B, Jiang H. (
CAG
)
n
loci as genetic modifiers of age at onset in patients with spinocerebellar ataxia type 1 from mainland China. Eur J Neurol 2019; 26:1130-1136. [PMID: 30891880 DOI: 10.1111/ene.13954] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 03/11/2019] [Indexed: 02/02/2023]
Affiliation(s)
- P. Wang
- Department of Neurology Xiangya Hospital Central South University Changsha HunanChina
| | - Z. Chen
- Department of Neurology Xiangya Hospital Central South University Changsha HunanChina
| | - Y. Peng
- Department of Neurology Xiangya Hospital Central South University Changsha HunanChina
| | - L. Cao
- Department of Neurology and Institute of Neurology Rui Jin Hospital School of Medicine Shanghai Jiao Tong University ShanghaiChina
| | - X. Li
- Department of Neurology First Affiliated Hospital of Sun Yat‐Sen University GuangzhouChina
| | - C. Wang
- Department of Neurology Xiangya Hospital Central South University Changsha HunanChina
| | - H. Yang
- Department of Neurology Xiangya Hospital Central South University Changsha HunanChina
| | - H. Peng
- Department of Neurology Xiangya Hospital Central South University Changsha HunanChina
| | - Y. Shi
- Department of Neurology Xiangya Hospital Central South University Changsha HunanChina
| | - X. Zhou
- Department of Neurology Xiangya Hospital Central South University Changsha HunanChina
| | - T. Li
- Department of Neurology Xiangya Hospital Central South University Changsha HunanChina
| | - L. Feng
- Department of Neurology First Affiliated Hospital of Sun Yat‐Sen University GuangzhouChina
| | - C. Wu
- Department of Neurology First Affiliated Hospital of Sun Yat‐Sen University GuangzhouChina
| | - R. Qiu
- School of Information Science and Engineering Central South University Changsha Hunan China
| | - K. Xia
- Center for Medical Genetics Central South University Changsha Hunan China
| | - B. Tang
- Department of Neurology Xiangya Hospital Central South University Changsha HunanChina
- Center for Medical Genetics Central South University Changsha Hunan China
- National Clinical Research Center for Geriatric Diseases Central South University Changsha Hunan China
- Key Laboratory of Hunan Province in Neurodegenerative Disorders Central South University Changsha HunanChina
- Parkinson's Disease Center of Beijing Institute for Brain Disorders BeijingChina
| | - H. Jiang
- Department of Neurology Xiangya Hospital Central South University Changsha HunanChina
- Center for Medical Genetics Central South University Changsha Hunan China
- National Clinical Research Center for Geriatric Diseases Central South University Changsha Hunan China
- Key Laboratory of Hunan Province in Neurodegenerative Disorders Central South University Changsha HunanChina
- Xinjiang Medical University Xinjiang China
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31
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Pulst SM. The complex structure of ATXN2 genetic variation. Neurol Genet 2018; 4:e299. [PMID: 30588499 PMCID: PMC6290488 DOI: 10.1212/nxg.0000000000000299] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 11/02/2018] [Indexed: 12/13/2022]
Affiliation(s)
- Stefan M Pulst
- Department of Neurology, University of Utah, Salt Lake City, UT
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32
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Consensus Paper: Neurophysiological Assessments of Ataxias in Daily Practice. THE CEREBELLUM 2018; 17:628-653. [DOI: 10.1007/s12311-018-0937-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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33
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Abstract
The cerebellum plays an integral role in the control of limb and ocular movements, balance, and walking. Cerebellar disorders may be classified as sporadic or hereditary with clinical presentation varying with the extent and site of cerebellar damage and extracerebellar signs. Deficits in balance and walking reflect the cerebellum's proposed role in coordination, sensory integration, coordinate transformation, motor learning, and adaptation. Cerebellar dysfunction results in increased postural sway, hypermetric postural responses to perturbations and optokinetic stimuli, and postural responses that are poorly coordinated with volitional movement. Gait variability is characteristic and may arise from a combination of balance impairments, interlimb incoordination, and incoordination between postural activity and leg movement. Intrinsic problems with balance lead to a high prevalence of injurious falls. Evidence for pharmacologic management is limited, although aminopyridines reduce attacks in episodic ataxias and may have a role in improving gait ataxia in other conditions. Intensive exercises targeting balance and coordination lead to improvements in balance and walking but require ongoing training to maintain/maximize any effects. Noninvasive brain stimulation of the cerebellum may become a useful adjunct to therapy in the future. Walking aids, orthoses, specialized footwear and seating may be required for more severe cases of cerebellar ataxia.
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Affiliation(s)
- Jonathan F Marsden
- Department of Rehabilitation, School of Health Professions, University of Plymouth, Plymouth, United Kingdom.
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34
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Amarante TRP, Takeda SYM, Teive HAG, Zonta MB. Impact of disease duration on functional status of patients with spinocerebellar ataxia type 2. ARQUIVOS DE NEURO-PSIQUIATRIA 2017; 75:773-777. [PMID: 29236819 DOI: 10.1590/0004-282x20170146] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 08/04/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To correlate disease duration in spinocerebellar ataxia type 2 (SCA2) with disease severity, balance and functionality. METHOD Sixteen SCA2 patients were analyzed for: disease duration, disease severity (SARA score), balance (Berg balance scale score) and functionality (FIM and Lawton scores). RESULTS Greater severity was correlated with worse functionality (Lawton: r = -0.0561, FIM: r = -0.6402) and balance (r = -0.7188). Longer disease duration was correlated with greater severity (p = 0.0002) and reduced functionality (FIM: p = 0.005; Lawton: p = 0.0402) and balance (p = 0.0036). A year increase in disease duration corresponded to a 0.8-point increase on the SARA scale, a 1.38-point decrease in FIM score, a 2.30-point decrease on the Berg balance scale and a 0.45-point decrease on the Lawton scale. CONCLUSION Longer disease duration in this series of SCA2 patients was correlated with greater disease severity, worse balance and greater functional dependency.
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Affiliation(s)
- Thiago R Padilha Amarante
- Universidade Federal do Paraná, Programa de Residência Integrada Multiprofissional em Cuidados Hospitalares - Saúde para Adultos e Idosos, Curitiba PR, Brasil
| | - Sibele Y M Takeda
- Universidade Federal do Paraná, Departamento de Prevenção e Reabilitação de Fisioterapia, Curitiba PR, Brasil
| | - Hélio A G Teive
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Medicina Interna, Curitiba PR, Brasil.,Universidade Federal do Paraná, Unidade dos Distúrbios do Movimento, Curitiba PR, Brasil
| | - Marise Bueno Zonta
- Universidade Federal do Paraná, Programa de Residência Integrada Multiprofissional em Cuidados Hospitalares - Saúde para Adultos e Idosos, Curitiba PR, Brasil
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35
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Kuo PH, Gan SR, Wang J, Lo RY, Figueroa KP, Tomishon D, Pulst SM, Perlman S, Wilmot G, Gomez CM, Schmahmann JD, Paulson H, Shakkottai VG, Ying SH, Zesiewicz T, Bushara K, Geschwind MD, Xia G, Subramony SH, Ashizawa T, Kuo SH. Dystonia and ataxia progression in spinocerebellar ataxias. Parkinsonism Relat Disord 2017; 45:75-80. [PMID: 29089256 DOI: 10.1016/j.parkreldis.2017.10.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 10/03/2017] [Accepted: 10/09/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Dystonia is a common feature in spinocerebellar ataxias (SCAs). Whether the presence of dystonia is associated with different rate of ataxia progression is not known. OBJECTIVES To study clinical characteristics and ataxia progression in SCAs with and without dystonia. METHODS We studied 334 participants with SCA 1, 2, 3 and 6 from the Clinical Research Consortium for Spinocerebellar Ataxias (CRC-SCA) and compared the clinical characteristics of SCAs with and without dystonia. We repeatedly measured ataxia progression by the Scale for Assessment and Rating of Ataxia every 6 months for 2 years. Regression models were employed to study the association between dystonia and ataxia progression after adjusting for age, sex and pathological CAG repeats. We used logistic regression to analyze the impact of different repeat expansion genes on dystonia in SCAs. RESULTS Dystonia was most commonly observed in SCA3, followed by SCA2, SCA1, and SCA6. Dystonia was associated with longer CAG repeats in SCA3. The CAG repeat number in TBP normal alleles appeared to modify the presence of dystonia in SCA1. The presence of dystonia was associated with higher SARA scores in SCA1, 2, and 3. Although relatively rare in SCA6, the presence of dystonia was associated with slower progression of ataxia. CONCLUSIONS The presence of dystonia is associated with greater severity of ataxia in SCA1, 2, and 3, but predictive of a slower progression in SCA6. Complex genetic interactions among repeat expansion genes can lead to diverse clinical symptoms and progression in SCAs.
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Affiliation(s)
- Pei-Hsin Kuo
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA; Department of Neurology, Buddhist Tzu Chi General Hospital, Tzu Chi University, Hualien, Taiwan
| | - Shi-Rui Gan
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA; Department of Neurology, Institute of Neurology, First Affiliated Hospital of Fujian Medical University, Fujian Key Laboratory of Molecular Neurology, Fuzhou, China
| | - Jie Wang
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA; Department of Fundamental and Community Nursing, School of Nursing, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Raymond Y Lo
- Department of Neurology, Buddhist Tzu Chi General Hospital, Tzu Chi University, Hualien, Taiwan
| | - Karla P Figueroa
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Darya Tomishon
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Stefan M Pulst
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Susan Perlman
- Department of Neurology, University of California, Los Angeles, CA, USA
| | - George Wilmot
- Department of Neurology, Emory University, Atlanta, GA, USA
| | | | - Jeremy D Schmahmann
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Henry Paulson
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | | | - Sarah H Ying
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Theresa Zesiewicz
- Department of Neurology, University of South Florida, Tampa, FL, USA
| | - Khalaf Bushara
- Department of Neurology, University of Minnesota, Minneapolis, MN, USA
| | | | - Guangbin Xia
- Department of Neurology, University of New Mexico, Albuquerque, NM, USA
| | - S H Subramony
- Department of Neurology, McKnight Brain Institute, University of Florida, Gainsville, FL, USA
| | | | - Sheng-Han Kuo
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
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36
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Gan SR, Wang J, Figueroa KP, Pulst SM, Tomishon D, Lee D, Perlman S, Wilmot G, Gomez CM, Schmahmann J, Paulson H, Shakkottai VG, Ying SH, Zesiewicz T, Bushara K, Geschwind MD, Xia G, Subramony SH, Ashizawa T, Kuo SH. Postural Tremor and Ataxia Progression in Spinocerebellar Ataxias. Tremor Other Hyperkinet Mov (N Y) 2017; 7:492. [PMID: 29057148 PMCID: PMC5647398 DOI: 10.7916/d8gm8krh] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 09/07/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Postural tremor can sometimes occur in spinocerebellar ataxias (SCAs). However, the prevalence and clinical characteristics of postural tremor in SCAs are poorly understood, and whether SCA patients with postural tremor have different ataxia progression is not known. METHODS We studied postural tremor in 315 patients with SCA1, 2, 3, and 6 recruited from the Clinical Research Consortium for Spinocerebellar Ataxias (CRC-SCA), which consists of 12 participating centers in the United States, and we evaluated ataxia progression in these patients from January 2010 to August 2012. RESULTS Among 315 SCA patients, postural tremor was most common in SCA2 patients (SCA1, 5.8%; SCA2, 27.5%; SCA3, 12.4%; SCA6, 16.9%; p = 0.007). SCA3 patients with postural tremor had longer CAG repeat expansions than SCA3 patients without postural tremor (73.67 ± 3.12 vs. 70.42 ± 3.96, p = 0.003). Interestingly, SCA1 and SCA6 patients with postural tremor had a slower rate of ataxia progression (SCA1, β = -0.91, p < 0.001; SCA6, β = -1.28, p = 0.025), while SCA2 patients with postural tremor had a faster rate of ataxia progression (β = 1.54, p = 0.034). We also found that the presence of postural tremor in SCA2 patients could be influenced by repeat expansions of ATXN1 (β = -1.53, p = 0.037) and ATXN3 (β = 0.57, p = 0.018), whereas postural tremor in SCA3 was associated with repeat lengths in TBP (β = 0.63, p = 0.041) and PPP2R2B (β = -0.40, p = 0.032). DISCUSSION Postural tremor could be a clinical feature of SCAs, and the presence of postural tremor could be associated with different rates of ataxia progression. Genetic interactions between ataxia genes might influence the brain circuitry and thus affect the clinical presentation of postural tremor.
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Affiliation(s)
- Shi-Rui Gan
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Neurology and Institute of Neurology, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Jie Wang
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Basic and Community Nursing, School of Nursing, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Karla P. Figueroa
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Stefan M. Pulst
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Darya Tomishon
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Danielle Lee
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Susan Perlman
- Department of Neurology, University of California, Los Angeles, CA, USA
| | - George Wilmot
- Department of Neurology, Emory University, Atlanta, GA, USA
| | | | - Jeremy Schmahmann
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Henry Paulson
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | | | - Sarah H. Ying
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Theresa Zesiewicz
- Department of Neurology, University of South Florida, Tampa, FL, USA
| | - Khalaf Bushara
- Department of Neurology, University of Minnesota, Minneapolis, MN, USA
| | | | - Guangbin Xia
- Department of Neurology, School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - S. H. Subramony
- Department of Neurology, School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | | | - Sheng-Han Kuo
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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