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Qiu YT, Chen Y, Tan HX, Su W, Guo QF, Gao Q. Efficacy and Safety of Repetitive Transcranial Magnetic Stimulation in Cerebellar Ataxia: a Systematic Review and Meta-analysis. CEREBELLUM (LONDON, ENGLAND) 2024; 23:243-254. [PMID: 36604400 DOI: 10.1007/s12311-022-01508-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/20/2022] [Indexed: 01/07/2023]
Abstract
Cerebellar ataxia(CA) is defined as a degenerative disease of the nervous system. Repetitive transcranial magnetic stimulation (rTMS) has been a promising treatment for neurological and psychiatric diseases. Hence, to find out whether cerebellar rTMS impacts CA as a potential therapy, we performed a systematic review and meta-analysis. Qualified studies through a systematic search were retrieved for randomized controlled trials (RCTs) using acknowledged databases. Review Manager 5.4 software was employed to synthesize the data. A total of seven studies were identified as eligible and included in the quantitative review. Comparing real and sham-rTMS interventions, the utilization of rTMS on cerebellum improved the scale for the assessment and rating of ataxia (SARA) (SMD - 0.87, 95% CI - 1.41 to - 0.34; P = 0.001; I2 = 62%), the International Cooperative Ataxia Rating Scale (ICARS) (SMD - 1.06, 95% CI - 1.47 to - 0.64; P < 0.00001; I2 = 0%) and Berg balance Scale (BBS) (SMD 0.76, 95% CI 0.33 to 1.19; P = 0.0005; I2 = 39%). The subgroup analysis demonstrated high-frequency of rTMS had a positive effect (SMD - 1.28, 95% CI - 1.82 to - 0.74; P < 0.00001; I2 = 0%). For the safety, the incidence of adverse events between the two groups was not significantly different (OR 1.73, 95% CI 0.55 to 5.46; P = 0.35; I2 = 0%). In conclusion, this meta-analysis provided limited evidence, suggesting a possible strategy that rTMS over the cerebellum could be a viable therapy for symptoms associated with CA. Besides, rTMS intervention was well-attended and did not result in unanticipated negative effects.
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Affiliation(s)
- Yi-Tong Qiu
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Sichuan Province, Chengdu, China
- Key Laboratory of Rehabilitation Medicine of Sichuan Province, Chengdu, Sichuan Province, China
| | - Yi Chen
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Sichuan Province, Chengdu, China
- Key Laboratory of Rehabilitation Medicine of Sichuan Province, Chengdu, Sichuan Province, China
| | - Hui-Xin Tan
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Sichuan Province, Chengdu, China
- Key Laboratory of Rehabilitation Medicine of Sichuan Province, Chengdu, Sichuan Province, China
| | - Wei Su
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Sichuan Province, Chengdu, China
- Key Laboratory of Rehabilitation Medicine of Sichuan Province, Chengdu, Sichuan Province, China
| | - Qi-Fan Guo
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Sichuan Province, Chengdu, China
- Key Laboratory of Rehabilitation Medicine of Sichuan Province, Chengdu, Sichuan Province, China
| | - Qiang Gao
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Sichuan Province, Chengdu, China.
- Key Laboratory of Rehabilitation Medicine of Sichuan Province, Chengdu, Sichuan Province, China.
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Lee J, Oubre B, Daneault JF, Lee SI, Gupta AS. Estimation of ataxia severity in children with ataxia-telangiectasia using ankle-worn sensors. J Neurol 2023; 270:5097-5101. [PMID: 37368132 PMCID: PMC10826283 DOI: 10.1007/s00415-023-11786-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 06/28/2023]
Affiliation(s)
- Juhyeon Lee
- College of Information and Computer Sciences, University of Massachusetts Amherst, 140 Governors Dr, Amherst, MA, USA
| | - Brandon Oubre
- College of Information and Computer Sciences, University of Massachusetts Amherst, 140 Governors Dr, Amherst, MA, USA
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 100 Cambridge St, Boston, MA, USA
| | - Jean-Francois Daneault
- Department of Rehabilitation and Movement Sciences, Rutgers University, 65 Bergen St, Newark, NJ, USA
| | - Sunghoon Ivan Lee
- College of Information and Computer Sciences, University of Massachusetts Amherst, 140 Governors Dr, Amherst, MA, USA.
| | - Anoopum S Gupta
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 100 Cambridge St, Boston, MA, USA.
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Lima M, Raposo M, Ferreira A, Melo ARV, Pavão S, Medeiros F, Teves L, Gonzalez C, Lemos J, Pires P, Lopes P, Valverde D, Gonzalez J, Kay T, Vasconcelos J. The Homogeneous Azorean Machado-Joseph Disease Cohort: Characterization and Contributions to Advances in Research. Biomedicines 2023; 11:biomedicines11020247. [PMID: 36830784 PMCID: PMC9953730 DOI: 10.3390/biomedicines11020247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 01/19/2023] Open
Abstract
Machado-Joseph disease (MJD)/spinocerebellar ataxia type 3 (SCA3) is the most common autosomal dominant ataxia worldwide. MJD is characterized by late-onset progressive cerebellar ataxia associated with variable clinical findings, including pyramidal signs and a dystonic-rigid extrapyramidal syndrome. In the Portuguese archipelago of the Azores, the worldwide population cluster for this disorder (prevalence of 39 in 100,000 inhabitants), a cohort of MJD mutation carriers belonging to extensively studied pedigrees has been followed since the late 1990s. Studies of the homogeneous Azorean MJD cohort have been contributing crucial information to the natural history of this disease as well as allowing the identification of novel molecular biomarkers. Moreover, as interventional studies for this globally rare and yet untreatable disease are emerging, this cohort should be even more important for the recruitment of trial participants. In this paper, we profile the Azorean cohort of MJD carriers, constituted at baseline by 20 pre-ataxic carriers and 52 patients, which currently integrates the European spinocerebellar ataxia type 3/Machado-Joseph disease Initiative (ESMI), a large European longitudinal MJD cohort. Moreover, we summarize the main studies based on this cohort and highlight the contributions made to advances in MJD research. Knowledge of the profile of the Azorean MJD cohort is not only important in the context of emergent interventional trials but is also pertinent for the implementation of adequate interventional measures, constituting relevant information for Lay Associations and providing data to guide healthcare decision makers.
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Affiliation(s)
- Manuela Lima
- Faculdade de Ciências e Tecnologia, Universidade dos Açores, 9500-321 Ponta Delgada, Portugal
- Correspondence:
| | - Mafalda Raposo
- Instituto de Biologia Molecular e Celular (IBMC), Universidade do Porto, 4200-135 Porto, Portugal
- Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, 4200-135 Porto, Portugal
| | - Ana Ferreira
- Faculdade de Ciências e Tecnologia, Universidade dos Açores, 9500-321 Ponta Delgada, Portugal
- Instituto de Biologia Molecular e Celular (IBMC), Universidade do Porto, 4200-135 Porto, Portugal
- Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, 4200-135 Porto, Portugal
| | - Ana Rosa Vieira Melo
- Faculdade de Ciências e Tecnologia, Universidade dos Açores, 9500-321 Ponta Delgada, Portugal
- Instituto de Biologia Molecular e Celular (IBMC), Universidade do Porto, 4200-135 Porto, Portugal
- Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, 4200-135 Porto, Portugal
| | - Sara Pavão
- Faculdade de Ciências e Tecnologia, Universidade dos Açores, 9500-321 Ponta Delgada, Portugal
| | - Filipa Medeiros
- Faculdade de Ciências e Tecnologia, Universidade dos Açores, 9500-321 Ponta Delgada, Portugal
| | - Luís Teves
- Faculdade de Ciências e Tecnologia, Universidade dos Açores, 9500-321 Ponta Delgada, Portugal
- Instituto de Biologia Molecular e Celular (IBMC), Universidade do Porto, 4200-135 Porto, Portugal
- Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, 4200-135 Porto, Portugal
| | - Carlos Gonzalez
- Serviço de Psicologia Clínica, Hospital do Divino Espírito Santo, 9500-370 Ponta Delgada, Portugal
| | - João Lemos
- Unidade de Psicologia Clínica, Hospital do Santo Espírito da Ilha Terceira, 9700-049 Angra do Heroísmo, Portugal
| | - Paula Pires
- Serviço de Neurologia, Hospital do Santo Espírito da Ilha Terceira, 9700-049 Angra do Heroísmo, Portugal
| | - Pedro Lopes
- Serviço de Neurologia, Hospital do Divino Espírito Santo, 9500-370 Ponta Delgada, Portugal
| | - David Valverde
- Serviço de Patologia Clínica, Unidade de Saúde da Ilha das Flores, 9500-370 Santa Cruz das Flores, Portugal
| | - José Gonzalez
- Augenarztpraxis Petrescu Wuppertal, Department of Ophthalmology, 42389 Wuppertal, Germany
| | - Teresa Kay
- Serviço de Genética Médica, Hospital D. Estefânia, 1169-045 Lisboa, Portugal
| | - João Vasconcelos
- Faculdade de Ciências e Tecnologia, Universidade dos Açores, 9500-321 Ponta Delgada, Portugal
- Hospital Internacional dos Açores (HIA), 9560-421 Ponta Delgada, Portugal
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Tang W, van Ooijen PMA, Sival DA, Maurits NM. 2D Gait Skeleton Data Normalization for Quantitative Assessment of Movement Disorders from Freehand Single Camera Video Recordings. SENSORS (BASEL, SWITZERLAND) 2022; 22:4245. [PMID: 35684866 PMCID: PMC9185346 DOI: 10.3390/s22114245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/30/2022] [Accepted: 05/31/2022] [Indexed: 06/15/2023]
Abstract
Overlapping phenotypic features between Early Onset Ataxia (EOA) and Developmental Coordination Disorder (DCD) can complicate the clinical distinction of these disorders. Clinical rating scales are a common way to quantify movement disorders but in children these scales also rely on the observer's assessment and interpretation. Despite the introduction of inertial measurement units for objective and more precise evaluation, special hardware is still required, restricting their widespread application. Gait video recordings of movement disorder patients are frequently captured in routine clinical settings, but there is presently no suitable quantitative analysis method for these recordings. Owing to advancements in computer vision technology, deep learning pose estimation techniques may soon be ready for convenient and low-cost clinical usage. This study presents a framework based on 2D video recording in the coronal plane and pose estimation for the quantitative assessment of gait in movement disorders. To allow the calculation of distance-based features, seven different methods to normalize 2D skeleton keypoint data derived from pose estimation using deep neural networks applied to freehand video recording of gait were evaluated. In our experiments, 15 children (five EOA, five DCD and five healthy controls) were asked to walk naturally while being videotaped by a single camera in 1280 × 720 resolution at 25 frames per second. The high likelihood of the prediction of keypoint locations (mean = 0.889, standard deviation = 0.02) demonstrates the potential for distance-based features derived from routine video recordings to assist in the clinical evaluation of movement in EOA and DCD. By comparison of mean absolute angle error and mean variance of distance, the normalization methods using the Euclidean (2D) distance of left shoulder and right hip, or the average distance from left shoulder to right hip and from right shoulder to left hip were found to better perform for deriving distance-based features and further quantitative assessment of movement disorders.
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Affiliation(s)
- Wei Tang
- Department of Neurology, University Medical Center Groningen, University of Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands;
| | - Peter M. A. van Ooijen
- Data Science Center in Health, University Medical Center Groningen, University of Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands;
| | - Deborah A. Sival
- Department of Pediatric Neurology, University Medical Center Groningen, University of Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands;
| | - Natasha M. Maurits
- Department of Neurology, University Medical Center Groningen, University of Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands;
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Smith Fine A, Kaufman M, Goodman J, Turk B, Bastian A, Lin D, Fatemi A, Keller J. Wearable sensors detect impaired gait and coordination in LBSL during remote assessments. Ann Clin Transl Neurol 2022; 9:468-477. [PMID: 35257509 PMCID: PMC8994975 DOI: 10.1002/acn3.51509] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 12/17/2021] [Accepted: 12/28/2021] [Indexed: 02/02/2023] Open
Abstract
Background Leukoencephalopathy with brainstem and spinal cord involvement and lactate elevation (LBSL) is a rare leukodystrophy with motor impairment due to biallelic mutations in DARS2, which encodes mitochondrial aspartyl tRNA synthetase. Progressive ataxia is the primary feature. Objective The study objective is to determine the feasibility of remotely collecting quantitative gait and balance measures in LBSL. Methods The study design uses wearable accelerometers and the scale for the assessment and rating of ataxia (SARA) scale to assess gait and postural sway in LBSL and control participants' homes through video conferencing. Results Lateral step variability (LSV), which indicates stride variability, and elevation of the step at mid‐swing are increased for LBSL patients during brief walking tests. During stance with the eyes closed, LBSL participants show rapid accelerations and decelerations of body movement covering a large sway area and path. Both the LSV and sway area during stance with the feet together and eyes closed correlate strongly with the SARA. Conclusions Wearable accelerometers are valid and sensitive for detecting ataxia in LBSL patients during remote assessments. The finding of large increases in the sway area during stance with the eyes closed is intriguing since dorsal column dysfunction is universally seen in LBSL. This approach can be applied to related rare diseases that feature ataxia.
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Affiliation(s)
- Amena Smith Fine
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Miriam Kaufman
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Jordan Goodman
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Bela Turk
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Amy Bastian
- Center for Movement Studies, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Doris Lin
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ali Fatemi
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Jennifer Keller
- Center for Movement Studies, Kennedy Krieger Institute, Baltimore, Maryland, USA
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Mukherjee A, Bhuin S, Biswas S, Roy A, Pandit A, Gangopadhyay G. Etiology and course of cerebellar ataxia: A study from eastern India. MEDICAL JOURNAL OF DR. D.Y. PATIL VIDYAPEETH 2022. [DOI: 10.4103/mjdrdypu.mjdrdypu_314_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Hsu LC, Chiang PY, Lin WP, Guo YH, Hsieh PC, Kuan TS, Lien WC, Lin YC. Botulinum toxin injection for Cockayne syndrome with muscle spasticity over bilateral lower limbs: A case report. World J Clin Cases 2021; 9:4728-4733. [PMID: 34222439 PMCID: PMC8223832 DOI: 10.12998/wjcc.v9.i18.4728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/16/2020] [Accepted: 02/01/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cockayne syndrome (CS) is a rare inherited disease characterized by progressive motor symptoms including muscle weakness, joint contracture, ataxia, and spasticity. Botulinum neurotoxin type A has been used for conditions such as dystonia and spasticity, but it has rarely been used in patients with CS. CASE SUMMARY We report a 6-year-and-9-mo old girl diagnosed with CS who received an injection of botulinum neurotoxin type A to manage her difficulty with walking. A total dose of 210 units of botulinum neurotoxin type A was administered into the bilateral tibialis posterior and gastrocnemius muscles. To evaluate the treatment effects on spasticity, joint contracture, pain, and ataxia, measurement tools including the Modified Ashworth Scale, the passive range of motion, the Faces Pain Scale-Revised, and the Scale for the Assessment and Rating of Ataxia, were employed. The first week after the injection, the Modified Ashworth Scale score for the plantar flexors and foot invertors improved bilaterally, along with advancements in the passive range of motion of the bilateral ankles and a lower score for the Faces Pain Scale-Revised. These treatment effects persisted to the 8th week post-injection, but returned to baseline values at the 12th week post-injection, except for the pain scale. CONCLUSION Botulinum toxin injection can thus be considered as a treatment option for lower extremity spasticity, joint contracture, and pain derived from CS.
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Affiliation(s)
- Lin-Chieh Hsu
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Po-Ying Chiang
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Wei-Pin Lin
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Yao-Hong Guo
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Pei-Chun Hsieh
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Ta-Shen Kuan
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Wei-Chih Lien
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Yu-Ching Lin
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
- Medical Device Innovation Center, National Cheng Kung University, Tainan 704, Taiwan
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Early Onset Ataxia with Comorbid Dystonia: Clinical, Anatomical and Biological Pathway Analysis Expose Shared Pathophysiology. Diagnostics (Basel) 2020; 10:diagnostics10120997. [PMID: 33255407 PMCID: PMC7760948 DOI: 10.3390/diagnostics10120997] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/15/2020] [Accepted: 11/16/2020] [Indexed: 01/01/2023] Open
Abstract
In degenerative adult onset ataxia (AOA), dystonic comorbidity is attributed to one disease continuum. However, in early adult onset ataxia (EOA), the prevalence and pathogenesis of dystonic comorbidity (EOAD+), are still unclear. In 80 EOA-patients, we determined the EOAD+-prevalence in association with MRI-abnormalities. Subsequently, we explored underlying biological pathways by genetic network and functional enrichment analysis. We checked pathway-outcomes in specific EOAD+-genotypes by comparing results with non-specifically (in-silico-determined) shared genes in up-to-date EOA, AOA and dystonia gene panels (that could concurrently cause ataxia and dystonia). In the majority (65%) of EOA-patients, mild EOAD+-features concurred with extra-cerebellar MRI abnormalities (at pons and/or basal-ganglia and/or thalamus (p = 0.001)). Genetic network and functional enrichment analysis in EOAD+-genotypes indicated an association with organelle- and cellular-component organization (important for energy production and signal transduction). In non-specifically, in-silico-determined shared EOA, AOA and dystonia genes, pathways were enriched for Krebs-cycle and fatty acid/lipid-metabolic processes. In frequently occurring EOAD+-phenotypes, clinical, anatomical and biological pathway analyses reveal shared pathophysiology between ataxia and dystonia, associated with cellular energy metabolism and network signal transduction. Insight in the underlying pathophysiology of heterogeneous EOAD+-phenotype-genotype relationships supports the rationale for testing with complete, up-to-date movement disorder gene lists, instead of single EOA gene-panels.
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Perez-Lloret S, van de Warrenburg B, Rossi M, Rodríguez-Blázquez C, Zesiewicz T, Saute JAM, Durr A, Nishizawa M, Martinez-Martin P, Stebbins GT, Schrag A, Skorvanek M. Assessment of Ataxia Rating Scales and Cerebellar Functional Tests: Critique and Recommendations. Mov Disord 2020; 36:283-297. [PMID: 33022077 DOI: 10.1002/mds.28313] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 08/28/2020] [Accepted: 09/08/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND We assessed the clinimetric properties of ataxia rating scales and functional tests, and made recommendations regarding their use. METHODS A systematic literature search was conducted to identify the instruments used to rate ataxia symptoms. The identified rating scales and functional ability tests were reviewed and ranked by the panel as "recommended," "suggested," or "listed" for the assessment of patients with discrete cerebellar disorders, using previously established criteria. RESULTS We reviewed 14 instruments (9 rating scales and 5 functional tests). "Recommended" rating scales for the assessment of symptoms severity were: for Friedreich's ataxia, the Friedreich's Ataxia Rating Scale, the International Cooperative Ataxia Rating Scale (ICARS), and the Scale for the Assessment and Rating of Ataxia (SARA); for spinocerebellar ataxias, ICARS and SARA; for ataxia telangiectasia: ICARS and SARA; for brain tumors, SARA; for congenital disorder of glycosylation-phosphomannomutase-2 deficiency, ICARS; for cerebellar symptoms in multiple sclerosis, ICARS; for cerebellar symptoms in multiple system atrophy: Unified Multiple System Atrophy Rating Scale and ICARS; and for fragile X-associated tremor ataxia syndrome, ICARS. "Recommended" functional tests were: for Friedreich's ataxia, Ataxia Functional Composite Score and Composite Cerebellar Functional Severity Score; and for spinocerebellar ataxias, Ataxia Functional Composite Score, Composite Cerebellar Functional Severity Score, and SCA Functional Index. CONCLUSIONS We identified some "recommended" scales and functional tests for the assessment of patients with major hereditary ataxias and other cerebellar disorders. The main limitations of these instruments include the limited assessment of patients in the more severe end of the spectrum and children. Further research in these populations is warranted. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Santiago Perez-Lloret
- National Research Council (CAECIHS-UAI, CONICET), Buenos Aires, Argentina.,Faculty of Medicine, Pontifical Catholic University of Argentina, Buenos Aires, Argentina.,Department of Physiology, Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Bart van de Warrenburg
- Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Malco Rossi
- Movement Disorders Section, Raul Carrea Institute for Neurological Research, Buenos Aires, Argentina
| | | | - Theresa Zesiewicz
- Department of Neurology, University of South Florida, Tampa, Florida, USA
| | - Jonas A M Saute
- Medical Genetics Division, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.,Neurology Division, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.,Postgraduate Program in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Department of Internal Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Alexandra Durr
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute (ICM), AP-HP, INSERM, CNRS, University Hospital Pitié-Salpêtrière, Paris, France
| | | | - Pablo Martinez-Martin
- Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health, Madrid, Spain
| | - Glenn T Stebbins
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Anette Schrag
- Department of Clinical Neurosciences, UCL Institute of Neurology, Royal Free Campus, London, United Kingdom
| | - Matej Skorvanek
- Department of Neurology, Faculty of Medicine, P. J. Safarik University, Kosice, Slovak Republic.,Department of Neurology, University Hospital L. Pasteur, Kosice, Slovak Republic
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Corticospinal tract involvement in spinocerebellar ataxia type 3: a diffusion tensor imaging study. Neuroradiology 2020; 63:217-224. [PMID: 32876704 DOI: 10.1007/s00234-020-02528-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 08/16/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The aim of this study was to evaluate the integrity of the corticospinal tracts (CST) in patients with SCA3 and age- and gender-matched healthy control subjects using diffusion tensor imaging (DTI). We also looked at the clinical correlates of such diffusivity abnormalities. METHODS We assessed 2 cohorts from different Brazilian centers: cohort 1 (n = 29) scanned in a 1.5 T magnet and cohort 2 (n = 91) scanned in a 3.0 T magnet. We used Pearson's coefficients to assess the correlation of CST DTI parameters and ataxia severity (expressed by SARA scores). RESULTS Two different results were obtained. Cohort 1 showed no significant between-group differences in DTI parameters. Cohort 2 showed significant between-group differences in the FA values in the bilateral precentral gyri (p < 0.001), bilateral superior corona radiata (p < 0.001), bilateral posterior limb of the internal capsule (p < 0.001), bilateral cerebral peduncle (p < 0.001), and bilateral basis pontis (p < 0.001). There was moderate correlation between CST diffusivity parameters and SARA scores in cohort 2 (Pearson correlation coefficient: 0.40-0.59). CONCLUSION DTI particularly at 3 T is able to uncover and quantify CST damage in SCA3. Moreover, CST microstructural damage may contribute with ataxia severity in the disease.
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Perez Maturo J, Zavala L, Vega P, González-Morón D, Medina N, Salinas V, Rosales J, Córdoba M, Arakaki T, Garretto N, Rodríguez-Quiroga S, Kauffman MA. Overwhelming genetic heterogeneity and exhausting molecular diagnostic process in chronic and progressive ataxias: facing it up with an algorithm, a gene, a panel at a time. J Hum Genet 2020; 65:895-902. [DOI: 10.1038/s10038-020-0785-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/19/2020] [Accepted: 05/20/2020] [Indexed: 12/18/2022]
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Lanza G, Casabona JA, Bellomo M, Cantone M, Fisicaro F, Bella R, Pennisi G, Bramanti P, Pennisi M, Bramanti A. Update on intensive motor training in spinocerebellar ataxia: time to move a step forward? J Int Med Res 2020; 48:300060519854626. [PMID: 31537137 PMCID: PMC7579332 DOI: 10.1177/0300060519854626] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Some evidence suggests that high-intensity motor training slows down the severity of spinocerebellar ataxia. However, whether all patients might benefit from these activities, and by which activity, and the underlying mechanisms remain unclear. We provide an update on the effect and limitations of different training programmes in patients with spinocerebellar ataxias. Overall, data converge of the finding that intensive training is still based either on conventional rehabilitation protocols or whole-body controlled videogames ("exergames"). Notwithstanding the limitations, short-term improvement is observed, which tends to be lost once the training is stopped. Exergames and virtual reality can ameliorate balance, coordination, and walking abilities, whereas the efficacy of adapted physical activity, gym, and postural exercises depends on the disease duration and severity. In conclusion, although a disease-modifying effect has not been demonstrated, constant, individually tailored, high-intensity motor training might be effective in patients with degenerative ataxia, even in those with severe disease. These approaches may enhance the remaining cerebellar circuitries or plastically induce compensatory networks. Further research is required to identify predictors of training success, such as the type and severity of ataxia and the level of residual functioning.
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Affiliation(s)
- Giuseppe Lanza
- Department of Surgery and Medical-Surgical Specialties,
University of Catania, Catania, Italy
- Department of Neurology IC, Oasi Research Institute – IRCCS,
Troina, Italy
- Giuseppe Lanza, Via Santa Sofia, 78 – 95125,
Catania, Italy.
| | | | - Maria Bellomo
- School of Human and Social Science, University Kore of Enna,
Enna, Italy
| | - Mariagiovanna Cantone
- Department of Neurology, Sant’Elia Hospital, ASP Caltanissetta,
Caltanissetta, Italy
| | - Francesco Fisicaro
- Department of Medical and Surgical Sciences and Advanced
Technologies, University of Catania, Catania, Italy
| | - Rita Bella
- Department of Medical and Surgical Sciences and Advanced
Technologies, University of Catania, Catania, Italy
| | - Giovanni Pennisi
- Department of Surgery and Medical-Surgical Specialties,
University of Catania, Catania, Italy
| | | | - Manuela Pennisi
- Department of Biomedical and Biotechnological Sciences,
University of Catania, Catania, Italy
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13
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The neurological update: therapies for cerebellar ataxias in 2020. J Neurol 2020; 267:1211-1220. [DOI: 10.1007/s00415-020-09717-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/12/2020] [Accepted: 01/18/2020] [Indexed: 12/28/2022]
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14
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Acar Arslan E, Erden A, Dilber B, Esenülkü G, Şahin S, Kamaşak T, Özkan Kart P, Arslan E, Topbaş M, Cansu A. Turkish version of Brief Ataxia Rating Scale. Disabil Rehabil 2019; 43:2497-2501. [PMID: 31829051 DOI: 10.1080/09638288.2019.1701101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
AIM Our aim was to perform the Turkish-language adaptation of a practical ataxia rating scale for children. METHODS The Brief Ataxia Rating Scale was subjected to cultural adaptation following receipt of the requisite permissions. Thirty-six children aged 4-18 years followed-up with a diagnosis of ataxia were included in the study. Evaluation of each child was recorded on video. The video recordings were scored independently by nine observers (four physiotherapists, one pediatric neurologist, and four pediatricians). Intra-rater reliability was tested by the same video images being scored twice, at 15-day intervals, by a pediatric neurologist. Intraclass correlation coefficients were used for inter-rater and intra-rater reliability. The Scale for the Assessment and Rating of Ataxia was used for concurrent validity. RESULTS Good to excellent reliability was determined among the nine observers in terms of total scores with the intraclass correlation coefficient among the nine observers (intraclass correlation coefficient = 0.926; 95% CI: 0.885-0.956). Intra-rater reliability analysis results exhibited strong reliability in terms of scores elicited at two-week intervals (intraclass correlation coefficient = 0.967; 95% CI: 0.890-0.987, r = 0.97, p < 0.001). At concurrent validity analysis, a strong relation was determined between total Scale of the Assessment and Rating of Ataxia score and total Brief Ataxia Rating Scale score (r = 0.942, p < 0.001). CONCLUSION The Turkish-language adaptation of the Brief Ataxia Rating Scale is reliable and valid for application in children.Implications for RehabilitationThis study shows the reliability and validity of the Turkish language adaptation of brief ataxia rating scale in children.The scale being both practical and easily applicable to ataxic children will contribute to broadening its use in the pediatric age group in particular.
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Affiliation(s)
- Elif Acar Arslan
- Department of Pediatric Neurology, School of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Arzu Erden
- Department of Physiotherapy and Rehabilitation, Faculty of Health Science, Karadeniz Technical University, Trabzon, Turkey
| | - Beril Dilber
- Department of Pediatric Neurology, School of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Gülnur Esenülkü
- Department of Pediatric Neurology, School of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Sevim Şahin
- Department of Pediatric Neurology, School of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Tülay Kamaşak
- Department of Pediatric Neurology, School of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Pınar Özkan Kart
- Department of Pediatric Neurology, School of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Erhan Arslan
- Department of Neurosurgery, School of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Murat Topbaş
- Department of Public Health, Faculty of Medicine, School of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Ali Cansu
- Department of Pediatric Neurology, School of Medicine, Karadeniz Technical University, Trabzon, Turkey
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15
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Lanza G, Casabona JA, Bellomo M, Cantone M, Fisicaro F, Bella R, Pennisi G, Bramanti P, Pennisi M, Bramanti A. Update on intensive motor training in spinocerebellar ataxia: time to move a step forward? J Int Med Res 2019. [PMID: 31537137 DOI: 10.1177/0300060519854626.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Some evidence suggests that high-intensity motor training slows down the severity of spinocerebellar ataxia. However, whether all patients might benefit from these activities, and by which activity, and the underlying mechanisms remain unclear. We provide an update on the effect and limitations of different training programmes in patients with spinocerebellar ataxias. Overall, data converge of the finding that intensive training is still based either on conventional rehabilitation protocols or whole-body controlled videogames ("exergames"). Notwithstanding the limitations, short-term improvement is observed, which tends to be lost once the training is stopped. Exergames and virtual reality can ameliorate balance, coordination, and walking abilities, whereas the efficacy of adapted physical activity, gym, and postural exercises depends on the disease duration and severity. In conclusion, although a disease-modifying effect has not been demonstrated, constant, individually tailored, high-intensity motor training might be effective in patients with degenerative ataxia, even in those with severe disease. These approaches may enhance the remaining cerebellar circuitries or plastically induce compensatory networks. Further research is required to identify predictors of training success, such as the type and severity of ataxia and the level of residual functioning.
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Affiliation(s)
- Giuseppe Lanza
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy.,Department of Neurology IC, Oasi Research Institute - IRCCS, Troina, Italy
| | | | - Maria Bellomo
- School of Human and Social Science, University Kore of Enna, Enna, Italy
| | - Mariagiovanna Cantone
- Department of Neurology, Sant'Elia Hospital, ASP Caltanissetta, Caltanissetta, Italy
| | - Francesco Fisicaro
- Department of Medical and Surgical Sciences and Advanced Technologies, University of Catania, Catania, Italy
| | - Rita Bella
- Department of Medical and Surgical Sciences and Advanced Technologies, University of Catania, Catania, Italy
| | - Giovanni Pennisi
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | | | - Manuela Pennisi
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
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16
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Brandsma R, Verschuuren-Bemelmans CC, Amrom D, Barisic N, Baxter P, Bertini E, Blumkin L, Brankovic-Sreckovic V, Brouwer OF, Bürk K, Catsman-Berrevoets CE, Craiu D, de Coo IFM, Gburek J, Kennedy C, de Koning TJ, Kremer HPH, Kumar R, Macaya A, Micalizzi A, Mirabelli-Badenier M, Nemeth A, Nuovo S, Poll-The B, Lerman-Sagie T, Steinlin M, Synofzik M, Tijssen MAJ, Vasco G, Willemsen MAAP, Zanni G, Valente EM, Boltshauser E, Sival DA. A clinical diagnostic algorithm for early onset cerebellar ataxia. Eur J Paediatr Neurol 2019; 23:692-706. [PMID: 31481303 DOI: 10.1016/j.ejpn.2019.08.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 05/25/2019] [Accepted: 08/06/2019] [Indexed: 10/26/2022]
Abstract
Early onset cerebellar Ataxia (EOAc) comprises a large group of rare heterogeneous disorders. Determination of the underlying etiology can be difficult given the broad differential diagnosis and the complexity of the genotype-phenotype relationships. This may change the diagnostic work-up into a time-consuming, costly and not always rewarding task. In this overview, the Childhood Ataxia and Cerebellar Group of the European Pediatric Neurology Society (CACG-EPNS) presents a diagnostic algorithm for EOAc patients. In seven consecutive steps, the algorithm leads the clinician through the diagnostic process, including EOA identification, application of the Inventory of Non-Ataxic Signs (INAS), consideration of the family history, neuro-imaging, laboratory investigations, genetic testing by array CGH and Next Generation Sequencing (NGS). In children with EOAc, this algorithm is intended to contribute to the diagnostic process and to allow uniform data entry in EOAc databases.
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Affiliation(s)
- R Brandsma
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - C C Verschuuren-Bemelmans
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - D Amrom
- Department of Neurology, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium; Neurology Unit, Kannerklinik Centre Hospitalier de Luxembourg, Luxembourg, Grand Duchy of Luxembourg
| | - N Barisic
- Department of Pediatrics, Clinical Medical Centre Zagreb, University of Zagreb Medical School, Croatia
| | - P Baxter
- Department of Paediatric Neurology, Sheffield Children's Hospital, UK
| | - E Bertini
- Unit of Neuromuscular and Neurodegenerative Disorders, Bambino Gesu' Children's Research Hospital, Rome, Italy
| | - L Blumkin
- Pediatric Neurology Unit, Wolfson Medical Center, Holon and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - V Brankovic-Sreckovic
- Clinic for Child Neurology and Psychiatry, Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - O F Brouwer
- Department of Paediatric Neurology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - K Bürk
- Paracelsus-Elena-Klinik Kassel, University of Marburg, Germany
| | - C E Catsman-Berrevoets
- Department of Pediatric Neurology, Erasmus University Hospital/Sophia Children's Hospital, Rotterdam, the Netherlands
| | - D Craiu
- Carol Davila University of Medicine Bucharest, Department of Clinical Neurosciences, Pediatric Neurology II Discipline, Alexandru Obregia Hospital, Bucharest, Romania
| | - I F M de Coo
- Department of Genetics and Cell Biology, University of Maastricht, Maastricht, the Netherlands
| | - J Gburek
- Centre for Paediatrics and Adolescent Medicine, Hannover Medical School, Hannover, Germany
| | - C Kennedy
- Clinical Neurosciences, Faculty of Medicine, University of Southampton, UK
| | - T J de Koning
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Department of Paediatric Neurology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - H P H Kremer
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - R Kumar
- Department of Pediatric Neurology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - A Macaya
- Grup de Recerca en Neurologia Pediàtrica, Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona, Secció de Neurologia Pediàtrica, Hospital Universitari Vall d'Hebron, 08002, Barcelona, Spain
| | - A Micalizzi
- Laboratory of Medical Genetics, Bambino Gesu Children's Hospital, Rome, Italy
| | - M Mirabelli-Badenier
- DINOGMI Department-University of Genoa/Unit of Child Neuropsychiatry, G. Gaslini Institute, Genoa, Italy
| | - A Nemeth
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom; Oxford Centre for Genomic Medicine, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - S Nuovo
- Neurogenetics Unit, IRCCS Santa Lucia Foundation, Rome, Italy; Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - B Poll-The
- Department of Pediatric Neurology, Emma Children's Hospital, Academic Medical Centre (AMC), University of Amsterdam, the Netherlands
| | - T Lerman-Sagie
- Pediatric Neurology Unit, Wolfson Medical Center, Holon and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - M Steinlin
- Division of Neuropediatrics, Development and Rehabilitation, University Children's Hospital Bern, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - M Synofzik
- Department of Neurodegenerative Diseases, Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany; German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany
| | - M A J Tijssen
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - G Vasco
- Division of Neurorehabilitation, Bambino Gesu' Children's Research Hospital, Rome, Italy
| | - M A A P Willemsen
- Department of Pediatric Neurology, Radboud University Medical Center/Amalia Children's Hospital, Nijmegen, the Netherlands
| | - G Zanni
- Unit of Neuromuscular and Neurodegenerative Disorders, Bambino Gesu' Children's Research Hospital, Rome, Italy
| | - E M Valente
- Neurogenetics Unit, IRCCS Santa Lucia Foundation, Rome, Italy; Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - E Boltshauser
- Department of Pediatric Neurology, University Children's Hospital, Zürich, Switzerland
| | - D A Sival
- Department of Paediatric Neurology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
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17
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Arcuria G, Marcotulli C, Galasso C, Pierelli F, Casali C. 15-White Dots APP-Coo-Test: a reliable touch-screen application for assessing upper limb movement impairment in patients with cerebellar ataxias. J Neurol 2019; 266:1611-1622. [PMID: 30955123 DOI: 10.1007/s00415-019-09299-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 03/23/2019] [Accepted: 03/27/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Giuseppe Arcuria
- Department of Medical and Surgical Sciences and Biotechnologies (DSBMC), Polo Pontino-University of Rome "Sapienza", Via Faggiana 34, 40100, Latina, Italy.
| | - Christian Marcotulli
- Department of Medical and Surgical Sciences and Biotechnologies (DSBMC), Polo Pontino-University of Rome "Sapienza", Via Faggiana 34, 40100, Latina, Italy
| | - Claudio Galasso
- Department of Medical and Surgical Sciences and Biotechnologies (DSBMC), Polo Pontino-University of Rome "Sapienza", Via Faggiana 34, 40100, Latina, Italy
| | - Francesco Pierelli
- Department of Medical and Surgical Sciences and Biotechnologies (DSBMC), Polo Pontino-University of Rome "Sapienza", Via Faggiana 34, 40100, Latina, Italy
| | - Carlo Casali
- Department of Medical and Surgical Sciences and Biotechnologies (DSBMC), Polo Pontino-University of Rome "Sapienza", Via Faggiana 34, 40100, Latina, Italy
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