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Zetterberg L, Niemi Andersson E, Åsenlöf P, Nyholm D, de Roos P, Bring A. "I'm still the person I am. Not the body it has become." An active but challenging life with cervical dystonia. Physiother Theory Pract 2024:1-9. [PMID: 38814175 DOI: 10.1080/09593985.2024.2359495] [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: 09/23/2023] [Accepted: 05/20/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Improvement of activity and participation for the disabled and chronically ill is an important aim of rehabilitation. Cervical dystonia is a neurological movement disorder characterized by involuntary contractions of the neck muscles. Until now, research has identified factors contributing to disability rather than factors which may make it easier to be active and participate in the community. OBJECTIVE Explore and describe perceived experiences of activity and participation in daily life as experienced by persons with cervical dystonia. METHODS Sixteen informants participated in this semi-structured interview study. Inductive qualitative content analysis was performed to understand and interpret experiences shared by the informants. RESULTS Results from the analysis generated two themes "An active life" and "A challenging life" and six sub-themes: Using helpful coping strategies, Accepting a new life situation, Adhering to BT treatment, Facing the negative impact of stress, Experiencing a negative self-image and Suffering from pain and fatigue. CONCLUSIONS Our results support the importance of actions using a rehabilitation approach that consider both motor and non-motor symptoms. Future studies should compare the effects of physiotherapy taking into account wishes and challenges in patients' everyday life versus traditional physiotherapy addressing mostly the motor disorder.
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Affiliation(s)
- Lena Zetterberg
- Department of Women's and Children's Health, Physiotherapy, Uppsala University, Uppsala, Sweden
| | | | - Pernilla Åsenlöf
- Department of Women's and Children's Health, Physiotherapy, Uppsala University, Uppsala, Sweden
| | - Dag Nyholm
- Department of Medical Sciences, Neurology, Uppsala University, Uppsala, Sweden
| | - Paul de Roos
- Department of Medical Sciences, Neurology, Uppsala University, Uppsala, Sweden
| | - Annika Bring
- Department of Women's and Children's Health, Physiotherapy, Uppsala University, Uppsala, Sweden
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Chrobak AA, Rusinek J, Dec-Ćwiek M, Porębska K, Siwek M. Content overlap of 91 dystonia symptoms among the seven most commonly used cervical dystonia scales. Neurol Sci 2024; 45:1507-1514. [PMID: 37910323 PMCID: PMC10943139 DOI: 10.1007/s10072-023-07157-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 10/19/2023] [Indexed: 11/03/2023]
Abstract
INTRODUCTION Dystonia is a movement disorder characterized by sustained or intermittent muscle contractions. Cervical dystonia (CD) is the most common focal dystonia. There are several instruments assessing the symptoms of CD. However, different scales assess different features which may lead to poor patient evaluation. AIM The aim of the study was to evaluate the degree of overlap of most often used CD rating scales identified by the literature review. METHODS A thorough search of the Medline database was conducted in September 2021. Then the frequency of each scale was calculated, and 7 most common scales were included in the content overlap analysis using Jaccard index (0 - no overlap, 1 - full overlap). RESULTS Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS), Tsui score, Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS), Cervical Dystonia Impact Profile 58 (CDIP-58), Craniocervical Dystonia Questionnaire 24 (CDQ-24), Cervical Dystonia Severity Rating Scale (CDSS), Cervical Dystonia Severity Rating Scale (DDS) and The Dystonia Non-Motor Symptoms Questionnaire (DNMSQuest) were the most common scales. 91 CD symptoms were distinguished from 134 items used in the scales. The mean overlap among all scales was 0.17. 52 (62%) symptoms were examined by more than one scale. The CIDP-58 captured the highest number of symptoms (63.0%), while the CDSS captured the lowest number (8.0%). None of the symptoms were examined by seven instruments. CONCLUSIONS There was a very weak overlap among scales. High inconsistency between the scales may lead to highly different dystonia severity assessment in clinical practice. Thus, the instruments should be combined.
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Affiliation(s)
- Adrian Andrzej Chrobak
- Department of Adult Psychiatry, Chair of Psychiatry, Jagiellonian University Medical College, Kraków, Poland
| | - Jakub Rusinek
- Students' Scientific Group of Neurology at the Department of Neurology, Jagiellonian University Medical College, Kraków, Poland
| | - Małgorzata Dec-Ćwiek
- Department of Neurology, Jagiellonian University Medical College, Kraków, Poland
| | - Karolina Porębska
- Department of Neurology, Jagiellonian University Medical College, Kraków, Poland
| | - Marcin Siwek
- Department of Affective Disorders, Chair of Psychiatry, Jagiellonian University Medical College, Kopernika 21a St., 31-501, Kraków, Poland.
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Goldman JG, Holden SK. Cognitive Syndromes Associated With Movement Disorders. Continuum (Minneap Minn) 2022; 28:726-749. [PMID: 35678400 DOI: 10.1212/con.0000000000001134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW This article reviews the recognition and management of cognitive syndromes in movement disorders, including those with parkinsonism, chorea, ataxia, dystonia, and tremor. RECENT FINDINGS Cognitive and motor syndromes are often intertwined in neurologic disorders, including neurodegenerative diseases such as Parkinson disease, atypical parkinsonian syndromes, Huntington disease, and other movement disorders. Cognitive symptoms often affect attention, working memory, and executive and visuospatial functions preferentially, rather than language and memory, but heterogeneity can be seen in the various movement disorders. A distinct cognitive syndrome has been recognized in patients with cerebellar syndromes. Appropriate recognition and screening for cognitive changes in movement disorders may play a role in achieving accurate diagnoses and guiding patients and their families regarding progression and management decisions. SUMMARY In the comprehensive care of patients with movement disorders, recognition of cognitive syndromes is important. Pharmacologic treatments for the cognitive syndromes, including mild cognitive impairment and dementia, in these movement disorders lag behind the therapeutics available for motor symptoms, and more research is needed. Patient evaluation and management require a comprehensive team approach, often linking neurologists as well as neuropsychologists, psychologists, psychiatrists, social workers, and other professionals.
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Santiano RAS, Rosales RL. A Cross-Cultural Validation of the Filipino and Hiligaynon Versions of the Parts IIIB (Non-Motor Features) and IV (Activities of Daily Living) of the X-Linked Dystonia-Parkinsonism- MDSP Rating Scale. Clin Park Relat Disord 2022; 5:100100. [PMID: 34988424 PMCID: PMC8710412 DOI: 10.1016/j.prdoa.2021.100100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 05/30/2021] [Accepted: 06/05/2021] [Indexed: 01/20/2023] Open
Abstract
Introduction X-linked dystonia-parkinsonism (XDP) is a progressive movement disorder which also encompasses non-motor features and alterations in activities of daily living. The study aims to translate the Parts IIIB (Non-Motor Features) and IV (Activities of Daily Living) of the XDP-Movement Disorder Society of Philippines Rating Scale to Filipino and Hiligaynon and subsequently validate these versions, which are more understandable to the natives given that XDP originated from the Panay Islands in the Philippines. Methods This is a cross-cultural, cross-sectional validation study, composed of the following steps: forward translation, backward translation, panel reconciliation, pretesting, and field testing. Two sets of 10 XDP patients were recruited to the Filipino and Hiligaynon groups for pretesting and cognitive debriefing while another 2 sets of 50 XDP patients were assigned for field testing. Results The Filipino version had a good internal consistency with a Cronbach's alpha of 0.951 during the pretesting and 0.886 during the field testing. Similar results were seen in the Hiligaynon version (0.837; 0.900). Both also had good conceptual equivalence as demonstrated by significant Pearson r values of 0.384 to 0.814 for the Filipino and 0.355 to 0.800 for the Hiligaynon versions. Conclusion The Filipino and Hiligaynon versions of the Parts IIIB and IV of the XDP-MDSP scale are internally valid and reliable. These scales are considered acceptable to assess the severity of the non-motor features and difficulties in activities of daily living among XDP patients.
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Affiliation(s)
- Richelle Ann S Santiano
- Department of Neurology and Psychiatry, University of Santo Tomas Hospital, Espana, Manila, Philippines
| | - Raymond L Rosales
- The Neuroscience Institute, Department of Neurology and Psychiatry, University of Santo Tomas Hospital, Espana, Manila, Philippines.,Department of Neuroscience and Behavioral Medicine, Faculty of Medicine and Surgery, University of Santo Tomas, Espana, Manila, Philippines.,Movement Disorders Service and Section of Neurology, Institute for Neurosciences, St. Luke's Medical Center, Philippines.,Collaborative Center for X-Linked Dystonia-Parkinsonism, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
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Rosales RL, Cuffe L, Regnault B, Trosch RM. Pain in cervical dystonia: mechanisms, assessment and treatment. Expert Rev Neurother 2021; 21:1125-1134. [PMID: 34569398 DOI: 10.1080/14737175.2021.1984230] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION In patients with cervical dystonia (CD), pain is a major contributor to disability and social isolation and is often the main reason patients seek treatment. Surveys evaluating patient perceptions of their CD symptoms consistently highlight pain as a troublesome and disabling feature of their condition with significant impact on daily life and work. AREAS COVERED In this article, the authors review the epidemiology, assessment, possible mechanisms and treatment of pain in CD, including a meta-analysis of randomized controlled trial data with abobotulinumtoxinA. EXPERT OPINION Mechanisms of pain in CD may be muscle-based and non-muscle based. Accumulating evidence suggests that non-muscle-based mechanisms (such as abnormal transmission and processing of nociceptive stimuli, dysfunction of descending pain inhibitory pathways as well as structural and network changes in the basal ganglia, cortex and other areas) may also contribute to pain in CD alongside prolonged muscle contraction. Chemodenervation with botulinum toxin is considered the first-line treatment for CD. Treatment with botulinum toxin is usually effective, but optimization of the injection parameters should include consideration of pain as a core symptom in addition to the motor problems.
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Affiliation(s)
- Raymond L Rosales
- Dept. of Neurology and Psychiatry, the Neuroscience Institute, University of Santo Tomas Hospital, Manila, Philippines.,The Institute for Neurosciences, St. Luke's Medical Center, Quezon City, Philippines
| | | | | | - Richard M Trosch
- The Parkinson's and Movement Disorders Center, Farmington Hills, MI, USA
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da Silva-Júnior FP, Dos Santos Alves CO, Silva SMCA, Borges V, Ferraz HB, Rocha MSG, Limongi JCP, Barbosa ER, de Carvalho Aguiar P. High prevalence of self-reported non-motor symptoms and lack of correlation with motor severity in adult patients with idiopathic isolated dystonia. Neurol Sci 2021; 43:1061-1065. [PMID: 34297264 DOI: 10.1007/s10072-021-05452-3] [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: 04/06/2021] [Accepted: 06/27/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Although abnormal movements and postures are the hallmark of dystonia, non-motor symptoms (NMS) are common and negatively affect quality of life. OBJECTIVES The aim of this study was to screen dystonia patients for NMS and analyze their association with clinical parameters, including motor disability. METHODS Adult patients with idiopathic isolated dystonia were interviewed and examined. Dystonia severity was evaluated with the Fahn-Marsden Dystonia Rating Scale and the presence of NMS was assessed using a list of 29 complaints. RESULTS A hundred and two patients (63.7% female) were enrolled. Dystonia began after 20 years of age in 61.8% and was focal or segmental in 82.8% of patients. Only eight patients (7.8%) had no NMS and 59.8% reported more than five. The most prevalent NMS were pain (72.5%) and anxiety (63.7%), followed by difficulty recalling information (44.1%), sadness/anhedonia (41.2%), and difficulty falling asleep (38.2%). No correlation was found between the total number of NMS and dystonia severity (p = 0.18) or regular botulinum toxin use (p = 0.66). The majority of NMS domains correlated with each other. CONCLUSIONS Our results confirm a high prevalence of NMS among dystonia patients, even in those with mild motor disability. The pathophysiology of NMS in dystonia remains to be completely understood.
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Affiliation(s)
- Francisco Pereira da Silva-Júnior
- Department of Neurology, Universidade de São Paulo, São Paulo, SP, Brazil. .,Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | | | - Sônia Maria Cesar Azevedo Silva
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil.,Hospital Do Servidor Público Estadual, São Paulo, SP, Brazil
| | - Vanderci Borges
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Henrique Ballalai Ferraz
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | | | | | - Patrícia de Carvalho Aguiar
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.,Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Vilaseca I, Hidalgo J, Cámara A, Compta Y, Martí MJ. Non-motor symptoms in spasmodic dysphonia: A case control-study. Auris Nasus Larynx 2021; 49:100-105. [PMID: 34092434 DOI: 10.1016/j.anl.2021.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/30/2021] [Accepted: 05/18/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Non-motor symptoms (NMS) have been identified in some focal adult-onset dystonia. In the present study we aimed to evaluate the presence of NMS in patients with spasmodic dysphonia (SD), a focal action-induced dystonia that affects intrinsic laryngeal muscle control. METHODS Seventeen SD patients and 17 control subjects not significantly different in age and sex were evaluated for the presence of NMS. Additionally, voice handicap index (VHI-10), reflux symptom index, neuropsychiatric symptoms and QoL were assessed by validated scales and questionnaires. RESULTS Patients' group significantly differed from control group in mild depressive symptoms (4.35 ± 3.9 vs. 1.47 ± 2; p=0.01), insomnia (35.3% vs. 14.7%; p=0.016), smell and taste loss (11.8% vs. 0%; p=0.033), swallowing difficulties (17.6% vs. 0%; p=0.007) and throat pain (17.6% vs. 0%; p=0.007). In the group of SD, there was no correlation between voice perception evaluated by VHI-10, number of NMS or QoL. CONCLUSION Patients with SD have a greater burden of depressive, smell, taste, and sleep NMS than control subjects.
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Affiliation(s)
- Isabel Vilaseca
- Otorhinolaryngology Department, Hospital Clínic, Barcelona, Spain; Faculty of Medicine, University of Barcelona, Barcelona, Spain; Institut d'Investigació Biomèdica Agustí Pi Sunyer (IDIBAPS), Barcelona, Spain; CIBERNED: CB06/05/0018-ISCIII, ERN-RND (ID No 739510), Barcelona, Spain.
| | - Judit Hidalgo
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Ana Cámara
- Institut d'Investigació Biomèdica Agustí Pi Sunyer (IDIBAPS), Barcelona, Spain; CIBERNED: CB06/05/0018-ISCIII, ERN-RND (ID No 739510), Barcelona, Spain; Parkinson's disease and Movement Disorders Unit, Neurology Service, Hospital Clinic Barcelona, Universitat de Barcelona
| | - Yaroslau Compta
- Institut d'Investigació Biomèdica Agustí Pi Sunyer (IDIBAPS), Barcelona, Spain; CIBERNED: CB06/05/0018-ISCIII, ERN-RND (ID No 739510), Barcelona, Spain; Parkinson's disease and Movement Disorders Unit, Neurology Service, Hospital Clinic Barcelona, Universitat de Barcelona
| | - María José Martí
- Institut d'Investigació Biomèdica Agustí Pi Sunyer (IDIBAPS), Barcelona, Spain; CIBERNED: CB06/05/0018-ISCIII, ERN-RND (ID No 739510), Barcelona, Spain; Parkinson's disease and Movement Disorders Unit, Neurology Service, Hospital Clinic Barcelona, Universitat de Barcelona
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Dystonia and leveraging oral pharmacotherapy. J Neural Transm (Vienna) 2021; 128:521-529. [PMID: 33877451 DOI: 10.1007/s00702-021-02339-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 04/15/2021] [Indexed: 11/27/2022]
Abstract
Dystonia is a clinically diverse disorder, characterized by sustained or intermittent muscle contractions causing abnormal and often repetitive movements and/or postures. Accurate clinical diagnosis is tantamount to effective dystonia management. Current guidelines in the treatments of dystonia, including oral therapy, are prescribed to improve symptoms and to restore functional capacity. Identifying treatable causes from co-existing phenomenologies is relevant to provide the most optimal and disease-specific medications. In other forms of dystonia, genetic factors may affect outcome. Moreover, proper selection of patients, early initiation of medications and customized drug titration are keys to increasing the chances of success when using oral therapies for dystonia. Treatment of dystonia primarily involves agents that target dopamine and acetylcholine receptors. Other drugs used include benzodiazepines, baclofen, antiepileptics, some antipsychotics drugs and antihistamine, with different levels of evidence of effectiveness. Unfortunately, most of the widely used drugs have low levels of evidence and are primarily based on anecdotal experiences. Finally, other adjunctive therapeutic strategies are often necessary to complement oral therapy.
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9
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Weissbach A, Saranza G, Domingo A. Combined dystonias: clinical and genetic updates. J Neural Transm (Vienna) 2020; 128:417-429. [PMID: 33099685 DOI: 10.1007/s00702-020-02269-w] [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: 09/08/2020] [Accepted: 10/09/2020] [Indexed: 12/28/2022]
Abstract
The genetic combined dystonias are a clinically and genetically heterogeneous group of neurologic disorders defined by the overlap of dystonia and other movement disorders such as parkinsonism or myoclonus. The number of genes associated with combined dystonia syndromes has been increasing due to the wider recognition of clinical features and broader use of genetic testing. Nevertheless, these diseases are still rare and represent only a small subgroup among all dystonias. Dopa-responsive dystonia (DYT/PARK-GCH1), rapid-onset dystonia-parkinsonism (DYT/PARK-ATP1A3), X-linked dystonia-parkinsonism (XDP, DYT/PARK-TAF1), and young-onset dystonia-parkinsonism (DYT/PARK-PRKRA) are monogenic combined dystonias accompanied by parkinsonian features. Meanwhile, MYC/DYT-SGCE and MYC/DYT-KCTD17 are characterized by dystonia in combination with myoclonus. In the past, common molecular pathways between these syndromes were the center of interest. Although the encoded proteins rather affect diverse cellular functions, recent neurophysiological evidence suggests similarities in the underlying mechanism in a subset. This review summarizes recent developments in the combined dystonias, focusing on clinico-genetic features and neurophysiologic findings. Disease-modifying therapies remain unavailable to date; an overview of symptomatic therapies for these disorders is also presented.
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Affiliation(s)
- Anne Weissbach
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany.,Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| | - Gerard Saranza
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, ON, Canada
| | - Aloysius Domingo
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA. .,Collaborative Center for X-Linked Dystonia-Parkinsonism, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
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Bradnam LV, Meiring RM, Boyce M, McCambridge A. Neurorehabilitation in dystonia: a holistic perspective. J Neural Transm (Vienna) 2020; 128:549-558. [PMID: 33099684 PMCID: PMC8099801 DOI: 10.1007/s00702-020-02265-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 10/09/2020] [Indexed: 01/12/2023]
Abstract
Rehabilitation for isolated forms of dystonia, such as cervical or focal hand dystonia, is usually targeted towards the affected body part and focuses on sensorimotor control and motor retraining of affected muscles. Recent evidence, has revealed people who live with dystonia experience a range of functional and non-motor deficits that reduce engagement in daily activities and health-related quality of life, which should be addressed with therapeutic interventions. These findings support the need for a holistic approach to the rehabilitation of dystonia, where assessment and treatments involve non-motor signs and symptoms, and not just the dystonic body part. Most studies have investigated Cervical Dystonia, and in this population, it is evident there is reduced postural control and walking speed, high fear of falling and actual falls, visual compensation for the impaired neck posture, and a myriad of non-motor symptoms including pain, fatigue, sleep disorders and anxiety and depression. In other populations of dystonia, there is also emerging evidence of falls and reduced vision-related quality of life, along with the inability to participate in physical activity due to worsening of dystonic symptoms during or after exercise. A holistic approach to dystonia would support the management of a wide range of symptoms and signs, that if properly addressed could meaningfully reduce disability and improve quality of life in people living with dystonia.
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Affiliation(s)
- Lynley V Bradnam
- Department of Exercise Sciences, Faculty of Science, University of Auckland, Auckland, New Zealand.
| | - Rebecca M Meiring
- Department of Exercise Sciences, Faculty of Science, University of Auckland, Auckland, New Zealand
| | - Melani Boyce
- Graduate School of Health, Discipline of Physiotherapy, University of Technology, Sydney, NSW, Australia.,Department of Physiotherapy, Westmead Hospital, Sydney, NSW, Australia
| | - Alana McCambridge
- Graduate School of Health, Discipline of Physiotherapy, University of Technology, Sydney, NSW, Australia
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Huang M, de Koning TJ, Tijssen MAJ, Verbeek DS. Cross-disease analysis of depression, ataxia and dystonia highlights a role for synaptic plasticity and the cerebellum in the pathophysiology of these comorbid diseases. Biochim Biophys Acta Mol Basis Dis 2020; 1867:165976. [PMID: 33011198 DOI: 10.1016/j.bbadis.2020.165976] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/15/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND There is growing evidence that the neuropsychiatric and neurological disorders depression, ataxia and dystonia share common biological pathways. We therefore aimed to increase our understanding of their shared pathophysiology by investigating their shared biological pathways and molecular networks. METHODS We constructed gene sets for depression, ataxia, and dystonia using the Human Phenotype Ontology database and genome-wide association studies, and identified shared genes between the three diseases. We then assessed shared genes in terms of functional enrichment, pathway analysis, molecular connectivity, expression profiles and brain-tissue-specific gene co-expression networks. RESULTS The 33 genes shared by depression, ataxia and dystonia are enriched in shared biological pathways and connected through molecular complexes in protein-protein interaction networks. Biological processes common/shared to all three diseases were identified across different brain tissues, highlighting roles for synaptic transmission, synaptic plasticity and nervous system development. The average expression of shared genes was significantly higher in the cerebellum compared to other brain regions, suggesting these genes have distinct cerebellar functions. Several shared genes also showed high expression in the cerebellum during prenatal stages, pointing to a functional role during development. CONCLUSIONS The shared pathophysiology of depression, ataxia and dystonia seems to converge onto the cerebellum that maybe particularly vulnerable to changes in synaptic transmission, regulation of synaptic plasticity and nervous system development. Consequently, in addition to regulating motor coordination and motor function, the cerebellum may likely play a role in mood processing.
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Affiliation(s)
- Miaozhen Huang
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Tom J de Koning
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Pediatrics, Department of Clinical Sciences, Lund University, Sweden
| | - Marina A J Tijssen
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Dineke S Verbeek
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
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Bajenaru OL, Popescu-Olaru I, Dumitrescu L, Serban E, Cozma L, Raicu F, Cocos R, Popescu OB. Non-Motor Manifestations in Idiopathic Dystonia with Focal Onset - A Pilot Study. J Med Life 2020; 13:170-174. [PMID: 32742509 PMCID: PMC7378344 DOI: 10.25122/jml-2020-0094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Recent studies emphasize an increased prevalence of non-motor symptoms in idiopathic dystonia with focal onset (IDFO), but their pathophysiological relationship is not clear. We aimed to identify the prevalence of depression and neurocognitive impairment in a group of patients with idiopathic dystonia with focal onset and their impact on the patients' quality of life. This study represents a component of an ongoing research project - GENDYS. From the database of this project, we selected 48 patients 56.62+/-14.16 years old who have been examined clinically and using specific scales: Patient Health Questionnaire-9 (for depression), Montreal Cognitive Assessment - MoCA (for cognitive impairment), and a 5-degree analog scale for subjective perception of the severity of the disease. We conducted a descriptive cross-sectional study on patients with depression and cognition evaluated by the above-mentioned scales. We also performed a nested case-control analysis on 20 IDFO patients with and without at least moderate depression matched for age and gender; the cut-offs for depression were PHQ-9 score ≥10 and PHQ9 <5, for the depression group and the control group, respectively. The cut-off for MoCA was 26 points. 22 IDFO patients (46%) had depression; 54.5% of IDFO patients with depression had cognitive impairment, indicating a slight trend of increased cognitive impairment in those with depression compared to those without; the perception of the severity of disease was the greatest in patients with depression. Depression is more prevalent in patients with IDFO and is associated with a worse perception of the disease severity.
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Affiliation(s)
- Ovidiu-Lucian Bajenaru
- Department of Clinical Neurosciences, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,"Ana Aslan" National Institute of Geriatrics and Gerontology, Bucharest, Romania
| | - Iulia Popescu-Olaru
- Department of Clinical Neurosciences, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Neurology, clinical Hospital Colentina, Bucharest, Romania
| | - Laura Dumitrescu
- Department of Clinical Neurosciences, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Neurology, clinical Hospital Colentina, Bucharest, Romania
| | - Elena Serban
- Department of Clinical Neurosciences, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Liviu Cozma
- Department of Clinical Neurosciences, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Neurology, clinical Hospital Colentina, Bucharest, Romania
| | - Florina Raicu
- Department of Medical Genetics, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Relu Cocos
- Department of Medical Genetics, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Ovidiu Bogdan Popescu
- Department of Clinical Neurosciences, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Neurology, clinical Hospital Colentina, Bucharest, Romania.,Laboratory of Molecular Biology, "Victor Babes" National Institute of Pathology, Bucharest, Romania
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Achenbach J, von Hein SM, Saft C. Functional and cognitive capacity differ in dystonic motor subtypes when compared to choreatic and hypokinetic-rigid motor subtypes in Huntington's disease. Brain Behav 2020; 10:e01704. [PMID: 32530575 PMCID: PMC7428484 DOI: 10.1002/brb3.1704] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/07/2020] [Accepted: 05/17/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Motor phenotypes in Huntington's disease vary manifold. Phenotype classification is essential to adapt treatment. The aim of this study was to classify a dystonic subtype closer. METHODS A total of 7,512 manifest ENROLL-HD participants were subdivided into mainly choreatic (N = 606), dystonic (N = 402), and hypokinetic-rigid (N = 369) subjects. Cognitive (verbal fluency, symbol digit, stroop color, trail making, Mini-Mental State Examination), functional (total functional capacity, Independence Scale), and psychiatric (problem behaviors assessment, Hospital Anxiety and Depression Scale) performance was evaluated at baseline visit. RESULTS Symptoms onset for dystonic were similar to hypokinetic-rigid, but earlier compared to choreatic subjects (p < .001). Cognition was better in both groups compared to hypokinetic rigid (all p < .001). Functionality differed between all groups (all p < .001). Differences remained (all p < .001) after controlling for CAP score, CAG, age, disease duration, and education. CONCLUSIONS Motor subtypes differ in functional and cognitive capacities but less in psychiatric. We identified better cognitive and functional capacities and similar onsets in predominant dystonic compared to hypokinetic-rigid patients.
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Affiliation(s)
| | | | - Carsten Saft
- Department of NeurologySt. Josef‐HospitalBochumGermany
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Frederick NM, Shah PV, Didonna A, Langley MR, Kanthasamy AG, Opal P. Loss of the dystonia gene Thap1 leads to transcriptional deficits that converge on common pathogenic pathways in dystonic syndromes. Hum Mol Genet 2019; 28:1343-1356. [PMID: 30590536 DOI: 10.1093/hmg/ddy433] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 11/26/2018] [Accepted: 12/11/2018] [Indexed: 12/15/2022] Open
Abstract
Dystonia is a movement disorder characterized by involuntary and repetitive co-contractions of agonist and antagonist muscles. Dystonia 6 (DYT6) is an autosomal dominant dystonia caused by loss-of-function mutations in the zinc finger transcription factor THAP1. We have generated Thap1 knock-out mice with a view to understanding its transcriptional role. While germ-line deletion of Thap1 is embryonic lethal, mice lacking one Thap1 allele-which in principle should recapitulate the haploinsufficiency of the human syndrome-do not show a discernable phenotype. This is because mice show autoregulation of Thap1 mRNA levels with upregulation at the non-affected locus. We then deleted Thap1 in glial and neuronal precursors using a nestin-conditional approach. Although these mice do not exhibit dystonia, they show pronounced locomotor deficits reflecting derangements in the cerebellar and basal ganglia circuitry. These behavioral features are associated with alterations in the expression of genes involved in nervous system development, synaptic transmission, cytoskeleton, gliosis and dopamine signaling that link DYT6 to other primary and secondary dystonic syndromes.
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Affiliation(s)
| | | | - Alessandro Didonna
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Monica R Langley
- Parkinson Disorders Research Program, Iowa Center for Advanced Neurotoxicology, Department of Biomedical Sciences, Iowa State University, Ames, IA, USA
| | - Anumantha G Kanthasamy
- Parkinson Disorders Research Program, Iowa Center for Advanced Neurotoxicology, Department of Biomedical Sciences, Iowa State University, Ames, IA, USA
| | - Puneet Opal
- Davee Department of Neurology.,Department of Cell and Molecular Biology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Marciniec M, Szczepańska-Szerej A, Kulczyński M, Sapko K, Popek-Marciniec S, Rejdak K. Pain in cervical dystonia and the antinociceptive effects of botulinum toxin: what is currently known? Rev Neurosci 2019; 30:771-779. [DOI: 10.1515/revneuro-2018-0119] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 01/25/2019] [Indexed: 12/14/2022]
Abstract
Abstract
Pain is the most common and disabling non-motor symptom in cervical dystonia (CD). Up to 88.9% of patients report pain at some point in the course of the disease. It is still a matter of debate whether CD-related pain originates only from prolonged muscle contraction. Recent data suggest that the alterations of transmission and processing of nociceptive stimuli play a crucial role in pain development. Botulinum toxin (BT) is the first-line therapy for CD. Despite fully elucidated muscle relaxant action, the antinociceptive effect of BT remains unclear and probably exceeds a simple decompression of the nerve fibers due to the reduction in muscle tone. The proposed mechanisms of the antinociceptive action of BT include inhibition of pain mediator release, inhibition of membrane sodium channels, retrograde axonal transport and impact on the other pain pathways. This article summarizes the current knowledge about the antinociceptive properties of BT and the clinical analgesic efficacy in the treatment of CD patients.
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Affiliation(s)
- Michał Marciniec
- Chair and Department of Neurology , Medical University of Lublin , Independent Public Clinical Hospital , No. 4, ul. Jaczewskiego 8 , 20-954 Lublin , Poland
| | | | - Marcin Kulczyński
- Chair and Department of Neurology , Medical University of Lublin , Lublin , Poland
| | - Klaudia Sapko
- Chair and Department of Neurology , Medical University of Lublin , Lublin , Poland
| | - Sylwia Popek-Marciniec
- Department of Cancer Genetics with Cytogenetics Laboratory , Medical University of Lublin , Lublin , Poland
| | - Konrad Rejdak
- Chair and Department of Neurology , Medical University of Lublin , Lublin , Poland
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Pain in focal dystonias – A focused review to address an important component of the disease. Parkinsonism Relat Disord 2018; 54:17-24. [DOI: 10.1016/j.parkreldis.2018.04.030] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 04/05/2018] [Accepted: 04/26/2018] [Indexed: 12/16/2022]
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Rodríguez-Blázquez C, Forjaz MJ, Kurtis MM, Balestrino R, Martinez-Martin P. Rating Scales for Movement Disorders With Sleep Disturbances: A Narrative Review. Front Neurol 2018; 9:435. [PMID: 29951032 PMCID: PMC6008651 DOI: 10.3389/fneur.2018.00435] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 05/23/2018] [Indexed: 12/11/2022] Open
Abstract
Introduction: In recent years, a wide variety of rating scales and questionnaires for movement disorders have been developed and published, making reviews on their contents, and attributes convenient for the potential users. Sleep disorders are frequently present in movement disorders, and some movement disorders are accompanied by specific sleep difficulties. Aim: The aim of this study is to perform a narrative review of the most frequently used rating scales for movement disorders with sleep problems, with special attention to those recommended by the International Parkinson and Movement Disorders Society. Methods: Online databases (PubMed, SCOPUS, Web of Science, Google Scholar), related references from papers and websites and personal files were searched for information on comprehensive or global rating scales which assessed sleep disturbances in the following movement disorders: akathisia, chorea, dystonia, essential tremor, myoclonus, multiple system atrophy, Parkinson's disease, progressive supranuclear palsy, and tics and Tourette syndrome. For each rating scale, its objective and characteristics, as well as a summary of its psychometric properties and recommendations of use are described. Results: From 22 rating scales identified for the selected movement disorders, only 5 included specific questions on sleep problems. Movement Disorders Society-Unified Parkinson's Disease Rating scale (MDS-UPDRS), Non-Motor Symptoms Scale and Questionnaire (NMSS and NMSQuest), Scales for Outcomes in Parkinson's Disease (SCOPA)-Autonomic and Progressive Supranuclear Palsy Rating Scale (PSPRS) were the only rating scales that included items for assessing sleep disturbances. Conclusions: Despite sleep problems are frequent in movement disorders, very few of the rating scales addresses these specific symptoms. This may contribute to an infra diagnosis and mistreatment of the sleep problems in patients with movement disorders.
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Affiliation(s)
| | - Maria João Forjaz
- National School of Public Health and REDISSEC, Institute of Health Carlos III, Madrid, Spain
| | - Monica M. Kurtis
- Movement Disorders Unit, Neurology Department, Hospital Ruber International, Madrid, Spain
| | - Roberta Balestrino
- Department of Neuroscience “Rita Levi Montalcini, ” University of Turin, Turin, Italy
| | - Pablo Martinez-Martin
- National Center of Epidemiology and CIBERNED, Institute of Health Carlos III, Madrid, Spain
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