1
|
Quintas S, Sanles‐Falagan R, Berbís MÁ. I 123-FP-CIT (DaTSCAN) SPECT beyond the Most Common Causes of Parkinsonism: A Systematic Review. Mov Disord Clin Pract 2024; 11:613-625. [PMID: 38693679 PMCID: PMC11145110 DOI: 10.1002/mdc3.14055] [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: 11/14/2023] [Revised: 01/23/2024] [Accepted: 03/30/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND As the diagnosis of Parkinson's disease (PD) is fundamentally clinical, the usefulness of ioflupane (123I) single-photon emission computed tomography (SPECT) or DaTSCAN as a diagnostic tool has been a matter of debate for years. The performance of DaTSCAN is generally recommended in the follow-up of patients with a clinically uncertain diagnosis, especially in those with a suspected essential tremor, drug-induced parkinsonism, or vascular parkinsonism. However, there is a dearth of DaTSCAN findings regarding neurodegenerative parkinsonisms besides PD and atypical parkinsonisms. To date, a specific nigrostriatal dopamine uptake pattern that would help differentiate PD from the most frequent atypical parkinsonisms is yet to be described. This fact is further complicated by the possible visualization of abnormalities in the uptake pattern in patients with rarer neurodegenerative parkinsonisms. OBJECTIVES We aimed to summarize the current literature regarding DaTSCAN findings in patients with rare neurodegenerative parkinsonisms. METHODS The PubMed database was systematically screened for studies in English or Spanish up to October 15, 2023, using search terms "DaTSCAN", "ioflupane", "DaT-SPECT", "123I-FP-CIT SPECT", "dopamine transporter imaging", and "[123I] FP-CIT SPECT". Duplicated publications and studies regarding PD, atypical parkinsonisms, dystonia-parkinsonism, essential tremor, and parkinsonism due to non-degenerative causes were excluded. RESULTS The obtained results were reviewed and summarized, including DaTSCAN findings in fragile X-associated tremor/ataxia syndrome, prion diseases, Huntington's disease, spinocerebellar ataxia, hereditary spastic paraparesis, metabolic disorders, and other diseases (anti-IgLON5 disease, ring chromosome 20 syndrome, chorea-acanthocytosis, and neuronal ceroid lipofuscinosis). CONCLUSIONS This review highlights the need to determine in the future the utility and cost-effectiveness of DaTSCAN, both as a diagnostic and a prognostic tool, in patients with parkinsonian symptoms in rare neurodegenerative diseases.
Collapse
Affiliation(s)
- Sonia Quintas
- Department of NeurologyLa Princesa University HospitalMadridSpain
| | | | - M. Álvaro Berbís
- Department of RadiologyHT Médica, San Juan de Dios HospitalCórdobaSpain
- Faculty of MedicineAutonomous University of MadridMadridSpain
| |
Collapse
|
2
|
Kulcsarova K, Skorvanek M, Postuma RB, Berg D. Defining Parkinson's Disease: Past and Future. JOURNAL OF PARKINSON'S DISEASE 2024:JPD230411. [PMID: 38489197 DOI: 10.3233/jpd-230411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
Parkinson's disease (PD) is the second most common still relentlessly progressive neurodegenerative disorder with a long period in which the pathophysiological process is already spreading but cardinal motor symptoms are not present. This review outlines the major developments and milestones in our understanding of PD that have shaped the way we define this disorder. Past criteria and definitions of PD have been based on clinical motor manifestations enabling diagnosis of the disease only in later symptomatic stages. Nevertheless, with advancing knowledge of disease pathophysiology and aim of early disease detection, a major shift of the diagnostic paradigm is being advocated towards a biological definition similar to other neurodegenerative disorders including Alzheimer's disease and Huntington's disease, with the ultimate goal of an earlier, disease course modifying therapy. We summarize the major pillars of this possible approach including in vivo detection of neuronal α-synuclein aggregation, neurodegeneration and genetics and outline their possible application in different contexts of use in the frame of biological PD definition.
Collapse
Affiliation(s)
- Kristina Kulcsarova
- Department of Neurology, P. J. Safarik University, Kosice, Slovak Republic
- Department of Neurology, L. Pasteur University Hospital, Kosice, Slovak Republic
- Department of Clinical Neurosciences, University Scientific Park MEDIPARK, P. J. Safarik University, Kosice, Slovak Republic
| | - Matej Skorvanek
- Department of Neurology, P. J. Safarik University, Kosice, Slovak Republic
- Department of Neurology, L. Pasteur University Hospital, Kosice, Slovak Republic
| | - Ronald B Postuma
- Department of Neurology, Montreal Neurological Institute, Montreal, Quebec, Canada
| | - Daniela Berg
- Department of Neurology, Kiel University and University Medical Center Schleswig-Holstein, Kiel, Germany
| |
Collapse
|
3
|
Sharma PK, Aram A, Polaka Y, Pandian V. Huntington's Disease: A Report of an Interesting Case and Literature Review. Cureus 2024; 16:e55443. [PMID: 38567236 PMCID: PMC10986899 DOI: 10.7759/cureus.55443] [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: 01/18/2024] [Accepted: 03/03/2024] [Indexed: 04/04/2024] Open
Abstract
Huntington's disease (HD), referred to as Huntington's chorea, is an infrequent neurodegenerative ailment with an autosomal-dominant inheritance pattern characterized by the progressive deterioration of GABAergic neurons in the basal ganglia. Other ones include subcortical-type dementia, behavioral abnormalities, midlife psychosis, and gradual inadvertent choreoathetosis movements. HD is characterized by atrophy of the dorsal striatum (caudate nucleus and putamen) with concurrent expansion of the frontal horns of the lateral ventricles on imaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI). A molecular study validates the diagnosis of HD by identifying the disorder's hallmark amplified CAG triplet. Currently, there is no cure for HD, and treatment focuses on providing supportive care and managing the symptoms. Multidisciplinary approaches involving healthcare professionals, neurologists, and psychiatrists are crucial for comprehensive management. Medications are used to alleviate motor symptoms and manage psychiatric manifestations. Physical and occupational therapies help maintain functional abilities and improve quality of life. Genetic counseling and psychosocial support are essential for patients and their families. An additional crucial objective entails advancing more precise and dependable techniques for the timely identification and assessment of HD. Timely interventions and improved symptom management are made possible by early diagnosis. Based on clinical and imaging findings, we present a case of HD in a 62-year-old female.
Collapse
Affiliation(s)
- Praveen K Sharma
- Department of Radiology, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences (SIMATS) Saveetha University, Chennai, IND
| | - Arun Aram
- Department of Radiology, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences (SIMATS) Saveetha University, Chennai, IND
| | - Yashaswinii Polaka
- Department of Radiology, Saveetha Medical college and Hospital, Saveetha Institute of Medical and Technical Sciences (SIMATS) Saveetha University, Chennai, IND
| | - Vinoth Pandian
- Department of Radiology, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences (SIMATS) Saveetha University, Chennai, IND
| |
Collapse
|
4
|
Krause A, Anderson DG, Ferreira-Correia A, Dawson J, Baine-Savanhu F, Li PP, Margolis RL. Huntington disease-like 2: insight into neurodegeneration from an African disease. Nat Rev Neurol 2024; 20:36-49. [PMID: 38114648 DOI: 10.1038/s41582-023-00906-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2023] [Indexed: 12/21/2023]
Abstract
Huntington disease (HD)-like 2 (HDL2) is a rare genetic disease caused by an expanded trinucleotide repeat in the JPH3 gene (encoding junctophilin 3) that shows remarkable clinical similarity to HD. To date, HDL2 has been reported only in patients with definite or probable African ancestry. A single haplotype background is shared by patients with HDL2 from different populations, supporting a common African origin for the expansion mutation. Nevertheless, outside South Africa, reports of patients with HDL2 in Africa are scarce, probably owing to limited clinical services across the continent. Systematic comparisons of HDL2 and HD have revealed closely overlapping motor, cognitive and psychiatric features and similar patterns of cerebral and striatal atrophy. The pathogenesis of HDL2 remains unclear but it is proposed to occur through several mechanisms, including loss of protein function and RNA and/or protein toxicity. This Review summarizes our current knowledge of this African-specific HD phenocopy and highlights key areas of overlap between HDL2 and HD. Given the aforementioned similarities in clinical phenotype and pathology, an improved understanding of HDL2 could provide novel insights into HD and other neurodegenerative and/or trinucleotide repeat expansion disorders.
Collapse
Affiliation(s)
- Amanda Krause
- Division of Human Genetics, National Health Laboratory Service and School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - David G Anderson
- Division of Human Genetics, National Health Laboratory Service and School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- University of Glasgow, Department of Neurology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, UK
| | - Aline Ferreira-Correia
- Department of Psychology, School of Human and Community Development, Faculty of Humanities, University of the Witwatersrand, Johannesburg, South Africa
| | - Jessica Dawson
- Division of Human Genetics, National Health Laboratory Service and School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Centre for Molecular Medicine and Therapeutics, Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fiona Baine-Savanhu
- Division of Human Genetics, National Health Laboratory Service and School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Pan P Li
- Division of Neurobiology, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Russell L Margolis
- Division of Neurobiology, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
5
|
Chun K. Dual phase 18F-FP CIT PET and 99mTc- ECD SPECT findings of Huntington's disease. Radiol Case Rep 2022; 17:2460-2463. [PMID: 35586167 PMCID: PMC9108749 DOI: 10.1016/j.radcr.2022.03.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 03/27/2022] [Accepted: 03/30/2022] [Indexed: 11/15/2022] Open
Abstract
Fluorine-18 N-3-fluoropropyl-2-beta-carboxymethoxy-3-beta-(4-iodophenyl) nortropane (18F- FP CIT) has been used for the differential diagnosis of atypical parkinsonian disorders, and Technetium 99m ethyl cysteinate dimer (99mTc- ECD) has been used for evaluation of cerebral blood flow. A 60-year-old female with a history of Huntington's disease (HD) with full mutation of cytosine-adenine-guanine (GAG) 18/43 repeats underwent early and late 18F- FP CIT positron emission tomography/computed tomography (PET/CT) and 99mTc- ECD single-photon emission computed tomography (SPECT). The 18F-FP CIT PET/CT showed decreased uptake in both basal ganglia, both frontal and parietotemporal lobes at early images, and decreased presynaptic dopamine transporter (DAT) binding in both ventral & posterior putamen at late images. 99mTc- ECD SPECT showed decreased perfusion in both basal ganglia, both frontal and temporal lobes. Early 18F- FP CIT PET/CT and 99mTc- ECD SPECT images showed similar findings in Huntington's disease.
Collapse
Affiliation(s)
- KyungAh Chun
- Department of Nuclear Medicine, Yeungnam University Hospital, Namgu Daemyung 5-dong 317-1, 705-717, Daegu, Korea
| |
Collapse
|
6
|
Yeh SHH, Tsai CJ, Yu TH, Chiang YH, Lin SZ, Peng NJ, Huang WS. 99mTc-TRODAT-1 SPECT Revealed That Striatal Dopamine Transport Availability Significantly Decreases in Late Mid-Aged Healthy Taiwanese and Then Remains Stable. Clin Nucl Med 2022; 47:201-208. [PMID: 35081059 PMCID: PMC8820763 DOI: 10.1097/rlu.0000000000004063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/12/2021] [Accepted: 11/12/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Neuroimaging studies in the past 20 years have documented an age-related decline in striatal dopamine transporters (DATs), which is a marker of dopaminergic neurodegeneration; however, concerns about ethnic variations in the decline in DAT with age have not been addressed. The purpose of this study was to assess the rate of striatal DAT loss in healthy Taiwanese adults using kit-based 99mTc-TRODAT-1, a radioligand for DAT SPECT. PATIENTS AND METHODS Fifty healthy subjects (mean age ± SD, 63 ± 12 years; range, 30-80 years) were studied. 99mTc-TRODAT-1 was prepared from a lyophilized kit. Brain DAT SPECT imaging was acquired between 165 and 195 minutes postinjection (~740 MBq or 20 mCi) using a dual-head camera equipped with fan-beam collimators (Helix SPX; GE). Specific uptake in the striatum (ST), caudate nucleus (CA), and putamen (PU) were calculated from reconstructed transaxial slices at the level of maximal striatal activity. Occipital cortices were used as reference areas. Data were presented as specific binding ratios. RESULTS Age had a significant moderate to large negative effect on striatal DAT, which declined by -25.7% ± 6.10% between the ages of 30 and 80 years, equivalent to 6.4% loss per decade. The rates of decline in the CA and PU were 6.9% and 7.3% per decade, respectively. CONCLUSIONS This study suggests ethnic variations may not significantly affect the age-related decline in DAT. The data generated in this study could also be used as a reference to estimate DAT loss/occupancy in patients with DAT-related diseases.
Collapse
Affiliation(s)
- Skye Hsin-Hsien Yeh
- From the Brain Research Center, National Yang Ming Chaio Tung University
- School of Medicine, National Defense Medical Center
| | - Chi-Jung Tsai
- Department of Nuclear Medicine, Taipei Medical University Hospital
- Department of Nuclear Medicine, Tri-Service General Hospital
| | - Tsung-Hsun Yu
- From the Brain Research Center, National Yang Ming Chaio Tung University
| | | | | | - Nan-Jing Peng
- Department of Nuclear Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wen-Sheng Huang
- Department of Nuclear Medicine, Taipei Medical University Hospital
- Department of Nuclear Medicine, Tri-Service General Hospital
| |
Collapse
|
7
|
circRNA Regulates Dopaminergic Synapse, MAPK, and Long-term Depression Pathways in Huntington Disease. Mol Neurobiol 2021; 58:6222-6231. [PMID: 34476673 DOI: 10.1007/s12035-021-02536-1] [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: 06/30/2021] [Accepted: 08/17/2021] [Indexed: 10/20/2022]
Abstract
Huntington disease (HD) is the most common neurogenetic disorder caused by expansion of the CAG repeat in the HTT gene; nevertheless, the molecular bases of the disease are not fully understood. Non-coding RNAs have demonstrated to be involved in the physiopathology of HD. However, the role of circRNAs has not been investigated. The aim of this study was to identify the circRNAs with differential expression in a murine cell line model of HD and to identify the biological pathways regulated by the differentially expressed circRNAs. CircRNA expression was analyzed through a microarray, which specifically detects circular species of RNA. The expression patterns between a murine cell line expressing mutant Huntingtin and cells expressing wild-type Huntingtin were compared. We predicted the miRNAs with binding sites for the differentially expressed circRNAs and the corresponding target genes for those miRNAs. Using the target genes, we performed a function enrichment analysis. We identified 23 circRNAs differentially expressed, 19 downregulated and four upregulated. Most of the downregulated circRNAs derive from the Rere gene. The dopaminergic synapse, MAPK, and long-term depression pathways were significantly enriched. The three identified pathways have been previously associated with the physiopathology of HD. The understanding of the circRNA-miRNA-mRNA network involved in the molecular mechanisms driving HD can lead us to identify novel biomarkers and potential therapeutic targets. To the best of our knowledge, this is the first study analyzing circRNAs in a model of Huntington disease.
Collapse
|
8
|
Huntington disease like 2 (HDL-2) with parkinsonism and abnormal DAT-SPECT – A novel observation. Parkinsonism Relat Disord 2020; 71:46-48. [DOI: 10.1016/j.parkreldis.2020.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/13/2020] [Accepted: 01/14/2020] [Indexed: 11/24/2022]
|
9
|
How to approach a patient with parkinsonism - red flags for atypical parkinsonism. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2019; 149:1-34. [PMID: 31779810 DOI: 10.1016/bs.irn.2019.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Parkinsonism is a clinical syndrome defined by bradykinesia plus rigidity or tremor. Though most commonly encountered in the setting of idiopathic Parkinson's disease, a number of neurodegenerative, structural, metabolic and toxic neurological disorders can result in parkinsonism. Accurately diagnosing the underlying cause of parkinsonism is of both therapeutic and prognostic relevance, especially as we enter the era of disease-modifying treatment trials for neurodegenerative disorders. Being aware of the wide array of potential causes of parkinsonism is of paramount importance for clinicians. In this chapter, we present a pragmatic clinical approach to patients with parkinsonism, specifically focusing on 'red flags', which should alert one to consider diagnoses other than idiopathic Parkinson's disease.
Collapse
|
10
|
Ha J, Na BS, Ahn JH, Kim M, Kim JW, Lee JH, Cho JW, Kim JS, Youn J. Anti-CV2/CRMP5 Paraneoplastic Chorea Effectively Managed with Intravenous Amantadine. Tremor Other Hyperkinet Mov (N Y) 2019; 9:tre-09-701. [PMID: 31656691 PMCID: PMC6790010 DOI: 10.7916/tohm.v0.701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 09/16/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Paraneoplastic chorea is typically a subacute progressive hyperkinetic movement disorder. The mainstay of treatment is managing the underlying neoplasm. However, the clinical course may be variable, and effective symptomatic management can precede the start of cancer treatment. CASE REPORT A 63-year-old man presented with insidious onset, slowly progressive generalized chorea for 1 year, later diagnosed as anti-CV2/CRMP5 autoantibody positive paraneoplastic chorea. His chorea was markedly improved with intravenous amantadine. DISCUSSION In patients with anti-CV2/CRMP5 autoantibody-related chorea, sequential follow-up of brain magnetic resonance imaging reveals progression from active inflammation to atrophy. Our report highlights the efficacy of intravenous amantadine in paraneoplastic chorea.
Collapse
Affiliation(s)
- Jongmok Ha
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, KR,Neuroscience Center, Samsung Medical Center, Seoul, KR
| | - Boo Suk Na
- Department of Neurology, Dongshin Hospital, Seoul, KR
| | - Jong Hyeon Ahn
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, KR,Neuroscience Center, Samsung Medical Center, Seoul, KR
| | - Minkyeong Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, KR,Neuroscience Center, Samsung Medical Center, Seoul, KR
| | - Jae Woo Kim
- Department of Neurology, Dong-A University College of Medicine, Busan, KR
| | - Jae Hyeok Lee
- Department of Neurology, Pusan National University Yangsan Hospital, Yangsan, KR
| | - Jin Whan Cho
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, KR,Neuroscience Center, Samsung Medical Center, Seoul, KR
| | - Ji Sun Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, KR,Neuroscience Center, Samsung Medical Center, Seoul, KR
| | - Jinyoung Youn
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, KR,Neuroscience Center, Samsung Medical Center, Seoul, KR,To whom correspondence should be addressed. E-mail:
| |
Collapse
|
11
|
Ehrlich DJ, Walker RH. Functional neuroimaging and chorea: a systematic review. JOURNAL OF CLINICAL MOVEMENT DISORDERS 2017. [PMID: 28649394 PMCID: PMC5479019 DOI: 10.1186/s40734-017-0056-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Chorea is a hyperkinetic movement disorder consisting of involuntary irregular, flowing movements of the trunk, neck or face. Although Huntington’s disease is the most common cause of chorea in adults, chorea can also result from many other neurodegenerative, metabolic, and autoimmune conditions. While the pathophysiology of these different conditions is quite variable, recent advances in functional imaging have enabled the development of new methods for analysis of brain activity and neuronal dysfunction. In this paper we review the growing body of functional imaging data that has been performed in chorea syndromes and identify particular trends, which can be used to better understand the underlying network changes within the basal ganglia. While it can be challenging to identify whether changes are primary, secondary, or compensatory, identification of these trends can ultimately be useful in diagnostic testing and treatment in many of the conditions that cause chorea.
Collapse
Affiliation(s)
- Debra J Ehrlich
- Department of Neurology, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, 1st Floor, Box 1637, New York, NY 10029 USA
| | - Ruth H Walker
- Department of Neurology, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, 1st Floor, Box 1637, New York, NY 10029 USA.,Department of Neurology, James J Peters Veterans Affairs Medical Center, 130 West Kingsbridge Road, Bronx, NY 10468 USA
| |
Collapse
|
12
|
Paoli RA, Botturi A, Ciammola A, Silani V, Prunas C, Lucchiari C, Zugno E, Caletti E. Neuropsychiatric Burden in Huntington's Disease. Brain Sci 2017; 7:E67. [PMID: 28621715 PMCID: PMC5483640 DOI: 10.3390/brainsci7060067] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 05/29/2017] [Accepted: 06/13/2017] [Indexed: 11/22/2022] Open
Abstract
Huntington's disease is a disorder that results in motor, cognitive, and psychiatric problems. The symptoms often take different forms and the presence of disturbances of the psychic sphere reduces patients' autonomy and quality of life, also impacting patients' social life. It is estimated that a prevalence between 33% and 76% of the main psychiatric syndromes may arise in different phases of the disease, often in atypical form, even 20 years before the onset of chorea and dementia. We present a narrative review of the literature describing the main psychopathological patterns that may be found in Huntington's disease, searching for a related article in the main database sources (Medline, ISI Web of Knowledge, Scopus, and Medscape). Psychiatric conditions were classified into two main categories: affective and nonaffective disorders/symptoms; and anxiety and neuropsychiatric features such as apathy and irritability. Though the literature is extensive, it is not always convergent, probably due to the high heterogeneity of methods used. We summarize main papers for pathology and sample size, in order to present a synoptic vision of the argument. Since the association between Huntington's disease and psychiatric symptoms was demonstrated, we argue that the prevalent and more invalidating psychiatric components should be recognized as early as possible during the disease course in order to best address psychopharmacological therapy, improve quality of life, and also reduce burden on caregivers.
Collapse
Affiliation(s)
- Ricardo Augusto Paoli
- Department of Psychiatry, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20122, Italy.
| | - Andrea Botturi
- Department of Psychiatry, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20122, Italy.
- Department of Neuro-Oncology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan 20133, Italy.
| | - Andrea Ciammola
- Department of Neurology-Stroke Unit and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan 20149, Italy.
| | - Vincenzo Silani
- Department of Neurology-Stroke Unit and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan 20149, Italy.
- Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, Università degli Studi di Milano, Milan 20122, Italy.
| | - Cecilia Prunas
- Department of Psychiatry, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20122, Italy.
| | - Claudio Lucchiari
- Department of Philosophy, Università degli Studi di Milano, Milan 20122, Italy.
| | - Elisa Zugno
- Department of Psychiatry, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20122, Italy.
| | - Elisabetta Caletti
- Department of Psychiatry, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20122, Italy.
| |
Collapse
|
13
|
Brüggemann N, Rosales RL, Waugh JL, Blood AJ, Domingo A, Heldmann M, Jamora RD, Münchau A, Münte TF, Lee LV, Buchmann I, Klein C. Striatal dysfunction in X-linked dystonia-parkinsonism is associated with disease progression. Eur J Neurol 2017; 24:680-686. [DOI: 10.1111/ene.13256] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Accepted: 01/11/2017] [Indexed: 11/28/2022]
Affiliation(s)
- N. Brüggemann
- Department of Neurology; University of Lübeck; Lübeck Germany
- Institute of Neurogenetics; University of Lübeck; Lübeck Germany
| | - R. L. Rosales
- Department of Neurology and Psychiatry; Faculty of Medicine and Surgery; University of Santo Tomas; Manila Philippines
| | - J. L. Waugh
- Boston Children's Hospital; Massachusetts General Hospital; Harvard University; Boston MA USA
- Departments of Psychiatry and Neurology; Athinoula A. Martinos Center for Biomedical Imaging; Massachusetts General Hospital; Charlestown MA USA
| | - A. J. Blood
- Departments of Psychiatry and Neurology; Athinoula A. Martinos Center for Biomedical Imaging; Massachusetts General Hospital; Charlestown MA USA
| | - A. Domingo
- Institute of Neurogenetics; University of Lübeck; Lübeck Germany
| | - M. Heldmann
- Department of Neurology; University of Lübeck; Lübeck Germany
| | - R. D. Jamora
- Department of Neurosciences; College of Medicine, Philippine General Hospital; University of the Philippines Manila; Manila Philippines
| | - A. Münchau
- Institute of Neurogenetics; University of Lübeck; Lübeck Germany
| | - T. F. Münte
- Department of Neurology; University of Lübeck; Lübeck Germany
| | - L. V. Lee
- Philippine Children's Medical Center; Quezon City Philippines
| | - I. Buchmann
- Section of Nuclear Imaging; Institute of Radiology; Lübeck Germany
| | - C. Klein
- Institute of Neurogenetics; University of Lübeck; Lübeck Germany
| |
Collapse
|
14
|
Borghammer P, Knudsen K, Østergaard K, Danielsen EH, Pavese N, Arveschoug A, Bluhme H, Bode M, Morsing A. Combined DaT imaging and olfactory testing for differentiating parkinsonian disorders. Int J Clin Pract 2014; 68:1345-51. [PMID: 24754902 DOI: 10.1111/ijcp.12445] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Dopamine transporter (DaT) imaging with single photon emission computed tomography (SPECT) detects loss of striatal dopaminergic innervation with very high sensitivity. It cannot readily distinguish idiopathic Parkinson's disease (iPD) and dementia with Lewy bodies (DLB) from atypical disorders (aPD). However, most iPD/DLB patients are hyposmic, whereas the majority of aPD patients were reported to have intact olfaction. For this reason, we conducted a longitudinal follow-up study to investigate the power of combined DaT imaging and olfactory testing to predict the final diagnosis of the patients. MATERIALS AND METHODS A total of 129 patients received [123I]FP-CIT SPECT and olfactory testing at baseline assessment. Clinical follow-up 30 ± 12 months later was the diagnostic standard of truth. A normative dataset of 24 healthy controls was used for comparison. RESULTS Baseline DaT imaging predicted a dopamine-deficient diagnosis with 98% sensitivity and 98% specificity. The combined DaT/olfactory testing correctly classified 91% of patients as iPD/DLB (PPV 91%). The PPV rose to 97% or greater in anosmic patients. In contrast, only 45% of aPD patients were categorised correctly by combined DaT/olfactory testing - mainly because of the presence of normosmic iPD patients. CONCLUSIONS In patients with an abnormal DaT SPECT, hyposmia yields an a posteriori likelihood of iPD/DLB of > 90%. In contrast, a finding of normosmia only increases the a posteriori likelihood of aPD to approximately the 50%.
Collapse
Affiliation(s)
- P Borghammer
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus C, Denmark
| | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Gonzalez V, Cif L, Biolsi B, Garcia-Ptacek S, Seychelles A, Sanrey E, Descours I, Coubes C, de Moura AMR, Corlobe A, James S, Roujeau T, Coubes P. Deep brain stimulation for Huntington's disease: long-term results of a prospective open-label study. J Neurosurg 2014; 121:114-22. [PMID: 24702329 DOI: 10.3171/2014.2.jns131722] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
UNLABELLED OBJECT.: To date, experience of globus pallidus internus (GPi) deep brain stimulation (DBS) in the treatment of Huntington's disease (HD) has been limited to a small number of case reports. The aim of this study was to analyze long-term motor outcome of a cohort of HD patients treated with GPi DBS. METHODS Seven patients with pharmacologically resistant chorea and functional impairment were included in a prospective open-label study from 2008 to 2011. The main outcome measure was the motor section of the Unified Huntington's Disease Rating Scale. The primary end point was reduction of chorea. RESULTS Patients underwent MRI-guided bilateral GPi implantation. The median duration of follow-up was 3 years. A significant reduction of chorea was observed in all patients, with sustained therapeutic effect; the mean improvement on the chorea subscore was 58.34% at the 12-month follow-up visit (p = 0.018) and 59.8% at the 3-year visit (p = 0.040). Bradykinesia and dystonia showed a nonsignificant trend toward progressive worsening related to disease evolution and partly to DBS. The frequency of stimulation was 130 Hz for all patients. DBS-induced bradykinesia was managed by pulse-width reduction or bipolar settings. Levodopa mildly improved bradykinesia in 4 patients. Regular off-stimulation tests confirmed a persistent therapeutic effect of DBS on chorea. CONCLUSIONS GPi DBS may provide sustained chorea improvement in selected HD patients with pharmacologically resistant chorea, with transient benefit in physical aspects of quality of life before progression of behavioral and cognitive disorders. DBS therapy did not improve dystonia or bradykinesia. Further studies including quality of life measures are needed to evaluate the impact of DBS in the long-term outcome of HD.
Collapse
|
16
|
Atypical Parkinsonism Revealing a Late Onset, Rigid and Akinetic Form of Huntington's Disease. Case Rep Neurol Med 2011; 2011:696953. [PMID: 22937345 PMCID: PMC3420516 DOI: 10.1155/2011/696953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Accepted: 07/11/2011] [Indexed: 11/17/2022] Open
Abstract
Huntington's disease (HD) is a rare hereditary neurodegenerative disorder characterized in over 90 percent of cases by chorea as the presenting motor symptom. We report a 54-year-old male who presented with Parkinsonism as the initial symptom of the disease. Genetic analysis revealed expansion of 40 CAG repeats, and brain MRI showed both severe caudate nuclei and cortical atrophy. Single-photon emission computed tomography (SPECT) imaging of the dopamine transporter showed nigrostriatal pathway degeneration. Here, we also describe his 2 years of clinical followup after ensuing dopaminergic stimulation.
Collapse
|
17
|
Huang HC, Wu YC, Shih LY, Lo WC, Tsai CH, Shyu WC. Reversible abnormal functional neuroimaging presentations in polycythemia vera with chorea. J Neurol 2011; 258:2054-7. [PMID: 21559940 DOI: 10.1007/s00415-011-6069-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Revised: 03/31/2011] [Accepted: 04/19/2011] [Indexed: 10/18/2022]
Abstract
We report a case of polycythemia vera with chorea in which the brain metabolism and dopamine system were investigated using 2-[(18)F]fluoro-2-deoxy-D-glucose positron emission tomography (FDG PET) and (99m)Tc-labeled tropane dopamine transporter ((99m)Tc-TRODAT-1) single photon emission computed tomography (SPECT). Along with normalization of the hematocrit and clinical symptoms after consecutive phlebotomies, the FDG PET scan and (99m)Tc-TRODAT-1 SPECT images returned towards normal. It is hypothesized that the development of polycythemia chorea is associated with a reversible alteration in the corticobasal ganglia metabolism and disturbed dopaminergic function.
Collapse
Affiliation(s)
- Hui-Chun Huang
- Department of Neurology, China Medical University Hospital, 404 Taichung, Taiwan
| | | | | | | | | | | |
Collapse
|
18
|
Is the time ripe to adopt semiquantitative analysis of SPECT evaluation in movement disorders as a standard? Eur J Nucl Med Mol Imaging 2011; 38:596-7. [DOI: 10.1007/s00259-010-1709-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Accepted: 12/15/2010] [Indexed: 10/18/2022]
|