1
|
X-linked dystonia parkinsonism: epidemiology, genetics, clinical features, diagnosis, and treatment. Acta Neurol Belg 2023; 123:45-55. [PMID: 36418540 DOI: 10.1007/s13760-022-02144-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 11/09/2022] [Indexed: 11/27/2022]
Abstract
X-linked dystonia parkinsonism (XDP) is a rare X-linked recessive degenerative movement disorder that only affects Filipino descent, predominantly males. Its underlying cause is associated with the genetic alterations in the TAF1/DYT3 multiple transcription system. SINE-VNTR-Alu (SVA) retrotransposon insertion was suggested to be the responsible genetic mutation. Clinically, it initially presents as focal dystonia and generalizes within years. Parkinsonism arises years later and coexists with dystonia. Nonmotor symptoms like cognitive impairment and mood disorders are also common among XDP patients. XDP diagnosis relies on clinical history and physical examination. On imaging, abnormalities of the striatum, such as atrophy, are widely seen and can explain the clinical presentations with a three-model pathway of the striatum. Treatments aim for symptomatic relief of dystonia and parkinsonism and to prevent complications. Oral medications, chemo-denervation, and surgery are used in XDP patients. This review summarizes the currently important information regarding XDP, providing a synoptic overview and understanding of XDP for future studies.
Collapse
|
2
|
Andelman-Gur MM, Leventer RJ, Hujirat M, Ganos C, Yosovich K, Carmi N, Lev D, Nissenkorn A, Dobyns WB, Bhatia K, Lerman-Sagie T, Blumkin L. Bilateral polymicrogyria associated with dystonia: A new neurogenetic syndrome? Am J Med Genet A 2020; 182:2207-2213. [PMID: 33001581 DOI: 10.1002/ajmg.a.61795] [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: 01/05/2020] [Revised: 04/15/2020] [Accepted: 06/23/2020] [Indexed: 11/07/2022]
Abstract
The clinical presentation of bilateral perisylvian polymicrogyria (PMG) is highly variable, including oromotor dysfunction, epilepsy, intellectual disability, and pyramidal signs. Extrapyramidal features are extremely rare. We present four apparently unrelated patients with a unique association of PMG with dystonia. The clinical, genetic, and radiologic features are described and possible mechanisms of dystonia are discussed. All patients were female and two were born to consanguineous families. All presented with early childhood onset dystonia. Other neurologic symptoms and signs classically seen in bilateral perisylvian PMG were observed, including oromotor dysfunction and speech abnormalities ranging from dysarthria to anarthria (4/4), pyramidal signs (3/4), hypotonia (3/4), postnatal microcephaly (1/4), and seizures (1/4). Neuroimaging showed a unique pattern of bilateral PMG with an infolded cortex originating primarily from the perisylvian region in three out of four patients. Whole exome sequencing was performed in two out of four patients and did not reveal pathogenic variants in known genes for cortical malformations or movement disorders. The dystonia seen in our patients is not described in bilateral PMG and suggests an underlying mechanism of impaired connectivity within the motor network or compromised cortical inhibition. The association of bilateral PMG with dystonia in our patients may represent a new neurogenetic disorder.
Collapse
Affiliation(s)
| | - Richard J Leventer
- Department of Neurology, Royal Children's Hospital, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of Pediatrics, University of Melbourne, Melbourne, Australia
| | | | - Christos Ganos
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, UK
- Department of Neurology, Charité University Hospital Berlin, Berlin, Germany
| | - Keren Yosovich
- Metabolic-Neurogenetic Clinic, Wolfson Medical Center, Holon, Israel
- Rina Mor Institute of Medical Genetics, Wolfson Medical Center, Holon, Israel
- Molecular Genetics Laboratory, Wolfson Medical Center, Holon, Israel
| | - Nirit Carmi
- Child Development Center, Maccabi Health Services, Bnei Brak, Israel
| | - Dorit Lev
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Metabolic-Neurogenetic Clinic, Wolfson Medical Center, Holon, Israel
- Rina Mor Institute of Medical Genetics, Wolfson Medical Center, Holon, Israel
| | - Andreea Nissenkorn
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Pediatric Neurology Unit, Wolfson Medical Center, Holon, Israel
| | - William B Dobyns
- Departments of Pediatrics and Neurology, University of Washington, Seattle, Washington, USA
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Kailash Bhatia
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, UK
| | - Tally Lerman-Sagie
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Metabolic-Neurogenetic Clinic, Wolfson Medical Center, Holon, Israel
- Pediatric Neurology Unit, Wolfson Medical Center, Holon, Israel
| | - Lubov Blumkin
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Metabolic-Neurogenetic Clinic, Wolfson Medical Center, Holon, Israel
- Pediatric Neurology Unit, Wolfson Medical Center, Holon, Israel
- Pediatric Movement Disorders Service, Wolfson Medical Center, Holon, Israel
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Targeted gene capture sequencing in diagnosis of dystonia patients. J Neurol Sci 2018; 390:36-41. [PMID: 29801903 DOI: 10.1016/j.jns.2018.04.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 03/27/2018] [Accepted: 04/04/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Dystonia is a movement disorder with high clinical and genetic heterogeneity. Molecular diagnosis is important for an accurate diagnosis of dystonia. Targeted gene capture sequencing has been an effective method for screening multiple candidate genes simultaneously. This method, however, has been rarely reported to be used with dystonia patients. OBJECTIVES AND METHODS To assess the effectiveness of the targeted gene capture sequencing in dystonia, we performed custom target gene capture followed by next-generation sequencing in dystonia patients from China. Sanger sequencing was utilized to substantiate the findings. The effects of identified variants were classified according to the American College of Medical Genetics and Genomics (ACMG) standards and guidelines. RESULTS A total of 65 patients (34 female and 31 male) were recruited in this study. The mean age at onset was 22.7 ± 13.3 years ranging from 2 to 59 years. According to ACMG standards and guidelines, of 65 patients, 12 were identified with pathogenic variants (12/65, 18.5%) in gene TOR1A, PANK2 or ATP1A3, and another four were identified with likely-pathogenic variants (4/65, 6.2%) in gene PRRT2, GCH1 or THAP1. In total, 24.6% of patients in this cohort were detected to have a genetic cause of dystonia. Another four patients (4/65, 6.2%) were identified with variants which were considered to be VUS (Variants of Uncertain Significance) in gene SGCE, TH, ANO3 and ATP1A3 respectively. The most common detected gene was TOR1A, known to be causative for DYT1 (8/65, 12.3%). CONCLUSIONS The study demonstrates that targeted gene capture sequencing is an effective tool for identifying the genetic cause of heterogeneous dystonia patients.
Collapse
|
5
|
Alterman RL, Stone S. Deep Brain Stimulation for Dystonia. Neuromodulation 2018. [DOI: 10.1016/b978-0-12-805353-9.00076-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
6
|
Deep brain stimulation for dystonia: a novel perspective on the value of genetic testing. J Neural Transm (Vienna) 2017; 124:417-430. [PMID: 28160152 DOI: 10.1007/s00702-016-1656-9] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 11/16/2016] [Indexed: 10/20/2022]
Abstract
The dystonias are a group of disorders characterized by excessive muscle contractions leading to abnormal movements and postures. There are many different clinical manifestations and underlying causes. Deep brain stimulation (DBS) provides an effect treatment, but outcomes can vary considerably among the different subtypes of dystonia. Several variables are thought to contribute to this variation including age of onset and duration of dystonia, specific characteristics of the dystonic movements, location of stimulation and stimulator settings, and others. The potential contributions of genetic factors have received little attention. In this review, we summarize evidence that some of the variation in DBS outcomes for dystonia is due to genetic factors. The evidence suggests that more methodical genetic testing may provide useful information in the assessment of potential surgical candidates, and in advancing our understanding of the biological mechanisms that influence DBS outcomes.
Collapse
|
7
|
Combe L, Abu-Arafeh I. Status dystonicus in children: Early recognition and treatment prevent serious complications. Eur J Paediatr Neurol 2016; 20:966-970. [PMID: 27444503 DOI: 10.1016/j.ejpn.2016.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 06/06/2016] [Accepted: 07/05/2016] [Indexed: 10/21/2022]
Abstract
This is a retrospective study of all patients presenting to our paediatric unit with status dystonicus (SD) over a period of five years. Anonymous information was collected and a descriptive analysis is made. There were four episodes of SD in three children between 11 and 15 years of age. All children are known to have severe dyskinetic cerebral palsy and presented with an acute or sub-acute deterioration in their symptoms. Symptoms were triggered by infections in three of the four episodes. Early features included frequent and repetitive generalized muscle spasms, poor swallowing, poor sleep, distress and pain. Patients responded to supportive treatment, rehydration, benzodiazepines, baclofen and l-dopa. Intensive care was not necessary in any of the patients and patients made full recovery within 5-14 days. This report shows the value of early recognition and treatment of SD can be successful in preventing serious complications.
Collapse
Affiliation(s)
- Laura Combe
- Department of Paediatrics, Forth Valley Royal Hospital, Larbert, FK5 4WR, UK
| | - Ishaq Abu-Arafeh
- Department of Paediatrics, Forth Valley Royal Hospital, Larbert, FK5 4WR, UK.
| |
Collapse
|
8
|
Andriuta D, Tir M, Godefroy O, Krystkowiak P. Huntington's Disease Revealed by Familial Cervical Dystonia. Mov Disord Clin Pract 2016; 3:415-416. [DOI: 10.1002/mdc3.12311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 10/23/2015] [Accepted: 11/08/2015] [Indexed: 01/31/2023] Open
Affiliation(s)
- Daniela Andriuta
- Department of Neurology; Amiens University Hospital; Amiens France
| | - Mélissa Tir
- Department of Neurology; Amiens University Hospital; Amiens France
| | - Olivier Godefroy
- Department of Neurology; Amiens University Hospital; Amiens France
| | | |
Collapse
|
9
|
Fremont R, Tewari A, Khodakhah K. Aberrant Purkinje cell activity is the cause of dystonia in a shRNA-based mouse model of Rapid Onset Dystonia-Parkinsonism. Neurobiol Dis 2015; 82:200-212. [PMID: 26093171 DOI: 10.1016/j.nbd.2015.06.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 06/08/2015] [Accepted: 06/09/2015] [Indexed: 11/19/2022] Open
Abstract
Loss-of-function mutations in the α3 isoform of the sodium pump are responsible for Rapid Onset Dystonia-Parkinsonism (RDP). A pharmacologic model of RDP replicates the most salient features of RDP, and implicates both the cerebellum and basal ganglia in the disorder; dystonia is associated with aberrant cerebellar output, and the parkinsonism-like features are attributable to the basal ganglia. The pharmacologic agent used to generate the model, ouabain, is selective for sodium pumps. However, close to the infusion sites in vivo it likely affects all sodium pump isoforms. Therefore, it remains to be established whether selective loss of α3-containing sodium pumps replicates the pharmacologic model. Moreover, while the pharmacologic model suggested that aberrant firing of Purkinje cells was the main cause of abnormal cerebellar output, it did not allow the scrutiny of this hypothesis. To address these questions RNA interference using small hairpin RNAs (shRNAs) delivered via adeno-associated viruses (AAV) was used to specifically knockdown α3-containing sodium pumps in different regions of the adult mouse brain. Knockdown of the α3-containing sodium pumps mimicked both the behavioral and electrophysiological changes seen in the pharmacologic model of RDP, recapitulating key aspects of the human disorder. Further, we found that knockdown of the α3 isoform altered the intrinsic pacemaking of Purkinje cells, but not the neurons of the deep cerebellar nuclei. Therefore, acute knockdown of proteins associated with inherited dystonias may be a good strategy for developing phenotypic genetic mouse models where traditional transgenic models have failed to produce symptomatic mice.
Collapse
Affiliation(s)
- Rachel Fremont
- Dominick P Purpura Department of Neuroscience, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Ambika Tewari
- Dominick P Purpura Department of Neuroscience, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Kamran Khodakhah
- Dominick P Purpura Department of Neuroscience, Albert Einstein College of Medicine, Bronx, NY 10461, USA.
| |
Collapse
|
10
|
Wada T, Takano K, Tsurusaki Y, Miyake N, Nakashima M, Saitsu H, Matsumoto N, Osaka H. Japanese familial case of myoclonus-dystonia syndrome with a splicing mutation in SGCE. Pediatr Int 2015; 57:324-6. [PMID: 25868953 DOI: 10.1111/ped.12613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 06/17/2014] [Accepted: 06/25/2014] [Indexed: 11/29/2022]
Abstract
Myoclonus-dystonia syndrome (MDS) is a rare autosomal-dominant movement disorder characterized by brief, frequently alcohol-responsive myoclonic jerks that begin in childhood or early adolescence, caused by mutations in the ε-sarcoglycan gene (SGCE). The patient was a 6-year-old boy. At 2 years 8 months, he had abnormal movement when he ran due to dystonia of his left leg. At 3 years 5 months, he exhibited dystonia and myoclonic movement of his arms when eating. Myoclonus was likely to develop when he felt anxiety or exhaustion. Genomic DNA showed a heterozygous mutation in SGCE (c.109 + 1 G > T). His father and uncle with the same mutation also experienced milder dystonia or myoclonic movements. SGCE mutation can cause a broad range of clinical symptoms between and within families. We should consider MDS as a differential diagnosis for patients with paroxysmal walking abnormalities and/or myoclonic movements.
Collapse
Affiliation(s)
- Takahito Wada
- Division of Neurology, Kanagawa Children's Medical Center, Yokohama, Japan; Department of Medical Ethics and Medical Genetics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | | | | | | | | | | | | |
Collapse
|
11
|
|
12
|
Lerner RP, Niethammer M, Eidelberg D. Understanding the anatomy of dystonia: determinants of penetrance and phenotype. Curr Neurol Neurosci Rep 2013; 13:401. [PMID: 24114145 PMCID: PMC3883436 DOI: 10.1007/s11910-013-0401-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The dystonias comprise a group of syndromes characterized by prolonged involuntary muscle contractions resulting in repetitive movements and abnormal postures. Primary dystonia has been associated with over 14 different genotypes, most of which follow an autosomal dominant inheritance pattern with reduced penetrance. Independent of etiology, the disease is characterized by extensive variability in disease phenotype and clinical severity. Recent neuroimaging studies investigating this phenomenon in manifesting and non-manifesting genetic carriers of dystonia have discovered microstructural integrity differences in the cerebello-thalamo-cortical tract in both groups related to disease penetrance. Further study suggests these differences to be specific to subrolandic white matter regions somatotopically related to clinical phenotype. Clinical severity was correlated to the degree of microstructural change. These findings suggest a mechanism for the penetrance and clinical variability observed in dystonia and may represent a novel therapeutic target for patients with refractory limb symptoms.
Collapse
Affiliation(s)
- Renata P Lerner
- Center for Neurosciences, The Feinstein Institute for Medical Research, 350 Community Drive, Manhasset, NY, 11030, USA
| | | | | |
Collapse
|