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Xu J, Luo Y, Zhang J, Zhong L, Liu H, Weng A, Yang Z, Zhang Y, Ou Z, Yan Z, Cheng Q, Fan X, Zhang X, Zhang W, Hu Q, Liang D, Peng K, Liu G. Progressive thalamic nuclear atrophy in blepharospasm and blepharospasm-oromandibular dystonia. Brain Commun 2024; 6:fcae117. [PMID: 38638150 PMCID: PMC11025674 DOI: 10.1093/braincomms/fcae117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/21/2024] [Accepted: 04/05/2024] [Indexed: 04/20/2024] Open
Abstract
The thalamus is considered a key region in the neuromechanisms of blepharospasm. However, previous studies considered it as a single, homogeneous structure, disregarding potentially useful information about distinct thalamic nuclei. Herein, we aimed to examine (i) whether grey matter volume differs across thalamic subregions/nuclei in patients with blepharospasm and blepharospasm-oromandibular dystonia; (ii) causal relationships among abnormal thalamic nuclei; and (iii) whether these abnormal features can be used as neuroimaging biomarkers to distinguish patients with blepharospasm from blepharospasm-oromandibular dystonia and those with dystonia from healthy controls. Structural MRI data were collected from 56 patients with blepharospasm, 20 with blepharospasm-oromandibular dystonia and 58 healthy controls. Differences in thalamic nuclei volumes between groups and their relationships to clinical information were analysed in patients with dystonia. Granger causality analysis was employed to explore the causal effects among abnormal thalamic nuclei. Support vector machines were used to test whether these abnormal features could distinguish patients with different forms of dystonia and those with dystonia from healthy controls. Compared with healthy controls, patients with blepharospasm exhibited reduced grey matter volume in the lateral geniculate and pulvinar inferior nuclei, whereas those with blepharospasm-oromandibular dystonia showed decreased grey matter volume in the ventral anterior and ventral lateral anterior nuclei. Atrophy in the pulvinar inferior nucleus in blepharospasm patients and in the ventral lateral anterior nucleus in blepharospasm-oromandibular dystonia patients was negatively correlated with clinical severity and disease duration, respectively. The proposed machine learning scheme yielded a high accuracy in distinguishing blepharospasm patients from healthy controls (accuracy: 0.89), blepharospasm-oromandibular dystonia patients from healthy controls (accuracy: 0.82) and blepharospasm from blepharospasm-oromandibular dystonia patients (accuracy: 0.94). Most importantly, Granger causality analysis revealed that a progressive driving pathway from pulvinar inferior nuclear atrophy extends to lateral geniculate nuclear atrophy and then to ventral lateral anterior nuclear atrophy with increasing clinical severity in patients with blepharospasm. These findings suggest that the pulvinar inferior nucleus in the thalamus is the focal origin of blepharospasm, extending to pulvinar inferior nuclear atrophy and subsequently extending to the ventral lateral anterior nucleus causing involuntary lower facial and masticatory movements known as blepharospasm-oromandibular dystonia. Moreover, our results also provide potential targets for neuromodulation especially deep brain stimulation in patients with blepharospasm and blepharospasm-oromandibular dystonia.
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Affiliation(s)
- Jinping Xu
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Yuhan Luo
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou 510080, China
| | - Jiana Zhang
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou 510080, China
| | - Linchang Zhong
- Department of Medical Imaging, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Huiming Liu
- Department of Medical Imaging, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Ai Weng
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou 510080, China
| | - Zhengkun Yang
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou 510080, China
| | - Yue Zhang
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou 510080, China
| | - Zilin Ou
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou 510080, China
| | - Zhicong Yan
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou 510080, China
| | - Qinxiu Cheng
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Xinxin Fan
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Xiaodong Zhang
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Weixi Zhang
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou 510080, China
| | - Qingmao Hu
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Dong Liang
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Kangqiang Peng
- Department of Medical Imaging, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Gang Liu
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou 510080, China
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Kilic-Berkmen G, Kim H, Chen D, Yeo CI, Dinasarapu AR, Scorr LM, Yeo WH, Peterson DA, Williams H, Ruby A, Mills R, Jinnah HA. An Exploratory, Randomized, Double-Blind Clinical Trial of Dipraglurant for Blepharospasm. Mov Disord 2024; 39:738-745. [PMID: 38310362 PMCID: PMC11045316 DOI: 10.1002/mds.29734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/12/2023] [Accepted: 01/12/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND Blepharospasm is treated with botulinum toxin, but obtaining satisfactory results is sometimes challenging. OBJECTIVE The aim is to conduct an exploratory trial of oral dipraglurant for blepharospasm. METHODS This study was an exploratory, phase 2a, randomized, double-blind, placebo-controlled trial of 15 participants who were assigned to receive a placebo or dipraglurant (50 or 100 mg) and assessed over 2 days, 1 and 2 hours following dosing. Outcome measures included multiple scales rated by clinicians or participants, digital video, and a wearable sensor. RESULTS Dipraglurant was well tolerated, with no obvious impact on any of the measurement outcomes. Power analyses suggested fewer subjects would be required for studies using a within-subject versus independent group design, especially for certain measures. Some outcome measures appeared more suitable than others. CONCLUSION Although dipraglurant appeared well tolerated, it did not produce a trend for clinical benefit. The results provide valuable information for planning further trials in blepharospasm. © 2024 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Gamze Kilic-Berkmen
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Hodam Kim
- IEN Center for Human-Centric Interfaces and Engineering at the Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA, USA
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Dongdong Chen
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Cameron I. Yeo
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Ashok R. Dinasarapu
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Laura M. Scorr
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Woon-Hong Yeo
- IEN Center for Human-Centric Interfaces and Engineering at the Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA, USA
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Tech and Emory University, Atlanta, GA, USA
- Parker H. Petit Institute for Bioengineering and Biosciences, Institute for Materials, Neural Engineering Center, Institute for Robotics and Intelligent Machines, Georgia Institute of Technology, Atlanta, GA, USA
| | - David A. Peterson
- Institute for Neural Computation, University of California in San Diego, La Jolla, CA, United States
| | - Hilde Williams
- Drug Development Consultant, Addex Pharmaceuticals Inc. Geneva Switzerland
| | - April Ruby
- Drug Development Consultant, Addex Pharmaceuticals Inc. Geneva Switzerland
| | - Roger Mills
- Drug Development Consultant, Addex Pharmaceuticals Inc. Geneva Switzerland
| | - H. A. Jinnah
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
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Boz D, Kilic‐Berkmen G, Perlmutter JS, Norris SA, Wright LJ, Klein C, Bäumer T, Löns S, Feuerstein JS, Mahajan A, Wagle‐Shukla A, Malaty I, LeDoux MS, Ondo W, Pantelyat A, Frank S, Saunders‐Pullman R, Jinnah H. An Empirical Comparison of Commonly Used Universal Rating Scales for Dystonia. Mov Disord Clin Pract 2023; 10:1777-1786. [PMID: 38094647 PMCID: PMC10715345 DOI: 10.1002/mdc3.13909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/19/2023] [Accepted: 10/08/2023] [Indexed: 02/01/2024] Open
Abstract
Background There are several widely used clinical rating scales for documenting the severity and distribution of various types of dystonia. Objectives The goal of this study was to evaluate the performance of the most commonly used scales in a large group of adults with the most common types of isolated dystonia. Methods Global Dystonia Rating Scale (GDRS) and the Burke-Fahn-Marsden Dystonia Rating Scale (BFM) scores were obtained for 3067 participants. Most had focal or segmental dystonia, with smaller numbers of multifocal or generalized dystonia. These scales were also compared for 209 adults with cervical dystonia that had Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) scores and 210 adults with blepharospasm that had Blepharospasm Severity Scale (BSRS) scores. Results There were strong correlations between the GDRS and BFM total scores (r = 0.79) and moderate correlations for their sub scores (r > 0.5). Scores for both scales showed positive skew, with an overabundance of low scores. BFM sub-scores were not normally distributed, due to artifacts caused by the provoking factor. Relevant sub-scores of the GDRS and BFM also showed moderate correlations with the TWSTRS (r > 0.5) for cervical dystonia and the BSRS (r > 0.5) for blepharospasm. Conclusions The BFM is more widely used than the GDRS, but these results suggest the GDRS may be preferable for focal and segmental dystonias. The overabundance of very low scores for both scales highlights challenges associated with discriminating very mild dystonia from other abnormal movements or variants of normal behavior.
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Affiliation(s)
- Deniz Boz
- College of Arts & SciencesGeorgia State UniversityAtlantaGeorgiaUSA
| | | | - Joel S. Perlmutter
- Department of Neurology, Radiology, Neuroscience, Physical Therapy and Occupational TherapyWashington University School of MedicineSt LouisMissouriUSA
| | - Scott A. Norris
- Department of Neurology and RadiologyWashington UniversitySt LouisMissouriUSA
| | - Laura J. Wright
- Department of Neurology at Washington University at St LouisSt LouisMissouriUSA
| | | | - Tobias Bäumer
- Institute of NeurogeneticsUniversity of LübeckLübeckGermany
| | - Sebastian Löns
- Institute of NeurogeneticsUniversity of LübeckLübeckGermany
| | | | - Abhimanyu Mahajan
- Rush Parkinson's disease and Movement disorders program, Department of Neurological SciencesChicagoIllinoisUSA
| | - Aparna Wagle‐Shukla
- Fixel Institute for Neurological Disease, University of Florida Department of NeurologyUniversity of FloridaGainesvilleFloridaUSA
| | - Irene Malaty
- Fixel Institute for Neurological Disease, University of Florida Department of NeurologyUniversity of FloridaGainesvilleFloridaUSA
| | - Mark S. LeDoux
- Department of PsychologyUniversity of Memphis, Memphis, TN, USA; Veracity Neuroscience LLCMemphisTennesseeUSA
| | - William Ondo
- Department of Neurology, Methodist Neurological InstituteHouston TX and Weill Cornell Medical SchoolNew YorkNew YorkUSA
| | - Alexander Pantelyat
- Department of NeurologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Samuel Frank
- Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMassachusettsUSA
| | - Rachel Saunders‐Pullman
- Department of NeurologyIcahn School of Medicine at Mount Sinai, and Mount Sinai Beth IsraelNew YorkNew YorkUSA
| | - H.A. Jinnah
- Department of NeurologyEmory University School of MedicineAtlantaGeorgiaUSA
- Department of Human GeneticsEmory University School of MedicineAtlantaGeorgiaUSA
- Department of PediatricsEmory University School of MedicineAtlantaGeorgiaUSA
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4
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Albanese A. Clinical features of dystonia and the science of classification. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2023; 169:1-20. [PMID: 37482389 DOI: 10.1016/bs.irn.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
This chapter describes advances in understanding the clinical features of dystonia since initial clinical recognition and its organization into a coherent and systematic clinical set. The clinical features of dystonia were at first considered an odd neurological movement disorder. Etymology of the word misleadingly underlined muscle tone. The main clinical features of dystonia were recognized gradually. They encompass dystonic movements, dystonic postures, alleviating maneuvers, overflow and mirroring. These features are observed in patients who present a variety of syndromes where dystonia occurs in isolation or combined with other movement disorders, or with other neurologic or systemic features. A large number of syndromic combinations is observed in the clinic and some of the syndomes are highlighted here. Practitioners are required to exert dedicated skills to recognize dystonia and correctly diagnose and classify their patients.
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Affiliation(s)
- Alberto Albanese
- Department of Neurology, IRCCS Humanitas Research Hospital, Milano, Italy; Department of Neuroscience, Catholic University, Milano, Italy.
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Younce JR, Cascella RH, Berman BD, Jinnah HA, Bellows S, Feuerstein J, Wagle Shukla A, Mahajan A, Chang FCF, Duque KR, Reich S, Richardson SP, Deik A, Stover N, Luna JM, Norris SA. Anatomical categorization of isolated non-focal dystonia: novel and existing patterns using a data-driven approach. DYSTONIA 2023; 2:11305. [PMID: 37920445 PMCID: PMC10621194 DOI: 10.3389/dyst.2023.11305] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
According to expert consensus, dystonia can be classified as focal, segmental, multifocal, and generalized, based on the affected body distribution. To provide an empirical and data-driven approach to categorizing these distributions, we used a data-driven clustering approach to compare frequency and co-occurrence rates of non-focal dystonia in pre-defined body regions using the Dystonia Coalition (DC) dataset. We analyzed 1,618 participants with isolated non-focal dystonia from the DC database. The analytic approach included construction of frequency tables, variable-wise analysis using hierarchical clustering and independent component analysis (ICA), and case-wise consensus hierarchical clustering to describe associations and clusters for dystonia affecting any combination of eighteen pre-defined body regions. Variable-wise hierarchical clustering demonstrated closest relationships between bilateral upper legs (distance = 0.40), upper and lower face (distance = 0.45), bilateral hands (distance = 0.53), and bilateral feet (distance = 0.53). ICA demonstrated clear grouping for the a) bilateral hands, b) neck, and c) upper and lower face. Case-wise consensus hierarchical clustering at k = 9 identified 3 major clusters. Major clusters consisted primarily of a) cervical dystonia with nearby regions, b) bilateral hand dystonia, and c) cranial dystonia. Our data-driven approach in a large dataset of isolated non-focal dystonia reinforces common segmental patterns in cranial and cervical regions. We observed unexpectedly strong associations between bilateral upper or lower limbs, which suggests that symmetric multifocal patterns may represent a previously underrecognized dystonia subtype.
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Affiliation(s)
- J. R. Younce
- Department of Neurology and Biomedical Research Imaging Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - R. H. Cascella
- School of Medicine, Washington University, St. Louis, MO, United States
| | - B. D. Berman
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, United States
| | - H. A. Jinnah
- Department of Neurology, Emory University, Atlanta, GA, United States
- Department of Human Genetics, Emory University, Atlanta, GA, United States
| | - S Bellows
- Department of Neurology, Baylor College of Medicine, Houston, TX, United States
| | - J. Feuerstein
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - A. Wagle Shukla
- Department of Neurology, University of Florida, Gainesville, FL, United States
| | - A. Mahajan
- Rush Parkinson’s Disease and Movement Disorders Program, Rush University Medical Center, Chicago, IL, United States
| | - F. C. F. Chang
- Movement Disorders Unit, Neurology Department, Westmead Hospital & Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - K. R. Duque
- James J. and Joan A. Gardner Family Center for Parkinson’s Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, United States
| | - S. Reich
- Department of Neurology, University of Maryland, Baltimore, MD, United States
| | - S. Pirio Richardson
- Department of Neurology, University of New Mexico and New Mexico VA Healthcare System, Albuquerque, NM, United States
| | - A. Deik
- Parkinson Disease and Movement Disorders Center, Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
| | - N. Stover
- Department of Neurology, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - J. M. Luna
- Department of Radiology, School of Medicine, Washington University, St. Louis, MO, United States
| | - S. A. Norris
- Department of Radiology, School of Medicine, Washington University, St. Louis, MO, United States
- Department of Neurology, School of Medicine, Washington University, St. Louis, MO, United States
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Vizcarra JA, Jinnah HA. What Is Hemidystonia? Mov Disord Clin Pract 2023; 10:477-481. [PMID: 36949804 PMCID: PMC10026294 DOI: 10.1002/mdc3.13659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/02/2022] [Accepted: 01/06/2023] [Indexed: 01/18/2023] Open
Abstract
Background Hemidystonia is defined as dystonia restricted to one side of the body. It is traditionally believed to result from a lesion in the contralateral hemisphere. Objectives To describe a series of hemidystonia patients without lesions on brain imaging. Methods We searched for individuals with potential hemidystonia who were included in the Dystonia Coalition or Movement Disorder Society Genetic mutation database (MDSgene), and conducted a systematic review. Results We found 10 individuals classified as hemidystonia or with homolateral limb dystonia among 3696 cases enrolled by the Dystonia Coalition, 9 cases in MDSgene, and one idiopathic case in the literature. None had evidence of a brain lesion. Body distributions used to define hemidystonia varied considerably and were not always restricted to one side of the body. Conclusions Hemidystonia may be idiopathic or genetic, without any obvious brain lesion. The varied use of the term suggests the need for more specific clinical criteria to define "half the body."
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Affiliation(s)
| | - Hyder A. Jinnah
- Department of NeurologyEmory University School of MedicineAtlantaGeorgiaUSA
- Department of Human GeneticsEmory University School of MedicineAtlantaGeorgiaUSA
- Department of PediatricsEmory University School of MedicineAtlantaGeorgiaUSA
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