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Matar E, Bhatia K. Dystonia and Parkinson's disease: Do they have a shared biology? INTERNATIONAL REVIEW OF NEUROBIOLOGY 2023; 169:347-411. [PMID: 37482398 DOI: 10.1016/bs.irn.2023.05.001] [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
Parkinsonism and dystonia co-occur across many movement disorders and are most encountered in the setting of Parkinson's disease. Here we aim to explore the shared neurobiological underpinnings of dystonia and parkinsonism through the clinical lens of the conditions in which these movement disorders can be seen together. Foregrounding the discussion, we briefly review the circuits of the motor system and the neuroanatomical and neurophysiological aspects of motor control and highlight their relevance to the proposed pathophysiology of parkinsonism and dystonia. Insight into shared biology is then sought from dystonia occurring in PD and other forms of parkinsonism including those disorders in which both can be co-expressed simultaneously. We organize these within a biological schema along with important questions to be addressed in this space.
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Affiliation(s)
- Elie Matar
- UCL Queen Square Institute of Neurology Department of Clinical and Movement Neurosciences, Queen Square, London, United Kingdom; Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
| | - Kailash Bhatia
- UCL Queen Square Institute of Neurology Department of Clinical and Movement Neurosciences, Queen Square, London, United Kingdom
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Cho HJ, Waugh R, Wu T, Panyakaew P, Mente K, Urbano D, Hallett M, Horovitz SG. Role of supplementary motor area in cervical dystonia and sensory tricks. Sci Rep 2022; 12:21206. [PMID: 36481868 PMCID: PMC9731945 DOI: 10.1038/s41598-022-25316-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 11/28/2022] [Indexed: 12/13/2022] Open
Abstract
Sensory trick is a characteristic feature of cervical dystonia (CD), where a light touch on the area adjacent to the dystonia temporarily improves symptoms. Clinical benefit from sensory tricks can be observed before tactile contact is made or even by imagination. The supplementary motor area (SMA) may dynamically interact with the sensorimotor network and other brain regions during sensory tricks in patients with CD. In this study, we examined the functional connectivity of the SMA at rest and during sensory trick performance and imagination in CD patients compared to healthy controls using functional magnetic resonance imaging. The functional connectivity between the SMA and left intraparietal sulcus (IPS) region was lower in CD patients at rest and it increased with sensory trick imagination and performance. SMA-right cerebellum connectivity also increased with sensory trick imagination in CD patients, while it decreased in healthy controls. In CD patients, SMA connectivity increased in the brain regions involved in sensorimotor integration during sensory trick performance and imagination. Our study results showed a crucial role of SMA in sensorimotor processing during sensory trick performance and imagination and suggest the IPS as a novel potential therapeutic target for brain modulation.
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Affiliation(s)
- Hyun Joo Cho
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.
| | - Rebecca Waugh
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
- Department of Psychology, University of Virginia, Charlottesville, VA, USA
| | - Tianxia Wu
- Clinical Trial Unit, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Pattamon Panyakaew
- Department of Medicine, Chulalongkorn Centre of Excellence for Parkinson's Disease and Related Disorders, Faculty of Medicine, Chulalongkorn University and King, Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Karin Mente
- Departments of Neurology and Pathology, Case Western Reserve University, Cleveland, USA
- Neurology Service, VA Northeast Ohio Healthcare System, Cleveland, OH, USA
- Cleveland Alzheimer's Disease Research Center, Cleveland, OH, USA
| | - Demelio Urbano
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Silvina G Horovitz
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
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Huang X, Lin J, Shang H, Yang J. Voxel-based meta-analysis of gray matter abnormalities in idiopathic dystonia. J Neurol 2022; 269:2862-2873. [PMID: 35013788 DOI: 10.1007/s00415-022-10961-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 01/03/2022] [Accepted: 01/04/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Neuroimaging studies have reported gray matter changes in patients with idiopathic dystonia but with considerable variations. Here, we aimed to investigate the convergence of dystonia-related gray matter changes across studies. METHODS The whole brain voxel-based morphometry studies comparing idiopathic dystonia and healthy controls were systematically searched in the PubMed, Web of Science and Embase. Meta-analysis of gray matter changes was performed using the anisotropic effect size-based signed differential mapping. RESULTS Twenty-eight studies comparing 701 idiopathic dystonia patients and 712 healthy controls were included in the meta-analysis. Compared to healthy controls, idiopathic dystonia patients showed increased gray matter in bilateral precentral and postcentral gyri, bilateral putamen and pallidum, right insula, and left supramarginal gyrus, while decreased gray matter in bilateral temporal poles, bilateral supplementary motor areas, right angular gyrus, inferior parietal gyrus and precuneus, left insula and inferior frontal gyrus. These findings remained robust in the jackknife sensitivity analysis, and no significant heterogeneity was detected. Subgroup analyses of different phenotypes of dystonia were performed to further confirm the above findings. CONCLUSION The meta-analysis showed that consistent widespread gray matter abnormalities were shared in different subtypes of idiopathic dystonia and were not restricted to the corticostriatal circuits.
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Affiliation(s)
- Xiang Huang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Junyu Lin
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Huifang Shang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jing Yang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Morales-Briceno H, Fung VSC, Bhatia KP, Balint B. Parkinsonism and dystonia: Clinical spectrum and diagnostic clues. J Neurol Sci 2021; 433:120016. [PMID: 34642024 DOI: 10.1016/j.jns.2021.120016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 08/20/2021] [Accepted: 09/29/2021] [Indexed: 10/20/2022]
Abstract
The links between the two archetypical basal ganglia disorders, dystonia and parkinsonism, are manifold and stem from clinical observations, imaging studies, animal models and genetics. The combination of both, i.e. the syndrome of dystonia-parkinsonism, is not uncommonly seen in movement disorders clinics and has a myriad of different underlying aetiologies, upon which treatment and prognosis depend. Based on a comprehensive literature review, we delineate the clinical spectrum of disorders presenting with dystonia-parkinsonism. The clinical approach depends primarily on the age at onset, associated neurological or systemic symptoms and neuroimaging. The tempo of disease progression, and the response to L-dopa are further important clues to tailor diagnostic approaches that may encompass dopamine transporter imaging, CSF analysis and, last but not least, genetic testing. Later in life, sporadic neurodegenerative conditions are the most frequent cause, but the younger the patient, the more likely the cause is unravelled by the recent advances of molecular genetics that are focus of this review. Here, knowledge of the associated phenotypic spectrum is key to guide genetic testing and interpretation of test results. This article is part of the Special Issue "Parkinsonism across the spectrum of movement disorders and beyond" edited by Joseph Jankovic, Daniel D. Truong and Matteo Bologna.
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Affiliation(s)
- Hugo Morales-Briceno
- Neurology Department, Movement Disorders Unit, Westmead Hospital, NSW, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, NSW 2145, Australia
| | - Victor S C Fung
- Neurology Department, Movement Disorders Unit, Westmead Hospital, NSW, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, NSW 2145, Australia
| | - Kailash P Bhatia
- UCL Queen Square Institute of Neurology Department of Clinical and Movement Neurosciences, Queen Square, London WC1N 3BG, United Kingdom
| | - Bettina Balint
- Department of Neurology, University Hospital Heidelberg, Germany.
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Roman Casul YA, Humbert ML, Farooqui A, Wagle Shukla A, Nagaraja N. Dystonia as a Presenting Feature of Acute Ischemic Stroke: A Case Report and Literature Review. Cureus 2021; 13:e17272. [PMID: 34540493 PMCID: PMC8448260 DOI: 10.7759/cureus.17272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2021] [Indexed: 11/10/2022] Open
Abstract
Hypokinetic and hyperkinetic movement disorders can occur post-stroke. Of these, dystonia is known to occur in the chronic stage of stroke. Rarely, acute dystonia can present as a symptom of acute ischemic stroke or develop during hospitalization for ischemic stroke. In this article, we present a case of acute focal dystonia as a presenting symptom of acute ischemic stroke, review the literature to summarize previous reports, and provide more insight into the pathophysiologic mechanisms related to this presentation.
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Affiliation(s)
- Yoram A Roman Casul
- Department of Neurology, University of Florida College of Medicine, Gainesville, USA
| | - Meghan L Humbert
- Department of Neurology, University of Florida College of Medicine, Gainesville, USA
| | - Amreen Farooqui
- Department of Neurology, University of Florida College of Medicine, Gainesville, USA
| | - Aparna Wagle Shukla
- Department of Neurology, University of Florida College of Medicine, Gainesville, USA
| | - Nandakumar Nagaraja
- Department of Neurology, University of Florida College of Medicine, Gainesville, USA
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Suri R, Rodriguez-Porcel F, Donohue K, Jesse E, Lovera L, Dwivedi AK, Espay AJ. Post-stroke Movement Disorders: The Clinical, Neuroanatomic, and Demographic Portrait of 284 Published Cases. J Stroke Cerebrovasc Dis 2018; 27:2388-2397. [PMID: 29793802 DOI: 10.1016/j.jstrokecerebrovasdis.2018.04.028] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 04/07/2018] [Accepted: 04/23/2018] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Abnormal movements are a relatively uncommon complication of strokes. Besides the known correlation between stroke location and certain movement disorders, there remain uncertainties about the collective effects of age and stroke mechanism on phenomenology, onset latency, and outcome of abnormal movements. MATERIALS AND METHODS We systematically reviewed all published cases and case series with adequate clinical-imaging correlations. A total of 284 cases were analyzed to evaluate the distribution of different movement disorders and their association with important cofactors. RESULTS Posterolateral thalamus was the most common region affected (22.5%) and dystonia the most commonly reported movement disorder (23.2%). The most common disorders were parkinsonism (17.4%) and chorea (17.4%) after ischemic strokes and dystonia (45.5%) and tremor (19.7%) after hemorrhagic strokes. Strokes in the caudate and putamen were complicated by dystonia in one third of the cases; strokes in the globus pallidus were followed by parkinsonism in nearly 40%. Chorea was the earliest poststroke movement disorder, appearing within hours, whereas dystonia and tremor manifested several months after stroke. Hemorrhagic strokes were responsible for most delayed-onset movement disorders (>6 months) and were particularly overrepresented among younger individuals affected by dystonia. CONCLUSIONS This evidence-mapping portrait of poststroke movement disorders will require validation or correction based on a prospective epidemiologic study. We hypothesize that selective network vulnerability and resilience may explain the differences observed in movement phenomenology and outcomes after stroke.
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Affiliation(s)
- Ritika Suri
- James J. and Joan A. Gardner Center for Parkinson Disease and Movement Disorders, Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio
| | | | - Kelly Donohue
- James J. and Joan A. Gardner Center for Parkinson Disease and Movement Disorders, Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Erin Jesse
- Department of Chemistry, Ohio State University, Columbus, Ohio
| | - Lilia Lovera
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina
| | - Alok Kumar Dwivedi
- Department of Biomedical Sciences, Division of Biostatistics and Epidemiology, Texas Tech University Health Sciences Center El Paso, El Paso, Texas
| | - Alberto J Espay
- James J. and Joan A. Gardner Center for Parkinson Disease and Movement Disorders, Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio.
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Carvalho V, Massano J, França S, Cruto C. Sudden Fixed Posturing: Beyond Functional (Psychogenic) Dystonia. Eur Neurol 2017; 78:270-271. [DOI: 10.1159/000481453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 09/12/2017] [Indexed: 11/19/2022]
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Liuzzi D, Gigante AF, Leo A, Defazio G. The anatomical basis of upper limb dystonia: lesson from secondary cases. Neurol Sci 2016; 37:1393-8. [PMID: 27173653 DOI: 10.1007/s10072-016-2598-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 04/28/2016] [Indexed: 10/21/2022]
Abstract
Upper limb dystonia is a focal dystonia that may affect muscles in the arm, forearm and hand. The neuroanatomical substrates involved in upper limb dystonia are not fully understood. Traditionally, dysfunction of the basal ganglia is presumed to be the main cause of dystonia but a growing body of evidence suggests that a network of additional cortical and subcortical structures may be involved. To identify the brain regions that are affected in secondary upper limb dystonia may help to better understand the neuroanatomical basis of the condition. We considered only patients with focal upper limb dystonia associated with a single localized brain lesion. To identify these patients, we conducted a systematic review of the published literature as well as the medical records of 350 patients with adult-onset dystonia seen over past 15 years at our movement disorder clinic. The literature review revealed 36 articles describing 72 cases of focal upper limb dystonia associated with focal lesions. Among patients at our clinic, four had focal lesions on imaging studies. Lesions were found in multiple regions including thalamus (n = 39), basal ganglia (n = 17), cortex (n = 4), brainstem (n = 4), cerebellum (n = 1), and cervical spine (n = 7). Dystonic tremor was not associated with any particular site of lesion, whereas there was a trend for an inverse association between task specificity and thalamic involvement. These data in combination with functional imaging studies of idiopathic upper limb dystonia support a model in which a network of different regions plays a role in pathogenesis.
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Affiliation(s)
- Daniele Liuzzi
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, "Aldo Moro" University of Bari, 70124, Bari, Italy
| | - Angelo Fabio Gigante
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, "Aldo Moro" University of Bari, 70124, Bari, Italy
| | - Antonio Leo
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, "Aldo Moro" University of Bari, 70124, Bari, Italy
| | - Giovanni Defazio
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, "Aldo Moro" University of Bari, 70124, Bari, Italy. .,Department of Neuroscience and Sense Organs, "Aldo Moro" University of Bari, Policlinico di Bari, piazza Giulio Cesare, 11-70124, Bari, Italy.
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Dhakar MB, Watson C, Rajamani K. Acute Onset Dystonia after Infarction of Premotor and Supplementary Motor Cortex. J Stroke Cerebrovasc Dis 2015; 24:2880-2. [PMID: 26483154 DOI: 10.1016/j.jstrokecerebrovasdis.2015.09.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 09/10/2015] [Accepted: 09/17/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Poststroke dystonia is the second most common movement disorder after chorea and often has a delayed manifestation. Lesions of the contralateral lenticular nucleus, particularly the putamen, have been implicated in the pathogenesis of dystonia. We present an unusual case of rapid onset of focal dystonia of the left upper extremity, which developed after infarction of the right premotor cortex (PMC) and the supplementary motor area (SMA). METHOD A retrospective chart review of the patient was performed. RESULTS AND CONCLUSION We propose that disruption of the afferents from PMC and SMA in the setting of chronic striatal abnormality can result in acute dystonia due to disinhibition of the thalamocortical circuit.
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Affiliation(s)
- Monica B Dhakar
- Department of Neurology, Wayne State University, Detroit, Michigan.
| | - Carla Watson
- Department of Pediatric and Neurology, Wayne State University, Detroit, Michigan
| | - Kumar Rajamani
- Department of Neurology, Wayne State University, Detroit, Michigan
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Digby G, Jalini S, Taylor S. Medication-induced acute dystonic reaction: the challenge of diagnosing movement disorders in the intensive care unit. BMJ Case Rep 2015; 2015:bcr-2014-207215. [PMID: 26392457 DOI: 10.1136/bcr-2014-207215] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 62-year-old man presented with left middle cerebral artery stroke. 1 h postadministration of tissue plasminogen activator, he received a total of 4 mg of haloperidol for combativeness. He developed partial complex status epilepticus, requiring benzodiazepines, phenytoin, propofol and intubation. 5 h later, he developed recurrent stereotyped tonic movements involving arching of the back, extension of the arms and contraction of opposing muscle groups. Repeat CT scan of the head showed evolving insular infarct. Differential diagnoses for these movements included tonic/clonic seizures, extensor (decerebrate) posturing from haemorrhagic conversion, neuroleptic malignant syndrome, or dystonic reaction. Given the lack of response to antiseizure medications, the recent administration of haloperidol, and the prompt resolution of movements following diphenhydramine administration, an acute dystonic reaction was considered. This atypical case of a critically ill patient with stroke highlights the fact that these patients may have multiple abnormal movements requiring careful analysis to guide diagnosis-specific management.
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Affiliation(s)
| | | | - Sean Taylor
- Queen's University, Kingston, Ontario, Canada
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Miletić V, Blažina K. Hemidystonia caused by frontal cortical infarction. Acta Neurol Belg 2015; 115:383-4. [PMID: 25119274 DOI: 10.1007/s13760-014-0354-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 08/08/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Vladimir Miletić
- Department of Neurology, Movement Disorders Centre, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia,
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Zhang L, McCarthy DM, Sharma N, Bhide PG. Dopamine receptor and Gα(olf) expression in DYT1 dystonia mouse models during postnatal development. PLoS One 2015; 10:e0123104. [PMID: 25860259 PMCID: PMC4393110 DOI: 10.1371/journal.pone.0123104] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 02/27/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND DYT1 dystonia is a heritable, early-onset generalized movement disorder caused by a GAG deletion (ΔGAG) in the DYT1 gene. Neuroimaging studies and studies using mouse models suggest that DYT1 dystonia is associated with dopamine imbalance. However, whether dopamine imbalance is key to DYT1 or other forms of dystonia continues to be debated. METHODOLOGY/PRINCIPAL FINDINGS We used Dyt1 knock out (Dyt1 KO), Dyt1 ΔGAG knock-in (Dyt1 KI), and transgenic mice carrying one copy of the human DYT1 wild type allele (DYT1 hWT) or human ΔGAG mutant allele (DYT1 hMT). D1R, D2R, and Gα(olf) protein expression was analyzed by western blot in the frontal cortex, caudate-putamen and ventral midbrain in young adult (postnatal day 60; P60) male mice from all four lines; and in the frontal cortex and caudate putamen in juvenile (postnatal day 14; P14) male mice from the Dyt1 KI and KO lines. Dopamine receptor and Gα(olf) protein expression were significantly decreased in multiple brain regions of Dyt1 KI and Dyt1 KO mice and not significantly altered in the DYT1 hMT or DYT1 hWT mice at P60. The only significant change at P14 was a decrease in D1R expression in the caudate-putamen of the Dyt1 KO mice. CONCLUSION/SIGNIFICANCE We found significant decreases in key proteins in the dopaminergic system in multiple brain regions of Dyt1 KO and Dyt1 KI mouse lines at P60. Deletion of one copy of the Dyt1 gene (KO mice) produced the most pronounced effects. These data offer evidence that impaired dopamine receptor signaling may be an early and significant contributor to DYT1 dystonia pathophysiology.
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Affiliation(s)
- Lin Zhang
- Department of Biomedical Sciences, Center for Brain Repair, Florida State University College of Medicine, Tallahassee, Florida, United States of America
- * E-mail: (LZ); (PGB)
| | - Deirdre M. McCarthy
- Department of Biomedical Sciences, Center for Brain Repair, Florida State University College of Medicine, Tallahassee, Florida, United States of America
| | - Nutan Sharma
- Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Pradeep G. Bhide
- Department of Biomedical Sciences, Center for Brain Repair, Florida State University College of Medicine, Tallahassee, Florida, United States of America
- * E-mail: (LZ); (PGB)
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