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Tian X, Ding C, Liu M, Dai L, Xie Z, Fang T. Bilateral globus pallidus internus-deep brain stimulation in a 5-year-old boy with SGCE-related myoclonus dystonia syndrome. Pediatr Investig 2024; 8:154-156. [PMID: 38910854 PMCID: PMC11193369 DOI: 10.1002/ped4.12421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 01/31/2024] [Indexed: 06/25/2024] Open
Affiliation(s)
- Xiaojuan Tian
- Department of Neurology, Neurological CenterBeijing Children's Hospital, Capital Medical University, National Center For Children's HealthBeijingChina
| | - Changhong Ding
- Department of Neurology, Neurological CenterBeijing Children's Hospital, Capital Medical University, National Center For Children's HealthBeijingChina
| | - Ming Liu
- Department of Neurology, Neurological CenterBeijing Children's Hospital, Capital Medical University, National Center For Children's HealthBeijingChina
| | - Lifang Dai
- Department of Neurology, Neurological CenterBeijing Children's Hospital, Capital Medical University, National Center For Children's HealthBeijingChina
| | - Zixing Xie
- Department of Functional Neurosurgery, Neurological CenterBeijing Children's Hospital, Capital Medical University, National Center For Children's HealthBeijingChina
| | - Tie Fang
- Department of Functional Neurosurgery, Neurological CenterBeijing Children's Hospital, Capital Medical University, National Center For Children's HealthBeijingChina
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Belli E, Del Prete E, Unti E, Mazzucchi S, Palermo G, Ceravolo R. Perampanel as a novel treatment for subcortical myoclonus in myoclonus-dystonia syndrome. Neurol Sci 2023:10.1007/s10072-023-06803-y. [PMID: 37131084 DOI: 10.1007/s10072-023-06803-y] [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: 12/29/2022] [Accepted: 04/04/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND Myoclonus-dystonia (MD) is a syndrome characterized by subcortical myoclonus and milder dystonia. The main causative gene is the epsilon sarcoglycan gene (SGCE), but other genes may be involved. Response to medications is variable, with poor tolerability limiting their use. CASE PRESENTATION We present the case of a patient with severe myoclonic jerks and mild dystonia since childhood. At first neurological visit at the age of 46 years old, she presented brief myoclonic jerks predominating in the upper limbs and neck, mild at rest and elicited by action, posture and tactile stimulus. Myoclonus was accompanied by mild neck and right arm dystonia. Neurophysiological tests suggested subcortical origin of myoclonus, brain MRI was unremarkable. Myoclonus-dystonia was diagnosed, and genetic testing identified a novel mutation in SGCE gene (c.907delC) in heterozygosis. Over time she assumed a large variety of anti-epileptics without beneficial effect on myoclonus and low tolerability. Add-on treatment with Perampanel was started, with a beneficial effect. No adverse events were reported. Perampanel is the first selective non-competitive AMPA receptor antagonist approved in add-on for focal and generalized tonic-clonic seizures. To our knowledge, this is the first trial of Perampanel in MD. CONCLUSIONS We presented the case of a patient with MD due to SGCE mutation who was treated with Perampanel with beneficial effects. We propose Perampanel as a novel treatment for myoclonus in MD.
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Affiliation(s)
- Elisabetta Belli
- Unit of Neurology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Eleonora Del Prete
- Unit of Neurology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Elisa Unti
- Unit of Neurology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sonia Mazzucchi
- Unit of Neurology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giovanni Palermo
- Unit of Neurology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Roberto Ceravolo
- Unit of Neurology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
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Horisawa S, Kohara K, Ebise H, Nishitani M, Kawamata T, Taira T. Efficacy and Safety of Zolpidem for Focal Dystonia After Neurosurgical Treatments: A Retrospective Cohort Study. Front Neurol 2022; 13:837023. [PMID: 35592470 PMCID: PMC9111172 DOI: 10.3389/fneur.2022.837023] [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: 12/16/2021] [Accepted: 04/12/2022] [Indexed: 11/13/2022] Open
Abstract
Although there are several reports of the significant efficacy of zolpidem for treating dystonia, zolpidem is still considered an anecdotal treatment. Here, we evaluated the efficacy and safety of zolpidem for treating residual dystonia in patients who previously received various neurosurgical treatments majorly including deep brain stimulation and radiofrequency ablation. We retrospectively reviewed medical records from January 2021 to September 2021 to identify patients with dystonia who had been prescribed zolpidem after undergoing neurosurgery. Twenty patients were enrolled in this study, including those with blepharospasm (two), tongue dystonia (four), mouth dystonia (one), spasmodic dysphonia (two), cervical dystonia (six), focal hand dystonia (three), hemidystonia (two), blepharospasm with cervical dystonia (one), and mouth dystonia with cervical dystonia (one). Single doses of zolpidem ranged between 2.5 and 10 mg, while daily dosages ranged from 10 to 30 mg. The zolpidem dose prescribed was 5–10 mg, with single and daily doses of 7 ± 2.9 and 14.5 ± 6.0 mg, respectively. With zolpidem administration, the participants' Burke-Fahn-Marsden Dystonia Rating Scale-Movement Scale score significantly improved from 8.1 ± 6.7 to 3.7 ± 2.5 (50.6% improvement, p < 0.0001). Improvements in arm dystonia, blepharospasm, and spasmodic dysphonia were observed using the Arm Dystonia Disability Scale, Jankovic Rating Scale, and Voice Handicap Index, respectively. No improvements were observed in cervical dystonia on the Toronto Western Spasmodic Torticollis Rating Scale. Drowsiness, including three cases each of mild and moderate drowsiness, was the most frequent adverse effect (30%), which persisted for 2–3 h. Transient amnesia and rapid eye movement sleep behavior disorder occurred in two patients and one patient, respectively. Although our findings suggest that zolpidem can be a valuable treatment option for patients with residual dystonia after neurosurgical treatments, the beneficial effects for cervical dystonia were limited.
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Kutschenko A, Staege S, Grütz K, Glaß H, Kalmbach N, Gschwendtberger T, Henkel LM, Heine J, Grünewald A, Hermann A, Seibler P, Wegner F. Functional and Molecular Properties of DYT-SGCE Myoclonus-Dystonia Patient-Derived Striatal Medium Spiny Neurons. Int J Mol Sci 2021; 22:3565. [PMID: 33808167 PMCID: PMC8037318 DOI: 10.3390/ijms22073565] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/18/2021] [Accepted: 03/24/2021] [Indexed: 01/20/2023] Open
Abstract
Myoclonus-dystonia (DYT-SGCE, formerly DYT11) is characterized by alcohol-sensitive, myoclonic-like appearance of fast dystonic movements. It is caused by mutations in the SGCE gene encoding ε-sarcoglycan leading to a dysfunction of this transmembrane protein, alterations in the cerebello-thalamic pathway and impaired striatal plasticity. To elucidate underlying pathogenic mechanisms, we investigated induced pluripotent stem cell (iPSC)-derived striatal medium spiny neurons (MSNs) from two myoclonus-dystonia patients carrying a heterozygous mutation in the SGCE gene (c.298T>G and c.304C>T with protein changes W100G and R102X) in comparison to two matched healthy control lines. Calcium imaging showed significantly elevated basal intracellular Ca2+ content and lower frequency of spontaneous Ca2+ signals in SGCE MSNs. Blocking of voltage-gated Ca2+ channels by verapamil was less efficient in suppressing KCl-induced Ca2+ peaks of SGCE MSNs. Ca2+ amplitudes upon glycine and acetylcholine applications were increased in SGCE MSNs, but not after GABA or glutamate applications. Expression of voltage-gated Ca2+ channels and most ionotropic receptor subunits was not altered. SGCE MSNs showed significantly reduced GABAergic synaptic density. Whole-cell patch-clamp recordings displayed elevated amplitudes of miniature postsynaptic currents and action potentials in SGCE MSNs. Our data contribute to a better understanding of the pathophysiology and the development of novel therapeutic strategies for myoclonus-dystonia.
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Grants
- Karlheinz-Hartmann-Stiftung (Hannover, Germany), Ellen-Schmidt-Program (Hannover, Germany), Hermann and Lilly Schilling Stiftung für medizinische Forschung im Stifterverband, German Research Foundation (FOR2488) Karlheinz-Hartmann-Stiftung (Hannover, Germany), Ellen-Schmidt-Program (Hannover, Germany), Hermann and Lilly Schilling Stiftung für medizinische Forschung im Stifterverband, German Research Foundation (FOR2488)
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Affiliation(s)
- Anna Kutschenko
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (A.K.); (S.S.); (N.K.); (T.G.); (L.M.H.); (J.H.)
| | - Selma Staege
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (A.K.); (S.S.); (N.K.); (T.G.); (L.M.H.); (J.H.)
- Center for Systems Neuroscience, Bünteweg 2, 30559 Hannover, Germany
| | - Karen Grütz
- Institute of Neurogenetics, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany; (K.G.); (A.G.); (P.S.)
| | - Hannes Glaß
- Translational Neurodegeneration Section “Albrecht-Kossel“, Department of Neurology, University Medical Center, University of Rostock, Gehlsheimer Str. 20, 18147 Rostock, Germany; (H.G.); (A.H.)
| | - Norman Kalmbach
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (A.K.); (S.S.); (N.K.); (T.G.); (L.M.H.); (J.H.)
| | - Thomas Gschwendtberger
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (A.K.); (S.S.); (N.K.); (T.G.); (L.M.H.); (J.H.)
- Center for Systems Neuroscience, Bünteweg 2, 30559 Hannover, Germany
| | - Lisa M. Henkel
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (A.K.); (S.S.); (N.K.); (T.G.); (L.M.H.); (J.H.)
- Center for Systems Neuroscience, Bünteweg 2, 30559 Hannover, Germany
| | - Johanne Heine
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (A.K.); (S.S.); (N.K.); (T.G.); (L.M.H.); (J.H.)
| | - Anne Grünewald
- Institute of Neurogenetics, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany; (K.G.); (A.G.); (P.S.)
| | - Andreas Hermann
- Translational Neurodegeneration Section “Albrecht-Kossel“, Department of Neurology, University Medical Center, University of Rostock, Gehlsheimer Str. 20, 18147 Rostock, Germany; (H.G.); (A.H.)
- German Center for Neurodegenerative Diseases Rostock/Greifswald, 18147 Rostock, Germany
- Center for Transdisciplinary Neurosciences Rostock (CTNR), University Medical Center, University of Rostock, 18147 Rostock, Germany
| | - Philip Seibler
- Institute of Neurogenetics, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany; (K.G.); (A.G.); (P.S.)
| | - Florian Wegner
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (A.K.); (S.S.); (N.K.); (T.G.); (L.M.H.); (J.H.)
- Center for Systems Neuroscience, Bünteweg 2, 30559 Hannover, Germany
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