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Zhu L, Meng H, Zhang W, Xie W, Sun H, Hou S. The pathogenesis of blepharospasm. Front Neurol 2024; 14:1336348. [PMID: 38274886 PMCID: PMC10808626 DOI: 10.3389/fneur.2023.1336348] [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: 11/13/2023] [Accepted: 12/28/2023] [Indexed: 01/27/2024] Open
Abstract
Blepharospasm is a focal dystonia characterized by involuntary tetanic contractions of the orbicularis oculi muscle, which can lead to functional blindness and loss of independent living ability in severe cases. It usually occurs in adults, with a higher incidence rate in women than in men. The etiology and pathogenesis of this disease have not been elucidated to date, but it is traditionally believed to be related to the basal ganglia. Studies have also shown that this is related to the decreased activity of inhibitory neurons in the cerebral cortex caused by environmental factors and genetic predisposition. Increasingly, studies have focused on the imbalance in the regulation of neurotransmitters, including dopamine, serotonin, and acetylcholine, in blepharospasm. The onset of the disease is insidious, and the misdiagnosis rate is high based on history and clinical manifestations. This article reviews the etiology, epidemiological features, and pathogenesis of blepharospasm, to improve understanding of the disease by neurologists and ophthalmologists.
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Affiliation(s)
- Lixia Zhu
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Hongmei Meng
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Wuqiong Zhang
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Wenjing Xie
- Department of Neurology, The Second Hospital of Jilin University, Changchun, China
| | - Huaiyu Sun
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Shuai Hou
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
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Tolmacheva VA, Parfenov VA, Ostroumova TM, Saloukhina NI, Nodel MR, Romanov DV. [Mental disorders in blepharospasm]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:76-82. [PMID: 38147386 DOI: 10.17116/jnevro202312312176] [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] [Indexed: 12/27/2023]
Abstract
OBJECTIVE To analyze mental disorders in blepharospasm (BS) before and after botulinum therapy (BT). MATERIAL AND METHODS We examined 25 patients with BS (9 men and 16 women), aged 50 to 85 years (mean 64.1±18.5), with BS (main study group). The control group consisted of 20 healthy individuals (7 men and 13 women, mean age 63.5±8.5). Patients were examined before and after BT (after 3 weeks) using a diagnostic structured interview Mini International Neuropsychiatric Interview, GAD-7, PHQ-9, fear of negative assessment (short version) and The Liebowitz Social Anxiety Scale (LSAS). RESULTS Fifty-six percent of patients with BS, as assessed by the GAD-7, showed a high level of anxiety, while depression, measured by the PHQ-9 and found in 52% of patients, was mainly manifested by mild disorders. In the group of patients with BS, the mean scores were higher on the GAD-7, PHQ-9, fear of negative assessment (p<0.001) and LSAS (p<0.05) than in the control group. After treatment with BT, the levels of anxiety and depression in patients with BS decreased slightly and remained higher compared with the control group. Psychiatric examination in the majority (64%) of patients revealed mental disorders that could not be explained by the occurrence of BS. The remaining 36% of patients had adaptation disorders (nosogenic reactions) caused by BS. Affective mental pathology (recurrent depressive disorder and dysthymia) and anxiety disorders (social phobia and adjustment disorders) were more often observed in the main study group compared with the control group (24% versus 5% and 68% versus 10%, respectively). CONCLUSION A significant proportion of patients with BS have anxiety and depressive disorders, the severity of which does not depend only on the severity of motor symptoms and does not significantly decrease after successful BT, but is caused by mental disorders that preceded the manifestation of BS. Identification of mental disorders to varying degrees associated with BS, not only on the basis of psychometric scales, but also consultation with a psychiatrist, will allow, in addition to the correction of motor symptoms of BS, to differentiate the therapeutic approach through psychotherapy and psychopharmacotherapy.
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Affiliation(s)
- V A Tolmacheva
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - V A Parfenov
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - T M Ostroumova
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - N I Saloukhina
- Institute of Experimental Medicine, St. Peterburg, Russia
| | - M R Nodel
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - D V Romanov
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- Mental Health Research Center, Moscow, Russia
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Sim J, Narasimhalu K, Tan EK. A man with an arched back. Parkinsonism Relat Disord 2022; 103:175-176. [PMID: 36270736 DOI: 10.1016/j.parkreldis.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/30/2022] [Accepted: 07/06/2022] [Indexed: 06/16/2023]
Affiliation(s)
- Jingwei Sim
- Department of Neurology, Singapore General Hospital Campus, National Neuroscience Institute, Singapore
| | - Kaavya Narasimhalu
- Department of Neurology, Singapore General Hospital Campus, National Neuroscience Institute, Singapore
| | - Eng-King Tan
- Department of Neurology, Singapore General Hospital Campus, National Neuroscience Institute, Singapore.
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Owen RL, Grewal SS, Thompson JM, Hassan A, Lee KH, Klassen BT. Effectiveness of Thalamic Ventralis Oralis Anterior and Posterior Nuclei Deep Brain Stimulation for Posttraumatic Dystonia. Mayo Clin Proc Innov Qual Outcomes 2022; 6:137-142. [PMID: 35243206 PMCID: PMC8866047 DOI: 10.1016/j.mayocpiqo.2022.01.001] [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] [Indexed: 11/03/2022] Open
Abstract
Herein we report that the ventralis oralis anterior and posterior (Voa/Vop) nuclei of the thalamus may be effective alternative targets for deep brain stimulation (DBS) to improve posttraumatic dystonia when the globus pallidus interna is traumatically damaged. This patient presented at age 35 years with a clinical diagnosis of posttraumatic cervical and bilateral upper limb acquired dystonia resulting from intracerebral and intraventricular hemorrhage after a motorcycle accident at age 19 years. Due to a right globus pallidus interna traumatic lesion, conventional DBS targeting of the inferior basal ganglia was not possible; thus, the alternative Voa/Vop nuclei target was implanted. The patient realized significant benefit and at last follow-up 3 years postoperatively continued to endorse marked benefit and improvement of dystonia symptoms with minimal adverse effects from bilateral DBS implantation in the alternative targets of the Voa/Vop nuclei of the thalamus.
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Park J, Reilaender A, Petry-Schmelzer JN, Stöbe P, Cordts I, Harmuth F, Rautenberg M, Woerz SE, Demidov G, Sturm M, Ossowski S, Schwaibold EMC, Wunderlich G, Paus S, Saft C, Haack TB. Transcript-Specific Loss-of-Function Variants in VPS16 Are Enriched in Patients With Dystonia. Neurol Genet 2021; 8:e644. [PMID: 34901436 PMCID: PMC8656243 DOI: 10.1212/nxg.0000000000000644] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 10/08/2021] [Indexed: 01/14/2023]
Abstract
Background and Objectives Our objective was to improve rare variant interpretation using statistical measures as well as publicly accessible annotation of expression levels and tissue specificity of different splice isoforms. We describe rare VPS16 variants observed in patients with dystonia and patients without dystonia, elaborate on our interpretation of VPS16 variants affecting different transcripts, and provide detailed clinical description of the movement disorder caused by VPS16 variants. Methods In-house exome and genome data sets (n = 11,539) were screened for rare heterozygous missense and putative loss-of-function (pLoF) variants in VPS16. Using pext (proportion expressed across transcripts) values from the Genome Aggregation Database (gnomAD), we differentiated variants affecting weakly and highly expressed exons/transcripts and applied statistical measures to systematically identify disease-associated genetic variation among patients with dystonia (n = 280). Results Six different heterozygous pLoFs in VPS16 transcripts were identified in 13 individuals. Three of these pLoFs occurred in 9 individuals with different phenotypes, and 3 pLoFs were identified in 4 unrelated individuals with early-onset dystonia. Although pLoFs were enriched in the dystonia cohort (n = 280; p = 2.04 × 10−4; 4/280 cases vs 9/11,259 controls; Fisher exact test), it was not exome-wide significant. According to the pext values in gnomAD, all 3 pLoFs observed in the patients with dystonia were located in the highly expressed canonical transcript ENST00000380445.3, whereas 2 of 3 pLoFs detected in 8 individuals without dystonia were located in the first exon of the noncanonical transcript ENST00000380443.3 that is weakly expressed across all tissues. Taking these biological implications into account, pLoFs involving the canonical transcript were exome-wide significantly enriched in patients with dystonia (p = 1.67 × 10−6; 4/280 cases vs 1/11,259 controls; Fisher exact test). All VPS16 patients showed mild progressive dystonia with writer's cramp as the presenting symptom between age 7 and 34 years (mean 20 years) that often progressed to generalized dystonia and was even accompanied by hyperkinetic movements and myoclonus in 1 patient. Discussion Our data provide strong evidence for VPS16 pLoFs to be implicated in dystonia and knowledge on exon resolution expression levels as well as statistical measures proved to be useful for variant interpretation.
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Affiliation(s)
- Joohyun Park
- Institute of Medical Genetics and Applied Genomics (J.P., P.S., F.H., M.R., S.E.W., G.D., M.S., S.O.), University of Tübingen, Tübingen. Germany; Department of Neurology University Hospital (A.R.), Goethe University Frankfurt, Frankfurt. Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology (J.N.P-S., G.W.), Cologne. Germany; Department of Neurology (I.C.,), Klinikum rechts der Isar, Technical University Munich, Munich. Germany; Institute of Human Genetics (E.M.C.S.), Heidelberg University, Heidelberg. Germany; University of Cologne (G.W.), Faculty of Medicine and University Hospital Cologne, Centre for Rare Diseases, Cologne, Germany; Department of Neurology (S.P.), GFO Clinics Troisdorf, Troisdorf. Germany; Department of Neurology (C.S.), Huntington Centre NRW, Ruhr-University Bochum, St. Josef-Hospital, Bochum. Germany; Centre for Rare Diseases, University of Tübingen (T.B.H.), Tübingen. Germany
| | - Annemarie Reilaender
- Institute of Medical Genetics and Applied Genomics (J.P., P.S., F.H., M.R., S.E.W., G.D., M.S., S.O.), University of Tübingen, Tübingen. Germany; Department of Neurology University Hospital (A.R.), Goethe University Frankfurt, Frankfurt. Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology (J.N.P-S., G.W.), Cologne. Germany; Department of Neurology (I.C.,), Klinikum rechts der Isar, Technical University Munich, Munich. Germany; Institute of Human Genetics (E.M.C.S.), Heidelberg University, Heidelberg. Germany; University of Cologne (G.W.), Faculty of Medicine and University Hospital Cologne, Centre for Rare Diseases, Cologne, Germany; Department of Neurology (S.P.), GFO Clinics Troisdorf, Troisdorf. Germany; Department of Neurology (C.S.), Huntington Centre NRW, Ruhr-University Bochum, St. Josef-Hospital, Bochum. Germany; Centre for Rare Diseases, University of Tübingen (T.B.H.), Tübingen. Germany
| | - Jan N Petry-Schmelzer
- Institute of Medical Genetics and Applied Genomics (J.P., P.S., F.H., M.R., S.E.W., G.D., M.S., S.O.), University of Tübingen, Tübingen. Germany; Department of Neurology University Hospital (A.R.), Goethe University Frankfurt, Frankfurt. Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology (J.N.P-S., G.W.), Cologne. Germany; Department of Neurology (I.C.,), Klinikum rechts der Isar, Technical University Munich, Munich. Germany; Institute of Human Genetics (E.M.C.S.), Heidelberg University, Heidelberg. Germany; University of Cologne (G.W.), Faculty of Medicine and University Hospital Cologne, Centre for Rare Diseases, Cologne, Germany; Department of Neurology (S.P.), GFO Clinics Troisdorf, Troisdorf. Germany; Department of Neurology (C.S.), Huntington Centre NRW, Ruhr-University Bochum, St. Josef-Hospital, Bochum. Germany; Centre for Rare Diseases, University of Tübingen (T.B.H.), Tübingen. Germany
| | - Petra Stöbe
- Institute of Medical Genetics and Applied Genomics (J.P., P.S., F.H., M.R., S.E.W., G.D., M.S., S.O.), University of Tübingen, Tübingen. Germany; Department of Neurology University Hospital (A.R.), Goethe University Frankfurt, Frankfurt. Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology (J.N.P-S., G.W.), Cologne. Germany; Department of Neurology (I.C.,), Klinikum rechts der Isar, Technical University Munich, Munich. Germany; Institute of Human Genetics (E.M.C.S.), Heidelberg University, Heidelberg. Germany; University of Cologne (G.W.), Faculty of Medicine and University Hospital Cologne, Centre for Rare Diseases, Cologne, Germany; Department of Neurology (S.P.), GFO Clinics Troisdorf, Troisdorf. Germany; Department of Neurology (C.S.), Huntington Centre NRW, Ruhr-University Bochum, St. Josef-Hospital, Bochum. Germany; Centre for Rare Diseases, University of Tübingen (T.B.H.), Tübingen. Germany
| | - Isabell Cordts
- Institute of Medical Genetics and Applied Genomics (J.P., P.S., F.H., M.R., S.E.W., G.D., M.S., S.O.), University of Tübingen, Tübingen. Germany; Department of Neurology University Hospital (A.R.), Goethe University Frankfurt, Frankfurt. Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology (J.N.P-S., G.W.), Cologne. Germany; Department of Neurology (I.C.,), Klinikum rechts der Isar, Technical University Munich, Munich. Germany; Institute of Human Genetics (E.M.C.S.), Heidelberg University, Heidelberg. Germany; University of Cologne (G.W.), Faculty of Medicine and University Hospital Cologne, Centre for Rare Diseases, Cologne, Germany; Department of Neurology (S.P.), GFO Clinics Troisdorf, Troisdorf. Germany; Department of Neurology (C.S.), Huntington Centre NRW, Ruhr-University Bochum, St. Josef-Hospital, Bochum. Germany; Centre for Rare Diseases, University of Tübingen (T.B.H.), Tübingen. Germany
| | - Florian Harmuth
- Institute of Medical Genetics and Applied Genomics (J.P., P.S., F.H., M.R., S.E.W., G.D., M.S., S.O.), University of Tübingen, Tübingen. Germany; Department of Neurology University Hospital (A.R.), Goethe University Frankfurt, Frankfurt. Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology (J.N.P-S., G.W.), Cologne. Germany; Department of Neurology (I.C.,), Klinikum rechts der Isar, Technical University Munich, Munich. Germany; Institute of Human Genetics (E.M.C.S.), Heidelberg University, Heidelberg. Germany; University of Cologne (G.W.), Faculty of Medicine and University Hospital Cologne, Centre for Rare Diseases, Cologne, Germany; Department of Neurology (S.P.), GFO Clinics Troisdorf, Troisdorf. Germany; Department of Neurology (C.S.), Huntington Centre NRW, Ruhr-University Bochum, St. Josef-Hospital, Bochum. Germany; Centre for Rare Diseases, University of Tübingen (T.B.H.), Tübingen. Germany
| | - Maren Rautenberg
- Institute of Medical Genetics and Applied Genomics (J.P., P.S., F.H., M.R., S.E.W., G.D., M.S., S.O.), University of Tübingen, Tübingen. Germany; Department of Neurology University Hospital (A.R.), Goethe University Frankfurt, Frankfurt. Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology (J.N.P-S., G.W.), Cologne. Germany; Department of Neurology (I.C.,), Klinikum rechts der Isar, Technical University Munich, Munich. Germany; Institute of Human Genetics (E.M.C.S.), Heidelberg University, Heidelberg. Germany; University of Cologne (G.W.), Faculty of Medicine and University Hospital Cologne, Centre for Rare Diseases, Cologne, Germany; Department of Neurology (S.P.), GFO Clinics Troisdorf, Troisdorf. Germany; Department of Neurology (C.S.), Huntington Centre NRW, Ruhr-University Bochum, St. Josef-Hospital, Bochum. Germany; Centre for Rare Diseases, University of Tübingen (T.B.H.), Tübingen. Germany
| | - Sarah E Woerz
- Institute of Medical Genetics and Applied Genomics (J.P., P.S., F.H., M.R., S.E.W., G.D., M.S., S.O.), University of Tübingen, Tübingen. Germany; Department of Neurology University Hospital (A.R.), Goethe University Frankfurt, Frankfurt. Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology (J.N.P-S., G.W.), Cologne. Germany; Department of Neurology (I.C.,), Klinikum rechts der Isar, Technical University Munich, Munich. Germany; Institute of Human Genetics (E.M.C.S.), Heidelberg University, Heidelberg. Germany; University of Cologne (G.W.), Faculty of Medicine and University Hospital Cologne, Centre for Rare Diseases, Cologne, Germany; Department of Neurology (S.P.), GFO Clinics Troisdorf, Troisdorf. Germany; Department of Neurology (C.S.), Huntington Centre NRW, Ruhr-University Bochum, St. Josef-Hospital, Bochum. Germany; Centre for Rare Diseases, University of Tübingen (T.B.H.), Tübingen. Germany
| | - German Demidov
- Institute of Medical Genetics and Applied Genomics (J.P., P.S., F.H., M.R., S.E.W., G.D., M.S., S.O.), University of Tübingen, Tübingen. Germany; Department of Neurology University Hospital (A.R.), Goethe University Frankfurt, Frankfurt. Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology (J.N.P-S., G.W.), Cologne. Germany; Department of Neurology (I.C.,), Klinikum rechts der Isar, Technical University Munich, Munich. Germany; Institute of Human Genetics (E.M.C.S.), Heidelberg University, Heidelberg. Germany; University of Cologne (G.W.), Faculty of Medicine and University Hospital Cologne, Centre for Rare Diseases, Cologne, Germany; Department of Neurology (S.P.), GFO Clinics Troisdorf, Troisdorf. Germany; Department of Neurology (C.S.), Huntington Centre NRW, Ruhr-University Bochum, St. Josef-Hospital, Bochum. Germany; Centre for Rare Diseases, University of Tübingen (T.B.H.), Tübingen. Germany
| | - Marc Sturm
- Institute of Medical Genetics and Applied Genomics (J.P., P.S., F.H., M.R., S.E.W., G.D., M.S., S.O.), University of Tübingen, Tübingen. Germany; Department of Neurology University Hospital (A.R.), Goethe University Frankfurt, Frankfurt. Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology (J.N.P-S., G.W.), Cologne. Germany; Department of Neurology (I.C.,), Klinikum rechts der Isar, Technical University Munich, Munich. Germany; Institute of Human Genetics (E.M.C.S.), Heidelberg University, Heidelberg. Germany; University of Cologne (G.W.), Faculty of Medicine and University Hospital Cologne, Centre for Rare Diseases, Cologne, Germany; Department of Neurology (S.P.), GFO Clinics Troisdorf, Troisdorf. Germany; Department of Neurology (C.S.), Huntington Centre NRW, Ruhr-University Bochum, St. Josef-Hospital, Bochum. Germany; Centre for Rare Diseases, University of Tübingen (T.B.H.), Tübingen. Germany
| | - Stephan Ossowski
- Institute of Medical Genetics and Applied Genomics (J.P., P.S., F.H., M.R., S.E.W., G.D., M.S., S.O.), University of Tübingen, Tübingen. Germany; Department of Neurology University Hospital (A.R.), Goethe University Frankfurt, Frankfurt. Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology (J.N.P-S., G.W.), Cologne. Germany; Department of Neurology (I.C.,), Klinikum rechts der Isar, Technical University Munich, Munich. Germany; Institute of Human Genetics (E.M.C.S.), Heidelberg University, Heidelberg. Germany; University of Cologne (G.W.), Faculty of Medicine and University Hospital Cologne, Centre for Rare Diseases, Cologne, Germany; Department of Neurology (S.P.), GFO Clinics Troisdorf, Troisdorf. Germany; Department of Neurology (C.S.), Huntington Centre NRW, Ruhr-University Bochum, St. Josef-Hospital, Bochum. Germany; Centre for Rare Diseases, University of Tübingen (T.B.H.), Tübingen. Germany
| | - Eva M C Schwaibold
- Institute of Medical Genetics and Applied Genomics (J.P., P.S., F.H., M.R., S.E.W., G.D., M.S., S.O.), University of Tübingen, Tübingen. Germany; Department of Neurology University Hospital (A.R.), Goethe University Frankfurt, Frankfurt. Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology (J.N.P-S., G.W.), Cologne. Germany; Department of Neurology (I.C.,), Klinikum rechts der Isar, Technical University Munich, Munich. Germany; Institute of Human Genetics (E.M.C.S.), Heidelberg University, Heidelberg. Germany; University of Cologne (G.W.), Faculty of Medicine and University Hospital Cologne, Centre for Rare Diseases, Cologne, Germany; Department of Neurology (S.P.), GFO Clinics Troisdorf, Troisdorf. Germany; Department of Neurology (C.S.), Huntington Centre NRW, Ruhr-University Bochum, St. Josef-Hospital, Bochum. Germany; Centre for Rare Diseases, University of Tübingen (T.B.H.), Tübingen. Germany
| | - Gilbert Wunderlich
- Institute of Medical Genetics and Applied Genomics (J.P., P.S., F.H., M.R., S.E.W., G.D., M.S., S.O.), University of Tübingen, Tübingen. Germany; Department of Neurology University Hospital (A.R.), Goethe University Frankfurt, Frankfurt. Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology (J.N.P-S., G.W.), Cologne. Germany; Department of Neurology (I.C.,), Klinikum rechts der Isar, Technical University Munich, Munich. Germany; Institute of Human Genetics (E.M.C.S.), Heidelberg University, Heidelberg. Germany; University of Cologne (G.W.), Faculty of Medicine and University Hospital Cologne, Centre for Rare Diseases, Cologne, Germany; Department of Neurology (S.P.), GFO Clinics Troisdorf, Troisdorf. Germany; Department of Neurology (C.S.), Huntington Centre NRW, Ruhr-University Bochum, St. Josef-Hospital, Bochum. Germany; Centre for Rare Diseases, University of Tübingen (T.B.H.), Tübingen. Germany
| | - Sebastian Paus
- Institute of Medical Genetics and Applied Genomics (J.P., P.S., F.H., M.R., S.E.W., G.D., M.S., S.O.), University of Tübingen, Tübingen. Germany; Department of Neurology University Hospital (A.R.), Goethe University Frankfurt, Frankfurt. Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology (J.N.P-S., G.W.), Cologne. Germany; Department of Neurology (I.C.,), Klinikum rechts der Isar, Technical University Munich, Munich. Germany; Institute of Human Genetics (E.M.C.S.), Heidelberg University, Heidelberg. Germany; University of Cologne (G.W.), Faculty of Medicine and University Hospital Cologne, Centre for Rare Diseases, Cologne, Germany; Department of Neurology (S.P.), GFO Clinics Troisdorf, Troisdorf. Germany; Department of Neurology (C.S.), Huntington Centre NRW, Ruhr-University Bochum, St. Josef-Hospital, Bochum. Germany; Centre for Rare Diseases, University of Tübingen (T.B.H.), Tübingen. Germany
| | - Carsten Saft
- Institute of Medical Genetics and Applied Genomics (J.P., P.S., F.H., M.R., S.E.W., G.D., M.S., S.O.), University of Tübingen, Tübingen. Germany; Department of Neurology University Hospital (A.R.), Goethe University Frankfurt, Frankfurt. Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology (J.N.P-S., G.W.), Cologne. Germany; Department of Neurology (I.C.,), Klinikum rechts der Isar, Technical University Munich, Munich. Germany; Institute of Human Genetics (E.M.C.S.), Heidelberg University, Heidelberg. Germany; University of Cologne (G.W.), Faculty of Medicine and University Hospital Cologne, Centre for Rare Diseases, Cologne, Germany; Department of Neurology (S.P.), GFO Clinics Troisdorf, Troisdorf. Germany; Department of Neurology (C.S.), Huntington Centre NRW, Ruhr-University Bochum, St. Josef-Hospital, Bochum. Germany; Centre for Rare Diseases, University of Tübingen (T.B.H.), Tübingen. Germany
| | - Tobias B Haack
- Institute of Medical Genetics and Applied Genomics (J.P., P.S., F.H., M.R., S.E.W., G.D., M.S., S.O.), University of Tübingen, Tübingen. Germany; Department of Neurology University Hospital (A.R.), Goethe University Frankfurt, Frankfurt. Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology (J.N.P-S., G.W.), Cologne. Germany; Department of Neurology (I.C.,), Klinikum rechts der Isar, Technical University Munich, Munich. Germany; Institute of Human Genetics (E.M.C.S.), Heidelberg University, Heidelberg. Germany; University of Cologne (G.W.), Faculty of Medicine and University Hospital Cologne, Centre for Rare Diseases, Cologne, Germany; Department of Neurology (S.P.), GFO Clinics Troisdorf, Troisdorf. Germany; Department of Neurology (C.S.), Huntington Centre NRW, Ruhr-University Bochum, St. Josef-Hospital, Bochum. Germany; Centre for Rare Diseases, University of Tübingen (T.B.H.), Tübingen. Germany
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Rafee S, O'Keeffe F, O'Riordan S, Reilly R, Hutchinson M. Adult onset dystonia: A disorder of the collicular-pulvinar-amygdala network. Cortex 2021; 143:282-289. [PMID: 34148640 DOI: 10.1016/j.cortex.2021.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/10/2021] [Accepted: 05/21/2021] [Indexed: 11/30/2022]
Abstract
Models attempting to explain the pathogenesis of adult onset idiopathic focal dystonia often fail to accommodate the entire spectrum of this disorder: the diverse motor and non-motor symptoms, psychiatric and cognitive dysfunction, as well as the sub-clinical, physiological and anatomical, abnormalities. We propose, and present the accumulating evidence, that the adult onset dystonia syndrome is due to disruption in the covert-attentional network, the unconscious sub-cortical mechanism for the detection of potentially environmentally threatening (salient) stimuli, involving the collicular-pulvinar-amygdala network. A critical consideration of this network indicates a number of hypothesis-generated research questions aimed at elucidating the pathogenesis of adult onset dystonia. Given the rarity of adult onset dystonia, international, multidisciplinary, multicentre studies are required to elucidate the prevalence of non-motor symptoms in unaffected relatives, in particular, using temporal discrimination. Research focussing on the non-motor symptoms and the collicular-pulvinar-amygdala pathway may be the key to understanding adult-onset idiopathic focal dystonias (AOIFD) pathophysiology.
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Affiliation(s)
- Shameer Rafee
- Department of Neurology, St Vincent's University Hospital, Dublin, Ireland.
| | - Fiadhnait O'Keeffe
- Department of Psychology, St Vincent's University Hospital, Dublin, Ireland
| | - Sean O'Riordan
- Department of Neurology, St Vincent's University Hospital, Dublin, Ireland
| | - Richard Reilly
- Trinity Centre for Bio-engineering, Trinity College Dublin, Dublin, Ireland
| | - Michael Hutchinson
- Department of Neurology, St Vincent's University Hospital, Dublin, Ireland
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Honer J, Niemeyer KM, Fercher C, Diez Tissera AL, Jaberolansar N, Jafrani YMA, Zhou C, Caramelo JJ, Shewan AM, Schulz BL, Brodsky JL, Zacchi LF. TorsinA folding and N-linked glycosylation are sensitive to redox homeostasis. BIOCHIMICA ET BIOPHYSICA ACTA-MOLECULAR CELL RESEARCH 2021; 1868:119073. [PMID: 34062155 PMCID: PMC8889903 DOI: 10.1016/j.bbamcr.2021.119073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 05/18/2021] [Accepted: 05/26/2021] [Indexed: 01/03/2023]
Abstract
The Endoplasmic Reticulum (ER) is responsible for the folding and post-translational modification of secretory proteins, as well as for triaging misfolded proteins. During folding, there is a complex yet only partially understood interplay between disulfide bond formation, which is an enzyme catalyzed event in the oxidizing environment of the ER, along with other post-translational modifications (PTMs) and chaperone-supported protein folding. Here, we used the glycoprotein torsinA as a model substrate to explore the impact of ER redox homeostasis on PTMs and protein biogenesis. TorsinA is a AAA+ ATPase with unusual oligomeric properties and controversial functions. The deletion of a C-terminal glutamic acid residue (∆E) is associated with the development of Early-Onset Torsion Dystonia, a severe movement disorder. TorsinA differs from other AAA+ ATPases since it is an ER resident, and as a result of its entry into the ER torsinA contains two N-linked glycans and at least one disulfide bond. The role of these PTMs on torsinA biogenesis and function and the identity of the enzymes that catalyze them are poorly defined. Using a yeast torsinA expression system, we demonstrate that a specific protein disulfide isomerase, Pdi1, affects the folding and N-linked glycosylation of torsinA and torsinA∆E in a redox-dependent manner, suggesting that the acquisition of early torsinA folding intermediates is sensitive to perturbed interactions between Cys residues and the quality control machinery. We also highlight the role of specific Cys residues during torsinA biogenesis and demonstrate that torsinA∆E is more sensitive than torsinA when these Cys residues are mutated.
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Affiliation(s)
- Jonas Honer
- Department of Biological Sciences, A320 Langley Hall, University of Pittsburgh, Pittsburgh, PA 15260, United States of America
| | - Katie M Niemeyer
- Department of Biological Sciences, A320 Langley Hall, University of Pittsburgh, Pittsburgh, PA 15260, United States of America
| | - Christian Fercher
- Australian Research Council Training Centre for Biopharmaceutical Innovation, Australian Institute for Bioengineering and Nanotechnology, The University of Queensland, St. Lucia, QLD 4072, Australia
| | - Ana L Diez Tissera
- Fundación Instituto Leloir and Instituto de Investigaciones Bioquímicas de Buenos Aires (IIBBA-CONICET), 1405 Buenos Aires, Argentina
| | - Noushin Jaberolansar
- Australian Research Council Training Centre for Biopharmaceutical Innovation, Australian Institute for Bioengineering and Nanotechnology, The University of Queensland, St. Lucia, QLD 4072, Australia
| | - Yohaann M A Jafrani
- Australian Research Council Training Centre for Biopharmaceutical Innovation, Australian Institute for Bioengineering and Nanotechnology, The University of Queensland, St. Lucia, QLD 4072, Australia
| | - Chun Zhou
- School of Chemistry and Molecular Biosciences, The University of Queensland, St Lucia, Queensland, 4072, Australia
| | - Julio J Caramelo
- Fundación Instituto Leloir and Instituto de Investigaciones Bioquímicas de Buenos Aires (IIBBA-CONICET), 1405 Buenos Aires, Argentina
| | - Annette M Shewan
- School of Chemistry and Molecular Biosciences, The University of Queensland, St Lucia, Queensland, 4072, Australia
| | - Benjamin L Schulz
- Australian Research Council Training Centre for Biopharmaceutical Innovation, Australian Institute for Bioengineering and Nanotechnology, The University of Queensland, St. Lucia, QLD 4072, Australia; School of Chemistry and Molecular Biosciences, The University of Queensland, St Lucia, Queensland, 4072, Australia
| | - Jeffrey L Brodsky
- Department of Biological Sciences, A320 Langley Hall, University of Pittsburgh, Pittsburgh, PA 15260, United States of America
| | - Lucía F Zacchi
- Department of Biological Sciences, A320 Langley Hall, University of Pittsburgh, Pittsburgh, PA 15260, United States of America; Australian Research Council Training Centre for Biopharmaceutical Innovation, Australian Institute for Bioengineering and Nanotechnology, The University of Queensland, St. Lucia, QLD 4072, Australia; Fundación Instituto Leloir and Instituto de Investigaciones Bioquímicas de Buenos Aires (IIBBA-CONICET), 1405 Buenos Aires, Argentina; School of Chemistry and Molecular Biosciences, The University of Queensland, St Lucia, Queensland, 4072, Australia.
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Kim JE, Chae S, Kim S, Jung YJ, Kang MG, Heo WD, Kim D. Cerebellar 5HT-2A receptor mediates stress-induced onset of dystonia. SCIENCE ADVANCES 2021; 7:7/10/eabb5735. [PMID: 33658190 PMCID: PMC7929497 DOI: 10.1126/sciadv.abb5735] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 01/15/2021] [Indexed: 06/12/2023]
Abstract
Stress is a key risk factor for dystonia, a debilitating motor disorder characterized by cocontractions of muscles leading to abnormal body posture. While the serotonin (5HT) system is known to control emotional responses to stress, its role in dystonia remains unclear. Here, we reveal that 5HT neurons in the dorsal raphe nuclei (DRN) send projections to the fastigial deep cerebellar nuclei (fDCN) and that photostimulation of 5HT-fDCN induces dystonia in wild-type mice. Moreover, we report that photoinhibition of 5HT-fDCN reduces dystonia in a1A tot/tot mice, a genetic model of stress-induced dystonia, and administration of a 5HT-2A receptor inverse agonist (MDL100907; 0.1 to 1 mg/kg) or shRNA-mediated knockdown of the ht2ar gene in fDCN can notably reduce the onset of dystonia in a1A tot/tot mice. These results support the serotonin theory of dystonia and suggest strategies for alleviating symptoms in human patients by blocking 5HT-2A receptors.
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Affiliation(s)
- Jung Eun Kim
- Department of Biological Sciences, Korea Advanced Institute of Science and Technology (KAIST), Daejeon 305-701, Republic of Korea
| | - Sujin Chae
- KAIST Institute for the BioCentury, Korea Advanced Institute of Science and Technology (KAIST), Daejeon 305-701, Republic of Korea
| | - Sungsoo Kim
- Department of Biological Sciences, Korea Advanced Institute of Science and Technology (KAIST), Daejeon 305-701, Republic of Korea
| | - Yeon-Joo Jung
- Bio Core Center, Korea Advanced Institute of Science and Technology (KAIST), Daejeon 305-701, Republic of Korea
| | - Myoung-Goo Kang
- Department of Neuroscience, Cell Biology, and Anatomy, The University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Won Do Heo
- Department of Biological Sciences, Korea Advanced Institute of Science and Technology (KAIST), Daejeon 305-701, Republic of Korea
- KAIST Institute for the BioCentury, Korea Advanced Institute of Science and Technology (KAIST), Daejeon 305-701, Republic of Korea
| | - Daesoo Kim
- Department of Biological Sciences, Korea Advanced Institute of Science and Technology (KAIST), Daejeon 305-701, Republic of Korea.
- KAIST Institute for the BioCentury, Korea Advanced Institute of Science and Technology (KAIST), Daejeon 305-701, Republic of Korea
- Bio Core Center, Korea Advanced Institute of Science and Technology (KAIST), Daejeon 305-701, Republic of Korea
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Worthley A, Simonyan K. Suicidal Ideations and Attempts in Patients With Isolated Dystonia. Neurology 2021; 96:e1551-e1560. [PMID: 33504639 DOI: 10.1212/wnl.0000000000011596] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 12/07/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the hypothesis that individuals with isolated dystonia are at an increased risk for suicidal behavior, we administered an anonymous electronic survey to patients with dystonia, asking them about their history of suicidal ideations and suicide attempt. METHODS A total of 542 patients with dystonia completed an online 97-question survey, which captured the demographics of suicidal behavior and major psychiatric disorders. Statistical analyses examined the prevalence of suicidal behavior in patients with dystonia compared to the prevalence of suicidal ideations and attempt in the general global population and assessed the significance of risk associations between suicidality and psychiatric history in these patients. RESULTS Overall, 32.3% of patients with isolated dystonia reported a lifetime history of suicidal behavior, which was significantly different from the reported rates of suicidal ideation (9.2%) and attempt (2.7%) in the general global population. The prevalence of suicidality was higher in patients with multifocal/segmental and generalized forms of dystonia (range of 46%-50%) compared to patients with focal dystonias (range of 26.1%-33.3%). The highest suicidal ideation-to-attempt ratio of 4:1 was found in patients with generalized dystonia. Suicidality in patients with focal dystonia was significantly associated with history of depression and anxiety disorders. CONCLUSION Patients with isolated dystonia have an increased, albeit unrecognized, prevalence of suicidal behavior compared to the general global population. Screening for suicidal risk should be incorporated as part of the clinical evaluation of patients with dystonia to prevent their suicide-induced injury and death.
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Affiliation(s)
- Alexis Worthley
- From the Department of Otolaryngology-Head and Neck Surgery (A.W., K.S.), Massachusetts Eye and Ear; Department of Otolaryngology-Head and Neck Surgery (K.S.), Harvard Medical School; and Department of Neurology (K.S.), Massachusetts General Hospital, Boston
| | - Kristina Simonyan
- From the Department of Otolaryngology-Head and Neck Surgery (A.W., K.S.), Massachusetts Eye and Ear; Department of Otolaryngology-Head and Neck Surgery (K.S.), Harvard Medical School; and Department of Neurology (K.S.), Massachusetts General Hospital, Boston.
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Bai X, Vajkoczy P, Faust K. Morphological Abnormalities in the Basal Ganglia of Dystonia Patients. Stereotact Funct Neurosurg 2021; 99:351-362. [PMID: 33472209 DOI: 10.1159/000512599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 10/23/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The pathophysiology of dystonia is poorly understood. As opposed to secondary forms of dystonia, primary dystonia has long been believed to lack any neuroanatomical substrate. During trajectory planning for DBS, however, conspicuous T2-hyperinstensive signal alterations (SA) were registered within the target region, even in young patients, where ischemia is rare. METHODS Fifty MRIs of primary dystonia patients scheduled for DBS were analyzed. Total basal ganglia (BG) volumes, as well as proportionate SA volumes, were measured and compared to 50 age-matched control patients. RESULTS There was a 10-fold preponderance of percentaged SA within the globus pallidus (GP) in dystonia patients. The greatest disparity was in young patients <25 years. Also, total BG volume differences were observed with larger GP and markedly smaller putamen and caudate in the dystonia group. CONCLUSIONS BG morphology in primary dystonia differed from a control population. Volume reductions of the putamen and caudate may reflect functional degeneration, while volume increases of the GP may indicate overactivity. T2-hyperintensive SA in the GP of young primary dystonia patients, where microvascular lesions are highly unlikely, are striking. Their pathogenic role remains unclear.
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Affiliation(s)
- Xi Bai
- Department of Neurosurgery, Charité University Clinic, Berlin, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité University Clinic, Berlin, Germany
| | - Katharina Faust
- Department of Neurosurgery, Charité University Clinic, Berlin, Germany,
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11
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Reduced Interhemispheric Coherence after Cerebellar Vermis Output Perturbation. Brain Sci 2020; 10:brainsci10090621. [PMID: 32911623 PMCID: PMC7563959 DOI: 10.3390/brainsci10090621] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 08/26/2020] [Accepted: 09/04/2020] [Indexed: 11/17/2022] Open
Abstract
Motor coordination and motor learning are well-known roles of the cerebellum. Recent evidence also supports the contribution of the cerebellum to the oscillatory activity of brain networks involved in a wide range of disorders. Kainate, a potent analog of the excitatory neurotransmitter glutamate, can be used to induce dystonia, a neurological movement disorder syndrome consisting of sustained or repetitive involuntary muscle contractions, when applied on the surface of the cerebellum. This research aims to study the interhemispheric cortical communication between the primary motor cortices after repeated kainate application on cerebellar vermis for five consecutive days, in mice. We recorded left and right primary motor cortices electrocorticograms and neck muscle electromyograms, and quantified the motor behavior abnormalities. The results indicated a reduced coherence between left and right motor cortices in low-frequency bands. In addition, we observed a phenomenon of long-lasting adaptation with a modification of the baseline interhemispheric coherence. Our research provides evidence that the cerebellum can control the flow of information along the cerebello-thalamo-cortical neural pathways and can influence interhemispheric communication. This phenomenon could function as a compensatory mechanism for impaired regional networks.
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13
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Krause P, Völzmann S, Ewert S, Kupsch A, Schneider GH, Kühn AA. Long-term effects of bilateral pallidal deep brain stimulation in dystonia: a follow-up between 8 and 16 years. J Neurol 2020; 267:1622-1631. [PMID: 32055996 PMCID: PMC8592956 DOI: 10.1007/s00415-020-09745-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 01/31/2020] [Accepted: 02/03/2020] [Indexed: 11/29/2022]
Abstract
Objective Observational study to evaluate the long-term motor and non-motor effects of deep brain stimulation (DBS) of the globus pallidus internus (GPi) on medically refractory dystonia. Background Dystonia is a chronic disease affecting mainly young patients with a regular life expectancy and lifelong need for therapy. Pallidal DBS is an established treatment for severe isolated dystonia but long-term data are sparse. Methods We considered 36 consecutive patients with isolated generalized (n = 14) and cervical/segmental (n = 22) dystonia operated at Charité-University Hospital between 2000 and 2007 in a retrospective analysis for long-term outcome of pallidal DBS. In 19 of these patients, we could analyze dystonic symptoms and disability rated by the Burke–Fahn–Marsden Dystonia Rating scale (BFMDRS) at baseline, short-term (ST-FU, range 3–36 months) and long-term follow-up (LT-FU, range 93–197 months). Quality of life and mood were evaluated using the SF36 and Beck Depression Index (BDI) questionnaires. Results Patients reached an improvement in motor symptoms of 63.8 ± 5.7% (mean ± SE) at ST-FU and 67.9 ± 6.1% at LT-FU. Moreover, a significant and stable reduction in disability was shown following DBS (54.2 ± 9.4% at ST-FU and 53.8 ± 9.2% at LT-FU). BDI and SF36 had improved by 40% and 23%, respectively, at LT-FU (n = 14). Stimulation-induced adverse events included swallowing difficulties, dysarthria, and bradykinesia. Pulse generator (n = 3) and electrodes (n = 5) were revised in seven patients due to infection. Conclusions Pallidal DBS is a safe and efficacious long-term treatment for dystonia with sustained effects on motor impairment and disability, accompanied by a robust improvement in mood and quality of life. Electronic supplementary material The online version of this article (10.1007/s00415-020-09745-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- P Krause
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité, University Medicine Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany
| | - S Völzmann
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité, University Medicine Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany
| | - S Ewert
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité, University Medicine Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany
| | - A Kupsch
- Department of Neurology and Stereotactic Neurosurgery, University Medicine of Magdeburg, Magdeburg, Germany
| | - G H Schneider
- Department of Neurosurgery, Charité, University Medicine Berlin, Campus Mitte, Berlin, Germany
| | - Andrea A Kühn
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité, University Medicine Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany.
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Abstract
Dystonia is a neurological disorder characterized by involuntary, repetitive movements. Although the precise mechanisms of dystonia development remain unknown, the diversity of its clinical phenotypes is thought to be associated with multifactorial pathophysiology, which is linked not only to alterations of brain organization, but also environmental stressors and gene mutations. This chapter will present an overview of the pathophysiology of isolated dystonia through the lens of applications of major neuroimaging methodologies, with links to genetics and environmental factors that play a prominent role in symptom manifestation.
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Kongsaengdao S, Maneeton N, Maneeton B. Long-term quality of life in cervical dystonia after treatment with abobotulinum toxin A: a 2-year prospective study. Neuropsychiatr Dis Treat 2018; 14:1119-1124. [PMID: 29731634 PMCID: PMC5927345 DOI: 10.2147/ndt.s152252] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The short-term quality of life (QoL) in cervical dystonia (CD) after treating with abobotulinum toxin A (Abo-BTX A) and neubotulinum toxin A (Neu-BTX A) have been studied in Thai CD patients. However; the long-term study has not been published. OBJECTIVE The aim of the present study was to determine long-term improvement of the health-related quality of life (HRQoL) after eight injections of Abo-BTX A over 2 years in CD patients. PATIENTS AND METHODS A 2-year prospective study on the QoL of CD patients, as measured by HRQoL, before and after receiving eight injections of Abo-BTX A at 3-month intervals over a 2-year treatment period was performed. The disease-specific HRQoL was assessed before and after the treatment by using the Cervical Dystonia Impact Profile-58 (CDIP-58) questionnaire. The general HRQoL was assessed by using the Medical Outcomes 36-Item Short Form Health Survey (SF-36), while depressive disorder screening was assessed by using the Center of Epidemiologic Studies-Depression (CES-D) questionnaire. The SF-36 and CES-D questionnaire were administered before treatment and every 3 months before the next injection for a 2-year period. RESULTS A total of 20 CD patients were enrolled from January 2013 to December 2015. CDIP-58 showed a significant improvement after long-term injections of Abo-BTX A in all domains (P < 0.001). However, only vitality domain of SF-36, which assessed general HRQoL, showed a significant improvement after long-term injections (P = 0.037). There was no prevalence of depressive disorder in all patients (CES-D score <20) in this study. CONCLUSION The Abo-BTX A injections at 3-month intervals over a 2-year period improved the CDIP-58 scores, which assess disease-specific HRQoL, as well as an increased vitality domain of general HRQoL. No patient suffered from depression in this study.
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Affiliation(s)
- Subsai Kongsaengdao
- Division of Neurology, Department of Medicine, Rajavithi Hospital, Department of Medical Services, Public Health Ministry, Bangkok, Thailand.,Department of Medicine, College of Medicine, Rangsit University, Bangkok, Thailand
| | - Narong Maneeton
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Benchalak Maneeton
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Li J, Long Y, Huang X, Chen Y, Chen W, Liu S, Chu J, Yang Z, Sun H, Fang K. Deletion variant rs35153737 in TOR1A is associated with isolated dystonia in a Southwestern Chinese Population. Neurosci Lett 2017; 657:1-4. [PMID: 28756192 DOI: 10.1016/j.neulet.2017.07.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 07/21/2017] [Accepted: 07/24/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND TOR1A plays a very important role in early-onset isolated dystonia. Studying the association between the common variants of this gene and dystonia can help us understand the connection between TOR1A mutations and this disease. METHODS The TOR1A exon 5 was sequenced in 223 isolated dystonia patients and 210 age-adjusted controls. Patients and controls all came from Southwest China. RESULTS The following two common variants were found in the 3'-UTR of TOR1A: NM_000113.2:c.*414delG (rs35153737) and NM_000113.2:c.*824delG (rs3842225). The rs35153737 variant showed a statistically significant association with dystonia using the allele model (P=0.035) and the dominant genetic model (P=0.018); however, no association between rs3842225 and dystonia was found. CONCLUSION Our study suggests that there is an association between rs35153737 and dystonia in a southwestern Chinese population, and it may be caused by high linkage disequilibrium between this deletion and potential pathogenic variants in TOR1A.
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Affiliation(s)
- Jiang Li
- Department of Urology Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yuzhou Long
- Department of Neurology, The Fourth Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xiaoqin Huang
- Department of Medical Genetics, The Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China
| | - Yuan Chen
- Department of Medical Genetics, The Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China
| | - Weikang Chen
- Department of Urology Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Shang Liu
- Department of Urology Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jiayou Chu
- Department of Medical Genetics, The Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China
| | - Zhaoqing Yang
- Department of Medical Genetics, The Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China
| | - Hao Sun
- Department of Medical Genetics, The Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China.
| | - Kewei Fang
- Department of Urology Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, China.
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Long Y, Chen Y, Qian Y, Wang J, Luo L, Huang X, Li L, Chu J, Yang Z, Sun H. A rare variant in TOR1A exon 5 associated with isolated dystonia in southwestern Chinese. Mov Disord 2017; 32:1083-1087. [PMID: 28432771 DOI: 10.1002/mds.27016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 03/16/2017] [Accepted: 03/19/2017] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND TOR1A has been proposed as an important genetic factor in early-onset isolated dystonia. Variants located in the 3' untranslated region of TOR1A are of particular importance because they may influence gene expression, although related studies are limited. The objectives of the present study focused on variants in the TOR1A 3' untranslated region. METHODS The last exon of TOR1A was sequenced in 229 cases with isolated dystonia and in 210 controls. In addition, 471 controls were tested to determine the frequency of the variants in the 3' untranslated region. RESULTS Except for c.904_906delGAG, 3 rare sequence variants (NM_000113.2:c.*454T>A, NM_000113.2:c.860C>A [rs766483672], and NM_000113.2:c.*302T>A [rs563498119]) were found only in the patients. The c.*302T>A variant was located in the conserved region of the human microRNA (hsa-miR-494) binding site. A luciferase reporter assay showed that c.*302T>A significantly altered gene expression. CONCLUSIONS Population frequencies, computational analyses, and function experiments in this study implied that c.*302T>A is associated with dystonia. © 2017 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Yuzhou Long
- Neurology Department, Fourth Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yang Chen
- Department of Ultrasound, First People's Hospital of Yunnan Province, Kunming, China
| | - Yuan Qian
- Obstetrics and Gynecology Department, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jianlin Wang
- Neurology Department, Fourth Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Lihua Luo
- Neurology Department, Fourth Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xiaoqin Huang
- Department of Medical Genetics, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China
| | - Li Li
- Department of Medical Genetics, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China
| | - Jiayou Chu
- Department of Medical Genetics, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China
| | - Zhaoqing Yang
- Department of Medical Genetics, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China
| | - Hao Sun
- Department of Medical Genetics, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China
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Owen T, Adegboye D, Gimeno H, Selway R, Lin JP. Stable cognitive functioning with improved perceptual reasoning in children with dyskinetic cerebral palsy and other secondary dystonias after deep brain stimulation. Eur J Paediatr Neurol 2017; 21:193-201. [PMID: 27836441 DOI: 10.1016/j.ejpn.2016.10.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 08/28/2016] [Accepted: 10/11/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND Dystonia is characterised by involuntary movements (twisting, writhing and jerking) and postures. Secondary dystonias are described as a heterogeneous group of disorders with both exogenous and endogenous causes. There is a growing body of literature on the effects of deep brain stimulation (DBS) surgery on the motor function in childhood secondary dystonias, however research on cognitive function after DBS is scarce. METHODS Cognitive function was measured in a cohort of 40 children with secondary dystonia following DBS surgery using a retrospective repeated measures design. Baseline pre-DBS neuropsychological measures were compared to scores obtained at least one year following DBS. Cognitive function was assessed using standardised measures of intellectual ability and memory. RESULTS There was no significant change in the assessed domains of cognitive function following DBS surgery. A significant improvement across the group was found on the Picture Completion subtest, measuring perceptual reasoning ability, following DBS. CONCLUSION Cognition remained stable in children with secondary dystonia following DBS surgery, with some improvements noted in a domain of perceptual reasoning. Further research with a larger sample is necessary to further explore this, in particular to further subdivide this group to account for its heterogeneity. This preliminary data has potentially positive implications for the impact of DBS on cognitive functioning within the childhood secondary dystonia population.
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Affiliation(s)
- Tamsin Owen
- Complex Motor Disorders Service, Paediatric Neurosciences, Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK; Department of Clinical Psychology, Royal Holloway, University of London, UK.
| | - Dolapo Adegboye
- Complex Motor Disorders Service, Paediatric Neurosciences, Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Hortensia Gimeno
- Complex Motor Disorders Service, Paediatric Neurosciences, Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK; Department of Psychology, Institute of Psychiatry, King's College London, UK
| | - Richard Selway
- Functional Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Jean-Pierre Lin
- Complex Motor Disorders Service, Paediatric Neurosciences, Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
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Premi E, Diano M, Gazzina S, Cauda F, Gualeni V, Tinazzi M, Fiorio M, Liberini P, Lazzarini C, Archetti S, Biasiotto G, Turla M, Bertasi V, Cotelli M, Gasparotti R, Padovani A, Borroni B. Functional Connectivity Networks in Asymptomatic and Symptomatic DYT1 Carriers. Mov Disord 2016; 31:1739-1743. [PMID: 27453152 DOI: 10.1002/mds.26725] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 05/25/2016] [Accepted: 06/13/2016] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND DYT1 mutation is characterized by focal to generalized dystonia and incomplete penetrance. To explore the complex perturbations in the different neural networks and the mutual interactions among them, we studied symptomatic and asymptomatic DTY1 mutation carriers by resting-state functional MRI. METHODS A total of 7 symptomatic DYT1, 10 asymptomatic DYT1, and 26 healthy controls were considered. Resting-state functional MRI (Oxford Centre for Functional MRI of the Brain) [FMRIB] Software Library) (FSL) MELODIC, dual regression, (as a toolbox of FSL, with Nets is referred to "networks") (FSLNets) (http://fsl.fmrib.ox.ac.uk/fsl/fslwiki/FSLNets) was performed on 9 resting-state neural networks. RESULTS DYT1 mutation signature (symptomatic DYT1 and asymptomatic DYT1) was characterized by increased connectivity in the dorsal attention network and in the left fronto-parietal network. Functional correlates of symptomatic DYT1 patients (symptomatic DYT1 vs healthy controls) showed increased connectivity in the sensorimotor network. DISCUSSION This study argues that DYT1 dystonia is a network disorder, with crucial nodes in sensory-motor integration of posterior parietal structures. A better characterization of cortical networks involved in dystonia is crucial for possible neurophysiological therapeutic interventions. © 2016 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Enrico Premi
- Centre for Ageing Brain and Neurodegenerative Disorders, Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Matteo Diano
- GCS fMRI Koelliker Hospital, Turin, Italy.,Department of Psychology, University of Turin, Turin, Italy
| | - Stefano Gazzina
- Centre for Ageing Brain and Neurodegenerative Disorders, Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Franco Cauda
- GCS fMRI Koelliker Hospital, Turin, Italy.,Department of Psychology, University of Turin, Turin, Italy
| | - Vera Gualeni
- Centre for Ageing Brain and Neurodegenerative Disorders, Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Michele Tinazzi
- Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
| | - Mirta Fiorio
- Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
| | - Paolo Liberini
- Centre for Ageing Brain and Neurodegenerative Disorders, Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Clara Lazzarini
- Neurophysiology Department, University Hospital "Spedali Civili,", Brescia, Italy
| | - Silvana Archetti
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy.,Biotechnology Laboratory, Department of Diagnostic, "Spedali Civili" Hospital, Brescia, Italy
| | - Giorgio Biasiotto
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy.,Biotechnology Laboratory, Department of Diagnostic, "Spedali Civili" Hospital, Brescia, Italy
| | | | | | - Maria Cotelli
- Neurology Unit, Valle Camonica Hospital, Brescia, Italy
| | | | - Alessandro Padovani
- Centre for Ageing Brain and Neurodegenerative Disorders, Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Barbara Borroni
- Centre for Ageing Brain and Neurodegenerative Disorders, Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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20
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Albanese A, Sorbo FD. Dystonia and Tremor: The Clinical Syndromes with Isolated Tremor. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2016; 6:319. [PMID: 27152246 PMCID: PMC4850743 DOI: 10.7916/d8x34xbm] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 02/21/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Dystonia and tremor share many commonalities. Isolated tremor is part of the phenomenological spectrum of isolated dystonia and of essential tremor. The occurrence of subtle features of dystonia may allow one to differentiate dystonic tremor from essential tremor. Diagnostic uncertainty is enhanced when no features of dystonia are found in patients with a tremor syndrome, raising the question whether the observed phenomenology is an incomplete form of dystonia. METHODS Known forms of syndromes with isolated tremor are reviewed. Diagnostic uncertainties between tremor and dystonia are put into perspective. RESULTS The following isolated tremor syndromes are reviewed: essential tremor, head tremor, voice tremor, jaw tremor, and upper-limb tremor. Their varied phenomenology is analyzed and appraised in the light of a possible relationship with dystonia. DISCUSSION Clinicians making a diagnosis of isolated tremor should remain vigilant for the detection of features of dystonia. This is in keeping with the recent view that isolated tremor may be an incomplete phenomenology of dystonia.
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Affiliation(s)
- Alberto Albanese
- Istituto Clinico Humanitas, Rozzano, Italy; Istituto di Neurologia, Università Cattolica del Sacro Cuore, Milan, Italy
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21
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Hickey P, Stacy M. Taxonomy and Clinical Features of Movement Disorders. Mov Disord 2015. [DOI: 10.1016/b978-0-12-405195-9.00001-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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22
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Alshadwi A, Nadershah M, Osborn T. Therapeutic applications of botulinum neurotoxins in head and neck disorders. Saudi Dent J 2014; 27:3-11. [PMID: 25544809 PMCID: PMC4273262 DOI: 10.1016/j.sdentj.2014.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 08/18/2014] [Accepted: 10/20/2014] [Indexed: 11/06/2022] Open
Abstract
Objective The aim of this article is to review the mechanism of action, physiological effects, and therapeutic applications of botulinum neurotoxins in the head and neck area. Study design An extensive literature search was performed using keywords. The resulting articles were analyzed for relevance in four areas: overview on botulinum neurotoxins, the role of botulinum neurotoxins in the management of salivary secretory disorders, the role of botulinum neurotoxins in the management of facial pain, and the role of botulinum neurotoxins in head and neck movement disorders. Institutional review board approval was not needed due the nature of the study. Results Botulinum neurotoxin therapy was demonstrated to be a valuable alternative to conventional medical therapy for many conditions affecting the head and neck area in terms of morbidly, mortality, and patient satisfaction with treatment outcomes. Conclusion Botulinum neurotoxin therapy provides viable alternatives to traditional treatment modalities for some conditions affecting the head and neck region that have neurological components. This therapy can overcome some of the morbidities associated with conventional therapy. More research is needed to determine the ideal doses of botulinum neurotoxin to treat different diseases affecting the head and neck regions.
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Affiliation(s)
- Ahmad Alshadwi
- Department of Oral and Maxillofacial Surgery, Boston University-Henry M. Goldman School of Dental Medicine, 100 East Newton Street, Suite G-407, Boston, MA 02118, United States ; King Feisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Mohammed Nadershah
- Academic Faculty King Abdulaziz University-Dental School, Jeddah, Saudi Arabia
| | - Timothy Osborn
- Department of Oral and Maxillofacial Surgery, Boston University-Henry M. Goldman School of Dental Medicine, 100 East Newton Street, Suite G-407, Boston, MA 02118, United States
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Abstract
Background:Cervical dystonia (CD) may be classified according to the underlying cause into primary or secondary CD. Previous exposure to neuroleptics is one of the main causes of adult-onset secondary dystonia. There are few reports that characterize the clinical features of primary CD and secondary neuroleptic-induced CD. Herein our aim was to investigate a series of patients with neuroleptic induced tardive CD and to describe their clinical and demographic features.Patients and Methods:We retrospectively evaluated 20 patients with neuroleptic-induced tardive CD and compared clinical, demographic and therapeutic characteristics to another 77 patients with primary CD. All patients underwent Botulinum toxin type-A therapy.Results:We did not identify any relevant clinical and demographic characteristics in our group of patients that could be used to distinguish tardive and primary CD.Conclusion:Patients with tardive CD presented demographic characteristics and disease course similar to those with primary CD.
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24
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Dorboz I, Coutelier M, Bertrand AT, Caberg JH, Elmaleh-Bergès M, Lainé J, Stevanin G, Bonne G, Boespflug-Tanguy O, Servais L. Severe dystonia, cerebellar atrophy, and cardiomyopathy likely caused by a missense mutation in TOR1AIP1. Orphanet J Rare Dis 2014; 9:174. [PMID: 25425325 PMCID: PMC4302636 DOI: 10.1186/s13023-014-0174-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 10/28/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dystonia, cerebellar atrophy, and cardiomyopathy constitute a rare association. METHODS We used homozygosity mapping and whole exome sequencing to determine the mutation, western blot and immunolabelling on cultured fibroblasts to demonstrate the lower expression and the mislocalization of the protein. RESULTS We report on a boy born from consanguineous healthy parents, who presented at three years of age with rapidly progressing dystonia, progressive cerebellar atrophy, and dilated cardiomyopathy. We identified regions of homozygosity and performed whole exome sequencing that revealed a homozygous missense mutation in TOR1AIP1. The mutation, absent in controls, results in a change of a highly conserved glutamic acid to alanine. TOR1AIP1 encodes lamina-associated polypeptide 1 (LAP1), a transmembrane protein ubiquitously expressed in the inner nuclear membrane. LAP1 interacts with torsinA, the protein mutated in DYT1-dystonia. In vitro studies in fibroblasts of the patient revealed reduced expression of LAP1 and its mislocalization and aggregation in the endoplasmic reticulum as underlying pathogenic mechanisms. CONCLUSIONS AND RELEVANCE The pathogenic role of TOR1AIP1 mutation is supported by a) the involvement of a highly conserved amino acid, b) the absence of the mutation in controls, c) the functional interaction of LAP1 with torsinA, and d) mislocalization of LAP1 in patient cells. Of note, cardiomyopathy has been reported in LAP1-null mice and in patients with the TOR1AIP1 nonsense mutation. Other cases will help delineate the clinical spectrum of LAP1-related mutations.
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Affiliation(s)
- Imen Dorboz
- Inserm U1141, Université Paris Diderot-Sorbonne Paris Cité, DHU PROTECT, Paris, F-75019, France.
| | - Marie Coutelier
- Inserm, U1127, Paris, F-75013, France. .,CNRS, UMR 7225, Paris, 75013, France. .,Université Pierre et Marie Curie - Paris 6, UMR_S 1127, Institut du Cerveau et de la Moelle épinière, CHU Pitié-Salpêtrière, 75013, Paris, France. .,Laboratoire de Neurogénétique, Ecole Pratique des Hautes Etudes, Institut du Cerveau et de la Moelle épinière, CHU Pitié-Salpêtrière, 75013, Paris, France. .,Laboratoire de Génétique Humaine, Institut de Duve, UCL, 1200, Bruxelles, Belgium.
| | - Anne T Bertrand
- Inserm, U974, Paris, F-75013, France. .,Université Pierre et Marie Curie - Paris 6, UM 76; CNRS, UMR 7215; Institut de Myologie, Paris, F-75013, France.
| | | | | | - Jeanne Lainé
- Inserm, U974, Paris, F-75013, France. .,Université Pierre et Marie Curie - Paris 6, UM 76; CNRS, UMR 7215; Institut de Myologie, Paris, F-75013, France. .,Département de Physiologie, Université Pierre et Marie Curie - Paris 6, Site Pitié-Salpêtrière, Paris, F-75013, France.
| | - Giovanni Stevanin
- Inserm, U1127, Paris, F-75013, France. .,CNRS, UMR 7225, Paris, 75013, France. .,Université Pierre et Marie Curie - Paris 6, UMR_S 1127, Institut du Cerveau et de la Moelle épinière, CHU Pitié-Salpêtrière, 75013, Paris, France. .,Laboratoire de Neurogénétique, Ecole Pratique des Hautes Etudes, Institut du Cerveau et de la Moelle épinière, CHU Pitié-Salpêtrière, 75013, Paris, France.
| | - Gisèle Bonne
- Inserm, U974, Paris, F-75013, France. .,Université Pierre et Marie Curie - Paris 6, UM 76; CNRS, UMR 7215; Institut de Myologie, Paris, F-75013, France. .,AP-HP, Groupe Hospitalier Pitié-Salpêtrière, U.F. Cardiogénétique et Myogénétique, Service de Biochimie Métabolique, Paris, F-75013, France.
| | - Odile Boespflug-Tanguy
- Inserm U1141, Université Paris Diderot-Sorbonne Paris Cité, DHU PROTECT, Paris, F-75019, France. .,Service de neurologie pédiatrique et des maladies métaboliques, Hôpital Robert Debré, Assistance Publique des Hôpitaux de Paris, 75019, Paris, France.
| | - Laurent Servais
- Service de neurologie pédiatrique et des maladies métaboliques, Hôpital Robert Debré, Assistance Publique des Hôpitaux de Paris, 75019, Paris, France. .,Centre de Référence des Maladies Neuromusculaires, Hôpital de La Citadelle, 4000, Liège, Belgium. .,Institut de Myologie, Bâtiment Babinski, Hôpital de La Pitié Salpêtrière, 48/83 boulevard de l'Hôpital, 75013, Paris, France.
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25
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Beghi E, Regio V, Papantonio A, Bentivoglio AR, Fasano A, Fogli D, Giordano L, Piolti R, Rinaldi G, Simone P, Specchio LM, Tonali P, Torelli P, Zarrelli M, Messina P. Reliability of clinical diagnosis of dystonia. Neuroepidemiology 2014; 43:213-9. [PMID: 25402591 DOI: 10.1159/000367628] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 08/13/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There is only one small single-center study on the reliability of the diagnosis of focal dystonia. The aim of this study was to assess the inter-rater reliability of dystonia diagnosis among neurologists with different professional experience. METHODS Twenty-nine adults (18 with dystonia, 9 with other movement disorders, and 2 healthy controls) were videotaped while undergoing neurological examination and during the process of collecting information on the history of their condition. Each case was diagnosed by 35 blind raters (12 general neurologists, 21 neurology residents, and 2 experts in movement disorders) from different hospitals. Sensitivity and specificity were calculated confronting raters with the gold standard (the caring physician). Inter-rater agreement was measured by the Kappa statistic. RESULTS Specificity and sensitivity were 95.2 and 66.7%, 76.3 and 75.2%, 84.6 and 71.6% for experts, general neurologists, and residents, respectively. Kappa values on dystonia diagnosis ranged from 0.30 to 0.46. The agreement was moderate for experts and residents (0.40-0.60) and fair for general neurologists (0.20-0.40). Kappas were the highest among experts for cranial and laryngeal dystonia (0.61-1), but not for cervical dystonia (0.37). CONCLUSIONS The diagnosis of dystonia is difficult and only partially mirrors a physician's background.
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Affiliation(s)
- Ettore Beghi
- Department of Neuroscience, IRCCS - Institute for Pharmacological Research 'Mario Negri', Milan, Italy
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26
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Lehéricy S, Tijssen MAJ, Vidailhet M, Kaji R, Meunier S. The anatomical basis of dystonia: current view using neuroimaging. Mov Disord 2014; 28:944-57. [PMID: 23893451 DOI: 10.1002/mds.25527] [Citation(s) in RCA: 132] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2012] [Revised: 04/06/2013] [Accepted: 05/02/2013] [Indexed: 12/15/2022] Open
Abstract
This review will consider the knowledge that neuroimaging studies have provided to the understanding of the anatomy of dystonia. Major advances have occurred in the use of neuroimaging for dystonia in the past 2 decades. At present, the most developed imaging approaches include whole-brain or region-specific studies of structural or diffusion changes, functional imaging using fMRI or positron emission tomography (PET), and metabolic imaging using fluorodeoxyglucose PET. These techniques have provided evidence that regions other than the basal ganglia are involved in dystonia. In particular, there is increasing evidence that primary dystonia can be viewed as a circuit disorder, involving the basal ganglia-thalamo-cortical and cerebello-thalamo-cortical pathways. This suggests that a better understanding of the dysfunction in each region in the network and their interactions are important topics to address. Current views of interpretation of imaging data as cause or consequence of dystonia, and the postmortem correlates of imaging data are presented. The application of imaging as a tool to monitor therapy and its use as an outcome measure will be discussed. © 2013 Movement Disorder Society.
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Affiliation(s)
- Stéphane Lehéricy
- Institut du Cerveau et de la Moelle (ICM) epiniere, Centre de NeuroImagerie de Recherche (CENIR), Paris, France.
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27
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Hereditäre Dystonien. MED GENET-BERLIN 2013. [DOI: 10.1007/s11825-013-0388-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Zusammenfassung
Dystonien sind eine klinisch und ätiologisch heterogene Gruppe von Bewegungsstörungen. Charakteristisch sind unwillkürliche Muskelkontraktionen, die zu drehenden, schraubenden und repetitiven Bewegungen führen und sehr schmerzhaft sein können. Die Dystonie kann dabei das einzige Symptom sein („isolierte Dystonie“) oder von anderen Symptomen begleitet werden („kombinierte Dystonie“), sie kann aber auch eine Manifestation jedweder das Zentralnervensystem betreffenden Erkrankung sein, die das motorische System in Mitleidenschaft zieht (z. B. neurodegenerative, ischämische, traumatische Prozesse). In den letzten 20 Jahren hat die Entwicklung neuer molekulargenetischer Technologien zur Entdeckung neuer Gene geführt, die vielen Dystoniesubtypen zugrunde liegen, und eine verbesserte Klassifizierung sowie einen tieferen Einblick in die Pathophysiologie ermöglicht. Es wird eine aktuelle Übersicht über die genetisch determinierten Dystonien mit Fokus auf den sog. isolierten bzw. kombinierten Formen vorgelegt. Die Zusammenstellung phänotypischer Charakteristika zu spezifischen genetischen Veränderungen soll dem Kliniker ermöglichen, anhand konkreter klinischer Manifestationen eine entsprechende molekulargenetische Abklärung in die Wege zu leiten.
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28
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Casper C, Kalliolia E, Warner TT. Recent advances in the molecular pathogenesis of dystonia-plus syndromes and heredodegenerative dystonias. Curr Neuropharmacol 2013; 11:30-40. [PMID: 23814535 PMCID: PMC3580789 DOI: 10.2174/157015913804999432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 08/17/2012] [Accepted: 08/29/2012] [Indexed: 12/04/2022] Open
Abstract
The majority of studies investigating the molecular pathogenesis and cell biology underlying dystonia have been performed in individuals with primary dystonia. This includes monogenic forms such as DYT1and DYT6 dystonia, and primary focal dystonia which is likely to be multifactorial in origin. In recent years there has been renewed interest in non-primary forms of dystonia including the dystonia-plus syndromes and heredodegenerative disorders. These are caused by a variety of genetic mutations and their study has contributed to our understanding of the neuronal dysfunction that leads to dystonia These findings have reinforced themes identified from study of primary dystonia including abnormal dopaminergic signalling, cellular trafficking and mitochondrial function. In this review we highlight recent advances in the understanding of the dystonia-plus syndromes and heredodegenerative dystonias.
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Affiliation(s)
- Catharina Casper
- Department of Clinical Neurosciences, UCL Institute of Neurology, Royal Free Campus, Rowland Hill Street, London NW3 2PF, United Kingdom
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29
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Gimeno H, Lumsden D, Gordon A, Tustin K, Ashkan K, Selway R, Lin JP. Improvement in upper limb function in children with dystonia following deep brain stimulation. Eur J Paediatr Neurol 2013; 17:353-60. [PMID: 23332134 DOI: 10.1016/j.ejpn.2012.12.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 12/10/2012] [Accepted: 12/17/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND Childhood dystonia can severely impact upper limb function. Deep brain stimulation (DBS) has been shown to be effective in reducing dystonic symptoms in childhood. Functional recovery following DBS is however not well understood. AIMS To explore changes in upper limb function following DBS in paediatric dystonia. METHODS Upper limb outcomes, using the Melbourne Assessment of Unilateral Upper Limb Function, are reported in 20 cases of childhood dystonia (unilateral n = 1, four limb n = 19) at 6 and 12 months following DBS. RESULTS Improvement in at least in one upper limb was seen in the majority of cases (n = 17, 85%) at 12 months following DBS. Deterioration of scores in both upper limbs was seen in 3 children with progressive disorders. Grouping the children aetiologically, a significant improvement in the dominant hand was obtained for the primary dystonia/dystonia-plus group at both six (p = 0.018) and twelve months (p = 0.012). In secondary dystonia due to a static disorder, improvement was also seen at 6 (p = 0.043) and 12 months (p = 0.046) in the non-dominant hand. No significant change was found in the group of children with progressive disorders. CONCLUSIONS DBS has the potential to alter upper limb function in children with primary and secondary dystonia. The dominant hand improved most in children with primary dystonias, with greater improvement in the non-dominant hand in secondary-static cases.
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Affiliation(s)
- Hortensia Gimeno
- Complex Motor Disorders Service, Evelina Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK.
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30
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Song CH, Bernhard D, Bolarinwa C, Hess EJ, Smith Y, Jinnah HA. Subtle microstructural changes of the striatum in a DYT1 knock-in mouse model of dystonia. Neurobiol Dis 2013; 54:362-71. [PMID: 23336980 PMCID: PMC3628999 DOI: 10.1016/j.nbd.2013.01.008] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 01/04/2013] [Accepted: 01/10/2013] [Indexed: 11/21/2022] Open
Abstract
The dystonias are comprised of a group of disorders that share common neurological abnormalities of involuntary twisting or repetitive movements and postures. The most common inherited primary dystonia is DYT1 dystonia, which is due to loss of a GAG codon in the TOR1A gene that encodes torsinA. Autopsy studies of brains from patients with DYT1 dystonia have revealed few abnormalities, although recent neuroimaging studies have implied the existence of microstructural defects that might not be detectable with traditional histopathological methods. The current studies took advantage of a knock-in mouse model for DYT1 dystonia to search for subtle anatomical abnormalities in the striatum, a region often implicated in studies of dystonia. Multiple abnormalities were identified using a combination of quantitative stereological measures of immunohistochemical stains for specific neuronal populations, morphometric studies of Golgi-stained neurons, and immuno-electron microscopy of synaptic connectivity. In keeping with other studies, there was no obvious loss of striatal neurons in the DYT1 mutant mice. However, interneurons immunoreactive for choline acetyltransferase or parvalbumin were larger in the mutants than in control mice. In contrast, interneurons immunoreactive for neuronal nitric oxide synthase were smaller in the mutants than in controls. Golgi histochemical studies of medium spiny projection neurons in the mutant mice revealed slightly fewer and thinner dendrites, and a corresponding loss of dendritic spines. Electron microscopic studies showed a reduction in the ratio of axo-spinous to axo-dendritic synaptic inputs from glutamatergic and dopaminergic sources in mutant mice compared with controls. These results suggest specific anatomical substrates for altered signaling in the striatum and potential correlates of the abnormalities implied by human imaging studies of DYT1 dystonia.
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Affiliation(s)
- Chang-Hyun Song
- Department of Neurology, Emory University, Atlanta GA, 30322
| | | | - Caroline Bolarinwa
- Yerkes National Primate Research Center and Department of Neurology, Emory University, Atlanta GA, 30329
| | - Ellen J. Hess
- Department of Neurology, Emory University, Atlanta GA, 30322
- Department of Pharmacology, Emory University, Atlanta GA, 30322
| | - Yoland Smith
- Yerkes National Primate Research Center and Department of Neurology, Emory University, Atlanta GA, 30329
| | - H. A. Jinnah
- Departments of Neurology, Human Genetics and Pediatrics, Emory University, Atlanta GA 30322
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31
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Ramdhani RA, Simonyan K. Primary dystonia: conceptualizing the disorder through a structural brain imaging lens. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2013; 3. [PMID: 23610744 PMCID: PMC3629863 DOI: 10.7916/d8h70dj7] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 03/08/2013] [Indexed: 12/14/2022]
Abstract
Background Dystonia is a hyperkinetic movement disorder characterized by involuntary, repetitive twisting movements. The anatomical structures and pathways implicated in its pathogenesis and their relationships to the neurophysiological paradigms of abnormal surround inhibition, maladaptive plasticity, and impaired sensorimotor integration remain unclear. Objective We review the use of high-resolution structural brain imaging using voxel-based morphometry (VBM) and diffusion tensor imaging (DTI) techniques for evaluating brain changes in primary torsion dystonia and their relationships to the pathophysiology of this disorder. Methods A PubMed search was conducted to identify relevant literature. Results VBM and DTI studies produced somewhat conflicting results across different forms of primary dystonia and reported increases, decreases, or both in gray matter volume and white matter integrity. However, despite the discrepancies, these studies are consistent in revealing brain abnormalities in dystonia that extend beyond the basal ganglia and involve the sensorimotor cortex and cerebellum. Discussion Although limited to date, structural magnetic resonance imaging (MRI) studies combined with functional brain imaging and neurophysiological modalities begin to establish structural-functional relationships at different levels of the abnormal basal ganglia, cortical, and cerebellar networks and provide clues into the pathophysiological mechanisms that underlie primary dystonia. Cross-disciplinary studies are needed for further investigations of the interplay between structural-functional brain abnormalities and environmental and genetic risk factors in dystonia patients.
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Affiliation(s)
- Ritesh A Ramdhani
- Departments of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York 10029, United States of America
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Jinnah H, Richter A, Mink JW, Caldwell GA, Caldwell KA, Gonzalez-Alegre P, Cookson MR, Breakefield XO, Delong MR, Hess EJ. Animal models for drug discovery in dystonia. Expert Opin Drug Discov 2013; 3:83-97. [PMID: 23480141 DOI: 10.1517/17460441.3.1.83] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Dystonia is a neurological disorder characterized by involuntary twisting movements and unnatural postures. There are many different forms of dystonia, which affect over three million people worldwide. Effective treatments are available only for a minority of patients, so new treatments are sorely needed. Several animal species have been used to develop models for different forms of dystonia, each with differing strengths and weaknesses. This review outlines the strategies that have been used to exploit these models for drug discovery. Some have been used to dissect the pathogenesis of dystonia for the identification of molecular targets for intervention. Others have been used for the empirical identification of candidate drugs. Therefore, the animal models provide promising new tools for developing better treatments for dystonia.
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Affiliation(s)
- Ha Jinnah
- Department of Neurology, Johns Hopkins University, Baltimore, MD 21287, USA +1 410 614 6551 ; +1 410 505 6737
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Prudente C, Pardo C, Xiao J, Hanfelt J, Hess E, LeDoux M, Jinnah H. Neuropathology of cervical dystonia. Exp Neurol 2013; 241:95-104. [PMID: 23195594 PMCID: PMC3570661 DOI: 10.1016/j.expneurol.2012.11.019] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2012] [Revised: 10/20/2012] [Accepted: 11/13/2012] [Indexed: 01/13/2023]
Abstract
The aim of this study was to search for neuropathological changes in postmortem brain tissue of individuals with cervical dystonia (CD). Multiple regions of formalin-preserved brains were collected from patients with CD and controls and examined with an extensive battery of histopathological stains in a two-stage study design. In stage one, 4 CD brains underwent a broad screening neuropathological examination. In stage two, these 4 CD brains were combined with 2 additional CD brains, and the subjective findings were quantified and compared to 16 age-matched controls. The initial subjective neuropathological assessment revealed only two regions with relatively consistent changes. The substantia nigra had frequent ubiquitin-positive intranuclear inclusions known as Marinesco bodies. Additionally, the cerebellum showed patchy loss of Purkinje cells, areas of focal gliosis and torpedo bodies. Other brain regions showed minor or inconsistent changes. In the second stage of the analysis, quantitative studies failed to reveal significant differences in the numbers of Marinesco bodies in CD versus controls, but confirmed a significantly lower Purkinje cell density in CD. Molecular investigations revealed 4 of the CD cases and 2 controls to harbor sequence variants in non-coding regions of THAP1, and these cases had lower Purkinje cell densities regardless of whether they had CD. The findings suggest that subtle neuropathological changes such as lower Purkinje cell density may be found in primary CD when relevant brain regions are investigated with appropriate methods.
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Affiliation(s)
| | - C.A. Pardo
- Dept. of Neurology & Neuropathology, Johns Hopkins University, Baltimore MD -
| | - J. Xiao
- Dept. of Neurology, University of Tennessee Health Science Center, Memphis TN -
| | - J. Hanfelt
- Dept. of Biostatistics & Bioinformatics, Emory University, Atlanta GA -
| | - E.J. Hess
- Dept. of Pharmacology & Neurology, Emory University, Atlanta GA -
| | - M.S. LeDoux
- Dept. of Neurology, University of Tennessee Health Science Center, Memphis TN -
| | - H.A. Jinnah
- Dept. of Neurology, Human Genetics & Pediatrics, Emory University, Atlanta GA
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Jenkins ME, Miyasaki JM, Suchowersky O. Movement Disorders. Neurology 2012. [DOI: 10.1007/978-0-387-88555-1_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Akbari MT, Zand Z, Shahidi GA, Hamid M. Clinical features, DYT1 mutation screening and genotype-phenotype correlation in patients with dystonia from Iran. Med Princ Pract 2012; 21:462-6. [PMID: 22487959 DOI: 10.1159/000336783] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Accepted: 01/12/2012] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To test Iranian patients with primary torsion dystonia to determine the frequency of 904-906 del GAG mutation in the DYT1 (TOR1A) gene and to investigate the genotype-phenotype association for this disease. SUBJECTS AND METHODS Sixty-three patients with primary dystonia were investigated. DNA was extracted from peripheral blood and these samples were subjected to PCR-sequencing for exon 5 of the DYT1 gene. RESULTS Of the 63 patients, 10 (15.9%) carried the triplet GAG deletion mutation; this is a high DYT1-positive rate in comparison with other populations and the type of dystonia in this positive group was generalized in all except 1. In our patients, limbs were the most severely involved site at the time of onset and in most cases it developed to generalized form. The majority of DYT1-positive cases showed higher leg onset (5 patients, 62.5%) in comparison with higher arm onset in negative patients (20 patients, 50%). Also, the progression to generalized dystonia in DYT1-positive patients was significantly higher than in DYT1-negative patients. The mean age at onset was 8.6 ± 1.6 years (7-12 years) in DYT1-positive patients, while mean age at onset in patients with no GAG deletion mutation was higher (15.7 ± 11.5 years). CONCLUSIONS The DYT1 904-906 del GAG mutation is responsible for some of Iranian dystonia patients, and screening for the DYT1 deletion is significant in cases with the generalized type of primary dystonia. Also, patients with leg or arm onset at a younger age are more likely to be DYT1-positive among primary torsion dystonia cases.
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Affiliation(s)
- Mohammad Taghi Akbari
- Department of Medical Genetics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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Abstract
The last 25 years have seen remarkable advances in our understanding of the genetic etiologies of dystonia, new approaches into dissecting underlying pathophysiology, and independent progress in identifying effective treatments. In this review we highlight some of these advances, especially the genetic findings that have taken us from phenomenological to molecular-based diagnoses. Twenty DYT loci have been designated and 10 genes identified, all based on linkage analyses in families. Hand in hand with these genetic findings, neurophysiological and imaging techniques have been employed that have helped illuminate the similarities and differences among the various etiological dystonia subtypes. This knowledge is just beginning to yield new approaches to treatment including those based on DYT1 animal models. Despite the lag in identifying genetically based therapies, effective treatments, including impressive benefits from deep brain stimulation and botulinum toxin chemodenervation, have marked the last 25 years. The challenge ahead includes continued advancement into understanding dystonia's many underlying causes and associated pathology and using this knowledge to advance treatment including preventing genetic disease expression.
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Affiliation(s)
- Laurie J Ozelius
- Department of Genetics and Genomic Sciences, Mount Sinai School of Medicine, New York, New York, USA
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Bainbridge MN, Wiszniewski W, Murdock DR, Friedman J, Gonzaga-Jauregui C, Newsham I, Reid JG, Fink JK, Morgan MB, Gingras MC, Muzny DM, Hoang LD, Yousaf S, Lupski JR, Gibbs RA. Whole-genome sequencing for optimized patient management. Sci Transl Med 2011; 3:87re3. [PMID: 21677200 DOI: 10.1126/scitranslmed.3002243] [Citation(s) in RCA: 203] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Whole-genome sequencing of patient DNA can facilitate diagnosis of a disease, but its potential for guiding treatment has been under-realized. We interrogated the complete genome sequences of a 14-year-old fraternal twin pair diagnosed with dopa (3,4-dihydroxyphenylalanine)-responsive dystonia (DRD; Mendelian Inheritance in Man #128230). DRD is a genetically heterogeneous and clinically complex movement disorder that is usually treated with l-dopa, a precursor of the neurotransmitter dopamine. Whole-genome sequencing identified compound heterozygous mutations in the SPR gene encoding sepiapterin reductase. Disruption of SPR causes a decrease in tetrahydrobiopterin, a cofactor required for the hydroxylase enzymes that synthesize the neurotransmitters dopamine and serotonin. Supplementation of l-dopa therapy with 5-hydroxytryptophan, a serotonin precursor, resulted in clinical improvements in both twins.
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Affiliation(s)
- Matthew N Bainbridge
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030, USA
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Exome sequencing identifies GCDH (glutaryl-CoA dehydrogenase) mutations as a cause of a progressive form of early-onset generalized dystonia. Hum Genet 2011; 131:435-42. [DOI: 10.1007/s00439-011-1086-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Accepted: 08/28/2011] [Indexed: 01/20/2023]
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Puschmann A, Xiao J, Bastian RW, Searcy JA, LeDoux MS, Wszolek ZK. An African-American family with dystonia. Parkinsonism Relat Disord 2011; 17:547-50. [PMID: 21601506 DOI: 10.1016/j.parkreldis.2011.04.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Revised: 03/22/2011] [Accepted: 04/26/2011] [Indexed: 10/18/2022]
Abstract
The genetic cause of late-onset focal and segmental dystonia remains unknown in most individuals. Recently, mutations in Thanatos-associated protein domain containing, apoptosis associated protein 1 (THAP1) have been described in DYT6 dystonia and associated with some cases of familial and sporadic late-onset dystonia in Caucasians. We are not aware of any previous descriptions of familial dystonia in African-Americans or reports of THAP1 mutations in African-Americans. Herein, we characterize an African-American (AA) kindred with late-onset primary dystonia, clinically and genetically. The clinical phenotype included cervical, laryngeal and hand-forearm dystonia. Symptoms were severe and disabling for several family members, whereas others only displayed mild signs. There were no accompanying motor or cognitive signs. In this kindred, age of onset ranged from 45 to 50 years and onset was frequently sudden, with symptoms developing within weeks or months. DYT1 was excluded as the cause of dystonia in this kindred. The entire genomic region of THAP1, including non-coding regions, was sequenced. We identified 13 sequence variants in THAP1, although none co-segregated with dystonia. A novel THAP1 variant (c.-237-3G>T/A) was found in 3/84 AA dystonia patient alleles and 3/212 AA control alleles, but not in 5870 Caucasian alleles. In summary, although previously unreported, familial primary dystonia does occur in African-Americans. Genetic analysis of the entire genomic region of THAP1 revealed a novel variant that was specific for African-Americans. Therefore, genetic testing for dystonia and future studies of candidate genes must take genetic background into consideration.
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Affiliation(s)
- Andreas Puschmann
- Department of Neurology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
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Shen Y, Lee HY, Rawson J, Ojha S, Babbitt P, Fu YH, Ptácek LJ. Mutations in PNKD causing paroxysmal dyskinesia alters protein cleavage and stability. Hum Mol Genet 2011; 20:2322-32. [PMID: 21487022 PMCID: PMC3098736 DOI: 10.1093/hmg/ddr125] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Paroxysmal non-kinesigenic dyskinesia (PNKD) is a rare autosomal dominant movement disorder triggered by stress, fatigue or consumption of either alcohol or caffeine. Attacks last 1–4 h and consist of dramatic dystonia and choreoathetosis in the limbs, trunk and face. The disease is associated with single amino acid changes (A7V or A9V) in PNKD, a protein of unknown function. Here we studied the stability, cellular localization and enzymatic activity of the PNKD protein in cultured cells and transgenic animals. The N-terminus of the wild-type (WT) long PNKD isoform (PNKD-L) undergoes a cleavage event in vitro, resistance to which is conferred by disease-associated mutations. Mutant PNKD-L protein is degraded faster than the WT protein. These results suggest that the disease mutations underlying PNKD may disrupt protein processing in vivo, a hypothesis supported by our observation of decreased cortical Pnkd-L levels in mutant transgenic mice. Pnkd is homologous to a superfamily of enzymes with conserved β-lactamase domains. It shares highest homology with glyoxalase II but does not catalyze the same reaction. Lower glutathione levels were found in cortex lysates from Pnkd knockout mice versus WT littermates. Taken together, our results suggest an important role for the Pnkd protein in maintaining cellular redox status.
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Affiliation(s)
- Yiguo Shen
- Department of Neurology, University of California at San Francisco, San Francisco, CA 94158, USA
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Dias FMV, Kummer A, Doyle FCP, Harsányi E, Cardoso F, Fontenelle LF, Teixeira AL. Psychiatric disorders in primary focal dystonia and in Parkinson's disease. Neuropsychiatr Dis Treat 2011; 7:111-6. [PMID: 21552313 PMCID: PMC3083984 DOI: 10.2147/ndt.s17507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Primary focal dystonia and Parkinson's disease are movement disorders that have contrasting motor phenotypes. The aim of this study was to compare the frequency and the severity of psychiatric disorders in primary focal dystonia and Parkinson's disease. METHODS Two groups of 30 patients matched by gender and age underwent a neurological and psychiatric assessment. RESULTS Parkinson's disease patients were diagnosed with higher rates of major depression (P = 0.02) and generalized anxiety disorder (P = 0.02), and greater severity of depressive symptoms (P = 0.04), while patients with primary focal dystonia exhibited increased severity of obsessive-compulsive symptoms (P = 0.02). DISCUSSION The difference in pathophysiology of primary focal dystonia and Parkinson's disease may explain the different psychiatric profiles of these two diseases. The increased frequency of affective symptoms in Parkinson's disease may be related to the fact that Parkinson's disease is a neurodegenerative disease marked by the loss of monoaminergic neurons which does not happen in primary focal dystonia. CONCLUSION The psychiatric profile differs in movement disorders with distinct neurobiological bases.
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Affiliation(s)
| | | | - Flávia CP Doyle
- Movement Disorders Clinic, Neurology Unit, University Hospital, Federal University of Minas Gerais, Belo Horizonte
| | | | - Francisco Cardoso
- Movement Disorders Clinic, Neurology Unit, University Hospital, Federal University of Minas Gerais, Belo Horizonte
| | - Leonardo F Fontenelle
- Department of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Neychev VK, Gross RE, Lehéricy S, Hess EJ, Jinnah HA. The functional neuroanatomy of dystonia. Neurobiol Dis 2011; 42:185-201. [PMID: 21303695 DOI: 10.1016/j.nbd.2011.01.026] [Citation(s) in RCA: 320] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Revised: 01/08/2011] [Accepted: 01/28/2011] [Indexed: 10/18/2022] Open
Abstract
Dystonia is a neurological disorder characterized by involuntary twisting movements and postures. There are many different clinical manifestations, and many different causes. The neuroanatomical substrates for dystonia are only partly understood. Although the traditional view localizes dystonia to basal ganglia circuits, there is increasing recognition that this view is inadequate for accommodating a substantial portion of available clinical and experimental evidence. A model in which several brain regions play a role in a network better accommodates the evidence. This network model accommodates neuropathological and neuroimaging evidence that dystonia may be associated with abnormalities in multiple different brain regions. It also accommodates animal studies showing that dystonic movements arise with manipulations of different brain regions. It is consistent with neurophysiological evidence suggesting defects in neural inhibitory processes, sensorimotor integration, and maladaptive plasticity. Finally, it may explain neurosurgical experience showing that targeting the basal ganglia is effective only for certain subpopulations of dystonia. Most importantly, the network model provides many new and testable hypotheses with direct relevance for new treatment strategies that go beyond the basal ganglia. This article is part of a Special Issue entitled "Advances in dystonia".
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Abstract
The list of genetic causes of syndromes of dystonia parkinsonism grows constantly. As a consequence, the diagnosis becomes more and more challenging for the clinician. Here, we summarize the important causes of dystonia parkinsonism including autosomal-dominant, recessive, and x-linked forms. We cover dopa-responsive dystonia, Wilson's disease, Parkin-, PINK1-, and DJ-1-associated parkinsonism (PARK2, 6, and 7), x-linked dystonia-parkinsonism/Lubag (DYT3), rapid-onset dystonia-parkinsonism (DYT12) and DYT16 dystonia, the syndromes of Neurodegeneration with Brain Iron Accumulation (NBIA) including pantothenate kinase (PANK2)- and PLA2G6 (PARK14)-associated neurodegeneration, neuroferritinopathy, Kufor-Rakeb disease (PARK9) and the recently described SENDA syndrome; FBXO7-associated neurodegeneration (PARK15), autosomal-recessive spastic paraplegia with a thin corpus callosum (SPG11), and dystonia parkinsonism due to mutations in the SLC6A3 gene encoding the dopamine transporter. They have in common that in all these syndromes there may be a combination of dystonic and parkinsonian features, which may be complicated by pyramidal tract involvement. The aim of this review is to familiarize the clinician with the phenotypes of these disorders.
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Affiliation(s)
- Susanne A Schneider
- Sobell Department for Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, UK.
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Aránguiz R, Chana-Cuevas P, Alburquerque D, León M. Focal dystonia in musicians. NEUROLOGÍA (ENGLISH EDITION) 2011. [DOI: 10.1016/s2173-5808(11)70008-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Genetic and clinical features of primary torsion dystonia. Neurobiol Dis 2010; 42:127-35. [PMID: 21168499 DOI: 10.1016/j.nbd.2010.12.012] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Revised: 12/08/2010] [Accepted: 12/10/2010] [Indexed: 12/31/2022] Open
Abstract
Primary torsion dystonia (PTD) is defined as a syndrome in which dystonia is the only clinical sign (except for tremor), and there is no evidence of neuronal degeneration or an acquired cause by history or routine laboratory assessment. Seven different loci have been recognized for PTD but only two of the genes have been identified. In this review we will describe the phenotypes associated with these loci and discuss the responsible gene. This article is part of a Special Issue entitled "Advances in dystonia".
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Bragg DC, Armata IA, Nery FC, Breakefield XO, Sharma N. Molecular pathways in dystonia. Neurobiol Dis 2010; 42:136-47. [PMID: 21134457 DOI: 10.1016/j.nbd.2010.11.015] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2010] [Revised: 11/08/2010] [Accepted: 11/26/2010] [Indexed: 11/27/2022] Open
Abstract
The hereditary dystonias comprise a set of diseases defined by a common constellation of motor deficits. These disorders are most likely associated with different molecular etiologies, many of which have yet to be elucidated. Here we discuss recent advances in three forms of hereditary dystonia, DYT1, DYT6 and DYT16, which share a similar clinical picture: onset in childhood or adolescence, progressive spread of symptoms with generalized involvement of body regions and a steady state affliction without treatment. Unlike DYT1, the genes responsible for DYT6 and DYT16 have only recently been identified, with relatively little information about the function of the encoded proteins. Nevertheless, recent data suggest that these proteins may fit together within interacting pathways involved in dopaminergic signaling, transcriptional regulation, and cellular stress responses. This review focuses on these molecular pathways, highlighting potential common themes among these dystonias which may serve as areas for future research. This article is part of a Special Issue entitled "Advances in dystonia".
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Affiliation(s)
- D Cristopher Bragg
- Department of Neurology, Massachusetts General Hospital, Charlestown, MA, USA.
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Aránguiz R, Chana-Cuevas P, Alburquerque D, León M. Focal dystonia in musicians. Neurologia 2010; 26:45-52. [PMID: 21163218 DOI: 10.1016/j.nrl.2010.09.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2010] [Revised: 08/27/2010] [Accepted: 09/18/2010] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION A special group of focal dystonia is that known as occupational, which include dystonic disorders triggered by repetitive motor activity, closely associated with the professional activity of a specific task that the affected person performs. In this sense, musicians are a population particularly vulnerable to this disorder, which is presented during the execution of highly trained movements. OBJECTIVE This article reviews the pathophysiology of focal dystonia and its therapeutic implications. DEVELOPMENT The pathophysiological basis of focal dystonia in the musician is still not well established. However, due to the contribution of neurophysiological studies and functional neuroimaging, there is growing evidence of anomalies in the processing of sensory information, sensory-motor integration, cortical and subcortical inhibitory processes, which underline this disease. Clinically, it is characterised by the appearance of involuntary muscle contractions, and is associated with loss of motor control while practicing music. It is a gradual appearance and sometimes there may be a history of musculoskeletal injuries or non-physiological postures preceding the appearance of the symptoms. The neurological examination is usually normal, although subtle dystonic postures can develop spontaneously or with movements that involve the affected segments. The dystonia remains focal and is not generalised. CONCLUSIONS Treatment is based on using multiple strategies for the management of the dystonia, with variable results. Although a specific therapy has not been defined, there are general principles that are combined in each situation looking for results. This includes, among others, pharmacological interventions, management with botulinum toxin, and sensory re-training techniques.
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Affiliation(s)
- R Aránguiz
- Centro de Trastornos del Movimiento, Universidad de Santiago de Chile (CETRAM-USACH), Hospital Geriátrico de Santiago de Chile, Santiago de Chile, Chile.
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Abstract
Limb dystonia (LD) refers to dystonia affecting one arm or leg. Depending on the site of onset, age at onset, and the etiology, progression and prognosis will be different. Usually young-onset primary dystonia affects the lower limbs and tends to generalize, while in adult-onset, it appears in the arm and remains focal. Lower limb dystonia in adults is rare as a primary cause, and parkinsonism or other neurological diseases must always be ruled out. In the text that follows, we review the main clinical features of the primary and secondary limb dystonias considering the age at onset and etiology.
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Affiliation(s)
- C Pont-Sunyer
- Parkinson disease and Movement Disorders Unit, Neurology Service, Faculty of Medicine, Institut Clínic de Neurociències, Centro de Investigación en Red de Enfermedades Neurodegenerativas, Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain
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Dias FM, Doyle F, Kummer A, Cardoso F, Fontenelle LF, Teixeira AL. Frequency of psychiatric disorders in blepharospasm does not differ from hemifacial spasm. Acta Neuropsychiatr 2010; 22:223-7. [PMID: 26952832 DOI: 10.1111/j.1601-5215.2009.00436.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
UNLABELLED Dias FM, Doyle F, Kummer A, Cardoso F, Fontenelle LF, Teixeira AL. Frequency of psychiatric disorders in blepharospasm does not differ from hemifacial spasm. OBJECTIVE To compare the frequency of psychiatric disorders and the severity of psychiatric symptoms between patients with blepharospasm (BS) and hemifacial spasm (HS). METHODS BS is a type of primary focal dystonia characterised by recurrent and involuntary eye blinking. HS is a condition with different pathophysiology but similar clinical phenotype. Twenty-two patients with BS and 29 patients with HS participated in this study. They underwent a comprehensive psychiatric evaluation that included a structured clinical interview for current psychiatric diagnosis according to Diagnostic Statistical Manual, fourth edition (DSM-IV) (MINI-Plus) and psychometric scales, including the Yale-Brown Obsessive-Compulsive Scale (YBOCS), the Beck Depression Inventory (BDI), the Hamilton Rating Scale for Depression (HRSD), the Hamilton Anxiety Scale (HAS) and the Liebowitz Social Anxiety Scale (LSAS). RESULTS BS and HS groups did not differ in most demographic and clinical parameters, such as gender, age and length of symptoms. The frequency of psychiatric disorders and the severity of psychiatric symptoms were similar in both groups. CONCLUSION BS does not seem to have more psychiatric disorders than HS.
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Affiliation(s)
- Fernando Machado Dias
- 1Neuropsychiatric Branch, Neurology Unit, University Hospital, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Flávia Doyle
- 2Movement Disorders Clinic, Neurology Unit, University Hospital, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Arthur Kummer
- 1Neuropsychiatric Branch, Neurology Unit, University Hospital, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Francisco Cardoso
- 2Movement Disorders Clinic, Neurology Unit, University Hospital, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | - Antonio Lucio Teixeira
- 1Neuropsychiatric Branch, Neurology Unit, University Hospital, Federal University of Minas Gerais, Belo Horizonte, Brazil
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