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Rossi M, van der Veen S, Merello M, Tijssen MAJ, van de Warrenburg B. Myoclonus-Ataxia Syndromes: A Diagnostic Approach. Mov Disord Clin Pract 2020; 8:9-24. [PMID: 33426154 DOI: 10.1002/mdc3.13106] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 09/30/2020] [Accepted: 10/14/2020] [Indexed: 12/30/2022] Open
Abstract
Background A myriad of disorders combine myoclonus and ataxia. Most causes are genetic and an increasing number of genes are being associated with myoclonus-ataxia syndromes (MAS), due to recent advances in genetic techniques. A proper etiologic diagnosis of MAS is clinically relevant, given the consequences for genetic counseling, treatment, and prognosis. Objectives To review the causes of MAS and to propose a diagnostic algorithm. Methods A comprehensive and structured literature search following PRISMA criteria was conducted to identify those disorders that may combine myoclonus with ataxia. Results A total of 135 causes of combined myoclonus and ataxia were identified, of which 30 were charted as the main causes of MAS. These include four acquired entities: opsoclonus-myoclonus-ataxia syndrome, celiac disease, multiple system atrophy, and sporadic prion diseases. The distinction between progressive myoclonus epilepsy and progressive myoclonus ataxia poses one of the main diagnostic dilemmas. Conclusions Diagnostic algorithms for pediatric and adult patients, based on clinical manifestations including epilepsy, are proposed to guide the differential diagnosis and corresponding work-up of the most important and frequent causes of MAS. A list of genes associated with MAS to guide genetic testing strategies is provided. Priority should be given to diagnose or exclude acquired or treatable disorders.
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Affiliation(s)
- Malco Rossi
- Movement Disorders Section Neuroscience Department Buenos Aires Argentina.,Argentine National Scientific and Technological Research Council (CONICET) Buenos Aires Argentina
| | - Sterre van der Veen
- Pontificia Universidad Católica Argentina (UCA) Buenos Aires Argentina.,Department of Neurology University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - Marcelo Merello
- Movement Disorders Section Neuroscience Department Buenos Aires Argentina.,Argentine National Scientific and Technological Research Council (CONICET) Buenos Aires Argentina.,Pontificia Universidad Católica Argentina (UCA) Buenos Aires Argentina
| | - Marina A J Tijssen
- Department of Neurology University of Groningen, University Medical Center Groningen Groningen The Netherlands.,Expertise Center Movement Disorders Groningen University Medical Center Groningen (UMCG) Groningen The Netherlands
| | - Bart van de Warrenburg
- Department of Neurology, Donders Institute for Brain, Cognition & Behaviour Radboud University Medical Center Nijmegen The Netherlands
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Abstract
Genetic Creutzfeldt-Jakob disease (CJD) is associated with mutations in the human PrP gene (PRNP) on chromosome 20p12-pter. Pathogenic mutations have been identified in 10-15% of all CJD patients, who often have a family history of autosomal-dominant pattern of inheritance and variable penetrance. However, the use of genetic tests implemented by surveillance networks all over the world increasingly identifies unexpectedly PRNP mutations in persons apparently presenting with a sporadic form of CJD. A high phenotypic variability was reported in genetic prion diseases, which partly overlap with the features of sporadic CJD. Here we review recent advances on the epidemiologic, clinical, and neuropathologic features of cases that phenotypically resemble CJD linked to point and insert mutations of the PRNP gene. Multidisciplinary studies are still required to understand the phenotypic spectrum, penetrance, and significance of PRNP mutations.
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Morice AH, Millqvist E, Belvisi MG, Bieksiene K, Birring SS, Chung KF, Dal Negro RW, Dicpinigaitis P, Kantar A, McGarvey LP, Pacheco A, Sakalauskas R, Smith JA. Expert opinion on the cough hypersensitivity syndrome in respiratory medicine. Eur Respir J 2014; 44:1132-48. [PMID: 25142479 DOI: 10.1183/09031936.00218613] [Citation(s) in RCA: 228] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In 2011, a European Respiratory Society Task Force embarked on a process to determine the position and clinical relevance of the cough hypersensitivity syndrome, a disorder characterised by troublesome coughing often triggered by low levels of thermal, mechanical or chemical exposure, in the management of patients with chronic cough. A 21-component questionnaire was developed by an iterative process supported by a literature review. 44 key opinion leaders in respiratory medicine were selected and interviewed as to their opinions. There was a high degree of unanimity in the responses obtained, with all opinion leaders supporting the concept of cough hypersensitivity as a clinically useful paradigm. The classic stratification of cough into asthmatic, rhinitic and reflux-related phenotypes was supported. Significant disparity of opinion was seen in the response to two questions concerning the therapy of chronic cough. First, the role of acid suppression in reflux cough was questioned. Secondly, the opinion leaders were split as to whether a trial of oral steroids was indicated to establish a diagnosis of eosinophilic cough. The cough hypersensitivity syndrome was clearly endorsed by the opinion leaders as a valid and useful concept. They considered that support of patients with chronic cough was inadequate and the Task Force recommends that further work is urgently required in this neglected area.
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Affiliation(s)
- Alyn H Morice
- Centre for Cardiovascular and Metabolic Research, Respiratory Medicine, Hull York Medical School, University of Hull, Cottingham, UK
| | - Eva Millqvist
- Dept of Internal Medicine/Respiratory Medicine and Allergology, University of Gothenburg, Gothenburg, Sweden
| | - Maria G Belvisi
- Respiratory Pharmacology Group, Pharmacology and Toxicology Section, National Heart and Lung Institute, Imperial College London, London, UK
| | - Kristina Bieksiene
- Dept of Pulmonology and Immunology, Lithuanian University of Health Science, Kaunas, Lithuania
| | - Surinder S Birring
- Division of Asthma, Allergy and Lung Biology, King's College London, London, UK
| | - Kian Fan Chung
- National Heart and Lung Institute, Imperial College London and Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, UK
| | - Roberto W Dal Negro
- Centro Nazionale Studi di Farmacoeconomia e Farmacoepidemiologua Respiratoria CESFAR, Verona, Italy
| | - Peter Dicpinigaitis
- Einstein Division/Montefiore Medical Center, Albert Einstein College of Medicine, New York, , NY, USA
| | - Ahmad Kantar
- Paediatric Cough and Asthma Centre, Istituti Ospedalieri Bergamaschi, Bergamo, Italy
| | - Lorcan P McGarvey
- Centre for Infection and Immunity, Queen's University Belfast, Belfast, UK
| | - Adalberto Pacheco
- Chronic Cough Unit, Pneumology Service, Hospital Ramón y Cajal, Madrid, Spain
| | - Raimundas Sakalauskas
- Dept of Pulmonology and Immunology, Lithuanian University of Health Science, Kaunas, Lithuania
| | - Jaclyn A Smith
- Centre for Respiratory and Allergy, University of Manchester, University Hospital of South Manchester, Manchester, UK
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Karatayli-Ozgursoy S, Dominik J, Eidelman B, Guarderas JC. Chronic cough as the presenting symptom of hydrocephalus. South Med J 2010; 103:574-7. [PMID: 20710145 DOI: 10.1097/smj.0b013e3181de2ddf] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Chronic cough is defined as a daily cough lasting for more than eight weeks. We report an unusual case of chronic cough as the primary manifestation of obstructive hydrocephalus. Chronic cough in our case was determined to be of neurogenic origin only after exhaustive investigations failed to reveal a systemic cause, and, in particular, after a positive response to treatment of the hydrocephalus was observed. To the best of our knowledge, this is the first report of hydrocephalus presenting as chronic cough. We believe this case will remind physicians of the importance of considering neurological disease as a cause of chronic cough after common causes are excluded.
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Affiliation(s)
- Selmin Karatayli-Ozgursoy
- Department of Otolaryngology and Neurology, and Allergy Division, Mayo Clinic Florida, Jacksonville, FL 32224, USA.
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